Medical induction of labour

For many years now, I have been thinking about how I can help women when they are offered induction of labour.

The current situation is that approximately 1 in 3 babies are born through induced labour in our environment. Induction of labour is starting to become a real pandemic, masked by the health system, under the excuse of protocols and the supposed benefit for mother and baby.

This does not mean that there are no unnecessary inductions, of course. But the reality of care differs greatly from what the evidence actually tells us.

At the beginning I started by giving informative talks on medical induction of labour at the Dona Llum Association.

Later, with 3 fellow midwives from ALPACC, the Association of Homebirth Midwives of Catalonia, we began to draft a document on medical induction in childbirth (Albiol et al, 2023).

Accepting induction in childbirth with an awareness of the pros and cons

The goal has always been the same: to ensure that women who agree to induction do so knowing the pros and cons.

Just today I read that, in a study looking at experiences of informed consent to induction of labour, women did not always feel they had real choice in deciding whether or not to agree to this intervention (Kelly et al, 2023 ).

The reality is that many women are not given real information about what to expect from induction, what it involves and what effects it can have on them and their babies' short and long term health.

Most also do not receive alternative options to induction.

Therefore, they find that they have no choice. Obviously, many women are also unaware that health professionals have a duty (according to the Patient Autonomy Act) to offer them alternatives if they decline any kind of treatment.

Women often accept induction, agreeing, without much understanding, to the need for induction.

Many women feel pressured to accept induction, others receive biased or tendentious information.

This leads to a sense of infantilisation, obligation and obedience, where the adult, responsible woman's ability to make decisions about her own and her baby's health disappears or is greatly minimised.

To disregard a woman's values, beliefs, priorities and choices is to undervalue her. Every woman, surely, always wants the best for her son or daughter, and on that basis, all too often, fear is played upon.

Most of the time, the induction offer is not personalised, but rather the woman is made to fit into a protocol tailored to an entire population. It is not individualised, even though we know that individualisation in health is the most important aspect in obtaining good clinical results and satisfaction.

Information on induction of labour

Every woman has the right to receive varied, evidence-based information that explains:

• the reasons why you are being offered induction: is it urgent, can you wait and think about it or ask for a second opinion?
• what is an induction: when, where and how will it take place?
• pros and cons of induction: risks and benefits, for the woman and the baby
• What form of induction will you offer her in particular, what does it consist of and what can she expect from it?
• What alternative forms of induction could you have?
• how will you monitor your baby's and your own well-being?
• What methods of analgesia and support will you offer?
• What effects can it have on her and her baby's health, both in the short and long term?
• what are the alternatives to induction?
• what are your options if induction is unsuccessful?

Decision making: Induction yes or no

Some women may prefer induction, but others may not. And it is important that the information women receive is not coercive and that they have a real choice, without feeling pressured.

That is why ALPACC has prepared this informative document that we hope will be a reference for many mothers to decide whether or not they really want an induction, and whether or not they accept it with all the consequences, in an adult, responsible and fully informed manner.

When in doubt, as always, I encourage you to seek a second opinion from a midwife who is up to date with the scientific evidence and who can objectively accompany you in your decision making.

Childbirth is a key life experience with lifelong effects on the physical and emotional health of mother and baby. What a woman experiences, and how she experiences it, on the day of childbirth will forever shape her new identity as a woman and a mother.

It is worth giving it some thought and questioning the routine practices of protocols that are often not based on scientific evidence and do not take into account the reality of each woman and her motherhood.

Each baby is only born once, and we only have one chance to make the decision that we, as mothers, feel and believe is right for us and our children.

Albiol, M., Marcos, I., Morral, C. and Sàrries, I. 2023. Inducció mèdica al part. Barcelona. [on line]. ALPACC Accessed at: https://llevadorespartacasa.org/wp-content/uploads/junio-2023cat-INDUCCION-PARTO-ALPACC-2.pdf
Kelly et al, 2023. Women's experiences of consent to induction of labour: A qualitative study. Sexual & Reproductive Healthcare. 100928. 10.1016/j.srhc.2023.100928.