Induction Voices

by | 15 Sep, 2019 | BAME maternity | 6 comments

Autonomous responsible midwives who assist parents to have their babies in gentle, holistic ways are very fortunate in the vast majority of cases to see the beauty and perfection of spontaneous, physiological birth. If our clever hands are needed we use them respectfully in order to cause no harm to parents or baby/babies. The quality of our care is set at “thrive” not just “survive”. When we reflect on the results of our interactions with families we look at their whole health not just physical recovery.

A recent Cochrane systematic review on induction of labour at term (Middleton et al, 2018) was disappointing. A minimal list of outcomes was measured, and the majority of the reviewed trials were of ‘moderate’ or ‘low’ quality.

The ARRIVE trial … not just disappointing but misleading

The ARRIVE trial (Grobman et al, 2018) – again, not just disappointing but misleading. There are many commentaries on this trial (see the link below for Professor Hannah Dahlen’s excellent summary).

Many of us rightly believe that stretching a woman’s cervix open, releasing essential amniotic fluid from the baby’s membranes, using synthetic hormones to make the uterus contract (sadly missing out on endorphins that would be released with endogenous oxytocin) and using a variety of ways to extract the baby whose development would be incomplete (obviously or labour would have commenced spontaneously) are interventions that ought to be saved for parents and babies that really need it. After all it’s obvious that performing those actions can be harmful for more than a few; i f the parent’s hormone releases are not optimal and baby is not quite in the right position or condition for labour then of course there will be complications; that’s just common sense.

The induction train gains speed

So as the induction train gains speed for an increasing number of ridiculous and unfounded reasons, based on assessments with large margins of error and a moderate to poor evidence base, I thought I’d share some of the voices of parents who have had induction of labour. These will be the stories shared in secret, drenched in tears. Maternity service providers hear some of them but are often defensive or gaslight the parents into submission or notes get lost or fabricated.

The following are all verbatim quotes from real parents I have anonymized. I have gathered them from many debrief sessions, both in person and on Skype/Zoom, and from closed groups where other mothers like myself congregate – I was traumatized by my unnecessary induction 28 years ago.

Induction voices

“Apparently I gave birth. It really doesn’t feel like it.”

“They said my baby would weigh 4.2kg. She weighed 3.3kg.”

“They didn’t believe I was in labour so they sent my partner home. They wouldn’t move me to labour ward and so I couldn’t have my epidural. My baby was born in the antenatal ward. My partner missed her birth.”

“They said that my baby should be induced that day because she was overdue. I then had to wait 48 hours for induction to commence. Wasn’t that urgent after all I guess…”

“I cried. I screamed. They never listened to me.”
“I feel violated.”

“I wasn’t given time to open to 10cms. They said that my son was in distress. I found out at “birth afterthoughts” that he wasn’t – it was hospital policy to assist beyond a certain time frame. I’d been timed out. I feel like a failure.”

“They told me that I’d need ‘a little cut’ to place the forceps properly. It was a massive cut! The stitches didn’t hold because the wound got infected. I hate myself down there. It’s been 10 months. This is my first and last child. Sex won’t be happening any time soon.”

“I feel lost. I’m a terrible mother. My baby went through so much to be born. She’d be better off without me.”

“My husband won’t make eye contact with me. I think he feels guilty. I wish I was dead.”

“I returned to work but was no longer any good at it so we all agreed it would be best I resign. I’m sure I have PTSD. I don’t want to go to my GP because I’ll have to talk about my birth. Even thinking about it makes me dizzy and nauseous. I feel so alone.”

“I was coerced into inducing my labour. No facts, just warped opinions. My baby was not tiny – she was 7lbs 7oz.”

“They made me induce my labour with lots of scary stories – no mention of the risks. My baby and I almost died! Who pays the price for what has been done to me and my baby? My family?”

“I was bullied and emotionally tortured into induction. 56 hours later I had a c-section. My baby was 3.7kg and fine. They wouldn’t let her have all of her blood after birth. I should have fought for her more. I know how important that was for her and her health.”

“My baby got stressed out with the induction and eventually got a very low heartbeat whilst we waited for the completion of a c-section so I could have my own. My son now has severe development delay. I wish I’d been better informed. They never mentioned that there would be any risks. I failed my son.”

“I’m certain every midwife and doctor in the unit examined me inside over those 3 days of labour. By the end my boyfriend couldn’t even look at me.”

“They said my baby would be big because I had gestational diabetes. I diet-controlled it but they said induction would be best. It ended with a caesarean because she got distressed. I haemorrhaged and had to go to ICU. I didn’t get to cuddle her until she was 5 days old.”

“I told them I felt like my pelvis was breaking. They said I wasn’t contracting enough times in 10 minutes so turned up the syntocinon. I’ve found out I now have a broken coccyx. Next time it’s a c-section for sure.”

“The pain of induction is out of this world. All of it. The endless vaginal examinations, the ache from that pessary, my baby’s head was tipped to the side so needed forceps. The episiotomy was cut before I was completely numb! I wanted to kick that doctor in the face. There were strangers staring at my vagina. Never again!”

“My 100 hour induction fiasco has left me with a failed marriage and PTSD.”

“I ended up with a huge haemorrhage, 2 blood transfusions and then sepsis. It now turns out that my bile acid readings were way within normal limits. I can’t believe we didn’t ask more questions. If I’d knowm I’d NEVER have agreed to induction. They just don’t tell you the risks.”

“Induction for weak reasons is inhumane. We will look back at this era with shame and remorse.”

“Yup. I feel robbed of my healing birth. Fell for the scaremongering for the second time. It’s so hard not to. I can still see the forceps imprinted on my baby’s face. Not sure that I’m a very good mum…”

“I can’t believe I put my baby through all of this so unnecessarily.”

“I didn’t realise we had a choice. My husband totally agreed with them that induction was a great idea. We both didn’t consider what it actually meant or ask any questions. Our baby went to NICU and I didn’t get to cuddle him until his 3rd day here. We’ve already failed as parents.”

“My baby and I are still dealing with physical and mental damage from my induction almost 10 years ago. They still are not able to find my notes. I have no closure with this.”

If we … stay silent then we remain a part of the problem.

There are many many more.

So for all of those that love to remind us all that induction of labour saves lives (yes it does occasionally – we are lucky to have it) may I remind you that unnecessary inductions are clearly ruining many more lives than it is saving.

We owe it to these families to broadcast their stories. They tell them in shame and in secret but we who hear them can shout on their behalf. If even just one family suffers unnecessary harm and consequences then that is one family too many. We cannot continue to justify the use of interventions with such a broad brush with just moderate evidence and not even a nod to biomechanics & birth physiology. That is the definition of unprofessional and uncaring. We are meant to be advocates. Let’s end the collusion with those that dismiss the holistic health of families. This storm has been coming for some time. If we who truly know how to meet the needs of birthing families stay silent then we remain a part of the problem.

#ENOUGH #FIRSTDONOHARM

By Midwife Kemi Johnson

References

Middleton, P., Shepherd, E. and Crowther, C. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews. 2018 (5)

Grobman W Rice M Reddy U Tita A Silver R et. al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. New England Journal of Medicine. 2018 vol: 379 (6) pp: 513-523

https://www.all4maternity.com/the-arrive-trial-has-finally-arrived-a-midwifes-summary/

6 Comments

  1. Louise Scrivens

    Heartbreaking. I’m a stat too. First c/s for obstetric distress (you read that right) and failure to progress after induction, second for trial of labour and uterine rupture. Afterwards – PND, C-PTSD, alcoholic mess, resilience shot, family destroyed. A successful delivery both times. Please do keep shouting this out – we need this.

    Reply
  2. Concerned midwife

    This is all very sad and true, but as a midwife I see lots of women pushing for induction just because they cant be bothered being pregnant anymore and they know the right buzzwords to say to the doctors. The recent GAP study not only highlighted the importance of being aware of fetal movements in reducing IUD at or before term but now every 3rd woman is being induced for reduced fetal movements despite USS and ctg monitoring. They hear from other mums about managing to get the doctors to agree to induction because of “apparent reduced fetal movements”
    They dont appreciate the risks involved in the induction process and in fact get quite annoyed when you tell them that the induction process may take up to 4 days and there is a risk of c/section when things are not happening quick enough for them. I understand when there is a genuine concern over fetal/maternal wellbeing but not this culture of IOL for a “just in case” or maternal request.

    Reply
    • Jess

      Midwives are “with women” even if the choice a woman makes isn’t the choice you would make. If a woman wants to be induced, she shouldn’t have to jump through ridiculous hoops to get her wish. Just as a woman who wishes to decline induction and go to 43, 44 weeks shouldn’t be pressured into an induction.

      Reply
      • Nicky Grace

        Hi Jess, point well made. We should respect the woman’s choices. Actually listen to her! She knows herself best.

        Reply
  3. Carole liesse

    Having planned a home birth I was sent to an appiontment with a man who do not even introduce himself but in a matter of minutes, like a sausage in a sausage factory, booked me in to be induced. When I left the room in a state of shell shock there was a small group of midwives outside the door. They told me that I did not have to do that. I had my baby at home with the support of lovely midwives and my partner. Please speak up for mothers. I am normally quite assertive but being about to give birth seemed to take that away from me.

    Reply

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