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.
“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.
By Midwife Kemi Johnson
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