Understanding Induction of Labour: Important Considerations for Informed Decision-Making

intervention

30 Nov

Introduction

When it comes to childbirth, every expectant parent deserves comprehensive information to make informed decisions about their care pathway. Induction of labour (IOL) is a common medical intervention that can be lifesaving in certain situations. However, it's essential to consider both the benefits and potential risks associated with this procedure. In this article, we will explore some lesser-known aspects of induction, shedding light on factors that are often overlooked during discussions with healthcare providers.

Updated Guidelines and Expectant Management

According to the updated draft of the 2021 NICE guidelines, induction should be offered to pregnant individuals once they reach 41 weeks of gestation, as opposed to the previous range of 41-42 weeks. However, if you prefer to allow your body to initiate labour naturally, a decision known as expectant management, it is crucial that your choice is respected. In such cases, clinicians should work in partnership with you to devise an ongoing management plan.

Increased Monitoring during Expectant Management

For those opting for expectant management beyond 41+3 weeks, increased monitoring is recommended. This typically involves at least twice-weekly cardiotocography (CTG) scans, which record the baby's heart rate, along with the option of ultrasound estimation of amniotic fluid index (AFI). These monitoring measures help ensure the well-being of the baby during this extended waiting period.

Risks Associated with Induction of Labour

When discussing induction of labour with your healthcare provider, it's important to consider the specific risks associated with your pregnancy, as well as those associated with the induction process itself. Induction is not without risks and can potentially lead to a cascade of further medical interventions. Some notable risks include:

1. Uterine hyperstimulation: Induction may cause excessive uterine contractions, which can put the baby at risk of distress.

2. Ineffectiveness of induction: The process of softening the cervix for induction may require multiple agents or prove ineffective, leading to a need for alternative approaches.

3. Increased pain: Surges induced by synthetic oxytocin (a hormone used to stimulate contractions) may be more intense and painful compared to naturally occurring surges.

4. CTG monitoring: Induced labour often requires CTG monitoring to effectively manage synthetic hormone-related risks. However, this monitoring, along with the presence of an IV drip, may limit mobility and restrict the use of pain relief options like water immersion.

5. Pharmacological pain relief: The discomfort experienced during induced labour may increase the likelihood of choosing pharmacological pain relief options, such as epidurals.

6. Assisted delivery: The increased likelihood of medical intervention, including vacuum or forceps assistance, may be required for the baby's safe delivery. In some cases, an episiotomy (a surgical cut made in the perineum) may be indicated to facilitate the use of instruments.

7. Increased risk of caesarean birth: Induction can elevate the likelihood of requiring a caesarean section for a safe delivery.

Balancing Risks and Benefits

It is important to emphasize that inductions are not inherently bad. However, individuals should carefully weigh the potential risks and benefits based on their personal circumstances. Each pregnancy is unique, and discussions with healthcare providers should focus on understanding these risks and considering alternative options whenever possible.