Women getting induced during pregnancy has increased
According to the NHS, University Hospitals Coventry and Warwickshire (Oct, 2022), 1 in 3 women have their labours induced. This means that around 30-40% of pregnant women do not go into spontaneous labour and have their labour artificially started. In the UK, induction of labour rates are steadily rising. According to national UK maternity statistics, inductions have increased from 20.4% of births in 2007–2008, to 31.6% in 2017–2018. The latest figures from 2022-2023 show that the average number of UK induction of labours is at 33%. The rate of caesarean sections have also increased from 13% in 2012-2013, to 23% in 2022-2023. Women going into spontaneous labour has significantly decrease from 64% in 2012-2013, to 43% in 2022-2023.
Why have induction of labour rates increased?
Why has induction rates in the UK increased over the last 15 years? Well, in 2021 the NICE Guidelines were amended. Previously, NICE (2008) stated that “women with uncomplicated pregnancies should be given every opportunity to go into spontaneous labour." However, in 2021, they were amended to say that medical professionals should "discuss preferences about mode of birth with women early on in their pregnancy. Take into account their individual circumstances, and discuss that options for birth can include expectant management, induction of labour, or a planned caesarean birth.” (NICE, 2021). As Dr Sara Wickham states, "previously, there was no recommendation to discuss induction until 38 weeks of pregnancy, and the suggestion that planned caesarean should be discussed early in pregnancy is also new. Some clinicians and birth workers are concerned that this introduces doubt and undermines women’s confidence in their bodies from the beginning of pregnancy.
I believe that so many women hear stories, watch things on TV and become so terrified about giving birth, that when they are told early on in their pregnancy, that they can have a planned caesarean or a controlled vaginal birth, they start to put this into their birth plan and believe that their body won't be able to birth a baby naturally. I hear many women saying that they were chatting to their friend, sister, colleague, neighbour, random lady in the shop, about how they had had a really long labour that went on for days, they went "X" days overdue and just couldn't wait any longer to meet their baby. "I got very impatient" "I've waited 9 months to meet him/her". "At least with a planned caesarean or an induction, you know which day you'll be having your baby." "The placenta fails if you go overdue", "Baby was measuring big, so I needed to be induced".
These kinds of conversations make women worried about how they'll feel by 40 weeks, the risks that have been highlighted to them and they start to worry or think about how they'd feel if they went overdue or had a long labour. They trust their caregivers and "do as they're told or suggested". However, even with a planned caesarean section or an induction, you're not guaranteed to have your baby on a specific day. Emergencies come in, the postnatal ward and delivery suite become busy, so there are no beds. This means that your induction or c-section has to wait. With an induction you can be called into hospital, get all setup on the labour ward and then be waiting around for days, until a bed becomes available. Yes, you're not in labour, but it's not fun waiting in hospital until it's your turn. That control that you thought you'd have with an induction, suddenly becomes out of your control.
Why is Induction Offered?
Induction can be offered for various reasons.
Going "overdue" (40+ weeks)
Having a high BMI
Conceived via IVF
Being a "geriatric Mum"
Predicted small or large baby
Health conditions of Mum or baby
The most common reasons that I hear about why women are getting induced, is around going "overdue" and predicted small or large babies. If baby was really a concern they'd do an emergency c-section. They would not have you waiting around in hospital for an induction. To put it into perspective too, the placenta does not start to fail after 40 weeks. The risk of having a still birth from 37-40 weeks gestation, goes from 0.02% to 0.10% after 40 weeks. The risk increases as the gestational age increases. As you can see from these statistics though, the risk is still very low. According to NICE guideline 2021, the majority (32.5%) of women go into spontaneous labour between 40 weeks -40 weeks +6 days. The next common group (25.4%) of women go into spontaneous labour at 39 weeks - 39 +6 days. 16.2% at 41 weeks - 41+6 days and 0.9% at 42 weeks +.
Many women do not realise that a stretch and sweep is a form of intervention and that it can be the first stage of induction. NICE (2021) states that "at antenatal visits after 39+0 weeks, medical professionals should discuss with women, if they would like a vaginal examination for membrane sweeping, and if so, obtain verbal consent from them before carrying out the membrane sweep." I've sometimes heard women say that at their 39 week midwife appointment, their midwife didn't ask if they'd like a membrane sweep, but were told "I'm just going to do your stretch and sweep now." Almost like implying that it's a compulsory procedure, once you reach 39 weeks. If the majority of women don't go into spontaneous labour until between 39 - 41 weeks of pregnancy, why are women being offered a stretch and sweep so early? This early intervention can be the start of more intervention further down the line and could lead to complications. A stretch and sweep can have it's benefits, just like induction can, but it should be based on the individual and not a one size fits all guideline. To understand more about the induction process, visit my blog on can you say no to induction of labour?!
Women who are told that their baby is measuring big or small for gestational age are often offered induction early too. However, scans are very inaccurate and can be out by as much as 10-14 days. Offering induction early for a healthy woman and a "suspected" big/small baby, isn't very reliable. The only way to really tell the size of your baby is when they are born. Using the BRAINS acronym can really help you to make the right decision here. Read my blog called Baby Measuring Big? for more information about ultrasound scans and "big babies".
Preparing for birth is more important than ever
Birth preparation is more important than ever, with these rising induction and caesarean section rates in the UK. Do you know your local hospital's induction rates? In Yorkshire, the induction rate in September 2023 for Harrogate Trust was 39%, for Leeds it was 36% and for Mid Yorkshire Trust, it was 28%. Understanding your birth rights during pregnancy is key and you can do this by getting support from a Doula, Hypnobirthing Teacher or Antenatal teacher. Check out my website if you'd like any support from me. You can also visit various resources online, such as Birth Rights and Dr Sara Wickham. Make sure that you fully understand the induction process and ask WHY it is needed. Weigh up the risks and benefits of induction and c-section, versus waiting to go into labour naturally. Remember that you can say NO if it doesn't feel right for you and the NICE (2021) guidelines do state that healthcare providers should "recognise that women can decide to proceed with, delay, decline or stop an induction. Respect the woman's decision, even if healthcare professionals disagree with it, and do not allow personal views to influence the care they are given."
Being supported by your decisions and knowing that you are making an informed decision that feels right for you, is so important. You can still have a positive birth experience, even if it isn't the birth that you planned for. Knowing that the decisions that you've made, have been made on evidence based information and come from an informed place, this will make you feel calm, confident and in control. If you consent to being induced or to a caesarean section, make sure that it is for the right reasons for you and your circumstances.
Julia x