Welcome to module 27

Welcome to the illuminating module on "Induction of Labour and Natural Encouragement." In this comprehensive module, we delve into the intricacies of labour induction within hospital settings, explore the reasons behind inductions, and provide a balanced perspective backed by facts and figures.

Navigating Hospital Induction Methods:

1. Hospital Induction Methods: Gain insight into the various methods employed within hospital settings to induce labour. Understand the processes, medical interventions, and the scenarios in which inductions are recommended.

2. Reasons for Induction: Delve into the multifaceted reasons behind labour inductions. From medical necessity to maternal preferences, we'll explore the spectrum of factors influencing this decision.

3. Facts & Figures: Embrace the power of knowledge through data and statistics. Understand the prevalence, success rates, and potential outcomes associated with labour inductions.

Embracing Natural Ways to Encourage Labour

1. Natural Approaches: Embark on a journey into the realm of natural encouragement. From tenderly talking to the baby to intimate moments of connection, we explore the potential of intimacy, sexual stimulation, and nurturing practices.

2. Evidence-Based Exploration: Delve into the evidence surrounding induction of labour. Learn how to access and interpret research to make informed choices.

Empowerment through Knowledge and Choice:

As birth attendants, you have the privilege of guiding individuals through one of the most transformative experiences of their lives. By understanding the nuances of labor induction and embracing natural encouragement methods, you empower birthing individuals to make informed decisions aligned with their preferences and well-being.

Remember, this module offers a balanced perspective that acknowledges both medical interventions and the innate wisdom of the birthing process. Through knowledge and understanding, you can provide invaluable support to birthing individuals, ensuring that their journey is one of informed choice, empowerment, and holistic care.

Exploring Hospital Induction: Reasons and Considerations

When hospitals consider the decision to induce labour, they often prioritise immediate concerns and potential complications. While this approach is rooted in ensuring the safety of both birthing individuals and babies, it's essential to recognise that the underlying root causes of certain ailments may not always be fully addressed. Let's delve into the reasons hospitals may choose to induce labour and why addressing root causes may sometimes be overlooked.

Reasons Hospitals Choose Induction:

1. Maternal Health Concerns: Hospitals may recommend induction when maternal health conditions, such as gestational diabetes or high blood pressure, pose potential risks to the well-being of both the birthing individual and the baby. As previously discussed, nutrition is seldom discussed during pregnancy, so the above listed ailments are difficult to prevent with poor education.

2. Fetal Distress: The health and well-being of the baby are paramount. If fetal distress or abnormalities are detected through monitoring, induction may be suggested to ensure timely intervention.

3. Post-Term Pregnancy: Hospitals often induce labour if a pregnancy extends beyond the due date. This is to mitigate potential risks that can arise as the pregnancy progresses. We advise everyone to read a copy of "In Your Own Time - By Dr Sara Wickham"

4. Premature Rupture of Membranes (PROM): When the amniotic sac ruptures before the onset of labour, hospitals may consider induction to prevent infection and other complications.

The Significance of Amniotic Sac and Fluid:

The amniotic sac and fluid play a pivotal role in the labour process, usually remaining intact until the culmination of labour. However, for approximately 10% of women, the amniotic sac ruptures before labour initiation. This module examines the implications of this scenario and the subsequent approaches that are often taken.

The Standard Approach to Induction:

Hospitals frequently opt for labour induction using prostaglandins and/or syntocinon (pitocin) to stimulate contractions. The term "augmentation" is often used instead of "induction" in this context.

Balancing Immediate Concerns and Root Causes:

The rush to induce labour following membrane rupture is a relatively recent development. The module highlights how the standard approach has evolved over the years and explores the absence of new evidence driving this shift. It sheds light on the complexities of conducting research in a context influenced by cultural and social dynamics.

Outcomes and Experiences: Induction vs. Waiting:

For babies, a Cochrane Review reveals that inducing labour may have a slight reduction in neonatal infection. However, the evidence quality varies, and the distinction between "definite or probable" neonatal sepsis requires deeper exploration.

For mothers, a slight increase in uterine infection risk is associated with waiting for labour. The module emphasises the importance of recognising the limitations of these studies, particularly in a hospital setting.

Antibiotics - Unveiling the Complexities:

A Cochrane Review addressing antibiotics for pre-labour rupture of membranes at or near term underscores the need for cautious antibiotic use due to limited evidence of benefits and potential side effects. This module raises questions about the potential impact of antibiotics on both short-term and long-term health outcomes.

Informed Decision-Making and Holistic Care:

This module emphasises the significance of informed decision-making for women, allowing them to navigate the delicate balance between immediate interventions and holistic care. By providing comprehensive information, birth attendants empower women to make choices aligned with their well-being and preferences.

PLEASE CLICK HERE FOR FURTHER READING ON PROM

Challenges in Addressing Root Causes:

1. Time Constraints: Hospital protocols and considerations for safety may prioritiSe prompt action over extensive investigations into the root causes of certain ailments.

2. Complex Interactions: Medical conditions and complications can be intertwined, making it challenging to pinpoint a single root cause. Hospitals may focus on addressing immediate risks rather than delving into complexities.

3. Limited Resources: In a clinical setting, resources and available time may be allocated to addressing pressing concerns rather than conducting in-depth investigations into underlying causes.

Holistic Care Approach:

While hospitals prioritise safety and immediate well-being, addressing root causes necessitates a comprehensive, holistic approach. This approach involves exploring the interplay of physical, emotional, and environmental factors to uncover the origins of ailments.

As birth attendants, you have the unique opportunity to provide holistic care that delves into the deeper layers of health concerns. By considering the whole person and collaborating with healthcare professionals, you contribute to a more comprehensive understanding of health and well-being. By bridging the gap between immediate interventions and addressing root causes, you empower birthing individuals to make informed choices that support their long-term health and wellness.

Standard Induction Methods

In the realm of maternity care, various standard induction methods are employed to initiate labor when certain medical conditions or concerns arise. These methods are used with the aim of ensuring the safety and well-being of both the birthing woman and the baby. Below are some commonly used standard induction methods:

Prostaglandins: These are hormones used to ripen and soften the cervix, preparing it for labour. Prostaglandins can be administered in gel, tablet, or pessary form and are often inserted directly into the vagina.
Syntocinon (Pitocin): This synthetic form of the hormone oxytocin is used to stimulate uterine contractions. It is administered intravenously and can help regulate contractions during labour induction.
Amniotomy (Artificial Rupture of Membranes - ARM): This method involves intentionally breaking the amniotic sac, which can stimulate contractions and initiate labour.
Folley Bulb: Also known as a Foley catheter, this method involves inserting a catheter with an inflatable balloon into the cervix. The balloon is then inflated, putting pressure on the cervix and encouraging dilation.
Membrane Sweep (Cervical Sweep): A midwife or doctor uses a gloved finger to gently separate the amniotic sac from the cervix, stimulating the release of natural prostaglandins.
Cervical Ripening Balloon: This method utilises a balloon filled with saline solution to gently expand the cervix, promoting dilation and labour onset.
Herbal Remedies: Some natural remedies, such as herbal teas and tinctures, are believed to have labor-inducing properties. Examples include red raspberry leaf tea and evening primrose oil.
Acupressure and Reflexology: Certain pressure points on the body are believed to stimulate contractions and labour. Acupressure and reflexology techniques can be used to encourage labor naturally.
Nipple Stimulation / Sex: Gently massaging and stimulating the nipples can trigger the release of oxytocin, potentially leading to uterine contractions. Clitoral stimulation can also help encourage contractions.
Homeopathic Remedies: Some practitioners recommend specific homeopathic remedies thought to promote labour. These remedies are tailored to an individual's symptoms and constitution.

It's important to note that the choice of induction method depends on the medical situation, the birthing woman's preferences, and the care provider's expertise. Each method has its own considerations and potential risks, and informed decision-making plays a crucial role in the induction process.

Main Risks - Medical Induction

1. Prostaglandins:

Uterine hyperstimulation: Excessive contractions can lead to reduced blood flow to the baby and potential distress.
Increased risk of uterine rupture, particularly in women with a previous cesarean section.
Infection, although the risk is low when administered under sterile conditions.
Emotional trauma- When inductions fail or a cascade of medical intervention occurs due to IOL women often feel like their body has failed them, not to mention the lack of control many women report.

2. Syntocinon (Pitocin):

Uterine hyperstimulation: Overstimulation of contractions can lead to fetal distress and reduced oxygen supply.
Increased risk of uterine rupture, especially in women with a scarred uterus.
Rapid labour progression: This can lead to increased pain and potential complications.
Fluid imbalance or electrolyte disturbances due to increased fluid retention.

3. Amniotomy (Artificial Rupture of Membranes - ARM):

Increased risk of infection: Opening the protective barrier of the amniotic sac increases the likelihood of infection.
Cord prolapse: If the baby's head isn't engaged, there is a risk of the umbilical cord slipping into the birth canal ahead of the baby.

4. Folley Bulb:

Risk of infection from insertion.
Uterine hyperstimulation or excessive contractions leading to fetal distress.

5. Membrane Sweep (Cervical Sweep) and Membrane Stripping:

Risk of infection.
Minor bleeding or spotting.
Uterine contractions and discomfort.
Days of prodromal labour

6. Cervical Ripening Balloon:

Risk of infection from insertion.
Uterine hyperstimulation or excessive contractions leading to fetal distress.
Uterine perforation in rare cases.

"Overdue" - The Medicalisation Of Birth

The medicalisation of childbirth has led to a focus on specific due dates for babies, despite the variability of term being between 37 and 42 weeks. Only a small percentage of births (5%) actually occur on the estimated due date, regardless of the dating method used. Variability in pregnancy length is observed, with some pregnancies lasting almost three weeks beyond the standard 40-week calculation. Prolonged gestation can carry risks for both babies and mothers, potentially increasing the risk of death for babies, although inducing labour may also have its own risks, particularly if the cervix is not ready. Hospitals often have policies for the allowable duration of pregnancies.

Women are sometimes told that going beyond their due date could result in their baby's death, without receiving comprehensive information about the actual risks involved. Research reveals the risks of unexplained stillbirth at various gestational ages, emphasising the importance of informed decision-making:

At 35 weeks: 1 in 500
At 37 weeks: 1 in 556
At 38 weeks: 1 in 645
At 39 weeks: 1 in 730
At 40 weeks: 1 in 840
At 41 weeks: 1 in 926
At 42 weeks: 1 in 826
At 43 weeks: 1 in 769
At 44 weeks: 1 in 633

Recent research questions the value of recommending induction at 41 weeks and three days instead of waiting until 42 weeks, pointing out the lack of benefit and increased risks associated with earlier induction. Induction of labour has become a common intervention, affecting a third of women in the UK. If you choose to refuse induction and await natural developments, it's important to be aware of your right to make that decision. Further exploration of the risks and benefits of induction is recommended, as your choice plays a significant role in your birthing experience.

As birth attendants, it's important to recognise and respect the diverse perspectives and decisions made by your clients when it comes to their birthing experiences. Your clients have a wealth of knowledge about their bodies, their babies, and their family history, and this should be acknowledged and valued throughout their journey.

Before making decisions, your clients likely invest time in researching medical evidence, understanding their options, and considering the implications for their care. They may have personal insights into their conception date that differ from ultrasound estimates. Unfortunately, some healthcare professionals may dismiss or undermine this knowledge, potentially undermining the autonomy of your clients in making informed choices.

It's not uncommon for healthcare professionals to assume that if a woman declines their advice, she is putting her baby at risk or being irresponsible. However, this assumption fails to appreciate the complexities of decision-making and the nuanced understanding clients have about their circumstances. It's essential to avoid the implication that a woman taking responsibility for her choices is making the wrong decision. Furthermore, clients who choose to go against medical advice should be aware that healthcare providers remain accountable for their actions and decisions.

Coercive language or suggestions that a woman's decision could lead to her baby's death are unethical and against professional codes of practice. It's a fundamental right for clients to accept or refuse care and treatment, and midwives are expected to respect and support these decisions.

"Respect, support and document a person’s right to accept or refuse care and treatment.” (Nursing and Midwifery Council 2015).

Many women opt to create birth plans to communicate their preferences and desires during childbirth. Birth plans help clients and their partners articulate what matters to them and open discussions with healthcare providers. These plans can also serve as a guide for midwives to understand and honour their clients' choices. While some hospital-provided birth plans may focus solely on available options, consider guiding your clients toward resources that encourage them to explore the implications and alternatives comprehensively.

Sara Wickham's "What's Right For Me?" and Milli Hill's "The Positive Birth Book Visual Birth Plan Cards" are valuable tools that can aid clients in making well-informed decisions and creating birth plans that genuinely reflect their preferences.

Remember, as birth attendants, your role is to support, inform, and advocate for your clients' choices, fostering an environment of respect, empowerment, and shared decision-making. By embracing and nurturing these principles, you contribute to creating positive and empowering birthing experiences for your clients.

Module 27 – Induction Of Labour

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