Sweeps and Inducing Labour: Making Informed Decisions Links And Book Review
There are 2 books that I consider essential reading for any pregnant woman and her companions and family – Am I Allowed by Beverley Beech (book review HERE), should be read at the start of any pregnancy journey and Inducing Labour Making Informed Decisions by Dr. Sara Wickham (available HERE with free international postage on Wordery), is a must read by 37 weeks for all women and at any point induction is being suggested.
It is beautifully and compassionately written and this edition has been expanded to cover more areas, including IVF, “older” mums, big babies, post dates, premature and spontaneous rupture of membrane (PROM and SROM) and more. It presents information clearly and concisely and challenges current (often unevidenced) practice.
Click HERE for more information on National and Local Birth Pool and Tens hire.
Although very little information around induction in assisted conception and pregnancies is available, (IVF, ICSI) this study from 2014 “Risk of Stillbirth and Infant Death After Assisted Reproductive Technology” shows no basis for a policy of early induction.
After 28 + 0 gestational weeks there was no significant difference in the risk of stillbirth between ART and SC singletons. ART twins had a lower risk of stillbirth compared with SC twins, but when restricting the analysis to opposite-sex twins and excluding all monozygotic twins, there was no significant difference between the groups.
Induction rates are ever increasing, with the Royal College of Midwives claiming in their report “Interventions in Normal Labour And Birth” that intervention rates are being under reported.
My hard hitting blog post, “Why Do You Want Your Baby To Die“, discusses the impact of lack of information around induction.
Induction is a huge intervention, with massive potential side effects, including the increased chance of caesarean and instrumental delivery alongside PND and PTSD. There are always alternatives including caesarean.
PND and PTSD chances are significantly increased when induction is coerced and there is a lack of informed consent – induction is a many stepped process and each one, along with its pros and cons, need clear explanations.
If you have a life, birth or other story you would like to share, please email me HERE.
The first stage of induction is a “sweep”, which can increase risks of infection and over stimulate the uterus causing “false pains” which can in turn leave you exhausted before you even start the birth process. It is only likely to work if your body is ready to birth anyway and like all interventions slightly increases the risks of a caesarean.
Induction and sweeps are likely to be unsuccessful on women with low Bishops scores, always bearing in mind the cervix is not a crystal ball.
NHS Guidelines suggest a sweep for first time birthers at 40 weeks and women who have already birthed at 41 weeks.
If you are looking at being induced there are various methods, orgasm floods the body with oxytocin, aromatherapy, induction massage with clary sage, reflexology, acupuncture and acupressure are a few examples.
If these are not working the next step is a pessary. I always suggest making an induction plan, including if there are points at which you would prefer to go to caesarean birth.
Under NICE Guidelines (as at August 2018), induction is not recommended for big baby unless there are other risk factors. This push is a misuse of the new(ish) GROW charts introduced to identity growth restricted babies.
You can read the full NICE Guidelines on Induction HERE.
Since the Montgomery v Lanarkshire case, health care professionals have a legal, moral and ethical obligation to inform you about all pathways, including their risks and not just the benefits of those they wish you to folllow.
“The Montgomery case firmly rejected the application of Bolam to consent, establishing a duty of care to warn of material risks. The test of materiality defined in the Montgomery ruling was whether “a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.”
Would you be likely to attach risk to induction if you were fully informed – I believe any reasonable person would.
Induction for shoulder dystocia is absolutely not recommended by The Royal College of Gynaecologists (RCOG), in their green top guidance which was reviewed in December 2016, “Shoulder Dystocia – Green Top Guidance 42“.
5.1.1 Does Induction Of Labour Prevent Shoulder Dystocia?
Induction of labour does not prevent shoulder dystocia in a non-diabetic woman with a suspected macrosamic infant.
In the RCOG “Leaflet Information For You – Shoulder Dystocia“, induction is listed as a risk factor for shoulder dystocia (along with other factors including long labour and instrumental delivery both of which are more likely in induction), the leaflet also states,
“Ultrasound scans are not good at telling whether you are likely to have a large baby and therefore they are not recommended for predicting shoulder dystocia, if you have no other risk factors”.
“If you don’t have diabetes, early induction of labour does not prevent shoulder dystocia, even if your baby is suspected to be large. Caesarean section is also not routinely recommended in this situation”.
Midwives are highly trained to deal with shoulder dystocia and have a number of manoeuvres they can utilise in the 0.7% some degree of shoulder dystocia occurs.
Another bone of contention of mine is the use of the work “OXYTOCIN”, when referring to induction or augmentation (induction but during labour) – only the body can make oxytocin – this in itself is a misleading term.
All of life is a balance of risks and women deserve and are entitled to proper information to be able to assess what risks are material to them.
Another great blog posts by Dr. Sarah Wickham is – “10 Things I Wish Every Woman Knew About The Induction Of Labour“.
Induction can be a positive experience and I am currently undertaking a course on Positive Induction, however induction is a heavy duty intervention, with massive potential impacts on birth and breast feeding, I am not anti-induction – I am anti lack of informed consent and am shocked at the frequency of induction being sold to women as if it is taking a smartie. Positive induction can only happen when it is fully informed.
The lovely positive induction birth story of Jen Lewis can be read HERE.
This book enables women to unpick scaremongering and make informed decisions relating to their journey, their body, their baby and their birth. It is a huge step in providing balanced information and allowing women to make informed choices for themselves.
The book can be hired from me for £2.50 for 2 weeks and is available free to clients.
If relevant please join our local Positive Birth Group, South Wales Home Birth and Hopefuls group, or the National VBAC and Home Birth chat groups or the new but very informative Induction Of Labour group.
Samantha Gadsden walks with women on their life’s journeys. She is an experienced Doula, based close to Cardiff in South Wales, mother to 4 children and wife to Eddie, more information can be found on her facebook page, Samantha Gadsden Doula and her website, Caerphilly Doula. SOS Doula, Telephone and online support is always available.
If you are interested in writing a guest blog or sharing a life or birth story please feel free to contact her HERE.
“Your Journey, Your Body, Your Baby, Your Birth“
Please note there is an affiliate link to Wordery and I get a minuscule commission on purchases of the book.