Sweeps and Induction of Labour
Early sweeps and induction of labour 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.
This said I have many positive induction stories on my website and have supported women and their partners through beautiful inductions.
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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.
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.
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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. There is also a risk of accidental waters breaking.
A sweep is only likely to work if your body is ready to birth anyway and like all interventions increases the risks of a need for further interventions.
I have an excellent video about sweeps that I recommend all birthing women and people and their supporters watch.
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 and also is increasing with the Warwick Big Baby Trial (which I personally cannot understand how it passed the ethics committee).
You can read the full NICE Guidelines on Induction HERE.
My fellow doula Sophie Messenger has writing an excellent, well researched blog on “The Myth of the Aging Placenta” which I highly recommend reading.
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 word “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, however it 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.
The most up to date books on induction are “Inducing Labour Making Informed Decisions“, by Dr. Sarah Wickham and “Why Induction Matters” by Rachel Reed.
I am a Doula not a medical professional – I cannot give medical advice and I would not give advice at all, but I can read guidelines and am aware when they are not being followed – this blog should help to support you in accessing the information you should already be being given by your health care providers.
Both induction books support women and birthing people to unpick scaremongering and make informed decisions relating to their journey, their body, their baby and their birth.