Is induction of labour morally justifiable?
This blog asks a really important question about putting organisations before people: something which inevitably follows from centralising services.
Last year I attended Fiona’s third birth. There is a story to tell there, as Fiona’s experience during her first birth was the catalyst for me to undertake four years of study into why women are not listened to when they report that their labour has started, (Shallow 2018; Shallow, Deery & Kirkham 2018). Fiona, in turn this year, chose to support her friend with the birth of her second baby.
On the 11th March I heard from Fiona that her friend, gave birth to a girl. She weighed 7lb 13oz. All well, mother very tired and Fiona described being mightily relieved, after ‘waiting ages’ for the baby to arrive, as she went on call as her supporter and friend.
Fiona’s friend, let us call her Lucy, had an uncomplicated pregnancy. When her pregnancy went beyond the allotted due-date, she was advised to have her labour induced. The indication for induction was that her baby had progressed several days beyond her due date. Despite a dearth of evidence, women are told that by not agreeing to induction, they run the risk of having a still born baby.
Here is what Fiona wrote,
‘So Lucy’s induction day, all beds are full with back up from yesterday waiting. She’s been in for examination. They say they can pop waters, but labour ward is full. So she’s home waiting for the call when less busy. I’ll keep you posted’
In my experience, when women are advised to have induction, they are told that the baby will be safer born than remaining in utero. The research is questionable about this (See Wickham 2018). When women know no better, or we might say have not been properly informed, they agree to induction because someone has convinced them that it is safer for their babies to be forced out, rather than to stay in their mother’s warm velvety uterus that has safely nurtured the baby for the past nine months. When the induction process is then delayed, this causes severe maternal anxiety and fear.
After having been advised of the risk of continuing their pregnancy, suddenly, as it is not convenient for the unit, the mother is advised to go home and await the call; await her slot on the conveyor belt of last week’s and yesterday’s inductions. She is not today’s priority. Deflated mothers anxiously await the call, can’t sleep or rest for worrying and can’t eat due to nervous anticipation. None of this helps the hormonal flow that is so crucial for stimulating spontaneous labour.
Later that week Fiona wrote,
‘Still no beds’
I sent words of support and reassurance, but felt the inevitability of what was to come, of which neither Fiona or Lucy were fully aware. The weekend passed, and I sent a message enquiring of news. I was very aware of that ‘hasn’t she had it yet?’ pressure, but by now I was hooked on knowing the outcome. When I finally heard that baby was safely born, and Lucy was tired but okay, I was relieved. Then Fiona told me more as she called me to ‘debrief’ her first birth supporter experience.
Lucy was summoned for admission on the Sunday evening, several days after she was advised to be admitted for induction. Her waters were broken in the middle of the night and after two hours the syntocinon drip was commenced; in the early hours of the morning. Lucy was already exhausted; she had had no sleep for days and no decent nutrition. Eventually she succumbed to an epidural and Fiona described how she only just managed to birth her baby before the team planned further interventions. All this to effect the birth of an allegedly overdue baby. Here she is. What do you think?
This little girl was NOT ready to be born, as we can plainly see, by the thick coat of vernix still covering her body. Whereas these are joyful photos for Lucy to treasure, what I see is a baby plucked untimely from the womb. I am cross and upset. I am upset not just for Lucy, but for all the thousands of women who are hoodwinked into believing their own bodies are no longer safe places for their growing babies. And I am upset for the thousands of babies who are compromised, yes compromised, by this production line birthing machine. No doubt Lucy’s birth will be reported as a ‘normal birth’ and witness to what actually happens gets lost in the midst of misleading statistics. Mothers know they have been through hell and back, but they don’t really know why. Even that extraordinary stress and waiting and pressure and fear is ‘normalised’. Women put birth memories to the back of their minds and get on with their lives with their new or growing families, but they never forget. We don’t know what the long-term consequences are of these highly dangerous and yet increasingly common and often now, routine interventions.
Lucy gave me permission to use her photographs. I wonder how many of you out there are witnessing this same scenario or even worse, when failed inductions end up in theatre or traumatic instrumental deliveries with fetal or maternal distress? This is unacceptable and unethical. I am cross. If you have witnessed similar incidents, we recommend you submit a Serious Clinical Incident (SCI) form, because, untimely births like this little baby’s is an avoidable serious incident.
Shallow, H. E. D. (2018) When midwives become other. In: N. Edwards, R. Mander, and J. Murphy-Lawless, (eds.) Untangling the Maternity Crisis.First Edition ed. Oxford UK & New York: Routledge.
Shallow, H. E. D., Deery, R., and Kirkham, M. (2018) Exploring midwives’ interactions with women when labour begins: A study using participatory action research. Midwifery.Vol.58 pp.64-70.
Wickham, S. (2018) Inducing Labour: Making Informed Decisions. Birthmoon Creations– available on Amazon and Kindle. ISBN - 9781999806439