Brooke Elliston’s story today is inspiring in so many ways. Like so many of you out there, Brooke had a looming threat of induction – rates of which have doubled in the last twenty years in Australia.
I know a lot of women are struggling with whether to have an induction or not, so I have included a huge amount of information and data at the end of this blog and in Podcast show notes to help you make the right decision for your family.
Brooke is a yoga teacher, and we begin by talking about the language of the body and intuition. Then go onto discuss women’s power in birth plus many ideas and concepts I am exploring in depth in my new book.
In the podcast, we talk about
- Finding your hell YES and your hell NO
- Listening to your body and feeling resonance
- Creating strong boundaries for yourself
- Partners protecting the birthing space
- Your rights to decline an induction
- Coercion and lack of ethics often experienced in the system
- Risk and stillborn data being an individual’s choice as we assess risk differently
- Whether it is even possible for a labouring woman to give true consent
- How the environment we birth in has an impact on our outcomes and feelings
- Power dynamics in the birth space and my concept of ‘Power To’ that is desperately needed
At the end we also talk about conscious conception at the quantum level. And how the shakti takes us over during birth. And we go through a little ‘birth harvesting’ as I call it, where we speak to the gifts we receive from our births.
This is one of my favourite types of conversations, where we get to be spiritual but also really really practical, pragmatic and grounded in the body. This is one of the reasons I love birth so much, and yoga too because it really is where the rubber hits the road.
There are numerous issues unfolding along with the increase of inductions such as increased resuscitation of babies, decreased maternal satisfaction and increased postpartum hemorrhage. A lot of experts are saying we might be reaching the point of doing more harm than good in the birth space right now.
The data and articles below will help you make an informed and empowered decision. Remember that your choice needs to be an embodied decision also. Whatever you choose, remember that birth matters and you have rights. You have intelligence within your body. And you can connect to your higher self and inner feelings to help guide you at any time.
Our work at She Births® is to empower you and help protect you from the conveyer belt of the systems. But you have to take the education and apply it. Make sure that you choose a team that supports you 100%.
If these topics are of interest to you. If you want to connect more deeply with your intuition or if the idea of harvesting gifts from your birth or preparing in a pragmatic yet spiritual way for labour sounds like you, then make sure you subscribe to be part of my VIP book list. You will gain sneak peek access, discount offers and even help me choose the final title!
My upcoming book is perfect if you are pregnant, a mum currently or a partner wanting to be useful or understand birth more fully, and of course it is perfect if you are a birth worker. Go here to sign up www.shebirths.com/book
INDUCTION DATA ANALYSIS
Below we have listed important information about induction of labour to help you make a more informed decision for you and your family. Induction recommendations will differ between different hospitals and even different providers. The research data from the Cochrane Review is highly contested by many professionals. And the current NICE guidelines are extremely ambivalent.
Remember that guidelines are not law. Induction of labour being discussed with you at any gestation is always being given as an offer.
It is always your body and your choice. We hope the links below and the above podcast empower you to understand the risks and benefits. Alternatives to medical induction, the natural forms of induction plus the natural forms of pain relief are all taught in every She Births® online and face to face course.
Our courses help you understand the nature of medical induction and how it is a different experience to spontaneous labour for both mother and baby and requires more support from birthing partners. We provide you with the tools to combine the natural and the medical during the often more painful experience of medical induction. There are also birth story interviews in our Resources that you can access allowing you to hear from families who’s medical induction has been an overall positive experience.
It is important to know that an induction of labour will generally be a more challenging experience due to the lack of endorphins created because synthetic oxytocin does not cross the blood brain barrier. The readiness of your body along with a toolkit and team to support are key to a more positive induction experience.
Your readiness for labour and therefore readiness for induction needs to be assessed individually. The below Bishop’s Score Calculator is a great guide along with the She Births® resources to assist in optimal positioning. Remember dilation occurs from descent and descent occurs from position and space.
Latest Australian data and research
“Compared to first-time mothers who went into labour themselves, those who were induced were more likely to have:
- an instrumental birth with forceps or vacuum (28% for women who were induced vs 24% for women who gave birth spontanesously)
- a caesarean section (29% vs 14%)
- an epidural (71% vs 41%)
- an episiotomy, which is a surgical cut to the perineum, the area between the vaginal opening and the skin leading towards the anus (41% vs 30%).”
It can be very confusing trying to understand the data. All the numbers are here and a discussion of the evidence.
Podcast – discussing the numbers and actual risks
Increased postpartum hemorrhage risks with induction of labour
Increased maternal dissatisfaction with induction of labour
Are we in trouble in Australia?
Less than 30% of women in Australia go into spontaneous labour, without any form of medical induction or augmentation. This means 7 out 10 women are either being induced or scheduled for a c-section and only 3 out of 10 women are experiencing their body and their baby and natural hormonal orchestration at optimum levels for birth. Even with increased induction rates we have not seen any decrease in stillbirth rates
The overall stillbirth rate has remained between 7 and 8 per 1,000 births between 2003 and 2020.
“Induction among selected first-time mothers was relatively stable nationally until 2010 at around 26%, but has shown a steady increase since then to 46% in 2020.” AIHW
To reduce the risk of stillbirth, there is evidence that mums can learn how to ‘count the kicks’. See more here:
A great document to look up your local health district and also specific hospitals to check on their data eg types of induction and rates, c-section rates vs normal vaginal rates.
You can see here that the Royal Hospital for Women in Randwick, NSW has a 35.3% c-section rate and a 46.2% normal vaginal rate without any forceps, vacuum or breech presentation. North Shore Private hospital has a 59% c-section rate. Port Macquarie has a 52% induction rate. Induction rates can be lower in private hospitals often due to the high number of scheduled c-sections.
Overall, less than 30% of women in Australia go into spontaneous labour, without any form of medical induction or augmentation. That means 7 out 10 women are either being induced or scheduled for a c-section. Only 3 out of 10 are allowing their body and their baby to determine the natural hormonal orchestration and nature’s readiness for birth.
DISPUTING and DIFFERENT RESULTS FROM EVIDENCE
Two great books written by Dr Sara Wickham review the global research and dispute many of the NICE guidelines stating they are contradictory and non evidence based. Her book is an exploration of the many risks and the varied emotional outcomes for women. Her social media is great to follow also.
NICE Guidelines- to understand risks and also what process is involved for informed consent and ensure it has been explained to you in accordance with guidelines at your hospital.
The most common reasons for a medical induction are smaller or bigger babies and gestational diabetes.
1/ Gestational Diabetes data is analysed here. Unfortunately, there is very little data or analysis of the psychological impact of induction on the mother.
“The reviews of evidence show a minimal reduction in improvements due to medical induction eg. c-section lowers from 22.6% to 19% which many would consider an insignificant amount.”
Other outcomes such as stillbirth rates in GD mums show
“The absolute risk of perinatal death is low whether a mother chooses planned early birth or waits for labor to start on its own” It is possible that these potential benefits of early induction do not apply to mothers with GDM who have well-managed blood sugars.
- Management of gestational diabetes (diet, exercise, or medication) lowers the chance of having a big baby and shoulder dystocia down to normal levels.”
2/ Big Babies
‘In 2016, the American Congress of Obstetricians and Gynecologists (ACOG) released an opinion stating that induction is not recommended for suspected big babies, because induction does not improve outcomes for birthing people or babies (recommendation based on “Level B evidence = limited or inconsistent evidence”). The 2016 practice bulletin was reaffirmed by ACOG in 2018. This recommendation is similar to their 2002 guidelines that were reaffirmed in 2008 and 2015, and eventually replaced by this new position statement published in 2016. In 2020, ACOG released another practice bulletin stating that more research needs to be done to determine whether the potential benefits of inducing for a suspected big baby to prevent shoulder dystocia before 39 weeks outweigh the risks of early induction (ACOG, 2020).
In 2008, the National Institutes for Health and Clinical Excellence (NICE) in the United Kingdom also An updated recommendation from NICE, released as a draft in May 2021, suggests that all pregnant people should be offered induction at 41 weeks, rather than allowing babies to grow for up to 42 weeks, to lower possible complications. This advice is not specific to suspected big babies and is based on expert opinion not clinical trials.
French practice guidelines from 2016 recommend induction for suspected big baby if the cervix is favorable at 39 weeks of pregnancy or more (Sentilhes et al. 2016). This recommendation is based on “professional consensus,” not research evidence.”