A couple of days ago, I got a call from a woman in early labour. Her waters had broken a few hours before, and she was having mild contractions. She wanted to give birth at home, and was reluctant to let her midwife know about her waters breaking, because she knew that after 24h, there would be pressure to go to the hospital to induce labour. I reminded that it was her right to choose to stay at home, even if induction was offered. I also explained that she could either tell the truth (and be prepared to stand her ground), or chose not to, if having to argue during labour felt like too much.
She went into established labour shortly after our call. When her midwife arrived, she told her that her waters had broken 3h prior. The midwife said that she needed to transfer her to the hospital immediately for induction because, she said “your waters are GONE and there is a high risk of infection”.
This woman was a second time mum, and was having strong contractions every ⅔ minutes at this stage. She refused to transfer, insisting she wanted to give birth at home. The midwife left shortly afterwards, saying that she wasn’t in established labour. Five minutes after the midwife left, the woman started to push. She gave birth at home in the end, and the midwife came back, but what should have been a beautiful and joyful experience left her feeling angry and stressed instead.
The induction coercion
Over the last few weeks, I supported several births even though I’m not officially working as a doula anymore. People find me and I just can’t leave them without support in such a damaged system. Everytime I find myself supporting people, it is because they are being coerced by the system. In some cases I do home visits, officially to offer techniques for labour, but in reality I spend most of my time reminding people of their human rights.
The women I supported recently were either “late” to give birth, having a long prodromal labour, or had their waters break before contractions started.
What was the answer to all of these situations? You guessed it, induction of labour.
What prompted me to write this was the extreme unusual circumstance of the birth in the intro paragraph. The midwife who turned up at her homebirth was adamant that she needed to go to hospital to be induced, but there was no clinical rationale to do so, even within the very tight hospital guidelines.
In my nearly 15 years in birth work, I had never heard something as ludicrous. I suspect the midwife was a delivery unit midwife sent to cover for community midwives, and that she was not feeling safe supporting a homebirth. When this had happened in the past, and I saw spurious reasons used to suggest hospital transfer, at least there was some tiny something that was outside of guidelines, like an increased temperature 0.5 degrees over the upper limit. But here there was none, zero, nada.
The rise of induction of labour
When you have been around this field for as long as I have, you can see trends in plain sights.
Birth centre rates are dropping. In my local hospital, when the birth centre opened in 2012, the goal was that 30 to 40% of all births would take place there. In 2014, the rate of labour started in the birth centre was over 30%, and 25% of births taking place there. Based on the last 3 years of infographics, the current birth centre rate is only 13%.
Homebirth rates are also at an all time low. Before my local birth centre opened, the local homebirth rate was 6%. It is now below 1%. This is despite plenty of evidence showing that homebirth, for healthy pregnancies, is as safe as hospital birth, and with a much lower rate of intervention than in the hospital (90% chance of vaginal birth at home versus 58% in an obstetric unit, for the same category of low risk women). When the birth place study was published in 2012, I rejoiced thinking that we would see homebirths and birth centre births skyrocket. Instead, the exact opposite has happened.
This means that 85% of births are taking place inside an obstetric unit, an environment completely ill-suited to supporting the physiology of birth. Bright lights, no curtains, noise, tiny cramped rooms with no ensuite bathrooms, and staffed by people who have become deskilled at supporting physiological birth.
This also means that the percentage of women going into labour naturally is only 47%, the rate of vaginal birth is only 47%, and the rate of caesarean birth is 41%.
We are in the midst of an epidemy of unjustified induction of labour. With the recently updated NICE induction of labour guidelines, it is only going to get worse. My local hospital had an induction rate of 38% in their last infographic, and with the new guidelines making induction happen earlier in pregnancy, because induction doubles the change of having a caesarean, it is likely to be over 50% within the next few years.
Logically, it makes no sense. It is not biologically possible that less than half of women are able to start labour by themselves or give birth vaginally.
Scientifically it makes no sense, because the main reason to induce labour is to avoid stillbirth, yet rates have remained the same over the last ten years, despite rates of induction in the UK going up from around 21% to 34% on average (the latest UK maternity statistic available are from 2021, I suspect it’s already higher than this now).
The trauma induction causes
Induction of labour is not a benign intervention.
Recent research shows that induction can cause harm to both women and children
- “Women with uncomplicated pregnancies who had their labour induced had higher rates of epidural/spinal analgesia, CS (except for multiparous women induced at between 37 and 40 weeks gestation), instrumental birth, episiotomy and PPH than women with a similar risk profile who went into labour spontaneously.
- “Between birth and 16 years of age, and controlled for year of birth, their children had higher odds of birth asphyxia, birth trauma, respiratory disorders, major resuscitation at birth and hospitalisation for infection.”
- “IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed.”
Induction of labour can also be long, painful and traumatising. This isn’t explained to family when this option is “offered”. Nobody explains that it might take 5 days and you have about 50% chance to end up with a caesarean at the end. Nobody explains the process in detail, and the fact that the hospital is so busy, that they often stop the process half way through because there is no space in the obstetrics unit, leaving women in the ward, in limbo, sometimes for as long as 3 days. I wrote about this in my article, Induction of labour, do you know what you’re letting yourself in for?
Families I’ve supported have sometimes gone home for 24h in the middle of an induction, so they could rest, because nothing was happening. They were told off for this, told this was dangerous. Yet they were just being parked there, to quote a local midwife, “little cattle”.
How to push back
The system is so unfit for purpose, and the level of coercion is so rife within it (it’s gotten much worse since 2020 and this was one of the reason I stopped working as a birth doula) that whenever families call me for support, I have to tell them how to counter coercion with extremely assertive statements, lies, or legal threats. This is so wrong.
Educating yourself or people you support about your human rights, and reading or listening to people who look at the research and challenge medical guidelines, especially when they are harmful, can really help you feel stronger in sticking to what’s right for you.
My blog is full of articles on the subject. I also love both Dr Rachel Reed, her midwife thinking blog, her book about induction, and her podcast the Midwives’ Cauldron (there is an episode where I talk about the postpartum), and also Dr Sara Wickham, her blog, newsletter and many books, including What’s right for me.
A new model
Change will not come from within the system. Reading the book Closure really cemented this. I am no longer willing to waste my precious time and energy trying to make change happen from within. I have given 10 years of my life to maternity patient committees. It was an incredibly frustrating experience. I used to feel bad because I mistakenly believed that things didn’t change because I didn’t work hard enough.
I recently listened to podcasts from Australian midwife Jane Hardwick Collings. What is happening to women during birth, she said, is “institutionalised acts of abuse and violence on women and babies masquerading as safety.”
This really hit me hard. I had to pause and rewind and re-listen this sentence as I let it land. Because it felt so hard, and yet so true.
In my work I have heard and seen it so many times. The coercion, the abuse, so many horror birth stories. I hold trauma from witnessing these. It’s so ingrained that people inside the system do not even see it.
Over ten years ago, traumatised by the second birth I supported as a doula, I read Marsden Wagner’s paper, Fish can’t see water: The need to humanize birth in Australia. The paper was published in 2000, and yet everything he wrote is still true:
“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women – half of all people – that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society. On the other hand, respecting the woman as an important and valuable human being and making certain that the woman’s experience while giving birth is fulfilling and empowering is not just a nice extra, it is absolutely essential as it makes the woman strong and therefore makes society strong”
Tricia Anderson wrote her article, Out of the Laboratory: Back to the Darkened Room
in 2002, and her conclusion is also more apt than ever:
“Sadly most midwives and doctors working today have trained and worked for most of their lives in that laboratory: and in that laboratory – which is of course, a modern consultant maternity unit – childbirth is a mess. In this day and age of evidence-based practice, we talk so much of the importance of evaluating every intervention. Yet, no one is saying that we desperately need to evaluate the biggest intervention of them all – asking women in labour to get into their cars and drive to a large hospital where a stranger takes care of them.”
I used to try and make change happen from the inside, now my perspective has changed, I want to use my precious time and energy to facilitate change from outside the system. To help people stand up to institutionalised abuse. This is why I still support families, this is why I share rebozo techniques.
When I receive quotes like these, I know I am making a difference:
“My daughter is a week old and my wife’s labour went like this: contractions started at 6am one morning and at 9pm our midwife came to see us and my wife was only 1cm dilated. She said baby wasn’t in a great position and that we would wait until morning to see how things were going. Before she left she mentioned about ‘rebozo’ which we had both never heard of.
This led to us searching for the technique where we stumbled upon your website. A quick look at one video and a bit of information I attempted this on my wife. The next contraction she had we heard an audible clunk and her water broke. Contractions instantly got longer and stronger. This was about 10pm and 2 hours later we were holding our baby girl. Dan
This is why I write articles like this one, or like The Myth of the aging placenta. This is why I am currently teaching about using shamanic drumming to support pregnancy and birth. Because once a woman has, through the change of consciousness that drumming helps facilitate, communicated with her baby repeatedly, she has access to her intuitive knowledge and power. She knows she doesn’t need a machine to connect with her baby, and is therefore not likely to let an “expert” stranger dictate what she should do.
There is change brewing, and people are starting to take matters into their own hands. As my Chinese husband says, when you push the pendulum too far one way, it always swings back the other way.
I invite you to look at things from a bird’s eye perspective, and ask yourself: what can I do to facilitate a shift. I would love to hear your ideas.