Inducements For Induction: is it really a choice when push comes to shove?

INDUCE:

verb

gerund or present participle: inducing

succeed in persuading or leading (someone) to do something.

“the pickets induced many workers to stay away”

Of course, the definition we usually use in maternity care is:

bring about or give rise to.

“none of these measures induced a change of policy”

Typically used in the context of artificially bringing about the beginning labour.

Thing is, it seems to me the first definition is as valid as the second right now.

I think many, many doulas and midwives would agree that every day, in every way,

women are being induced to be induced.

The persuasion comes in many forms:

Much better to pop it out before it gets too big, eh?

So much nicer to know the day your baby will be born. We can make a plan and know where we stand

If you’re anxious, we can start the process for you if you like

I’ll just pop your name on the induction list and get that all booked in for you

Just to be on the safe side, eh? We have to err on the side of caution

We need to get your baby out now

During other conversations, the shadows start creeping in:

You are high risk

You wouldn’t want anything to happen

We don’t do that here

It’s hospital policy

Your placenta will fail

We have to

We need to

I’m just going to

Relax, just relax

You are too old and too young, you are too fat and too thin, you are diabetic, you have mental health, it’s your first baby and your 4th, your baby is too small and too big, you have too much water and not enough. You will never give birth on your own. You will bleed to death. You can’t have babies vaginally.

there’s no choice here you are going to have to be induced

I’d prefer not, you say…

I’m afraid that is not possible

I’m not authorized to allow that

Did the consultant give you permission?

Does your husband think this is a good idea?

Tell your wife to be sensible

Do you want your baby to die?

I’m afraid I will have to refer you to Social Services

We have a legal obligation to….

Listen, this is not a prison. Of course you can go home anytime. But are you going to come back in two days with a dead fetus inside you and say I didn’t warn you?

And when a mother has been induced to be induced, she is booked in with a smile and not told…

Not told about the wards, bursting at the seams

Not told about the noise and lack of sleep

Not told about the women moaning in pain or even birthing their babies just the other side of the curtain

Not told about the hospital being closed so their induction is paused

Not told about the lack of staff so their induction is paused

Not told about Delivery being full, so their induction is paused

Paused

Paused…

Not told that despite the ’emergency’ that requires their baby to be immediately evicted, the process could take a long time, or not work at all

Not told that they may be left to labour alone on a ward without their partner

Not told about the lack of space, the heat, the terrible food, the shared toilet and showering facilities

Not told what happens, in what order and why

Not told that sometimes it happens too quickly; the womb overstimulated in a white heat of pain

Not told that often it doesn’t happen at all

Not told about the 4-hourly vaginal exams, the drips, the monitoring belts, the coming and going, the changing of shifts

Induction is a choice. An item on the menu.

Choose according to your circumstances, preferences and instincts.
Choose based on information that is as factual as possible.
Choose based on the pros and cons.
Choose knowing the actual chances of various things happening (absolute not relative risk).
Choose knowing your care is being individualised to you.
Choose knowing that you are not being processed on a one-side-fits-all conveyor belt.
Choose knowing no one has a crystal ball.
Choose after conversations with people who are not crippled with fear.
Choose trusting yourself and your caregivers.
Choose having been given time and physical space and privacy.
Choose in the knowledge that you are the expert in your own baby.

Most of all, choose freely, without manipulation, coercion, blackmail, cul de sacs, fait accomplis, fearmongering, dead baby cards, well meaning platitudes, patronising exchanges, mansplaining, blinding with science, a sense of obligation to your caregiver, fear of being punished, or fear of having your children removed.

Because there is something worse than a difficult choice. There is having no choice at all.

Induction is an offer.
Please offer with kindness and compassion. With intelligent conversation pitched correctly.
Offer after asking lots of open questions and finding out how this person feels and what they want ideally. Explore their situation and provide facts, statistics, and information.
Be able to admit what you don’t know and can’t predict.
Offer whilst listening, intently and with empathy.
Offer knowing her human rights and offer understanding that she has full agency and dominion over her own body and baby.
Offer because in your clinical judgement, she deserves this choice, not merely because the guidelines tell you to.
Please offer gently, because this person in front of you is vulnerable and will remember your words for the rest of her life.