The Best Way To Avoid An Induction Of Labour (works 100% of the time)

“I would like to avoid an induction of labour if possible.”

I cannot recount how many times I have heard this over the years. Just last week at least three of the women who came to see me for body work at Essentially Birth told me these exact words.

As a midwife I used to hear them, too, along with “I would like my birth to be as natural as possible.” or “I would like to avoid interventions as much as possible.”

Women often ask me if I know of “a natural way to get labour going” (I do) or if I know how to “avoid an induction of labour” (I know that too).

Keep reading, I’ll tell you the answers to both of these, but let’s first look at the topic of induction of labour a bit closer.

Here’s how it works (and sometimes doesn't) in a nutshell:

1. Offer every woman a membrane sweep in late pregnancy (sometimes more than one)
2. “Ripen” and open the cervix so that the amniotic sac can be accessed
3. Perform an “Artificial Rupture of Membranes (ARM)”
4. Produce uterine contractions through a drip

Women’s experiences of induction of labour will differ.

On a purely physical and practical level they differ in that parts of the process might get skipped.

For instance when the waters have already released and that’s why the induction is suggested in the first place you'll most likely not have the ARM (though sometimes there "are forewaters" - aka the waters may never have gone in the first place or your waters were leaking from somewhere further behind the baby's head). Other women might release their waters themselves after step one or they might start making their own uterine contractions at some stage during the process negating the drip (at least momentarily).

On an emotional level women have different perceptions as well.

Women are generally less satisfied with their birth experiences after an induction of labour compared to spontaneous labour.and this is not surprising given that inductions lead to other interventions, too:

For mothers induction of labour is associated with a higher use of epidural analgesia, a higher chance of having an episiotomy, a higher chance of having an instrumental birth or a caesarean section and a higher chance of having a postpartum haemorrhage. Babies are also at a disadvantage when compared to babies who were born spontaneously. Short term they are more likely to have low oxygen during labour, suffer birth injuries and need resuscitation at birth. Longer term they are more likely to struggle with breastfeeding and they have a higher rate of hospital admissions for infections in childhood. This is according to the New South Wales Study that looked at almost 500 000 women and babies over fifteen years in Australia (Dahlen, et al., 2021). 

The Australia study was published in 2021, the same year that the NICE (National Institute for Care Excellence) reviewed their antenatal care guidelines and moved routine induction of labour for “prolonged pregnancy” from 42 to 41 weeks in the UK. This move in the UK followed the publication of a study called the ARRIVE trial which examined routine induction of labour at 39 weeks and found that induction of labour reduced your chances of having a caesarean section.

By proponents of the medical model of birth this was seen as a win-win: Induction of labour would “prevent” late term stillbirths whilst also reducing the caesarean section rate. Makes sense, right? 

It doesn't. Neither of those conclusions are true!

First of all - and this is something that midwives used to know and communicate to a much larger extent than they do now - on labour wards all over the world we see that induction of labour increases your chances of caesarean section (check out the resource section for further reading). I would suggest that you avoid any hospital where a spontaneous labour results in more caesareans than an inductions - those folks are clearly over-medicalising the spontaneous process! Most importantly though the equation around trying to “prevent” stillbirth through routine induction of labour “for prolonged pregnancy” does not tally!

The New South Wales Study found no difference in the rate of stillbirth between the women who waited (until 41+6 weeks in this case) and those who had inductions of labour before then. I want to re-iterate that this study included almost half a million women.

The gist of it is that the more we interfere routinely, the more harm we cause longer term. It really is that simple and although for a minority of women it is true that a route of the right kind of medical interventions at the right time will put them and their babies at an advantage, your intuition would tell you as much. If not your intuition then common sense; Routine induction of labour on the scale that we are seeing now is not justifiable.

Just imagine what would happen if we subjected any other mammal to the routine disruption of their reproductive processes in the same way we do it to ourselves? We would ultimately risk the resilience and survival of that species. 

I think this is why almost every single woman I have ever spoken to is not keen on induction or intervention in general. We know deep down that it is overall harmful. 

So, what’s the best way to avoid an induction of labour then?

The answer I tell all of my clients really is quite simple:

The best way to avoid an induction of labour is not to have one.

Once you've decided you have two other options:

1. Wait for labour to start
2. Have a caesarean section.

(actually, your third option is to change your mind and have the induction of labour).

Without placing any value on what your choice will be, it is my observation that most women who want to avoid an induction of labour also want to avoid a caesarean section and that leads us back to the idea of waiting. 

This is where I get asked if I know of a natural way to induce labour. 

Here's my super secret remedy to “get labour going”.

The beauty of it is that we all have access to it and we already possess heaps of it (though we often think that we don’t):

My secret remedy to induce labour is TIME!

There you have it.

Here's a possibility to ponder: What if it were as simple as get pregnant, stay pregnant until labour starts, be in labour until the baby comes, keep your baby on your chest until the placenta comes and take it from there.

Obviously this is only the start of the conversation. Ther is a bit more to it, especially in today's environment and also sometimes with regards to the specific circumstances for the mama/baby.

It is, nevertheless, a concept to spend some time thinking about because for eons of time it truly was this simple and for more and more women it is getting this simple again (not without issue for sure - it's never easy but you can choose to remove some of the complexities by shifting perspective). 

Apart from talking about the idea of giving yourself more time, at my 90-minute pregnancy massage sessions in Belfast, we explore ways of finding relaxation, of fostering your mind-body connection, of getting to the bottom of any persisting fears, of checking in to see if anything might be holding you back and importantly of nurturing the energetic and fascial pathways in the body that support your female reproductive cycles.

You see, to me, the statement

“I would like to avoid an induction of labour if possible” is loaded with subjects to explore more deeply. It reveals a certain conditioning and assumptions that are prevalent in today’s society. Here are five assumptions that i detect behind this statement:

1. A Mother’s wellbeing is secondary to the baby’s wellbeing
2. Medical technology is superior to nature
3. Labour doesn’t start on its own
4. Pregnancy has an expiration date
5. A mother is selfish not to comply with expert authority, i.e. only what the experts say is actually possible

There’s probably more there and each individual circumstance is different which is why I offer the opportunity to explore your particular situation in a lot  more detail.

We talk about your pregnancy so far so you can get some perspective.

Most women are already sitting on a “reason” for induction of labour without knowing it.

Check this out:

By the time you have spent your first 20 minutes or so at your “Booking Appointment” - that’s what we call the initial appointment in mainstream maternity systems here in Northern Ireland - you’ll already have had three interventions that could put you on the induction of labour list at around 40 weeks and that's without ever looking at your overall health or at how your baby is doing. And those three interventions in particular will have seemed entirely benign to you.You probably wouldn't even consider them an intervention.

Would you like to guess what they are? Send me an email to [email protected] and tell me what you think they might be?

Following those three interventions you’ll be offered a “dating scan” (hint: this has replaced a fourth seemingly benign disclosure on your part that allowed us to calculate when you are "due").

“Knowing” your “Due Date” is one of the biggest indicators for induction of labour.

Once we have identified what your chances of "being offered" an induction of labour will be, we think of how potential conversations around induction of labour might be presented to you later in pregnancy and where to find more information about them so that you can actually make a choice. Without access to data about potential benefits and risks of induction in your circumstance there is no choice.

Then we talk about bias.

What are your biases?

Importantly what are the biases of your care providers and what are the biases of friends and family?

I thik it is safe to say that as a society we are biased towards medicalising life in general and therefore birth.

Most doctors, midwives, doulas and childbirth educators (including myself) will have been conditioned towards believing at least on some level that medicalisation offers improved "safety". We all grew up against the same backdrop of a perceived societal norm.

Layered on top of our conditioning lie our biases somewhere on a scale between a bias towards total medicalisation and rejecting any medicalisation at all.

So for you as a pregnant mama, I think it is worthwhile to examine your conditioning and your beliefs about pregnancy.

Where did you pick up those beliefs and, now that you are looking at them in more detail, do you still think that what you believe is true?

For instance , do you believe that pregnancies have an expiration date?

How long would you think it is "safe" to wait?

How will you navigate the conversations around this with care providers?

Do you trust yourself in your decision making?

There’s a conversation in there about responsibility, too.

Most women want to explore

“What if something happens to my baby when I go against medical advice?”

And this is a very valuable thought to follow through. I offer plenty of perspective to explore here, too.

Like it or not: You are responsible for whatever choice you make.

Induction of labour, caesarean section or wait for labour to start.

You alone are responsible for all of your choices and you are the one who will live with the consequences of your choises.

And the corker is that risk can never be eliminated entirely. 

To lighten this up a bit I will say this: Regardless of what option you choose, it is relatively unlikely for the scenario that you think of when you express fear that "something might happen" to your baby one way or another. Statistically speaking, and in the context of your and your baby's chances of surviving it, birth is overall and overwhelmingly "safe".

However, whether or not a certain way forward makes you feel safe depends on what "safety" means for you. 

For me as a mother I have always asked myself this question: If the worst was to happen, which context would I find this outcome easiest to accept in. In other words, every single medicine can technically cause an adverse outcome (however rare) and doing nothing may mean that a spontaneously occurring adverse outcome happens which potentially could have been prevented through a medical pathway (also likely rare). The question is which one of the two would I find easier to accept. And we each have different answers to this and any answer you come up with is right.

Here are some helpful considerations:

What are your lifestyle choices in general? 

Where is your locus of trust?

Do you trust yourself over others’ opinions or are you unsure?

Are you prepared to go against the grain?

What is your tendency to comply in order to be seen as a “Good Girl”?

How assertive can you be?

Equally, do you have a tendency to be contrary and to defy authority for the sake of it.

Answer any of those without judgement. Just gather data to help you in your decision making.

It is worthwhile to understand your motivations. And it is important to know that you can do whatever you want at any time!

I write about these topics in much more detail in my book “7 Secrets Every Pregnant Woman Needs To Hear Before Giving Birth.” which made it onto the Amazon Bestseller list and was titled a “Hot New Release” on the weekend of its publication. You can get it here.

Talking about induction of labour also offers a great opportunity to explore your plan for your spontaneous labour. A spontaneous labour can look quite similar to an induced labour in the obstetric environment. Having an artificial rupture of membranes and a drip is not reserved for an induction of labour exclusively they frequently feature in spontaneous labour, too. Maybe you would want a homebirth in order to optimise your chances of an intervention free birth?

There’s so much to explore and the good news is, there’s plenty of help available to you.

If you have found yourself saying (or thinking) the words “I would like to avoid an induction of labour if possible”, my invitation to you is to go on a journey of self study. Knowing that you can opt into or out of whatever intervention is offered to you can be really helpful in finding YOUR answer. 

I would LOVE to help.

Have you heard of Born Through Yoga yet? This is the Couples' Hypnobirthing and Movement for Birth Program that I co-created with my amazing colleague Tara. We are both Yoga teachers and apart from learning about all the birth interventions and the data and evidence surrounding them, you'll also learn how to prepare your body in a way that will reduce your chances of having to even make any decisions about many of the routine interventions in labour. Why not join us for the start of the next program on February 9th? You'll get immediate access to the online course which is in the process of getting an upgrade (we have hired the videographer already). Check it out here.

To book a 90-Minute Pregnancy Massage Session in Belfast, click here.

Oh and don't forget to send me your answer: What are the three interventions at your booking appointment? Send your answers to [email protected] 

Further Reading:

New South Wales Study: https://bmjopen.bmj.com/content/bmjopen/11/6/e047040.full.pdf

ARRIVE trial: https://pubmed.ncbi.nlm.nih.gov/30089070/

Dr Wickham’s ARRIVE resources: https://www.sarawickham.com/tag/arrive/