Labour induction, fear, the cascade of interventions… and a new study

August through to October are busy times for acupuncturists, as we’re often seeing women in the last few weeks of pregnancy.

An over-riding concern some women have by this stage is that their Obstetrician has started talking about needing to induce labour, usually “at 38 weeks”.

In recent years women have disclosed how anxious and worried they are about being induced when their hearts are set on a ‘natural birth’. Many of these healthy women enjoying uncomplicated pregnancies feel that the decision to schedule a non-urgent induction had been made for them, rather than with them. These women are educated and well-read, and they’ve come to understand that inducing labour may result in a cascade of interventions which may culminate in Caesarian section.

At this point, I must state that it is definitley not within the scope of practice for acupuncturists to advise women on how, when or where to have their babies. Nor is it within our scope of practice to advise or guide women in their decision-making about labour induction. And acupuncturists cannot perform ‘acupuncture for labour induction’. Labor induction is a medical-obstetric procedure.

Nevertheless, it’s our job as responsible complementary health practitioners to stay abreast of contemporary research, and to understand the wider context in which our clients are receiving health and obstetric care.

Recently this large scale study was published and it received international attention: Labor Induction versus Expectant Management in Low-Risk Nulliparous Women, Grobman WA, et al. N Engl J Med 2018; 379:513-523 DOI: 10.1056/NEJMoa1800566

The findings of this study were summarised by Science Daily:

Inducing labor in healthy women at 39 weeks into their pregnancy reduces the need for cesarean section and is at least as safe for mother and baby as waiting for spontaneous labor. Choosing to induce could also reduce the risk that mothers will develop preeclampsia and that newborns will need respiratory support after delivery.

I particularly enjoyed the discussion Australia’s Dr Norman Swann had on The Health Report with Dr William Grobman about this research. You can read the transcript, or listen here. I recommend listening if you can, as this is a nuanced conversation and it’s not often we get to hear directly from clinical researchers like this.

Dr Grobman is Professor of Obstetrics and Gynaecology, Feinberg School of Medicine at Northwestern University, Chicago and the lead author of this paper.

As well as summarising the findings and outcomes of this study, Dr Grobman stated in that interview that:

What I really want to emphasise is that this isn’t a study about that induction is the right thing to do, this isn’t a study that induction is the wrong thing to do, this is a study that we hope really provides women and their obstetric providers with information so they can make the choice that’s right for them. I think the thing that we think we can do the worst for the people for whom we care is not allowing them to make good choices because we don’t have the right information or giving them the wrong information.

And he continued

So what I would say is on the basis of this I think women need to be counselled and should be counselled by their obstetric providers so they understand the benefits and risks or the trade-offs essentially of the different options; induction of labour at 39 weeks, assuming again a reliable dating, or expected management. I think the decision-making process is I think this trade-off between it seems that with induction of labour there is a somewhat lower risk of caesarean, although there was no different in major bad outcomes for the babies, that some baby things were better. But on the other hand there are some women who find a non-interventional approach to have such value that that’s something that we should of course be honouring and supporting.

And so I think the decision-making process is trying to understand what is of most value to any given individual and using a sort of shared decision-making framework to decide because there’s not going to be a one-size-fits-all for everyone, it’s going to be, you know, I think probably a reasonably complex decision that people are going to need to make.

So if you’re in your final trimester of a healthy pregnancy and your obstetric care providers have started talking about labour induction, hopefully this latest research will enhance the important conversations you’ll be having together.

Coming soon in another post, we’ll look at an Australian study Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. Levett KM, et al. BMJ Open 2016;6:e)10691. doi:10.1136/bmjopen-2015-010691. Download this study here.

The conclusion was that this study protocol significantly reduced epidural use and caesarian section.