Why is Induction of Labour So Common in the UK?

Induction of labour is a common medical procedure in the UK, yet it raises many questions among expectant mothers and their families. The decision to induce labour can be a complex one, and understanding why induction is so frequently used can help ease concerns and provide clarity for expectant parents. With over 20% of births in the UK involving induction, it’s important to recognise the factors behind this rise in its use, its potential benefits, and its risks. While some women may experience a spontaneous onset of labour, others may find themselves discussing induction with their healthcare team. This article will explore the reasons behind the increasing use of induction in the UK, explain how the process works, and provide guidance on what to expect during an induced labour. We will also discuss how antenatal care, including regular appointments and scans, plays a crucial role in identifying when induction may be necessary.

1. What is Induction of Labour?

Before diving into why induction is so common, it’s important to understand what it actually involves. Induction of labour is a medical procedure used to stimulate contractions and initiate labour artificially. This can be done for a variety of reasons, and it may involve the use of medications such as oxytocin (a hormone that induces labour) or prostaglandins (which help soften the cervix). In some cases, mechanical methods such as breaking the waters or using a balloon catheter may also be used. Labour induction is typically considered when a pregnancy goes beyond the due date, or when there are concerns for the health of the mother or baby. Antenatal care during pregnancy involves regular check-ups and scans to monitor the health of both the mother and the baby. These assessments often play a significant role in identifying situations where induction may be necessary.

2. Why is Induction So Common in the UK?

a) Post-Term Pregnancy (Overdue Babies)

One of the primary reasons for labour induction is when a pregnancy extends beyond 42 weeks. After this point, the placenta may begin to function less effectively, which can affect the baby’s health. Antenatal scans can help monitor the condition of the placenta, as well as assess the amniotic fluid levels and the baby’s growth, to determine whether induction is needed. While it’s completely normal for some pregnancies to go beyond the due date, studies suggest that inductions are more likely to occur for women who pass 40 weeks, as the risks associated with post-term pregnancies increase. Healthcare providers typically recommend induction between 41-42 weeks to reduce the chances of complications such as stillbirth or other birth-related issues.

b) Medical Conditions and Pregnancy Complications

Certain medical conditions may lead healthcare providers to recommend induction to safeguard the health of both the mother and the baby. Conditions like gestational diabetes, hypertension, and pre-eclampsia can all increase the risks of complications during pregnancy and birth. In some cases, if a mother develops these conditions, induction may be suggested to avoid further risks. For instance, gestational diabetes can increase the likelihood of having a larger baby (macrosomia), which may complicate the delivery process. In such cases, induction can help reduce the risk of needing a caesarean section or experiencing other complications during childbirth. Additionally, pregnancy care often involves regular monitoring of blood pressure and glucose levels to identify any complications that could warrant induction.

c) Concerns About the Baby’s Health

Sometimes, induction is considered when there are concerns about the baby’s well-being. If a baby is showing signs of distress or if there are concerns about their growth or movements, healthcare providers may recommend induction to ensure a safe delivery. Antenatal appointments include monitoring the baby’s movements and heart rate, and if any irregularities are detected, an induction may be scheduled to expedite the delivery. For example, if a baby is not growing as expected (intrauterine growth restriction or IUGR), induction might be recommended to prevent complications such as low birth weight or the risk of stillbirth.

d) Avoiding Labour Complications

For some women, induction may be recommended as a way of avoiding the unpredictability and potential complications of spontaneous labour. If the cervix is not dilating properly, or if contractions are not progressing effectively, medical intervention may be required to move things along. In these cases, induction can help initiate contractions in a controlled manner and prevent the need for emergency interventions later in the process.

e) Elective Inductions

In some cases, women may choose an elective induction, where there is no medical reason for the procedure but the mother wishes to have greater control over the timing of labour. While this is not the most common reason for induction, it has become a more frequent option in recent years. However, antenatal care and discussions with healthcare providers are crucial to understanding the benefits and risks of elective induction.

3. How Does Induction Work?

Induction methods vary depending on the individual circumstances of the pregnancy. The process generally begins with assessing the readiness of the cervix to start labour. If the cervix is not soft or dilated enough, medications or mechanical methods may be used to prepare it for the onset of labour.

a) Prostaglandin Gel or Tablets

Prostaglandins are used to help soften and ripen the cervix, making it easier for the baby to pass through the birth canal. Prostaglandin gel or tablets are often applied directly to the cervix, and contractions may begin within hours after this treatment. If the cervix is ready, the healthcare provider may then administer oxytocin, a hormone that stimulates contractions.

b) Breaking the Waters

Another method of induction involves breaking the amniotic sac, or “waters.” This can help speed up the onset of labour by releasing amniotic fluid and triggering contractions. This procedure is often done when the cervix is already partially dilated, and is typically followed by the administration of oxytocin to strengthen contractions.

c) Oxytocin (Pitocin)

Oxytocin is a hormone that stimulates contractions and is administered intravenously to help speed up the labour process. This is often used in combination with other methods such as breaking the waters or using prostaglandin. Antenatal appointments and close monitoring are essential when oxytocin is being used, as it can lead to stronger, more frequent contractions, and may require adjustments in dosage.

4. The Risks and Benefits of Induction

While induction is a useful tool in certain situations, it is not without its risks. Antenatal care ensures that women receive appropriate counselling and monitoring before proceeding with induction to make sure the benefits outweigh the risks. Some of the potential risks of induction include:

• Increased likelihood of intervention: Induced labour can sometimes lead to a higher likelihood of requiring further interventions, such as epidurals, assisted delivery (forceps or vacuum), or caesarean sections.
• Faster, more intense contractions: The use of medication like oxytocin can result in stronger, more frequent contractions, which can be more intense and may require pain relief options.
• Infection: If the waters are broken or a catheter is inserted to help induce labour, there is a small risk of infection for both the mother and the baby. However, there are several benefits to induction as well:
• Safer delivery: When there are concerns about the baby’s well-being or the health of the mother, induction can help reduce the risk of complications associated with post-term pregnancies or medical conditions.
• Predictable timing: For some women, induction provides a more predictable timeline for labour and delivery, which can reduce anxiety and allow for better planning.

5. Preparing for Induction: What to Expect

If your healthcare provider recommends induction, you may be anxious about what to expect. Antenatal support is vital during this time, as your healthcare team will guide you through the process and ensure your well-being. Here’s what you can expect:

• Timing and monitoring: Induction typically takes place in the hospital, where you will be closely monitored. Expect to have regular check-ups, antenatal scans, and monitoring of the baby’s heart rate and your contractions.
• Pain management: Induced labour can be more intense than spontaneous labour, so pain relief options, including epidurals, gas and air, or pain medications, will be available to you.
• Patience and flexibility: Induction doesn’t always happen quickly. It’s important to remain patient, as the process can take time and may require several methods before labour progresses. Induction is a common practice in the UK for a variety of medical and non-medical reasons. It can be a valuable tool in ensuring a safe and healthy delivery for both mother and baby. Understanding why induction is used and what it entails can help ease any concerns you may have and help you prepare for the experience. Regular antenatal appointments and scans provide vital information to determine when induction is necessary, and antenatal care ensures that your healthcare team is there to support you every step of the way. By approaching induction with a well-informed mindset, expectant parents can make decisions based on their unique circumstances, helping to ensure a safe and positive birth experience.