When the goalposts move, we should take notice

For as long as I’ve been working with pregnant women, my local hospital has been ‘offering’ induction of labour at 40+10 (10 days after the Expected Due Date).

‘Offering’ has meant that at the early scan, a healthcare assistant has chirpily told them, “We let you go 10 days over now, so your induction date is x”. That was my experience, shared by many of my clients. Others have had it booked in their notes without discussion.

When that date has rolled around, and women have felt uncomfortable about going ahead, there has been a huge spectrum of response from their care providers, ranging from entirely supportive to outrageous scaremongering. “You’re increasing your risk of your baby being stillborn”. “I can’t guarantee the safety of your baby tomorrow”. Just a couple of examples. It has often been presented as very important for the induction process to begin on this day.

(Unless, of course, that day was Christmas Day. Or another Bank Holiday, when women have been told, oh don’t worry we will play about with the date a bit. Right, ok.)

Women have been left feeling that they cannot return home to their planned place of birth after heading in for monitoring as the risks of continuing with a ‘prolonged’ pregnancy have been hammered into them. Of course there are very real risks associated with longer pregnancies, as there are with shorter ones, but there are risks that come with induction too, and its been a rare occasion that a woman has reported to me being given a balanced perspective on her individual situation and her options.

I was only semi surprised when I learnt last week at our Maternity Services Liaison Committee meeting that things have changed, and standard induction is now at 40+12. On one hand, I thought- this is fantastic. So many women who would give birth in that 2 day window avoiding the pressure of the decision, and potentially the impact of this procedure.

Then I started to feel cross. When I asked what had prompted this change, there was no new evidence to provoke this new policy. So whilst it’s truly positive for future Mamas, what of those who’ve entered this 2 day window before and had some really difficult experiences justifying their choices and being heard, respected.

It should be a lesson to us all when we consider going a different route than the road most travelled, to fall back on our BRAINs (benefits, risks, alternatives, instincts, nothing),

This is not about declining anything for the sake of it, or a blanket approach to refuse all intervention- that would be foolish. It’s about knowing that a policy is worth nothing without evidence to back it up. It feels like an enormous leap to decline any suggested procedure when we are so vulnerable, and particularly when we are so ready for it to be over. But suddenly that all important date has become meaningless. What might you be struggling with that could be the next thing to change?

What can you do if you’re faced with a choice around intervention/ policy led choices?

  1. Ask for the evidence (NICE guidelines, RCOG guidelines, what does the RCM say)
  2. Do your own research (www.aims.org.uk is a good starting point, I can always direct my clients to more specific resources for their circumstances)
  3. Weigh it up with what your own specific monitoring is throwing up, and take responsibility for your choices
  4. Remember, it’s for you to accept or decline, rather than you needing to persuade your caregivers of anything
  5. Remember that whatever you do, hypnobirthing can help- sometimes an intervention is exactly the right choice, of course we can be grateful for them. Get prepared and you will have all the tools you need to have a calm, confident, positive experience through the twists and turns. You’ve totally got this.



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