Dr Kara Thompson

If we haven’t met before, my name is Katherine Baquie. I’m a mum of three young girls, a physiotherapist for women and have an online community, FitNest Mama, which helps to provide pregnant and new mothers with exercises support and resources they need to feel good from the inside out as they prepare for and recover from childbirth. FitNest Mama has workouts that are tired-mum friendly, achy-mum friendly and toddler friendly that you can do in the convenience of your home at the end of a long day, whilst you Bubba sleeps, or whilst your toddler is running around causing havoc.

So as I mentioned, Kara is an obstetrician and she’s a gynecologist as well and she works in the public hospital system in Melbourne and Geelong, specializing in the care of high risk pregnancies. Kara is a mum of three little girls, and in between being a mum and a doctor. She loves running and swimming in the sea down the Great Ocean Road. Kara is passionate about the history and evolution of women’s health care from a feminist lens perspective, and in particular the way we support women to make informed choices about birth. Having gone through a difficult IVF journey to conceive Kara is conscious that not every pregnancy journey goes perfectly to plan. So stay tuned as Kara is really insightful and informative. In this important topic, Kara discusses why might a woman need an induction? What is the process of induction? And she takes us through a bit of a step by step journey. She discusses how long it might take to induce someone. We discuss whether or not the rates of induction are increasing and why this might be. We discuss also what are the side effects or what are the cons for having an induction and do inductions increase the risk of cesarean or instrumental birth? We discuss what is a stretch and sweep and whether or not you can also request an induction of labour if there is no medical indication, so stay tuned.

But before we dive in, I do invite you if you are pregnant, or your postnatal to come and join the free fitness community Facebook group. Simply search Pregnancy Birth and Beyond by FitNest Mama and the link is also in the show notes to come and join this rapidly growing amazing community of other pregnant and new mums who are all there to support each other and cheer each other on during this crazy and beautiful thing we call a motherhood.

Alright, let’s get into this episode with Kira.

Thank you, Kara for joining me today on the podcast.

DR. KARA THOMPSON

Thanks for having me, Kath.

KATH BAQUIE

So as I’ve just mentioned, we’re talking all about induction of labour. And it’s such a big topic, and I feel really honoured to chat to you. So thank you. For those who don’t know who you are, could you please introduce yourself and let us know who you are, what you do and why you do it?

DR. KARA THOMPSON

Ah, absolutely. So my name is Kara. I’m an obstetrician and it is the best job in the whole wide world. I absolutely love it. I get to go to work every day and hang out with pregnant women and care for them during their pregnancy and we guide them through the birth journey and look after them afterwards. And yeah, you know, it’s such a cliché to say it’s, you know, it’s a privilege to do your work, but it actually is in my case. I just love it. So, yeah, I work in Melbourne and Geelong. And I’ve recently started a podcast with one of my women’s health doctor colleagues and we just want to get women’s stories out there of pregnancy that hasn’t quite gone perfectly to plan you know not that perfect Instagram happy version of pregnancy. We know there’s a lot that can happen. And, yeah, we just wanted a platform for people to be able to hear about that and talk about it honestly, and feel not so alone if you’re someone who goes through one of those complications in pregnancy.

KATH BAQUIE

So that’s the “Pregnancy Uncut Podcast”, and I’ll link it in the show notes because it is a great podcast. Okay, so we’re chatting about induction. So let’s start at the start. Why might a woman need an induction?

DR. KARA THOMPSON

Yeah, it’s such a hot topic, as you say, because it’s something that we’re discussing and offering and women are having more and more frequently. So we used to not do that many inductions back in the day, you know, a generation or so ago. And then now it seems like well, it literally is every second woman having a first baby as being offered an induction. So it’s a huge part of pregnancy and birth in our current landscape in Australia. And there’s lots of different reasons why your midwife or doctor might talk to you about an induction. So basically, it comes down to something really simple. In the end, though, which is, do we think it’s safer to keep going and wait for natural labour, spontaneous onset of labour and birth? Or is there any reason why we think, hey, on the balance of everything, it might be safer for bubs to be happening. So that could be absolutely anything. So anything that’s up with baby, you know, maybe the placenta is not working as well, baby might be really small or concerns that the growth is slow down. It could be anything to do with mum as well. So thinking about things like high blood pressure, and risk of preeclampsia, diabetes, anything at all in pregnancy, that puts you potentially at a little bit of increased risk. It might be that we get to a point in the pregnancy that we think about baby out versus baby in and baby out is looking like the safer choice.

KATH BAQUIE

Yeah. Okay. So you mentioned that rates of induction are increasing. Why is this?

DR. KARA THOMPSON

So I think it’s definitely multifactorial. So it’s not just one thing. I think a big part of it is what are pregnant women looking like today, and they look very different than they did a generation ago. So there’s lots of different factors that play into sort of that risk in pregnancy, and most of them are increasing. So the classic ones we think about are maternal age, so women over 40, there’s some increased risk, especially towards the end of pregnancy. IVF, we know is increasing, and that can be associated with some risks, and things like the medical problems going into pregnancy. So a generation ago, someone with for example, you know, heart disease, or, you know, a major medical thing just wouldn’t have gotten pregnant, and now they are and we’re managing that in pregnancy. And definitely, we’re seeing a lot more diabetes in pregnancy, which is a bit of a controversial topic in itself in terms of how we diagnosing that in pregnancy, but, and that that is associated to some extent with increasing obesity rates. So lots of different things are playing into the demographics of our women who are pregnant now that there was different from you know, even 10 years ago. So that’s one thing. I think the other thing is women’s approach to induction and intervention in pregnancy.

So I think there’s really, there’s really such a broad range of approaches for women in regards to their birth choices and their pregnancy choices. So there’s a whole group of women who are super, super, super keen to avoid any intervention, they really want everything to be as natural as possible, and you know, only accept intervention if it’s really, really needed, which is fantastic. And we’re seeing, you know, lots of promotion of that approach. And I think it’s, you know, it’s super important. And it’s, it’s really good to have that, that balance in how we approach pregnancy rather than just be like, you know, we need to follow the guidelines and do these things. Exactly. Right. From a medical point of view. So that is definitely makes up a lot of women. But there’s also a group of women who, you know, doing the research and looking at the guidelines and thinking to themselves, hey, you know, if the risk of stillbirth, for example, goes up after say 39 or 40 weeks, I’m 39 weeks, maybe I don’t want to be pregnant anymore. Maybe I want to have my baby at 39 weeks. So we’re actually seeing a lot of some women that have come in and ask for that intervention, which is a conversation that we can then have about the pros and cons of it. So I think some of it is definitely directed by women themselves.

The other factor I would say that’s definitely changed is that we used to think that induction equals cesarean. So that’s the sort of typical thing that if you needed an induction a generation ago, you’d say, well, you’ve got a really high risk of cesarean. So why don’t we wait for natural labour? But over the last sort of 5-10 years, it’s been all these big studies have come out. That really showed us really without any doubt that induction doesn’t equal cesarean. It shows us that yes, there is a chance for any woman birthing their baby that cesarean might be needed. But we don’t think the induction process itself is what causes that. So it’s a bit of a controversial topic, which we can talk about more if you like. But we used to think that because the women who were being induced were the high risk women, so we didn’t just induce someone for no reason. And if you’ve got diabetes, or if you’ve got preeclampsia, or if your baby’s very small, you have a higher risk of needing a cesarean. And so we used to think those things went together, induction versus cesarean, whereas in fact, now we think it was the reason you were being induced is the reason you might have had a higher chance of cesarean. Whereas if everything else is equal, if you come into labour one day, or we induce you one day, your risk of cesarean should be the same. It’s there but the induction itself doesn’t make it harder.

KATH BAQUIE

Well, that’s good to know. How about the risk of instrumental delivery?

DR. KARA THOMPSON

Yes, absolutely. So it’s not all win wins. You know, when we talk about induction, it’s not this perfect answer to everything, because there’s absolutely no doubt that there are significant risks and things to worry about when you think about induction. So and that’s why it’s such an individual choice for each woman, you know, it’s not so simple as saying, you know, induction will fix all the problems because, yeah, definitely, there is risks to think about. I think instrumental is one of those major ones, especially if you’re having your first baby. So we think when you’re being induced, it’s probably going to be a longer process compared to going into natural labour. And we’re going to have you most likely on the drip, which is going to give you these strong contractions and they might go on for longer and stronger than you would if you’re in natural labour. So we find as a result of that a lot of women asking for epidurals more than in natural labour. It’s a bit of controversy over whether it be general increases your need for a forceps or vacuum. So an instrumental birth. But overall, we think probably in induction, it is a little bit more likely. So there’s quite a few considerations with that, as you would know more than anyone, Kath. And instrumental birth is, you know, you would never choose it over natural birth, would you in terms of the risk of damage to the pelvic floor and to the anal sphincter into long term problems with things like incontinence and prolapse, so no one wants a forceps or vacuum. And if we do think that maybe an induction makes it slightly more likely to need one in your first pregnancy. We don’t see that association for women in their second, third or four other pregnancies being induced.

KATH BAQUIE

And you mentioned that there might be an increased need of epidural if you have an induction? If so, is the risk with the like the forceps and the instrumental delivery, do you think that’s related to the induction or more perhaps to the epidural?

DR. KARA THOMPSON

We have always thought epidural equals increased risk of forceps or vacuum. And the thought is, well, if you’ve got a really good epidural, by definition, and you should be having a really good pain relief and a really good block. So you’re, you’re not feeling baby pushing down on your pelvic floor. And especially for first time mums, you’ve never pushed a baby before. So it’s hard to sort of know, you know, what direction am I pushing in Where’s the baby sort of, you know, it’s really quite numb. And so potentially, then it’s going to take longer to push baby out. And we’re seeing more instrumentals being performed for that.

More recently, because of this problem. There are lovely anaesthetic colleagues are trying super, super hard to work out the different ways that they could administer an epidural. So how much medication goes in and what doses to try and get a good pain relief block, but not a good motor block, meaning that you can still feel a bit and you can still push really well. So the latest research suggests that having an epidural doesn’t increase your risk of instrumental but I think it’s a bit of a work in progress in terms of our understanding of it and, and how, how dense that epidural block is. But I will say pain relief in labour is super important. I think it’s good to know all this stuff. But I think if you’re in labour, and you need your epidural, you know, it’s Yeah. I would say go for it. Because yeah, it’s, you shouldn’t you shouldn’t feel guilty or anything like that about asking for the pain relief you need.

KATH BAQUIE

Yeah, great. Okay, so are there different sorts of inductions that might occur for different reasons?

DR. KARA THOMPSON

Yes, there are. So the induction is not a one size fits all thing. There’s a few different ways that we can do an induction and there are different outcomes in terms of how long the process will take and what happens throughout it. So, absolutely, it’s pretty much dependent on what your cervix is up to. So at the start of your pregnancy, and before you’re pregnant, your cervix is usually rock hard and closed and really long. And then throughout the pregnancy is a long slow process of getting what we call favourable for going into labour. So it turns into a nice, soft, soft feeling, it gets shorter, and sometimes flattens out completely. And then hand labour, of course, is the cervix starting to open up. So for some women, that process is, is already well and truly started by the time they might be induced. So their cervix might already be, I guess, what we call favourable or ready to go. So it’s nice and soft. It’s already open baby’s hands right down on your cervix. And for those women, we can go straight to breaking their waters and getting you into labour. But more commonly, especially if it’s your first baby, we need to go back a step. And we need to spend a bit of time softening and ripening your cervix, before we can break your waters. So there’s a few different ways we can do that. And most of them, they all work pretty much equally well, we all end up in the same position, which is having a nice favourable cervix. But there’s a few different reasons why we might recommend one approach over another. And it also depends which hospital you’re at for no particular reason. Some hospitals are more likely to go down one path than the other. But it’s definitely worth having that conversation with your midwife or doctor and finding out what your options are. Because there’s usually a few options basically.

So one of them is to give you something called a prostaglandin. So prostaglandins are the things that you’d like a hormone that you’re making anyway, when you’re getting yourself ready for labour. So they’re coming from the uterus and around the cervix and doing all that work of getting your cervix nice and soft and ready for labour. So we can mimic that and give you those prostaglandins, which we can give either via something called prostin, which is the gel people might have heard about having the gel or something called cervidil, which is exactly the same staff. But it’s embedded in like a little mini tampon and it just sits up next to the cervix. Yeah, so same staff. The only difference is the cervidil is on a little string like a tampon. So if we need to, we can pull it out. Whereas the gel goes in and stays in, and then it’s absorbed, so we can’t take it out. Yeah, so there the prostaglandins, they usually work beautifully to soften the cervix. They can take a long time, though they might take the whole process makes it takes 12-24 hours.

Yeah, that’s yeah. Yes, of induction, I think is that people, we sort of talked to people about induction, and they come in at three o’clock. And I think a lot of people think, Oh, great, so I’ll have my baby, you know, few hours later. And, and it’s just it’s not the reality, it’s, I guess, when you think about it, we were trying to mimic a really complex, physiological natural process that takes a long time. It’s not, it’s not the in, you know, naturally, your body is not at all ready for labour. And then, you know, an hour later, boom, you’re in labour. We know that the natural processes that it takes, it’s a slow build over the changes that are happening over weeks to months. So we’re sort of trying to mimic that and get it to happen artificially. And yeah, can take time. Absolutely.

KATH BAQUIE

So can you have that gel and then go home?

DR. KARA THOMPSON

Usually not. So there is one thing you can have to soften your cervix at home, which is a cook’s balloon, or there’s a few different names for them. But basically, it’s like a little plastic catheter sits up in the cervix, we put a little bit of water in it, and it creates some pressure. And that’s doing essentially the same thing as the gel or the cervidil, just softening and opening the cervix. So some hospitals say yep, you can go home with that balloon in and then come back tomorrow, and some prefer your stay in. So it’s always worth asking about as well. The reason why we wouldn’t be keen for people to go home with the gel or the cervidil is that for some women, it can start to bring on contractions and even sometimes put you into labour. So we do want to be checking up on you checking up on baby putting on the heart rate monitor, making sure bub is happy. Because occasionally if you’re if you’re having lots of little contractions, so even you’re not in labour, and you might even be fairly comfortable, but the uterus is doing some tightening. And if baby is not coping with that, we want to know about that. So we want to be able to check that your baby are okay. And that gell or the server goes in.

KATH BAQUIE

And while your baby’s being monitored with the gel in, are you able to move around for that monitoring?

DR. KARA THOMPSON

Yes, absolutely. So the general thing is you would come in someone usually the midwife sometimes the doctor would do an examination. So having a feel of the cervix and working out is it favourable or not favourable. So people might have heard of this thing called the bishop score often care provider will talk about that what your score is based typically a score if he cervix is favourable or not, we’d like to put, we like to put numbers in. Got to be exactly. So yes, they’ll do that. And then if the cervix is not favourable, they will talk to you about Yeah, the cervidil or the prostin or the balloon, generally, we do monitor baby before any of those things. And then for a period of about half an hour or so afterwards, but then usually you can get up, walk around, you know, go get a coffee, do whatever you like. Most people would sleep with any of those things in and hopefully get a bit of rest before the main show, which is the when we come down and break your waters and get you into labour.

KATH BAQUIE

Yeah, okay. So you can still have a bit of an active labour in terms of being upright being against gravity doing some nice pelvic tilts on the bowl, and all that sort of stuff. Yeah, beautiful.

DR. KARA THOMPSON

Yeah, absolutely.

KATH BAQUIE

Okay, so I guess you’re taking us through a bit of a step by step. So let’s keep going along this line. I love it. So you’ve had they’ve checked out how favourable your cervix is. And they’ve decided whether or not put in gell or something to help ripen the cervix. You’re getting monitored, go for coffee, take us through the next few steps.

DR. KARA THOMPSON

Usually the depends on which version it is, but usually stays in for quite a few hours, and sometimes up to 24 hours. And then once the cervix is really soft, and opening opened up a couple of centimetres, then we can break the waters. So this is where we’re now going to birthweight usually, as opposed to often the first steps done just in the I can assessment area or something, something else. But once we’re going to break the waters, we’re coming down to birht way, you’re getting a midwife assigned to your care that will hopefully be able to look after you for the rest of your birth. And breaking the waters and then usually starting that drip, which is the oxytocin drip. So oxytocin is, it’s identical to the hormone that we making ourselves in birth. So it’s called the one we’re using the show is called syntocinon. So just means synthetic oxytocin. But structurally, it’s absolutely identical to the hormone that your brain produces when you go into labour. So we’re starting that nice and low, at a really slow rate. And we’re monitoring mum, and we’re monitoring baby super closely. So we want to feel your tummy, see how many contractions you’re having, and just ever so slowly increase that drip, until we get you into a really good pattern of contractions. So having sort of three to four contractions every 10 minutes, and balancing that with making sure baby’s not getting stressed out on the on the monitor.

KATH BAQUIE

Okay, so can I dig into that a little bit? Because I’ve spoken to a few midwives who talk about the fact that oxytocin that you get in the drip, it helps with your body’s preparation. But is it right, I don’t know if I’m saying the right thing here. But it doesn’t help with like your own body’s natural production of oxytocin, which can be really helpful in bonding with your baby and breastfeeding and that sort of thing.

I’ve heard this yet. So the concern is, yeah, is it, the normal oxytocin that you produce naturally is being produced in the brain is the synthetic version crossing through to their blood brain barrier, and having those same sort of emotional effects? If you like. I think my understanding is that, yes, we’re giving you a synthetic version, and it’s acting on the womb, and you’re getting contractions and going into labour. But you’re still, your body is absolutely still producing oxytocin as well. Because often, if we were to turn off the drip, it’s not that you would just stop contracting. So there’s still your body is still in labour, and it’s still responding. And there’s, there’s still your own oxytocin being produced. So I think I definitely understand that the you know, the real concern about is, you know, what adverse effects are we having by doing this artificially versus doing it naturally, and I think any anything like, you know, our emotional response after baby is born, our bonding our turns of our milk coming in and successful breastfeeding, it’s that’s all super important stuff. I personally don’t think that there would be any reduction in any of these things. I’ve never seen someone being juiced in their baby comes out, and they don’t have that, you know, that same beautiful response. I think the body’s producing so much of its own natural oxytocin, that it’s, I don’t think it’s something that that affects those outcomes. But it is, you know, it’s something along with a lot of other things. Some, you know, some downsides of inductions are a huge number of downsides to inductions that every woman has got to balance for themselves because for some women, as I said, avoiding any intervention is so important to them. And so for some women, the reason for an induction has to be really, really, really, really good. But for other women, they want the induction even if there’s no reason, so it’s so different for different women.

KATH BAQUIE

Interesting. And I know personally, my first was induced and that oxytocin was working fine. I remember thinking every other baby on the ward is so ugly, but mine was a beautiful baby.

DR. KARA THOMPSON

I’m sure it was Kath.

KATH BAQUIE

And I’m shocked. I think it was funny, because you see babies now like, all the same, but I was like, mine is a beautiful baby.

DR. KARA THOMPSON

Oh, I’m it’s yours.

KATH BAQUIE

What do you think about or hear about how we can help enhance our own body’s natural production in hospital having the dark environment? Maybe bringing your own pillow along having a few photos? What do you think about that?

DR. KARA THOMPSON

Oh absolutely, it’s super important. So we know Yeah, from, you know, just common sense. But also from studies that you know that you’ve got stress hormones floating around, then potentially, that’s going to have an impact on the way your body’s labouring. Anything we can do to relax ourselves and have the most, you know, calm, supportive environment in the birth space is incredibly important. And that’s going to mean different things for different women. You know, for some people, they, they are going to want to bring in things from home and different lights and different music. Some women bring in affirmations and put them on the wall. For a lot of people, that’s the main thing is, is who’s supporting them and who’s with them. So we know that continuity of care is the number one most important thing in pregnancy and birth and whether that’s your midwife. For some women, it’s you know, private obstetric care that they have the same person throughout their pregnancy journey. For some women that’s a doula, or another trusted person that they feel really safe with. So I think who’s with you is exceedingly important. Absolutely. But yeah, absolutely, they’re being in hospital. And I think that that’s one of the downsides, definitely of an induction for a lot of women is it might, it might disrupt their plans for where they wanted to birth and what they wanted their birth to look like. And so if you’re someone who was planning, for example, a home birth, or you’re planning to birth in a birth centre, as opposed to a hospital environment, an induction will change your ability to do that. So that’s one of the main factors for a lot of women.

But there are lots of things we can do to try and if not be the same as being at home, but you know, try and have the most calm environment that we can and try and remove all those hospital elements, you know, with the bright lights, and, you know, all the machines and the, you know, the scary sounding equipment as well. So I think it’s super important. Absolutely.

KATH BAQUIE

Lovely. So coming back on our journey of having an induction decided to break the waters. Can you keep talking us through?

DR. KARA THOMPSON

Yep. Yeah, absolutely. For some women, this can be quite a long journey. So we wish that it happened quite quickly. And for some women, it does, we get into the really strong active labour really quickly. But for other women, it can be a real process of being on the hormone drip for hours and hours and hours, without getting strong regular contractions and starting to open the cervix. So sometimes I think, especially if we do if we’re not told that that’s a possibility, that can be really, really, really disappointing for some women thinking why, you know, why is this taking so long? Why am I not getting into labour quicker, but I think it’s really important to, to be aware that, that that’s what can happen, it doesn’t mean that there’s anything wrong, it’s just, as we talked about that natural process of labour, for some women is really quick and sudden, and for others, they do have that really long latent stage of everything building up. And depending on where you were in that process of getting ready to go into labour, maybe you were going to go into labour anyway, really soon, or maybe your body naturally wasn’t going to labour for a few more weeks. And so for those people that might take, you know, maybe 10-12 hours on the hormone drip, before we get you into really strong labour. So I can see that would be that’d be really frustrating. It’s a long time. But it can be completely normal. So if you’re well, babies, well, we just sort of set those expectations if you like that it can be a can be a long process. That’s normal, doesn’t mean there’s anything wrong. And again, all your pain relief options that you might need available. If we are not needing the pain relief as well, that’s also fantastic. Because we know, with, as you said, mobilizing in labour and having that that birth preparation of what to expect with things like hypnobirthing and understanding that that process of what’s happening can be really effective as well rather than going into it being you know, not knowing what to expect and being scared basically.

KATH BAQUIE

Yeah. So does an induction birth feel different to then for women who go into birth, spontaneously?

DR. KARA THOMPSON

So I cannot talk with any authority because I have not had any induction. But I think talking to women who have had bows who’ve had an induction of labour and have gone into natural labour, I think there’s no doubt it’s different. And I think that’s the thing. Whenever I talk to women about induction, there’s no point being like, Oh, I have an induction, it’s going to be great. Induction is crap. Like, let’s be real. No one wants, what not, you know, no one wants to have an induction as opposed to just going into natural labour, right? The only reason that you would have an induction is because of, for one reason or another, you want everything to start sooner. So it’s about the timing. If we had sort of like a magic button or magic one that we could wave, and you say, Yep, you’re going to go into natural labour tomorrow, that is 100% going to be better every time because, you know, it’s you, when you’re being induced, you’re hooked up to the drip and you’ve got the monitor on and it’s a very much more of a medicalized process, it often takes longer, from the time that you come into hospital with your bags to when your baby’s born might be like 24-48-72 hours, and that might be completely normal. There’s nothing has gone wrong there. It just is taking that long. So yeah, I think I think we don’t want to pretend that induction is the same as spontaneous labour, it’s not. Given the choice, you would absolutely choose spontaneous labour over induction. It’s only when we start to add potential risks or reasons why waiting versus having an induction might be riskier that we sort of think, oh, is this going to be worth it?

KATH BAQUIE

I had just personally had an induction fan first, but not my second, too. And I have to say it was a while ago, but my second birth was more of a challenge. My first was induced so yeah, look, it’s just shows everything’s everyone’s had different. And there’s just no rule big book then.

DR. KARA THOMPSON

Yeah, absolutely, everyone is different. And the other thing to keep in mind when we’re thinking or someone’s talking to about an induction is, generally there’s a reason why they are and some of those reasons are really, really strong reasons. And some of them are not so strong. But generally, there’s something behind that recommendation. And when we’re thinking about having an induction or not, I guess in our mind, yeah, we like to think of do I want an induction? Or do I want spontaneous labour? And the answer to that is always going to be of course, we want spontaneous labour, it’s, you know, better on every way better in every way. But in fact, the reality of our choice, unfortunately, is do we want an induction or do we want to wait, and waiting might sometimes mean going into natural labour. But it also might mean we’re still pregnant, you know, a week or two or three later. And we’re still potentially looking at an induction except at a time when our risk is going up significantly. So that that’s sort of that’s why we think cesarean overall probably doesn’t increase with induction because the only option to the only option if we’re not being induced is to wait. And quite often that ends in a later induction, and then potentially, the baby’s placenta is not working as well, I was not going to cope with the stress of labour a few weeks later, or potentially the baby’s very big and might get stuck or acquired a number of factors can progress over that time. That means a cesarean or intervention is unfortunately more likely by waiting rather than having the induction earlier.

KATH BAQUIE

Okay, so we’ve talked about a few of the side effects. And I guess the cons of having an induction is there anything we haven’t talked about?

DR. KARA THOMPSON

So one thing that comes up a lot that women are often interested in is something called a stretch and sweep. So I’m not sure if anyone offered that to you, Katherine, you’re thinking of having your first introduction. But it’s something that that I think is a good option. It’s not for everyone. But basically what it is gloved finger, what we’re trying to do is gently stretch the cervix, if we can get a finger through the cervix, so sort of massage that cervix. And the idea is that can release some of your naturals prostaglandins. So if you remember, when we give you the gel or the cervidil, they’re the prostaglandins. But your body has got their own and will release them themselves. So that can sort of start that kick-start that process off. It’s a fairly, almost entirely risk free in the sense that it’s fair, there’s not really any adverse side effects other than it can be a little bit uncomfortable to get a little bit of bleeding. But it’s a pretty good, you know, pretty good chance that it might put you into labour or certainly make things more likely to be favourable. So, all the study suggests that if we do a stretch and sweep for eight women, one of them might go into labour. So that’s, you know, for something that’s pretty, pretty low in terms of risk, that’s something to consider. And you can do you can keep doing that. So you can do them every, every couple of days or every week. And you know if it if it means you avoid doing a formal induction, that’s fantastic. So that’s something to consider. And that’s something that your midwife or doctor might talk to you about.

KATH BAQUIE

So is a stretch and sweep generally offered to most women before they go and they have an induction?

DR. KARA THOMPSON

It should be often I would say to everyone, there’s no reason not to offer it. Some women prefer not to have it, which is, of course, absolutely fine. But I think it should be offered to everyone. Because if it if it avoids needing that whole, you know, 24-48 hour process of induction, then you just go into natural labour. That’s fantastic. Yeah.

KATH BAQUIE

Can a woman ask for an induction, when there’s no medical reason for an induction?

DR. KARA THOMPSON

So if I was talking to you 10 years ago, the answer would have been like, absolutely not, you will be told what you can and cannot have. And you know, that real paternalistic approach that we see in a lot of health care, but in particular, in women’s health care. So in a short amount of time, women, women are really self-leading this revolution in saying, Hey, this is my pregnancy. This is my body, they’re really well informed. And they’re reading about different studies that are available, saying that an induction is a safe thing to do overall, that it probably doesn’t increase your risk of cesarean. If your induction is happening from say, 39 weeks, and they’re also reading about things that can reduce the risk of stillbirth. So we know that stillbirth is rare, but you know, every week in my work, we hear about it and we look after women where it does happen. So it’s rare, but it happens. And women increasingly are wondering how can I avoid having you know, that most awful thing imaginable happened to my baby.

So we know that there’s this stillbirth curve, which is your chance of your baby, having a stillbirth goes up slightly from sort of 40 weeks, 41 weeks, and it goes up quite a bit steeper after 42 weeks. And then 43-44. It’s probably the main reason why we offer an induction for post stages. So we sort of arbitrarily have just picked a time really say, you know, between 40,41 and 42, that’s when you should have your baby if you haven’t gone into labour. And that, of course is a recommendation. It’s not you know; you can absolutely decline that recommendation. But generally that’s offered at that time. And the main reason for that is that stillbirth curve, taking a turn upwards after 42 weeks. But for some women, that’s that risk goes up significantly at an earlier time. So for example, if you’re had an IVF pregnancy, and you’re 43 years old, and it’s your first baby, and you’ve got you know, potentially other problems like high blood pressure or something like that, that curve will actually start to be high, quite a bit early. So maybe 39 weeks, your risk is starting to go up significantly. It’s different for everyone. But across the board. We think that in terms of babies, so what’s the best thing for babies short and long term outcomes, we think between 39 and 40 weeks, that’s sort of the prime time so less than 39 weeks, there’s so much value in still being in utero being in mom’s tummy in terms of long term stuff like how you know school outcomes, and you know, long term behavioural problems and things. Not for everyone, but across the board. When we look at 1000s of babies, the earlier you’re born, the slightly increased chance that you might have those things down the track, up until about 39 weeks. So once you’ve once you’ve hit 39 weeks, baby is cooked, ready to go. And the benefit of being pregnant for longer than that, in terms of baby’s long term outcomes is sort of stagnates from them. And then the risk of stillbirth goes up, as we said, in the light of pregnancy.

So we are getting women sort of educating themselves about this and then coming in and saying, Hey, why can I have an induction in 39 or 40 weeks? If you know, the only thing that happens after that is my risk of stillbirth goes up. If you’re someone who really wants an everything to be natural, of course, that’s not something that will appeal to you. And we would absolutely support those women. But then for the woman who doesn’t mind if they have an intervention, they just want, you know, they want one baby out at a safe time, then I think absolutely we should support those women as well. You know, there’s no, there’s no point supporting women if we’re only going to choose which women we support. So I think our role as healthcare providers, doctors, midwives is to say, Hey, this is the information. And this is what we know is what we don’t know. You know, what are your values? What are your preferences and then support women? Whichever way they choose to go, you know, without judgment, without bullying, just we’re providing parting information and supporting women in their choices.

KATH BAQUIE

I love that such a good approach. But Kara, I’m going to ask you a question. question that I think it pops up on social media a lot. And it’s a bit controversial. And I’d love to know what you think of this. There are a group of people who do, you can let me know whether or not like the statistics and research what you think. But saying that the medical profession, offering inductions when it’s not appropriate, and the rate of induction is increasing, but there’s no improved rates for mum as a result. So, inductions are being offered more and more and more, but it’s not helping the mums outcome or the baby outcomes.

DR. KARA THOMPSON

It’s really tricky to tease it all out, because the risks so our demographics are changing rapidly. So every year, we have an increased sort of risk factor profile for women being pregnant and our babies. In terms of yeah, the things we’ve discussed earlier, you know, obesity, diabetes, age, all of that. So I think it’s hard to tease out what is related to what I think the best way to look at it is, with the studies that we’ve done that I’ve looked at doing an induction for no reason, you know, the women are just choosing to have an induction. So from 39 to 40 weeks. And what those studies show is that the firstly, the rate of cesarean isn’t increased with induction and in fact is probably decreased again, because if we don’t have an induction, that means we’re waiting, and then potentially, the placenta is not working. And potentially we have a higher risk of things going wrong later in the in the pregnancy. But it also is not showing any adverse outcomes for mum. And we know that the longer we’re pregnant, the higher risk of having things happen in pregnancy to mum. So for example, preeclampsia gets more frequent each, each week we go in our pregnancy. And so generally, I think it’s really difficult to tease out when we’re looking at big, big sort of statements like that, what is related to induction, what is related to our demographics, what is related to our cesarean age, there’s so many factors playing into it. I think, as well, it’s tricky when we sort of read things on social media and then try and, or, you know, any, any media and then try and apply that to our own individual circumstances. Because, you know, if, if you’re someone who wants to avoid an induction, then you’re not going to ask for an induction at 39 to 40 weeks for no reason. And that’s fantastic. And we would, you know, no one is going to force you to have an induction of, you know, they shouldn’t in any circumstances. But I guess, if you’re being offered one, then we’d need to think why you know, why you’re being offered it is there really, a really big concern about you or concern about baby are the risks of not having an induction going to be significantly higher for you. And there’s so there’s so much nuance in that if everyone’s individual circumstances are going to be different. So I think it’s, it’s one thing to say, I don’t want an induction and why would any, you know, generally, that’s going to be most people, you don’t want any intervention unless you have to, and then it’s another to say, but what if things shift, and what if sudden, a new piece of information comes out, that means my baby is at higher risk than normal, or I’m at higher risk than normal. And so looking at that with sort of fresh eyes and an open mind. Because sometimes first, you know, some circumstances, those downsides of induction are going to be outweighed, because you might be at particularly high risk. And where you sit on that is going to be it’s going to be shaped by so many things. But it’s going to be different for every woman. And it’s so important that as doctors and midwives, we don’t we don’t just sort of say you need an induction. End of story. Because that’s not, you know, that’s not informed consent. And that’s not explaining why and I think there’s definitely circumstances where women are feeling that they were sort of pushed into it without even knowing why. And so that’s something that as a service, you know, anyone looking after pregnancy, that’s something we need to improve on. And that’s something we need to address is spending that extra time explaining why and not expecting women to just do what they’re told but to take that information, apply it to their own personal preferences and make that decision and support the woman in that decision.

KATH BAQUIE

Are there any stats on the success of the induction based on just station so do an, is an early induction better? Like more likely to result in a C section or later? I think you did say it didn’t you?

DR. KARA THOMPSON

Again, it depends if you’re a first time mum or you’ve had babies before, in particular if you’re a first time mum, if we do try and do an early induction, then there probably is a higher risk of cesarean or what we call a failed induction, which is a pretty awful term. And you know, unsuccessful we can’t get you into good labour. So that’s pretty uncommon. But it is more likely that earlier, we try and do an induction. So if we’re recommending an induction, for example, at 37 weeks, there’s usually a really strong reason for that, like, we’re usually really worried the baby’s placenta is failing or, you know, we’re worried about the baby’s not going to cope with labour, or there’s, you know, for example, mum’s got severe preeclampsia. And so it’s not every day that you’re going to be offered an induction at 37 weeks. But if you are, we do know that 37 weeks, you’re less likely to be ready to go into labour naturally. And so there probably is a high risk of cesarean at that point. One because you’re less ready for labour. But two, because the reason you’re being offered that induction is because there’s something going on that’s quite out of the usual. And then usually, yeah, we see that success rate of induction probably is best around again, 39 to 40 weeks, and probably most of 40 to 41 as well, as we go to 41. And certainly beyond 42 weeks that risk of you know, unsuccessful induction or risk of cesarean is definitely higher than that, again, is because the placenta is placenta is older, it’s less likely to support baby through a long labour, we’re more likely to see baby getting stuck, because babies putting on extra weight each week of the pregnancy. So yeah, in a perfect world, 39 To 40 weeks going into natural spontaneous labour would be the best and amazing. But yeah, it’s not a perfect world, we’ve got to try and balance out these risks of waiting versus risk of intervening.

KATH BAQUIE

Amazing. Well, thank you. I feel like you’ve just really helped to discuss all the pros and cons. And I reckon it’s really going to be really empowering to help women have a bit more knowledge about induction and why they might have to have it, so thank you.

Dr. KARA THOMPSON

There’s so many complexities in it, that it’s so hard to sort of talk generally about it because every woman or every pregnancy is different and everyone’s approach is different. So it’s good to get all the information you can and yeah chat to your care provider and work out a plan that suits you the best.

KATH BAQUIE

And that would be your biggest words of wisdom would not chat to your healthcare provider.

DR. KARA THOMPSON

Yeah, our job is to try and be as yeah is supportive and respectful and just providing the information. Absolutely. And try and get the best outcome for you and bub.

KATH BAQUIE

Yeah, brilliant. Well, thank you so much. Kara. How can we find more of you?

DR. KARA THOMPSON

Goodness. Well, yeah, I’ve got this podcast that is about pregnancy and pregnancy complications, Pregnancy Uncut. So if you head over to Instagram or website and yeah, just having a listen to some women’s experiences about their own pregnancies that haven’t gone to plan can be. Yeah, really, really empowering experience to validate your own experience if your pregnancy hasn’t gone to plan and yet can be beautiful to listen to those stories.

KATH BAQUIE

Thank you so much, Kara, for joining me today.

DR. KARA THOMPSON

Thanks Kath. Speak soon.

KATH BAQUIE

And before I sign off, remember, my team and I will be putting together the show notes for this episode with all the links including how to connect with Kara at www.fitnestmama.com/podcast. Have a fabulous day everyone and I look forward to you joining me next week for another episode of the FitNest Mama Podcast.