I’ll Bring You Cake Every Day - The Last Weeks of Pregnancy And Talk of Induction

Pregnancy is hard. For some people, it can involve complications, anxiety, depression, discomfort, body aches of all kinds, lots of emotions - the list is not exhaustive. 

Let’s say that you are at your midwives’ office and they offer you a sweep because you are 38 weeks pregnant and that’s standard procedure these days. She tells you that it can potentially shorten your gestation length by 3 days. You’d be inclined to agree, right? 

The truth is that sweeps don’t always work. The goal is to minimize the amount of birthers who will need a full-on induction. “This is a natural way to get your body into labour”, says the midwife.

Often getting a sweep can cause bleeding, irregular contractions, and may not even bring forth labour. (I’m bringing “forth” my Old English for this one, apparently…)

In a Cochrane review (Finucane et al 2020) it is stated: 

• Without membrane sweeping, 598 women in 1000 will end up in spontaneous labour. (That’s about 6 in 10).

• With membrane sweeping, 723 women in 1000 will end up in spontaneous labour. (So just over 7 in 10). 

The authors of the review state that, “Membrane sweeping may be effective in achieving a spontaneous onset of labour, but the evidence for this was of low certainty.”( Sara Wickham)

It’s possible that the birthers who had membrane sweeps in that particular review would have gone into labour anyway. It’s hard to know and the reality is, there isn’t enough evidence surrounding it. Ultimately, “natural induction” doesn’t exist. Either you go into labour spontaneously, or someone does something to start the process. If it’s the latter, it’s an induction. But for something to get to be so common practice (as sweeps are), it’s often just accepted as normal, and the pros and cons aren’t discussed properly. 

One of the risks is a premature rupture of membranes (water breaking). If labour doesn’t start on its own within a certain time of the waters being broken, there is a concern of infection (that’s an entire other blog post) and it can lead to induction anyway. 

OKAY. Back to our hypothetical situation. 

Let’s say you decline the sweep, and at your next appointment (39 weeks pregnant now), your belly is measuring on the larger side. “God, you’re going to have a huge baby”, says your doctor. “My recommendation would be to start induction because it’s safer for both you and your baby.” Maybe they send you for an ultrasound and it’s confirmed: your baby is going to be 10 pounds next week if you don’t get this show on the road. 

You are tired. Can you even push a HUGE BABY out of your vagina? THIS IS TERRIFYING. 

Rest assured, the only way to accurately weigh a baby is after they have exited the womb. 

AKA: after they have been born. 

According to Dr. Rachel Reed, “Clinical assessment ie. palpating and measuring pregnant bumps is incorrect more than 50% of the time (Chauhan et al. 2005). Even the best available method – measuring the baby’s abdomen with an ultrasound – only predicts the weight of the baby within 15% of their actual weight (Rossi et al. 2013). Therefore, lots of women are being incorrectly told that their baby is ‘big’. “

The belief of a big baby can lead to an induction of labour and a cascade of interventions, only to find that the baby is a beautiful, healthy weight of 8lbs 2oz.

Let’s say that you decline the induction for a suspected “big baby”. You decline the induction a week later at your following appointment. You go to your 41-week check-up and your Care Provider is concerned because you are past your due date. “My recommendation would be induction”, they say. “It’s not safe for your baby to go to 42 weeks, so we will book your induction for 41+3.”

(Induction itself can be a process lasting multiple days, so this way, your baby will be out before it turns into a pumpkin and your placenta to a banana at 42 weeks’ gestation).

The truth is, the average gestation period is more like 41+2, and even then, only 75% of birthers will have their babies spontaneously by that time. That means that 25% of people would naturally gestate past 41+2. (Evidence-based birth)

There are always risks to everything. One of my problems with induction is that it’s not always backed up with an adequate amount of information. There are times when inductions are necessary and I am thankful that we have that option. But if the only thing that is “wrong” is that a pregnancy goes post-dates (40+ weeks), it is not necessary.

The risks of staying pregnant are:

• Aging placenta (a little silly if you think about it, since there is always a concern of a “big baby” later in pregnancy. If the placenta wasn’t working, how would it be able to grow the baby so large?)

• Big baby (see above)

• Meconium in the fluid (see this post by Dr. Rachel Reed for more information on that)

• Perinatal death… (Essentially, according to the available research, if you are induced at 41 weeks your baby is less likely to die during, or soon after birth. However, the chance of your baby dying is small either way – less than 1%… or 30 out of every 10,000 for those waiting vs 3:10,000 for those induced. This research article reports the relative and absolute risk of stillbirth at various gestations with waiting vs induction. The authors state that 1476 women would need to have an induction to prevent 1 stillbirth at 41 weeks gestation.) (stats taken from this post)

Very few Care Providers provide families with all of the risks of induction. Outside of the more mild side effects (which are more common) like nausea and general discomfort, there are some more serious ones which include:

• With the use of Prostaglandins to ripen the cervix: hyperstimulation resulting in fetal distress and c-section.

• With the rupturing the membranes: fetal distress and c-section 

• With IV synthetic oxytocin / pitocin: Mother – rupture of uterus; post partum hemorrhage; water intoxication leading to convulsions, coma and/or death; reduced breastfeeding rates; increased postpartum depression/anxiety. Baby – hypoxic brain damage; neonatal jaundice; neonatal retinal hemorrhage; death. For mothers synthetic oxytocin/pitocin is associated with reduced breastfeeding and increased depression and anxiety at 2 months postpartum (Gu et al. 2015).

The more serious risks listed above are decently rare, but they do happen. The most common risk with induction is a higher chance of c-section. Now why wouldn’t a doctor or midwife tell their clients about the risks of the induction itself? Ultimately, a true informed choice would be to provide all the information and have the pregnant person weigh those risks and come to their own conclusion about what they are comfortable with. 

If one of the things you are up against is your own self feeling so done with being pregnant and wanting to meet your baby, I hear you. You want to kiss their little toes. You want to smell their skin. If you need someone to bring you a slice of cake every day from 40 weeks until your baby is born and talk about how incredible you are to keep you going, I’ll do it. (if you would rather talk on the phone, that works too!). Your body isn’t broken, it’s working perfectly to bring your baby into the world in its own unique time. I promise you, without a shred of doubt, that your baby will not stay inside you forever. Your body isn’t broken, but the system of induction is.

 Let me bring you some cake.