The Paradox of Induction…Guest Post: Kate Shirley, Founder of Effie + Ros
As with so many things these days I met Kate via Instagram and Facebook, and have loved her positive, buzzy energy and enthusiasm about all things birth (read about her at the bottom of this blog). I was delighted when she offered to share her induction story with me - this is such a useful read for all pregnant women, and just shows Kate's sensible and evidence based approach to birth. If you're in her area and looking for a hypnobirthing teacher, you'd be lucky to have her!
Two of Kate’s babies went well past their ‘guess dates’ and she is here to tell us a bit about why she let those babies stay in there, despite being rather pregnant and absolutely over it; how she coped with the pressure for induction and from friends and family to get those little babies out.
Induction is complicated. I don’t know anyone who has enjoyed being more than 40 weeks pregnant. I am not sure it is physically possible to enjoy (if you DID enjoy it please tell how!) But is induction always the right choice?
Do tell us your story, Kate. Your babies went past their official dates?
My first baby made an appearance on her official ‘due date’. The chances are so slim! It made life pretty easy in so far as we didn’t have lots of people texting and calling to see if the baby was here. I was quite happy being pregnant...yes, ready to not be pregnant but was not at the hanging in there, oh-my-god-I-am-STILL-pregnant stage that set in from 40+1 (or maybe a bit earlier if I am honest??!)
When my second was due, I was totally and utterly convinced that she would be early. I was dead SURE she would arrive by 38 weeks. They (my dad always asks me who “they” are?!) always say that later babies tend to come earlier than first babies. So my hospital bag was packed by 35 weeks and I was mentally ready. But 38 weeks passed, 39...until finally she came at 40 + 14. Then my third came at 40 + 13.
In both cases, with my second and third children, we had moved the dates forward from our ‘official’ due date.
Tell us more about moving the dates. They came at 42 and nearly 42 weeks, but if you moved the dates this means they actually came at 43 plus something?
Yes, exactly. At the 12 week scan, our due date based on my last menstrual period was four days earlier than our due date based on the scan. At the hospital I gave birth in, the policy is that they only change the date if it is five or more days out. I had done lots of hypnobirthing preparation and considered myself to be well informed about my choices, so I questioned it with my midwife. We discussed the fact that I would feel happier moving the date – it was pretty much five days out. I wanted to buy some time before we would have to tackle the induction conversation. I also explained that I have a long menstrual cycle, 6 weeks rather than the 4 weeks that the whole 40 week thing is based on. I didn’t truly think I would get to that point, but I knew I would be mindful of the fact that with an adjusted date, I would be 4 days behind where “hospital policy” would have put me.
So, if we hadn’t moved the date that would have put us at 40 + 18 with number two. What was really amazing was that the very first thing the midwife said – before we announced the sex of our new baby – was “oh my goodness that baby is not full term”!!! She said post-term babies are “more wrinkled”, have less vernix and long nails, and Milly had NONE of those things. If we had left the date, she would have been nearly 3 weeks ‘overdue’. At that point I felt pretty relieved that we hadn’t gone down the induction route.
And your next one? He came past his guess-date as well?
He came at 40 + 13. We had moved his date by a couple of days based on the scan, having chatted to the midwives about it again. This time we would have been 40 + 15 if we had left the date.
How did you feel being overdue? Your first came on her due date – what are the chances?!
I found it so hard!! It was so very different to the first. I felt massive, was running round after one/two other small people, and I felt such pressure from many people for the baby to arrive. Texts, calls, “oh my god you are still pregnant”-type chat. “YES I AM STILL FRICKIN’ PREGNANT!!!”
Those two weeks with M & W felt like an absolute lifetime. In all honesty I was pretty fed up and really would not wish a super long pregnancy on anyone. On top of this, there is pressure for induction from people telling you stories about how the placenta will stop working, you will run out of amniotic fluid and more…
Why did you choose to avoid induction? Did you just not want that baby the hell out of there?!
Yes I did want it out!! But induction can be hard if the baby isn’t ready. In natural labour the uterine muscles flex and release, but when labour is started with synthetic hormones the muscles never fully release so your muscles remain tense throughout birth. I – as a birthing mother – would also not have produced the same levels of hormones: endorphins – for their pain relieving properties, and relaxin - to help the cervix to soften and open. This means induction can either be long and drawn out, or else very quick and forceful, both of which put pressure on the mother and the baby.
So you had an otherwise healthy pregnancy, a long menstrual cycle and the hospital were happy to monitor you?
Yes, exactly. In my case of a long menstrual cycle, it made sense to me that I would have longer pregnancies (I am not a doctor, or a midwife but it seems to add up. I would love to know if it works the other way round too...?)
I read a really interesting article published by Evidence Based Birth - here. It explained that we use Naegele’s rule to determine a due date. To calculate your date based on Naegele’s rule, you add seven days to the first day of your last period and then count forward nine months. This rule was based on work done by a Dutch professor - Hermann Boerhaave - in 1744. However, Boerhaave did not actually explain whether you should add seven days to the start of the last period of to the last day of the last period. He simply said add seven days to the last period (Basekett & Nagele, 2000). According to this article, by the 1900s, most doctors were adding seven days to the first day of the last period, “a rule that is not based on any current evidence, and may not have even been intended by Naegele”.
Wow if we based it on the last day of your last period, that would give us another seven days of pregnancy! You mentioned the risks of a longer pregnancy. How did you deal with this? And not go a little crazy with ‘what if...’ worries?
The article I just mentioned has lots of really interesting statistics on the risks of going over 42 weeks. But I am not crazy. My husband and I absolutely were mindful of the risks of a longer pregnancy (and indeed of any pregnancy). I was also really aware of how I was feeling – the baby was still kicking regularly and I was being monitored by the hospital. For us, putting the date forward seemed the right thing. I felt informed and confident thanks to my hypnobirthing training and the support of some fabulous midwives.
I really truly am not saying that this is the case for everyone, induction can be a life saver for some women. That goes without saying. There are positive induction stories out there. However, being aware of your own, personal situation and having the confidence to ask questions about hospital policy is invaluable. I knew that I did have a choice and that hospital guidelines are just that – guidelines, based on an average. It was a guess date and in my case we guessed wrong!
Tell us a bit about how this contributes to your work as a hypnobirthing teacher?
The key for me is confidence. Confidence that you absolutely can birth your baby, with the help of some really incredible breathing and relaxation techniques, that I still use all the time with small kids running riot around me! Also confidence that you understand how your body works, and why you/your caregivers might want to take a particular course of action. The ability to ask questions.
One of the major parts of my hypnobirthing classes is making sure couples really know their options, so they are so confident to make choices. In my experience the midwives love a hypnobirthing couple, and are generally fully supportive as long as mother and baby are safe. I am a pretty sensible and pragmatic person – it is not the mindless pursuit of a particular type of birth; rather knowing that you have made the right choice for you, irrespective of how you birth and despite the twists and turns your birth may take.
We talk in classes about using our BRAIN – what are the Benefits, Risks, Alternatives, Implications or Nothing. Yes of course there are risks associated with birth, yes birth can be unpredictable but if you know your options, you have a plan A, B and C, you are more likely to be able to calmly and confidently make a choice. We want couples to feel that they have led the direction of their birth – of course with the support of some amazing midwives/doctors – rather than having felt they “ought” to do something. It is about taking responsibility for our births, rather than leaving it to chance and to healthcare pros to ‘make it happen’.
A little about Kate
I am a hypnobirthing teacher at Effie + Ros, in Teddington. I named by business after my two grannies. Effie was my Scottish granny. Little, but homely, wise, strong, cheeky, grounded, calm and comforting. She made us boxes of Scottish tablet and millionaires shortbread and we couldn't have been happier... Ros was a Southern American belle. She was supremely graceful, strong, knew her own mind and had a wicked sense of humour. She fed us chocolate sauce and ice cream for breakfast (need I say more...?!) There is little more in adjectives that I could choose to describe my little business. And these are words I think ALL women should feel about birth and parenthood. This is YOUR birth, own it as your own and enter parenthood feeling totally awesome, amazing and confident that you are making the right choices for YOU.