Christmas is not a valid reason for induction

Hello and welcome to mid-December, the time I remind those in their third trimester that the upcoming festive season and public holidays are not a good reason for induction.

Before I go on, I want to be clear that there are good reasons for induction in certain circumstances. When truly indicated, induction can be an important way to keep babies and their mothers or carrying parents safest. This article is not about those inductions but the ones that are pushed on pregnant women and people who do not want them, without medical need.

Unfortunately, this can and does happen, particularly in the lead up to Christmas.

Aside from February 29, which the babies of the world only get a crack at very four years, Australia’s four least common birthdays are all public holidays: Christmas Day, Boxing Day, New Year’s Day and January 26. A similar pattern is observed across many countries, including the USA.

Media coverage of birthday popularity generally asserts this is because surgeons don’t like to schedule caesareans on weekends, and public holidays even less so. But there’s another factor adding to the “quiet Christmas on the birth ward” situation, which is neatly summed up by Cara Terreri, writing for Lamaze:

“Few doctors want to be pacing the halls on Christmas or New Year's, so it's not uncommon to see a surge of people with healthy pregnancies being told that there might be an issue and that they should consider scheduling an induction, coincidentally, right before a holiday.”

“Surely when we know the early protective benefits and lifelong positive impacts those last few days and weeks in utero have for babies, they’re not being evicted just so the bigwigs can knock back some eggnog and Christmas cake in peace?” I hear you ask incredulously.

I hate to break it to you, but basically, yep. Let’s take a look at what happens across the year. According to this study of over 474 000 births in NSW between 2001-2016:

• 15% of all mothers (over 69 000 people) were induced without medical reason.

• First time mothers who were induced were more than twice as likely to end up having a cesarean than those whose labour started on its own (29.3% vs 13.8%).

• Those who did go on to birth vaginally after induction were more likely to have an instrumental birth, episiotomy, epidural and postpartum haemorrhage than those who went into labour naturally.

• Babies who were induced without medical reason experienced higher rates of neonatal birth trauma, resuscitation and respiratory disorders than those who were born after spontaneous labour. Induced babies also recorded higher rates or admission to hospital for infections (ear, nose, throat, respiratory and sepsis) up to the age of 16 years (and potentially beyond that - 16 years marked the end of the study time frame).

Also, ABS data tells us only 12% of subsequent births after c-sections are vaginal births which (physical health consequences of primary and repeat caesareans aside) is likely what these women and birth parents originally wanted or else they would’ve scheduled a caesarean section for their first birth from the get-go.

Of course, a doctor or midwife is pretty unlikely to walk into your appointment and say they’d really rather a day off for Chrissy and would you be so kind as to go through an extended, closely monitored and more-likely-to-be-painful induction process for a baby they have no acute concerns about? Instead, you’re more likely to hear that your baby is measuring big, or perhaps a bit small, or some variation as to why they think your body can’t be trusted to birth this baby it’s grown from a speck to an entire person on its own.

You may be told they’ll have fewer staff on during public holidays so “you don’t want to risk labouring that day” (they seem to leave out the part about how that’s because they’re not booking non-necessary inductions or elective caesareans for that day, which is not the same as saying no one will be available to help with either procedure if they end up being medically indicated).

Cheeky, huh? Photo by krakenimages on Unsplash

So here’s the deal.

I know late pregnancy is hard, December in Australia is also bloody hot and you probably want to:

A. Get both the end of pregnancy and birth over with, and

B. Meet your baby ASAP.

I can also surmise giving birth when your baby decides it’s ready for spontaneous labour on Christmas/Boxing/New Years’ Day is likely to make for statistically better outcomes for you and your baby than an unnecessary induction that was pressed upon you around the time of those now-not-so-mysterious spikes in birthday popularity on the 17/18 and 29/30 Dec. If anything a public holiday labour could potentially work in your favour, giving you more time to progress at your own pace with less interference.

As you approach the festive season squeeze, remember the job of a medical practitioner is to offer their professional opinion and services, which you are then entitled to consent to or decline. This is the case regardless of whether you are a public or private patient.

When attending appointments (especially in December), Lamaze suggests there are a number of “things you can do if you feel you are being pressured to schedule your birth”. These including asking questions, getting in touch with your gut feel, seeking independent support and getting informed.

[I highly recommend Dr Sara Wickham’s books In Your Own Time and Inducing Labour. Remember eBooks and the apps to read them exist so you can get to them quickly if needed!]

If you have already scheduled an induction, even with a provider who you’ve felt really supported by until now, know that it’s up to you whether you go through with it or not. Think of it this way: you’ve been on a lovely date with a guy and agree to go back to their place for a bit of “Netflix and chill”. A moment later you may be super excited and can’t wait to get there, or realise something feels a bit off and it’s all happening too fast. He’s booked the Uber but it hasn’t arrived yet: it’s up to you whether you get in the car, or tell him you’ve changed your mind. 

In this example, as with interactions with the hospital and medical systems, there is a power dynamic at play. It’s hard to say “no” to someone or something we don’t want if we fear judgement or retribution of some kind. At the same time, going against our instincts, gut feel and informed, rational decision making never feels good either.

If saying an outright “no” to the pressure to be induced before Christmas (or any other public holiday, or indeed any day) in person feels impossible, you are within your rights to say “I’ll think about it and get back to you” and leave the appointment.

I have heard of some healthy mothers of healthy babies scheduling an induction as *cough* “strongly encouraged” *cough*, then phoning or emailing the service reception later, asking them to pass on a cancellation/postponement message, and turning off their phones off until they felt ready to deal with the response (or went into labour).

Finally (and I would hope that your provider is treating you with dignity and respect and it wouldn’t come to this) if you have felt bullied, harassed or coerced, a pretty clear way to withdraw consent for any unwanted medical procedure is to not turn up for it.

Yes, it’s nearly Christmas. This doesn’t change the fact you have agency. Your birth experience and yours and your baby’s health (for 16 years!) is more important than your doctor’s hot lunch.

Merry Christmas.

Note: No part of this article/blog constitutes medical advice of any kind. I am not privvy to your situation and can not speculate or pretend to know whether an induction or caesarean is or is not medically justified and/or something you wish to consent to, and can not be held liable in any way for the outcomes of your course of action. Your decision making regarding your birth is yours alone, which is both thrilling and terrifying. I wish you a brilliant birth.