What do these statistics mean?

When comparing these statistics it soon becomes obvious that for the local NHS trusts that are providing maternity care that the rate of spontaneous labour (that starts on its own) and induction (where labour is started with medication) are about the same (40%) and caesarean without labour is around 20%. The effect of this high rate of induction and caesarean section means that only 50% of people are able to achieve an unassisted vaginal birth. In comparison My Independent Midwife (and the majority of independent midwives across the world) find that over 90% of their families are able to give birth safely without any medical assistance. This is largely due to using well researched holistic techniques to avoid unnecessary interventions in labour (like induction of labour), combined with their experience and confidence in enabling their clients to labour safely and without fear. The small number of clients who do require assistance to give birth are identified and help is given where it is needed. 

Have the rates of intervention always been the same?

The rate of induction and caesarean is rising in NHS trusts across the county. 

*Available from:  https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2020-21

The rate that people are allowed to go into spontaneous labour has reduced from 59% to 39%, whilst the induction rate has increased from 21% to 36% and the caesarean without any labour rate has increased from 12 to 19%. The effect of this means that those having an unassisted birth has fallen from 65% to 51% and the caesarean rate has increased from 23% to 35%. This has all happened in just 10 years and the rates of intervention continue to increase with each year that passes. 

Why are induction and elective caesarean sections recommended?

Induction and elective caesarean can be advised for a variety of reasons that fall into three categories; medical, preventative and social. Medical is known to save lives and is recommended for a variety of known complications such as pre-eclampsia or a baby who is growing too slowly. Preventative is where an induction or caesarean is recommended because the risk of complications is considered to be raised. Examples of preventative include; going past your due date, increased maternal age, having previously had a caesarean or a baby who is suspected to be large. Social is usually undertaken when a family request it, to fit in with their specific circumstances, such as the partner being required to work away and wishing to meet the baby before they go. 

But why does it matter that there is more intervention? Better safe than sorry right?

Preventative induction and elective caesarean sections are the main reason for the increased induction and caesarean section rates. This is in an attempt to improve the safety of giving birth and reduce litigation. However, its not working, safety rates and outcomes are not improving but the associated complications are increasing, leaving a physical and emotional impact on many people! 

Physical effects of induction:

A recent study by Dahlen et al (2021) showed that induction of labour leads to more intervention and more adverse maternal, neonatal and child outcomes. Women with uncomplicated pregnancies who had their labour induced had higher rates of epidural/spinal analgesia, caesarean, instrumental birth, episiotomy and postpartum haemorrhage than women with a similar risk profile who went into labour spontaneously. Furthermore, they found that there has been no reduction in stillbirth, despite the rising induction rate. This study also highlighted that children born after induction had a higher chance of problems, both around and after the time of birth. Between birth and 16 years of age, the children had higher odds of birth asphyxia, birth trauma, respiratory disorders, major resuscitation at birth and hospitalisation for infection. Another key finding is that, there was no gestational age for which any of these risks were significantly lower for those born after induction when compared with those born after spontaneous labour onset. This important, especially in the light of moves to offer earlier induction to more and more women without good medical reason.

Physical effects of caesarean:

A caesarean birth is one that is performed surgically and involves cutting through the abdominal wall and the uterine wall in order to remove the baby from the womb. A caesarean section is generally a safe procedure, but like any type of surgery it does carry a risk of complications. Some of the main risks of having a caesarean include: infection of the wound, infection of the uterine lining, haemorrhage, deep vein thrombosis (DVT) and damage to the bladder. It usually takes 6-10 weeks to recover following a caesarean section. Caesarean section is also associated with an increased risk of uterine rupture, low lying placenta, ectopic pregnancy, stillbirth, and preterm birth in subsequent pregnancies. Babies born by caesarean section are at increased risk of breathing difficulties at birth that require admission to the neonatal unit. There is also emerging evidence that babies born by caesarean section have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of caesarean section for the baby include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between caesarean section use and greater incidence of late childhood obesity and asthma are frequently reported (Sandall et al 2018).

Emotional effects of induction and caesarean:

We know that many people regret agreeing to or asking for an induction or caesarean and it is important to note that others, of course, are happy with their decision. But each additional study and review makes it clearer that we need to find better ways of getting good and balanced information to families before they make this decision. The latest research is a systematic review and thematic synthesis (Coates et al 2018) which brings together eleven papers containing peer-reviewed qualitative evidence. In other words, this is good quality data. The review indicates that induction of labour is a challenging experience for parents, they feel of lack of control when agreeing to be induced and during the induction process, they feel part of a production line system and they feel unsupported and uncomfortable in their surroundings. The overall result undermined the experiences of labour and birth.

One of the key things we hear over and over again was that people hadn't realised what the reality of induction or caesarean would be like and they didn't just mean in relation to the pain or the increased intervention; they wished they had known about the social aspects such as that they might end up on the antenatal ward for three days before their labour really kicked in or that their partner might only be allowed to visit during certain times.  That's why midwives, doulas and birth educators get passionate. When it comes to intervention in labour, it's not that we want everyone to say no; we want all women to have full information so they know what they are signing up for and don't have regrets later on.