“There are sometimes really good reasons for offering induction of labour. But sometimes it’s offered routinely, without thought for the individual, or for convenience. One size does not fit all.” – Dr. Sara Wickham.
There are several excellent books on induction out there, but this one is really something special. Dr Wickham has years of experience as a midwife, a researcher and academic and she wrote this book over a period of about six months while in lockdown in the UK. She doesn’t waste a single word, and it is researched to the absolute hilt. I don’t say that lightly - there is a twenty-five-page long reference list at the end of this book, with studies as recent as 2021.
This book is an utterly brilliant resource for all pregnant women and birth workers, as it neatly summarises some of the best and most up-to-date comprehensive research on induction that we have available. Dr. Wickham is succinct, yet eloquent, in her delivery of ideas about risk relating to maternity care, concerns about routine offering and acceptance of induction, and challenging of the concept that induction is low or without risk. She gives great details, with referenced studies, explaining how the evidence is stacked against many of the big reasons care providers offer induction.
She talks a lot of the benefits of waiting for your baby to be born alongside the often-unspoken risks of induction. She touches on one issue in particular that I don’t hear discussed much at all, but I think is so important: iatrogenic (that is, medically caused) prematurity in babies. She explains that the only way to know for certain that your baby is not being born too early is to not be induced – and even then, we still have some babies arriving before they are ready. She points out the flaws in calculating and relying on due dates and gives a great analogy explaining why babies are not like pumpkins (aside from the obvious!)
There are expertly referenced chapters addressing some of the major reasons that healthy women are offered induction which demonstrates both the lack of evidence for benefits and lack of consideration for risk of inducing women at varying gestations, particularly when they are healthy. These main reasons include the two most common reasons for induction: postdates pregnancies (being “overdue”) and the suspected big baby, as well as maternal age, BMI and race (which are other commonly provided reasons for induction). She expresses a belief that many of us know only too well, which is that overall, maternity care does not take the whole woman into account but puts them into boxes and makes recommendations based on the box they are placed in.
Dr. Wickham finishes the book by addressing the questions that most people would have after reading – where do we go from here? How do we change this? The widespread issue of routine recommendation of induction, as she demonstrates throughout the book, is related to many other issues in maternity care and even healthcare in general, and she points out that the political and economic structures that underpin these systems are at the crux of the problem. I appreciate that she identifies that the onus should not be on the women and their families or the individual care providers and support people to solve the problem, but that it goes far deeper. She explains what needs to happen as far as “reframing normality” and helping both women and care providers better understand risk in relation to maternity care.
This book isn’t going to tell you what conditions or diagnosis might trigger a recommendation for induction, nor will it walk you through the process and options of doing so. What it will do is challenge your ideas about induction and show you the actual evidence (or lack thereof) of benefits and risks of inducing.
If every pregnant woman could read this book, it could change the outcomes for so many. It is my number one recommended reading for pregnant women.
“I’m not anti-induction. I’m anti using limited and cherry-picked evidence and deceptive claims about risk to try and persuade entire groups of women to hand over control of their bodies and undergo intervention in the name of safety when the recommendations aren’t based on good science or an understanding of the wider consequences of such actions and may cause harm.” – Dr Sara Wickham.
My name is Katelyn Commerford and I am a doula and next birth after caesarean guide who has completed comprehensive doula education at Vicki Hobbs’ Doula Academy. If you want to know more about what I do and how I can help you, please visit my website where you can get your free cheat sheet of my favourite VBAC resources, or find me on instagram @thenbacguide where I answer commonly asked questions about planning the next birth after caesarean and share loads pregnancy, birth, postpartum and parenting content.
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