By Tanya Strusberg LCCE, FACCE

Dr. Rachel Reed is a Senior Lecturer in Midwifery at the University of the Sunshine Coast, Australia. Dr. Reed’s Ph.D. thesis explored women's experiences of birth and midwifery practice during birth. She is also the author of the internationally respected blog, Midwife Thinking. Dr. Reed has recently published a new book entitled, Why Induction Matters. The book, which is published by UK-based publishing house, Pinter & Martin, is the latest release in an excellent series of compact paperbacks each tackling an important and topical issue in our current maternity care environment.

While Rachel Reed may be well-known to maternity care professionals in Australia, she is probably a new name to many of you reading this blog. I would strongly encourage you to subscribe to her excellent blog, Midwife Thinking, so you can stay up to date with all of Rachel’s research and articles.

Why Induction Matters might be a compact read (it’s only just over 150 pages, excluding the reference section), but it packs a punch and is full of the latest, evidence-based research related to induction of labor. It is a fantastic and worthwhile addition to any Lamaze educator’s reference library and an equally great book to recommend to your clients, students, or to have as part of your lending library. The book is largely written with the pregnant person in mind and is designed to both comprehensively explain medical induction of labor - including a breakdown of the various methods of induction, such as cervical ripening, artificial rupture of membranes (AROM) and inducing contractions through the use of synthetic oxytocin (Pitocin - or Syntocinon as it is more commonly referred to in Australia, the UK, and Canada).

Throughout the book, Dr. Reed provides quotes from a number of women who were induced, which provides the reader with a realistic, yet balanced view from different people’s personal experiences. Dr. Reed is careful not to take sides and Why Induction Matters is not a book that sets out to argue why induction is bad or that it should be avoided. On the contrary, Dr. Reed is quick to point out that induction of labour is here to stay, and in many cases, it is a useful intervention that improves outcomes for pregnant people and their babies.

Dr. Reed explores the most common reasons why a person might be told that induction of labor is recommended, and then informs the reader as to whether or not there is good evidence to support that recommendation. She also covers common complications of pregnancy, such as high blood pressure, pre-eclampsia, diabetes and gestational diabetes, a growth-restricted baby (IUGR), reduced fetal movements and prolonged preterm rupture of membranes.

Chapter 3: Variations of Pregnancy discusses the many other reasons people are frequently told that they “need” an induction, but as Dr. Reed points out, the evidence is less than robust in many cases. These variations include; post-dates (a pregnancy that continues beyond around 41 weeks of pregnancy), advanced maternal age, vaginal birth after cesarean (VBAC), suspected big baby (macrosomia), multiples and finally, spontaneous rupture of membranes after 37 weeks of pregnancy.

Dr. Reed does a fantastic job of clearly explaining hormonal physiology and the impact on hormonal release when synthetic hormones and other medications are introduced into a person’s bloodstream. Again, first-person accounts of the experience of Pitocin-induced contractions help the reader to gain valuable insights. I was particularly glad to see that Dr. Reed included a number of known, potentially harmful side-effects of Pitocin that is rarely explained to people prior to a drip being placed in their arm. These include hyperstimulation of the uterus, Cesarean, malposition of the baby and shoulder dystocia, perineal tearing, neonatal complications at birth, postpartum haemorrhage, water retention (leading to an inaccurate birth weight for baby), difficulties with breastfeeding, postnatal depression and anxiety and perhaps somewhat more controversially, Dr. Reed points to some current research on the impact of intrapartum Pitocin and behavioural disorders in childhood, such as ADHD and autism spectrum disorder.

Chapter 7 deals with alternative (or ‘natural’) methods of induction and Reed examines the evidence behind some of the more common methods people are likely to encounter such as acupuncture and acupressure, aromatherapy, blue and black cohosh, nipple stimulation, castor oil, spicy foods, dates, evening primrose oil, raspberry leaf and sexual intercourse. Dr. Reed is quick to point out that the effectiveness and safety of some of these methods is difficult to establish and research is generally very limited and of poor quality. As a result, she outlines these methods very briefly and is careful not to give “instructions” on how they are to be used. I particularly like the fact that she doesn't like to use the term ‘natural induction’, because, as she rightly points out, inducing a labour by any means, before the process begins spontaneously, is not ‘natural’.

The final section of Why Induction Matters is devoted to assisting people to make informed choices by giving them practical information on how to create a birth plan for a medical induction. Given that between one in three and one in four pregnant people are now being induced, it is indeed valuable for people to think about creating a birth plan around induction, in the same way some educators and doulas are recommending that people put together a cesarean birth plan. Just writing it down isn’t going to make it happen, but if it DOES, then at least the pregnant person is well-informed of all their options and feels confident about asking questions and advocating for themselves.

US-based readers might find some of the references and terminology a little unfamiliar, and Dr. Reed’s references and resources at the end of the book are predominantly Australian and UK-based, however, it would not be difficult to find relevant local equivalents.

Dr. Rachel Reed has also kindly agreed to be interviewed for this blog, so watch out for Part 2 of this post in the new year.

In the meantime, Science & Sensibility has a signed copy of Dr. Reed’s book, Why Induction Matters to give away to one lucky blog post reader.  Leave a comment about induction and your thoughts in the comment section below by January 4th, 2019 and be entered in a drawing to have your own signed copy of this book!

About Tanya Strusberg

Tanya Strusberg is a member of the Lamaze International Board of Directors, the founder of birthwell birthright and the co-founder of Lamaze International Affiliate: Lamaze Australia. She is a Lamaze Certified Childbirth Educator, Lamaze Program Director, and birth doula. She is a passionate advocate for women’s maternity care and her articles have appeared in The Journal of Perinatal Education, Australian Midwifery News, Science & Sensibility, Interaction – the journal of the Childbirth and Parenting Educators Association of Australia (CAPEA), International Doula, Empowering Birth Magazine and Rockstar Birth Magazine. Last, but absolutely not least, she is also the mum of two beautiful children, her son Liev and daughter Amalia. She lives in Melbourne, Australia.

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