14/08/2025
Anna, a physiotherapist, and Sam, an anaesthetic fellow, were hoping to have an uncomplicated first pregnancy and a spontaneous ‘natural’ labour with minimal intervention. From early on, we were discussing analgesia (pain relief) options and Anna, who really wanted to remain mobile during her labour, was keen to try her best to get through labour without an epidural.
Everything was progressing normally until she tested positive for gestational diabetes (GDM). Many know that GDM increases the risk of having a big baby. Fewer know that it also increases the risk of stillbirth. For this reason, we discussed inducing her labour before her due date. She was not thrilled about this idea.
Anna’s sugar control was good, but her fasting levels stayed high. She was reluctant to start insulin so we used metformin (a tablet which can help control high blood sugar) to control her sugar levels. This worked well and she maintained good sugar control.
As we neared the due date we discussed induction again. Anna’s concern occurred after reading about the ‘cascade of intervention’– a commonly quoted theory that once an intervention occurs it leads to more interventions. Being a physiotherapist, a major concern was trying to avoid instrumental birth, a known risk factor for pelvic floor dysfunction. Her reading had brought her across a number of sources including her private birthing class, books and podcasts which consistently stated that induced labour was more painful than spontaneous labour and more likely to result in an epidural and instrumental birth. While she tried to take these with a grain of salt, this was enough to sow doubt in her mind about induction. I explained that while an epidural would affect her mobility and may increase the risk of instrumental birth, an induction would not. I described how many women that are induced can birth on all fours on the floor (as long as they don’t have an epidural). I explained that labour, whether it is induced or not, is painful and the likelihood is that, should she be able to get through a spontaneous labour without an epidural, the same would be true for an induced labour.
After some consideration of the risks, Anna agreed to be induced one day over her due date, to allow her the maximum amount of time to spontaneously labour prior. The week prior to her induction, her cervix was closed and had not yet begun to shorten. This was disappointing for her and she asked for another examination a few days before her planned induction. At this examination, her cervix was just 1cm dilated, without any other changes and at her request I performed a membrane sweep.
Unfortunately, this was not successful and two days later she came in for insertion of a balloon catheter to help to prepare her cervix for labour. Following the balloon at 0730, her cervix was 3cm dilated. I broke her waters and gave her two hours to see if that would be enough for her labour to start. When it didn’t, an oxytocin infusion was commenced. This worked very well and she progressed quickly to full dilation at 1215. She used nitrous oxide gas and a TENS machine for pain relief. She pushed for just under an hour, in multiple positions including on the bed on all fours and on the floor on all fours which is where she eventually gave birth, normally. Baby Oscar was born safely weighing 3120g. She didn’t require any stitches. Unexpectedly, two hours after birth, she had a large bleed which was able to be managed conservatively and safely on the birthsuite.
Anna was thrilled that she was able to have almost the birth that she has wanted, but mostly that she was able to avoid many of the things that she was concerned about. In her case, induction of labour did not have a negative impact on her birth experience and if anything, allowed her more freedom of choice. Importantly, it also ensured that her baby arrived safely.
