Questioning the Ethics of Hospital Induction Policies.
Preparing for your baby’s arrival is such an exciting time, but it can also come with a lot of questions, especially when you’re faced with hospital policies that might not align with your expectations. Recently, I’ve been hearing from parents about a private hospital in Perth, WA, telling women that if they go beyond 40 weeks of pregnancy, they won’t be able to birth there.
This raises serious ethical concerns for me: Is it right to pressure women into inductions just to fit into hospital policies? What about informed choice and respecting the natural variations in pregnancy?
I’m also not entirely sure how, and when, the hospital is informing families about this change in policy. And I am wondering: What happens if you go past 40 weeks? Are women who are forced to transfer to a public hospital being reimbursed for the costs they’ve already paid? This is something worth asking your care provider or the hospital directly to ensure you have all the information you need.
The Ethical Right to Make Your Own Decisions
It’s important to start by acknowledging that, as a pregnant woman, you have the same rights to privacy, bodily autonomy, and informed decision-making as any other person. Your right to make health decisions is not dependent on whether your doctor agrees with those decisions, but rather on whether you are fully informed and capable of making them. Even if your choice goes against medical advice, it is still your choice, and it should be respected.
When hospitals or healthcare providers push policies, like induction at a set number of weeks without a medical reason, it can undermine these rights. A blanket policy that limits options—like being unable to birth at a certain hospital after 40 weeks—does not consider your individual circumstances or preferences.
Ethical Standards for Obstetricians
The Medical Board of Australia’s Code of Conduct sets out the ethical expectations for all doctors, including obstetricians. These ethical standards include:
•Prioritising patient welfare: Ensuring that the health and well-being of the patient come first.
•Respecting patient autonomy and informed choice: Supporting patients to make their own decisions, even if they differ from the doctor’s recommendations.
•Maintaining professional competence and up-to-date knowledge: Ensuring that care is based on the latest evidence and best practices.
•Acting with integrity and transparency: Being honest, open, and clear with patients about their options and care.
These ethical guidelines reinforce the importance of patient-centred care, where your autonomy, preferences, and well-being are at the heart of all decisions. Healthcare providers are there to support you, not impose decisions on you.
(*I am using “patient” as this is the language the the Medical Board uses.)
The Average Pregnancy Length – It’s Not Always 40 Weeks!
You might be deciding to just cross your fingers and hope you birth before 40 weeks. However, this is a risky move.
40 weeks is often thought of as the “standard” due date, the reality is that many pregnancies, especially for first-time mums, go beyond this. (I have written several blogs on “Due Dates“)
We know from research that only about 4% of babies are actually born on their estimated due date. Despite this, there is still a lot of emphasis placed on that one day, as if it’s precise, that doesn’t account for the significant individual variation in the length of a healthy pregnancy.
There is plenty of evidence to suggest that a more individualised and flexible approach to due dates would better serve mums and babies.
I’m Not Anti-Induction – I’m Pro-Informed Choice
Let me be clear: I’m not anti-induction. In fact, I’ve worked with many clients who have had positive, empowering induction experiences, and I even have an entire online course dedicated to supporting positive inductions.
The key is informed choice. Every birth experience is different, and whether you go into labour naturally or with the help of an induction, the most important thing is that you feel confident, empowered, and informed about the decisions being made. My goal is to ensure that you understand the full picture, so you can make the best decision for you and your baby.
Informed Decision Making – Understanding Your Options
Valid Consent means your care provider should explain everything clearly—the reason they’re recommending an induction, the risks and benefits, and any alternatives available to you. Remember, it’s your body and your baby—you should feel empowered to make the choice that feels right for you.
A healthcare provider cannot impose medical advice on a competent pregnant woman. Even if a doctor disagrees with your decision, they are still required to respect it. You have the right to make decisions about your care based on what is best for you and your baby, and that decision should always be respected.
(You can read the AMA Position Statement on Maternal Decision-Making)
Unfortunately, unlike public hospitals, private hospitals can withdraw care based on policies like not allowing births after 40 weeks, but this raises ethical questions about whether it’s fair to deny care and force women to transfer hospitals at the end of their pregnancy.
Weighing the Risks and Benefits of Induction
Induction, like any medical intervention, comes with risks and benefits. While it can be lifesaving when needed, it also increases the chance of further interventions—like epidurals, instrumental deliveries (forceps or vacuum), or even a Caesarean section. Induced labours can be more intense, which often leads to needing more pain relief. And we know that one intervention can sometimes lead to another, creating a cascade of interventions birth and breastfeeding.
It’s important to take your time and think through these factors, remembering that your experience matters just as much as hospital policies.
Duty to Provide Evidence-Based Care
Your obstetrician has a duty to offer you care based on the latest evidence. If they’re suggesting induction at 40 weeks, it’s totally okay to ask about the evidence behind that decision. Does it align with the most up-to-date guidelines? For instance, the World Health Organization only recommends induction after 41 weeks unless there are other medical reasons. So, if you’re feeling unsure, ask why this recommendation is being made for you personally.
If something doesn’t sit right with you, don’t hesitate to seek a second opinion. You deserve to feel comfortable with your birth plan.
What About Brain Development in the Final Weeks?
It’s not just about timing though. The last weeks, and even days, of pregnancy are critical for a baby’s development, particularly their brain. In fact, research has shown that during the final weeks of pregnancy, a baby’s brain undergoes significant growth and development. So, every extra day in the womb means more brain development, which can have a long-lasting impact on their health and well-being after birth.
These final weeks are also important for the development of the baby’s lungs and other vital organs. That’s why, as long as both you and your baby are healthy, waiting for labour to begin naturally—rather than inducing early without medical need—can give your baby the best start. Which again makes me question the ethics of this policy because there is no way of knowing when any individual baby’s last weeks and days are.
How Gestational Age Impacts Child Development
A recent population-based study from the Netherlands explored the long-term impact of induction of labour on child development, specifically looking at school performance at age 12. The study included over 226,000 children born from 37 to 42 weeks of uncomplicated pregnancies. Researchers found that, at each week from 37 to 41 weeks, children born after induction had lower school performance scores and were less likely to reach higher secondary school levels compared to those born after spontaneous labour (Burger et al, 2023).
These findings suggest that induction of labour in uncomplicated pregnancies may have long-term effects on children’s cognitive development. This highlights the importance of considering both short-term and long-term consequences when deciding on induction, and that these effects should be part of the conversation when a hospital decides on a policy of inducing labour if women haven’t birthed by 40 weeks.
What Are Your Options?
At the end of the day, you have options. If you’re faced with the possibility of induction or being transferred, remember that it’s your right to ask questions, gather information, and make a decision that feels right for you and your family.
- Ask questions: It’s perfectly okay to ask why induction is being recommended, and what the evidence is for your situation.
- Consider your birthing location: If a private hospital is pressuring you for induction or has policies in place that limit your options (like not being able to birth there after 40 weeks), it’s important to ask yourself: Is birthing at this hospital worth the risks of induction? If you feel that these policies don’t align with your preferences for a more natural or flexible birth experience, you may want to consider alternative birth settings or hospitals. Your birth plan should reflect what’s best for you and your baby—not just hospital policies.
Your birth is a deeply personal experience, and you have the right to make decisions that feel safe and empowering for you, whether that means sticking with your chosen hospital or exploring other options.
If you need help navigating these decisions or want support with your birth plan, I’m always here to help. 💕
