I will be 42 weeks into my 1st pregnancy tomorrow and although I have been so lucky having zero problems throughout the wait is now starting to stress me out and turn me into a nervous wreck .

I have had no braxton hicks, no shows and an examination on Tuesday that gave me a bishops score of 3.

I am losing all hope of having my baby naturally and can't bear the thought of being induced. Is there anyone out there in my position who can relate to this as all the threads I've been reading have everyone willing to be induced to have their babies? Am I just being a coward?

I feel like a lamb being lead to the slaughter of Prostin/ARM/Syntocinon drip. Although the MW I've seen have been lovely and are not pressurising me in the slightest, I can't decide what to do when the call comes for me to go to hospital.

Any advise from someone who's been there would be much appreciated.

I went into labour at 42 weeks exactly, during a scan of the placenta
But I had been having braxton hicks since week 35.

Why are you worried about induction? You might start going with just the gel (I did). THen you get to be there from the word go (which was such a blessing for me).

I haven't been there but have you tried the natural alternatives? I am sure lulu will be there in a flash to recommend sex and nipple stimulation but what about reflexology, acupuncture. Also try a hot bath and visualise your cervix opening (that is what my hypnobirthing practitioner recommended). You need to relax (easier said than done I know) as stress may prevent anything from happening. Is there anything/fear that might hold you back?

I suppose you can also try clary sage in bath, eat spicy food and pinapple.

Alternatively you can put clary sage in the bath whilst DH/DP is stimulating your nipples and eat pinapple (still in the bath) whilst visualising your cervix opening

As long as your baby is still active and happy, I wouldn't worry too much.

Had DS at 41+5. Model pregnancy but then nothing happened! When I went for my 41 week check up I had elevated BP and they kept me in. Turned out DS could not have been delivered naturally (umbilical cord not attached in normal place and wrapped around his neck). After being induced 3 times and 21 hours of labour I eventually had em C-section and DS absolutely fine.

Although this was absolute opposite of my birth plan, it was the right course of action.

Try not to rule out any options. Your ideal may be natural birth, but the key is that you are both healthly and nothing else really matters.

You will probably go into spontaneous labour and all will be fine but try to keep an open mind about things!

I know you're not thinking of a home birth, but there's quite a lot of information on the homebirth website, including the birth stories of ladies that went post dates (some to 43+).

I went to 41+3 with DD1, and suspect I only went into labour then as I saw a Dr that gave me a very enthusiastic palpation - was a relief though as DD was breech so it was spontaneous labour or CS for me! DD was born after 7 hours of labour and was absolutely fine.

Fingers crossed your LO turns up soon

It seems to be a modern pressure to have your baby at 40-42 weeks. In the old days people were more relaxed about it. If you google it there'll probably be loads of birth stories about babies arriving safely at 42+ weeks. I'll have a look.

this is comforting.

Thanks for the comments so far it's even just helping by making my fear public...

riven lack of bh or practice contractions means I have no idea if all is working correctly

LadyOfWaffle I've heard a few good experiences of the gel however IF it doesn't work then you're on started on the slipperly slope towards emergency cs.

needahand I've only tried lots of curry and sex (twice a day now which I think is helping soften my cervix but little else and walking. I don't like the idea of clary sage but have just bought some lavender oil as I've been on a short course in aromatherapy and know that it's safe and stimulating /relaxing. My baby is very active and always has a good heartbeat on my MW visits - it's just the unknown placenta factor that concerns me and indecision on whether to keep going without induction or not.

7 births wow that's scary but I like the advice she got from a MW who had seen lots of healthy placentas. That's encouraging.

I am keeping an open mind and know that you can't always have your birthplan, I should have gone for a homebirth but started out thinking that the safest thing for a first baby would be to go to hospital in case of the complications.

It's nice to hear that when some of you had your examination it kicked things of for some of you

I've been googling like mad for "good experiences" but for every good one there's a horrible one so it's so confusing.

Just wanted to say that induction doesn't have to lead to drip/ARM etc. I went to 40+14 and was induced - only needed one lot of the prostin gel, and started getting "tightenings" within half an hour, and DD arrived 15 hours later! First babe, I'd had no BHs, no show, and a Bishops Score of 2. Obviously different for everyone, but in my case, induction didn't result in the cascade of intervention which I'd heard about. Good luck - I was terrified too, it probably didn't help that I spent every minute of the two weeks' delay reading horror stories about induction

First baby, not "babe", obviously

at babe! Thanks TarkaLiotta, I think you're right I've been reading too many horror stories and a friend that had her baby at the end of April went through the whole gel to cs situation and although she's fine and has said I have nothing to worry about, I just can't help myself. It helps hearing the good stories as it takes a bit of the edge off the fear factor!

Hi, I've had 4 inductions the first (41 weeks because I didn't have a dating scan and they didn't believe me about when I got pregnant) and 3rd (40 weeks due to health issues) did not go smoothly in that they took 3 lots of gel and an ARM, 2nd (40+16) and 4th (42 exact) went really well on 1 and 2 lots of gel retrospectively. With my last birth 6 hours after the first lot of gel my bishops score was still only 1, 2nd lot of gel and baby was here within 5 hours and it was a fantastic time.

Anyway a bishops score of 3 and lots of BH sounds fab to me as I never had BH that I was aware of. Ony ever had one tiny stitch and that was with dc2 who was 10lb6oz but there was grade 3 meconium which was a risk which helped me decide to be induced at 42 weeks with dc4.

Hi CarGirl, that's a lot of late babies! I'm glad your last birth went well and it's encouraging that you didn't need a cs. I am definitely going to find out if there are any health issues to help make a decision. I just feel a bit guilty for having lots of thoughts of not wanting a induction and getting quite stressy and angry about it when I discuss it with DH. Even though I still will go through with it if it means having a healthy baby.

I declined induction at 42 weeks and eventually had DS naturally at 42+6. I saw a consultant who listened to my reasons and said that he couldn't guarantee the safety of my baby (who can?) but that he was happy for me to go another week. DS was born with apgar scores of 10 and 10, no meconium in the waters, placenta beautiful (apparently!). I knew all along that he was well as he was kicking for England. He just needed a bit longer.

In retrospect I think it was DS bad position that made him take so long to come - both in bringing on labour and labour lasting so long. Has anyone suggested to you that your baby may not be in an ideal position?

I tried everything to make DS come on time - none of which worked. They come when they are ready or via induction. It's not an easy choice I know but obviously it worked out well for us. Good luck with whatever you decide

I never had Braxton Hicks either, this doesn't mean you won't go into labour!

At 40 weeks I had a sweep and had a cervix 'like a 38 weeker', cue tears and wailing from me. A week later I went into spontaneous labour. So, all is not lost.

Oh, and I only had a show when I was well into established labour.

pussface, I'm not sure what your particular concern is about induction - is it fear of further intervention?

If so, fwiw I have had to be induced all 3 times at 42 weeks (as did my mum, maybe some quirk). All it took was a prostin pessary and then all completely natural. Unremarkable in just about every way.

For me the decision was easy for the last 2, I wanted a homebirth and once you are past 42 weeks the local hospital won't support that and tbh after going 16 days over with dc2 the certainty of having an induction date (I think they were booked early in my pregnancy) helped me cope with the whole having to acutally go in the hospital in the first place.

I remember at my 41 week appt a diff dr bullied me into be induced at 10 days over, I walked out of the hospital and burst into tears. Once I collected myself I ran uup the midwifes and told them I wasn't going in and they were fine about it.

Even if they monitor you at the hospital the issue is that the placenta can be fine and then within 24 hours it's too late, I just didn't want to take that teeny tiny risk. I know people who didn't have good outcomes from waiting past 42 weeks so that has def coloured my attitude to it all.

Actually length of pregnancy usually follows the same pattern as your Mum especially if you have similar cycles to your Mum too.

Same here, my db and I were late, my Mum never went into spont labour, irregular cycles, very heavy periods leading to aneamia etc. Plus I often had 5-6 week cycles so hardly surprising my babies were keen to hang on in there!

Must admit, after 42 weeks, I really wanted to get on with it!

TheProvincialLady I have not asked much about positioning I've been told it's good head down on every check-up. I only just started to engage last week and baby is presenting 3/5, so I am doing optimal fetal positioning to try and encourage a good position. Many thanks for your story and best wishes

RubyRioja My concern is definitely further intervention and fear/anxiety over a cs/injections and being cut open. If labour starts with just the prostin gel like it did for you I think I will be fine, there's just no guarantee is there? It seems your only just increasing your chances of medical intervention.

CarGirl It's that risk that I'm worried about taking although my DH said he will support whatever decision I make, it's just not easy. I think there is something in family genetics and patterns, although I can't compare with my mum as I take after my dad, she is tiny in build compared to me and couldn't give birth due to her pelvis being to narrow and inflexible so she had cs.

I think with a bishops score of 3 you are well onto a high possibility of one lot of gel doing most of the work, it sounds as though with your Mum's history the only risk is that you may have a tiny pelvis but that would be a problem even if you went into spont labour.

Have they booked you in yet? In our local hospital they are absolutely full to the brim and delaying inductions here there and everywhere.......

No I'm on the waiting list and have not had any calls yet (thank goodness). I think they may call tomorrow (42 wks) and I am just getting myself worked up over what to say or do. Hormonal as I am I will probably surprise myself as I keep changing my mind over and over. I think you're right I may have a good chance with one gel (fingers crossed) and I'm getting worked up over nothing and may just grit my teeth and go for it as I don't know whether I am up for waiting. DH says I need to set myself a date for when I will hold out to, either tomorrow or try have a last go for relaxing /self inducing over the weekend and be ready to go for Monday. Maybe they will be so busy I will have to wait anyhow!

I went to 43+3 with my DD!!

Wow kookykid was it nerve-wracking or were you confident that DD was okay?

Don't geddit! So you HAVE to be induced, but only if your hospital isn't too busy!?

Are you sure of your dates, - do you have any doubts or queries about it? Are you going by the scan day, or your LMP, or an equally random one?

Pussface

Congratulations on your pregnancy

I went to 42+3 with my last baby. Induction was out of the question as I had had 2 previous sections, she was rather large at birth but it was a very easy and quick labour and birth (just over 1hr).

My mother was 2 - 3 weeks late with all 3 of us, I do think it runs in the family.

Good luck

Hi StarlightMcKenzie, I know you don't have to be induced but I get the impression from MWs that if you don't go along with the process of 42 weeks the hospital will be encouraging you (harrassing?) to go for checks, make a decision etc... I am definitely sure of the dates as I kept a diary of periods for over a year and it matches my cycle and my scan date matched too so I am over and the bump is neat but huge and lumpy, midwife reckons its an 8 pounder. I'm just not sure of what the risks are and how accurate the stats are as US says 2 die in 1000 births UK says 8 in 1000 and unless you can afford constant monitoring as CarGirl says it can just take a 24 hour period for something to happen by which time it's too late.

I had fantastic indep midwives, who were with me every step of the way. I so wanted my baby to be born the way I had planned (water-birth at home) and to me induction meant losing that control. Was SOSOSO hard at the time, but when DD finally arrived she was covered in vernix and a not-over-big 7lb11oz. I think the World Health Organisation recognises full term as 42 weeks, so really you're not overdue at all .
Sure someone will have said it, but turning your phone off is a good idea as one of the things that drove me demented was having people ask if the baby had arrived yet...!

Poor old Pussface - I do think a good nights sleep (as much as poss) and then a gel, followed by lots of walking around hospital gives a really good chance of doing it au naturel - my waters broke and went in my boots!

At the end of the day, we all feel a bit out of control, esp with a first baby. Just think, this time next week, you will be cuddled up with your baby!

Good luck

I thought you could go in everyday to be monitored?!

Also, - I'm not sure that those stats are correct, or at least probably out of context.

No-one wants an increased risk, - but if say 7 out of 1000 die with a term baby, then 8 out of 1000 would make sense iyswim but not actually be a significant increase!

BUT, - I'm not sure where to look to clarify this!

And, - there are increased risks, the more intervention you have too!

Hi kookykid, I do have my phones on straight to voicemail so I can choose who I want to speak to as the annoying any news yet is starting to drive me crazy.

I can't believe I am wavering about today as I have been so anti-induction all through this pregnancy which many people don't seem to understand and I got talked into putting my name down at the hospital to get a call and was told I can decline but they take care of you after 42 wks not the MW so you can't get out of it, so it seems.

Tell them you're having a homebirth. That usually makes them listen, - they'll do anything to get you in, even promise MW care!

Pussface - stop googling now, step away from the computer! Honestly, I know, it's so hard not to read everything you can about induction, but the only stuff you'll find will be either about the woman who spent 178 hours in labour and had 8th degree tearing, or the woman who farted and didn't even notice the baby had popped out! Uneventful, non-dramatic labours never seem to get written about online, but they do happen, and they happen a lot.

It's clearly a case of "Do as I say, not as I do" here though - I was SO SO SO bored when I went overdue that I spent loads of time frightening myself by reading too much, and now wish I'd spent more time reading loads of trashy fiction while I still had the time!

Hope it all goes well for you, good luck

No where does it say that you have to agree to induction, it might be what the medics want/advise because that is what they are used to and it is hospital protocol but it is your body, your baby and your choice

I do think you are having the worst of both worlds, if you had an induction date booked at least you can be positive and there is an end to the uncertainty but waiting for a phone call just sounds horrendous, complete uncertainty, stress levels through the rood - hardly conducive to going into labour and have a straight forward birth.

Perhaps just decide in your mind how long you want to wait and don't anwer their calls until you get to that point

My labour started after
Niggles on Friday afternoon,m/w thought I could have been in early labour
walk
rhubarb and custard
walk
curry
rhubarb and custard
raspberry leaf tablet
that night labour started
baby born next morning

Keep an eye on the movements and try not to stress.

Your body won't go into labour if your adrenaline and stress levels are high!!

You CAN get out of it! Your baby, your choice. Totally understand how you feel, but go with your heart. No-one wants to put their baby at risk, and the consultants are very good at making you feel like you are doing the wrong thing - they told me there was a chance my baby would die , but I just believed in my body and trusted my baby. In the end I had an 8 hour stress free, wonderful labour and gave my daughter the best start I think she could've had!

I have to go and decorate now (yuck) but will check back later!

It can be so scary. I was told I had to have a section at 40+5 by a consultant I had never seen before. She scared me silly with statistics of what could go wrong. (actually she was right about scar rupture, just 1 baby too soon.) I told my usual consultant I didn't want a section so he told me not to have one. DD was born naturally at 40+6.

DD1 born at 42+5 after just a sweep. We held out and refused induction and were supported by a good consultant. However, the MW team insisted on treated me as if I had been induced with all the extra monitoring that involves. Wish I'd had the nouse to say no to that too!

i had an induction, i thought it was fine tbh. 7 hours, lovely midwife, absolutely as active as i wanted it to be and the baby came out with a one cm tear that didn't need stitching. it's not necessarily a bad thing, try to remember that.

NICE guidelines say you get monitored twice a week by hospital if you decline induction, not sure about every day but will ask. I agree there are equal risks with both options (seemingly more with intervention) it's all down to the individual. I'm pretty healthy and have a very healthy lifestyle so I hope I have alot going for me and as you say one persons overdue is another persons early, it's not like boiling an egg! I've giving up on stats and googling as I think your right it's starting to get unhealthy!

Well DH is back from work so I'm off to get some RL attention. Thank you all for your advice and best wishes I will check on the posts later.

Apart from the monitoring for 45 mins after the gel I refused all other monitoring, by the time they examined me I had delivered 2 minutes later. By confident enough to say no to laying on the bed being monitored - stay upright, walk around etc etc etc

but you don't have to be lying on the bed to be monitored, really you don't.

i was on a ball, walking a bit, leaning on the bed etc etc. that's what your dh is for, to help you not get tangled.

try not to worry, OP.

Hey pussface, I was exactly the same as you in not wanting to be induced last time, and I was booked for a homebirth so I was extra paranoid if I went too far over they wouldn't let me. You don't have to be induced do you? I know I found some really good sample letter on a home birth website that state that you won't be going along with the hospital's plans (will have a look see if I can find the site for you) if that's what you want to do. Decide how long you'll be comfortable waiting and see how it goes.

Anyway, dates aren't set in stone eh, I thought my DS shoudl have been due a week later than the scan said, and he came the day before I thought he should (6 days after the due date I was given!)

Good luck, try not to get too worked up, but it is hard! Having sex kicked me off in the end if you feel like you can be bothered!

Hope this helps, induction does not have to be a cascade of intervention. I was induced at 41 +6 - had gel in the morning - not much happened until after lunch - contractions started about 2 ish. Asked to use the birth pool and was allowed in about 3.30 ish - baby born at 4.30 pm! He was my third and I had had one previous water birth but had never been induced before. Agree with one of the other posts that positive frame of mind is a huge help - if you can visualise going into labour and having birth you want then helps reduce stress levels, adrenaline etc which are all hindrances to labour progressing. Sending you lots of positive vibes .

You could agree to be induced 'tomorrow', - every day. After the monitoring and examination you can tell them you've changed your mind and will give it another 24 hours!!

I was desperate not to be induced on my first baby as I have a bleeding disorder amd wasn't allowed an epiduaral because of it. I didn't mind being induced if it would have been straight forward with prostin only. However I didn't fancy the syntocinon drip without some serious analgesia!

I was 12 days post dates and considered castor oil but came to my senses and put it in the bin (yes I went as far as going to 3 chemists to buy it - the first two pharmacists sent me away with a flea in my ear )

Previous to this I had LOTS of stretch and sweeps and finally SROM'd at 13 days post dates. I had a beautiful labour with gas and air and pethadine for transition.

Why don't you have a chat with your consultant and arrange an extra 3 days with lots of stretch and sweeps and careful monitoring. It's true that the concern with going over 42 weeks is the risk of placental failure but this can be monitored with either doppler scans or daily CTG's.

Going to bed, but keep us all posted on how it goes! Good luck with it all!

Thank-you for all the positive messages they really helped. I had a relaxing bath and early night last night. Am in a much more positive mood now and have calmed down, baby is jiggling about this morning and I will take your advice on board and remember that I'm in control of what happens to me and this birth. Hopefully I will be making a birth announcement soon! Thanks all xxx

Pussface, I was induced 15 days after my due date and it wasn't so bad. I had tried every method of bringing on labour, sex, curry, 3 cervical sweeps but nothing worked. The consultant wasn't in a hurry to induce me; the baby's heartbeat was strong so he was happy to keep monitoring me but at that stage I was getting very anxious about baby arriving safely and I had to turn on the tears to be kept in! I wasn't the birth I had dreamed of but at the end of the day I got a 9lb 5oz healthy beautiful boy, which is the most important thing. Good luck x

Hi pussface I think something like 85% of British women go 'overdue', it's such a weird concept as the medical profession here still won't acknowledge that pregnancy is actually 42 weeks (in line with WHO guidelines) Your EDD is just that, an estimation! I can totally sympathise with you're not wanting an induction, you can insist on daily monitoring and a scan to see if baby is presenting correctly. Most babies come when they're good and ready and when mum is relaxed as she can be, don't listen to the horror stories, visualise the birth you want and we'll all hope the best outcome for you and your baby.

I was induced twice and in both cases only needed the gel to get going. However, there were other women in the ward -(I was in for weeks due to health issues)- who did not go into labour with induction and had to keep trying, and my impression was that the hospital were fine about taking their time and not whisking them off to Caesarians just because that's the next step.

I did end up having a Caesarian with my second, but that was because ds's heartbeat went down and he was clearly in distress (and as I said, there were health concerns from the start so not totally unexpected).

My induction was a horrible experience, but if you want to go for one, there are ways you can make it easier. It can be a slippery slope once you start to get induced, but if you insist on staying mobile for as long as possible, that will help. My big problem, as a first time mother, was that I felt I couldn't argue with what was happening to me. Be strong, and ask for what you want. Even if you end up with monitors on you and are immobilised a bit, try to keep upright when you come to push. You can ask to kneel up over the back of the bed, which will make the delivery much easier than if you are lying on your back.

However, I was induced, strapped to a bed with monitors, told I WOULD need pain relief, and ended up with an epidural, two hours of pushing, episiotomy, forceps delivery, breastfeeding failure, multiple infections and a burst episiotomy. Not nice. I don't mean to scare you, but I felt very angry about my birth experience, and want you to know that it doesn't have to be like that if you are strong and remember that it is your body and you are in control.

Hope all goes well for you.

With dd1 went to 41 weeks, ds I went to 42 weeks. With dd2 I went to 42+2. Be extremely thankful that you have a positive midwife. I was pressured into an induction by one midwife at the hospital but declined crying on the phone to the induction unit midwives. The midwife there told me to CALM DOWN as stress prevents labour starting. I went into hospital every day during the last week for monitoring but I'm not sure if it was the best thing to do. I think I should have complained about the midwives who I saw at the WANDA clinic because I was given a horror story from one midwife who's baby was 'overcooked' and in distress and also told the day before I actually went into labour - "you could be holding your baby in your arms right now". As if I didn't already know that. I wanted to prevent induction at all costs so those comments did not help any.

When I went into labour at 42+2 baby passed meconium but baby's heartbeat was normal. I had planned a homebirth but midwife wasn't happy because of the meconium and sent me in to Shrewsbury Hospital. Was continuously monitored by extremely efficient nice midwives who didn't bat an eyelid at me being 42+2, unlike Telford midwives who were all doom and gloom. Baby's heartbeat didn't waver. The meconium in baby's case was just a sign of a mature gut. In the end it was a blessing to be transferred to Shrewsbury as I ended up with great midwives who didn't judge my reasons to wait for spontaneous labour. At that point I had lost all trust in Telford community midwives. Also had a relatively easy birth - very painful (obviously), quick - 2.5 hours, but no complications. Placenta was still o.k.

Not convinced with nipple stimulation or sex to start things off. Tried that but nothing happened for me.

Good luck with your decision and hopefully you're in labour RIGHT NOW.

Homebirth sites and midwifery sites can be good. One independent midwife who I 'met' on the site helped me keep my sanity in the last week. I'll try and find the sites and provide links for you.

Again good luck.

link to Midwifery UK

health.groups.yahoo.com/group/ukmidwifery/

You have to join this group but if you send in a request for urgent help then they'll fast track you. That's what they did for me nearly 3 years ago. you probably don't need this site as you have a supportive midwife but just in case, you can get NHS midwives and Independent Midwives view points on here.

link to Homebirth site (stories of births 42+ weeks)

www.homebirth.org.uk/

Go to Contents and then Overdue. Lots of info.

Have you seen this?
This article was published in THE PRACTICING MIDWIFE (2004 Jul-Aug;7(7):45-6)

Thousands of women in this country with normal pregnancies and healthy babies are being put at risk every day in maternity units across the country. Yet like lambs to the slaughter they pack up their bags and head for the hospital in the belief that the doctors, who instigate the barbaric treatment they are about to undergo, are saving their babies lives.

Many of them then spend the next few days in excruciating pain over and above that what is experienced in normal labour in an effort to drag their unready and unwilling bodies into labour. Their bodies are filled with drugs that may compromise their long-term health so they begin the spiralling cascade of interventions that all too often culminates with entry through the theatre doors.

The women and their families thank the doctors and hospital guidelines for saving them from the problems they had, problems that are often itrogenic in origin. And so the myth, that their bodies are failing them in the one thing women are best at, procuring a future generation, is perpetuated.

To add insult to injury my colleagues, midwives, who by definition of their title should be the protectors of women and babies, help daily to continue this unnecessary practice. Induction of labour for no medical reason has become a socially acceptable procedure.

The N.I.C.E. (National Institute for Clinical Excellence 2001) Guidelines are the gold seal that have been adopted with open arms and are now governing practice in maternity units throughout the country. The Induction of Labour (IOL) is one such guideline and one that recently instigated a rather heated conversation between a hospital antenatal clinic midwife and myself. Her role as head of the clinic involved speaking to many women who were booked for induction and therefore she was in a very responsible position to give true and unbiased information about IOL to large numbers of woman.

I had telephoned the clinic to arrange an ultrasound scan for a client who was 42 weeks pregnant with her second baby. The pregnancy was normal. The client was very well informed and despite knowing there was no evidence to support fetal surveillance had decided on a scan to check the well being of her baby. Social pressure had made her feel that she needed to "do something" and this course of action, she felt, at least appeased her family, friends and neighbours. What she did emphasise to me was that she did not want to be put under any pressure by anyone to be induced and this I clearly explained to the midwife I conversed with. I asked her to pass that information on to the midwife in charge; an appointment was made for 2 days hence. The following morning I received a letter from the midwife in charge. The letter informed me that a review of the hospital notes made the clients dates "wrong" and stated "in accordance with N.I.C.E Guidelines on post maturity, no woman should go over 42 weeks".

After reading the letter my client, feeling that was this was just the pressure she did not want to subject herself to, lost all faith in the maternity unit. She understandably felt that she would not be given the respect to make her own decisions especially as, without meeting her, judgment had been passed on her by the professions from which she had requested help. Also she must be a stupid woman after all if she knew when she got pregnant! She cancelled the appointment.

The guidelines of course do not say what the midwife had stated. The letter left me in no doubt that this head of antenatal clinic not only had not read the guidelines but also more worryingly had put her own interpretation on them. If this is but one example of how they are being used to manipulate and lie to women what hope do women and society have of knowing the truth and making an informed choice?

Following the publication, in Canada, (Hannah 1992) of the largest Randomised Controlled Trial (RCT) to date concerning induction of labour and further meta-analysis of other RCT The Royal College of Obstetricians and Gynaecologists (RCOG) adopted of the policy of offering induction at 41 weeks. This is now the recommendation of what is regarded as gold standard, The National Institute for Clinical Excellence (N.I.C.E) Guidelines.

However what is not widely known by obstetricians and midwives alike is that all the studies used to govern today’s practice was and is based on 8 babies! In the case of induction of labour, the number of babies that died following their mothers being induced versus the numbers of babies that died following their mothers left to proceed with pregnancy beyond 41 weeks. There were approximately 3000 women in the IOL group and 3000 in the expectant management group.

One baby died in the IOL group and 7 died in the expectant management group.

Hey presto it is obvious then many babies’ lives will be saved if we offer to induce every woman over 41 weeks.

Does anyone care about looking at the wider picture?

I was taught as a student nurses on diploma courses at the very beginning of my education not to use research that is more than 10 years out of date to underpin my practice. Yet to govern and recommend practice affecting thousands of women and babies, many of the RCT in the Meta analysis used to compile the N.I.C.E Guidelines are more than 20 years out of date, some of the studies even 40 years old. Whilst the way women grow and birth babies has not changed in millions of years, the ways our health as a nation and the ways in which maternity care is delivered and received certainly has. Never more so than in the last 40 years. We now have testing and screening so that abnormalities can be detected earlier fetal surveillance is available for at risk babies and the appropriate care free and accessible to all women.

If we do indeed look at the wider picture we see a whole new one emerging. Of the seven babies that died, two occurred in the 1960’s one of which had a suspected diabetic mother. Hardly a good inclusion criteria in a controlled trial by today’s standards. One baby had pneumonia that is irrelevant to induction of labour. One from a Chinese study that the baby had Meconium aspiration following refusal of induction of labour by its mother after a positive amnioscopy. Another from Meconium aspiration at 43+3 weeks, which would not have any bearing of induction at 41 weeks. One was from a placental abruption, which could occur at anytime. One was a baby of 2.6 grams and clearly growth retarded and the mother had received no antenatal care, (Menticoglou and Hall 2002).

Based on these finding where is the evidence that there is an increased risk of unexplained still birth at 41 weeks? How are the benefits to the 20-25% of women and babies that are being daily induced being demonstrated?

How are we as professionals informing women of the risks of induction of labour versus continuing the pregnancy? Are women given the information in a true and unbiased manner? I doubt it. Just as women are only told the "risks" around birth when they are planning a home birth but conveniently not told the many more risks associated with going into hospital. A woman screened for having a Downs Syndrome baby is informed that if she has a risk factor of less that 1:250 she is a low risk and further action not recommended and yet at 41 weeks gestation she is offered (if indeed it is an offer) IOL because the (very dubious) risk of increased stillbirth is 1:1000.

In a detailed review of the literature Menticoglou (2002) also highlighted details of a women who died in a hospital awaiting treatment for what appeared to be fulminating eclampsia. She was waiting because the wards were full and busy. As many midwives know the wards are often full to capacity and often due to the amount of routine induction of labours that are on going at any one time. Where do women and babies such as these two who died feature in the calculation of risk?

Other than the Hannah trial no further studies were looked at in depth for taking into account when devising the N.I.C.E guidelines. There are other good retrospective studies looking at this subject. Many that shows a substantial increase in the caesarean section rate for routine induction of labour and no significant difference in neonatal outcomes for women and babies that are left alone to continue with healthy pregnancies. The cost to the maternity services must be phenomenal. A cost that could be put to far better use. Money that could spent on improving services so that midwives come back to the profession. Then women and babies who ARE at risk from on going pregnancies may well be highlighted appropriately through good antenatal care instead of a hurried 10 minutes at each antenatal visit and routine induction for all!

We also must not forget the baby in the whole process because it too plays its part in the instigation of labour. The baby is not a passive receiver of the labour process and induced earlier may not have the readiness for labour itself. The biggest reason of all (22%) given in the National Sentinel Caesarean Section Audit (RCOG 2001) was fetal distress. Even given the many wrong diagnosis of fetal distress that exist how many of these babies were induced before they were ready to be born.

Routine induction of labour has become a socially acceptable norm. It is time we professionals, we who are the instigators of what over time becomes "normal" in women and societies eyes, stop this barbaric treatment and give back to women the respect that they and natures deserve.

any news? what did the hospital say to daily monitoring?

45% of inductions in a first-time pregnant mum end up as an emergency CS.

It makes my blood boil that women are BULLIED by midwives into medically uncessary inductions at 41 weeks.

A fascinating thread and really helpful to read. I'm 20 weeks and hoping for a home birth, I'm very concerned as pussface is about having to be induced if I'm overdue as I feel quite negative about giving birth in hospital (it's my first baby after miscarriage). All these encouraging words will hopefully help me to remain confident as I approach the big day. What an amazingly supportive bunch you all are!

Also, great article from fabsmum - will make a point of chatting to my midwives about going overdue and protocol etc.