The Induction Chat at 40+12. Can anyone help a proven slow cooker with arguments against?

(13 Posts)

Hi, this mit be long but as title suggests I am fairly sure I naturally cook babies longer than 40 weeks, and while I am obviously impatient to meet baby 2 and not really revelling in being whale-sized and slow, I don't want to be induced. I have a home birth planned, I am in perfect all round health, baby pointing the right way and very active, heartbeat fine etc etc.

So tomorrow morning (yes Sunday!!) I have to go to the induction appointment at hospital. My lovely community MW has already told them I'm not having it, but am content to go on the monitors just to show that all is well on the inside with placenta and baby.

I want to be prepared for the Obstetrician's hard sell though. I don't, for a start, agree that 40 weeks was when the scan thinks it was. I was OPK-ing for three months before conceiving so I know that my cycle length was 28 and luteal phase 14. So tomorrow I think I am actually only 40+5. DC1 was born at 42w (their clock) or 41+2 (mine) and was a well cooked 9lb5 but still had vernix etc showing he wasn't beyond mature.

I have two areas that I want to be prepared for - one is that I don't expect they will be mega staffed, so how long to wait around on a Sunday morning to be seen before giving up and going home to my birthing ball and more conducive spontaneous labour inducing surroundings...

That was the flippant one. The more important one is this: what is the monitoring for? What are they looking for? I know that the placenta can go into failure after 42 weeks (and I refer you to my original disagreement over what is 42 weeks, m'lud.). But is that a drop-off-a-cliff sort of failure or is there a recognised gradual pattern of reduced efficiency in amount of umbilical oxygen/blood flow? If so, isn't it something of a disadvantage that they have no baseline measurement of how my placenta was functioning at earlier points in the pregnancy?

Are there any open source but proper published scientific papers that I can get to which show all the proofs and "proving a negative" that would be relevant to this situation?

I am absolutely not trying to avoid medical treatment - if baby comes out at all distressed I am ready to amend my plans. I just don't want to be bullied into being up-risked unnecessarily. (I also have a load of similar questions for another time about postnatal transfer - I dont want to go in to a hot stuffy overcrowded PN ward where it's impossible to sleep, just to be seen on a ward round once every 12 hours, but would be entirely happy to go in at an agreed time for paed checks and then off home again.)

workingtitle Sat 07-Sep-13 11:29:54

this paper may be of interest.

It doesn't seem easy to find data on placental function, but this article about the placenta might be worth looking at. But it's probably a controversial perspective. They may be more interested in amniotic fluid levels? But pre 42 weeks I don't think they'd be measured.

This article from midwifery today, and this from the midwife thinking blog are worth reading.

Have you had any sweeps? Know your bishops score?

I would be looking for them to give me good reason why expectant management was not a good option.

Also, here is an extract from NICE guidelines on induction, in case you've not seen it:

1.2.1 Prevention of prolonged pregnancy
1.2.1.1 Women with uncomplicated pregnancies should be given every opportunity to go into spontaneous labour.
1.2.1.2 Women with uncomplicated pregnancies should usually be offered induction of labour between 41+0 and 42+0 weeks to avoid the risks of prolonged pregnancy. The exact timing should take into account the woman’s preferences and local circumstances
1.2.1.3 If a woman chooses not to have induction of labour, her decision should be respected. Healthcare professionals should discuss the woman’s care with her from then on.
1.2.1.4 From 42 weeks, women who decline induction of labour should be offered increased antenatal monitoring consisting of at least twice-weekly cardiotocography and ultrasound estimation of maximum amniotic pool depth

Good luck tomorrow

Thanks working title that's amazing.

Had a sweep on Thursday. Cervix posterior, long, 1cm, so she could get a bit of a sweep in but not much. I had been having a storm of BH contractions all afternoon and they went on into the evening and then everything ground to a halt when I went to bed.

I don't think my Bishops Score is likely to be above 5 but I don't know about effacement, station of baby (unless 4/5 palpable is a clue?)

workingtitle Sat 07-Sep-13 13:17:16

Have you given nipple stimulation a go(assuming you're low risk)? see here
It's top of my list if there's talk of induction!

Hmm, not for more than a few minutes at a time. Does using a breast pump have the same effect? Couldn't read the first link btw - unless I pay Wiley for it... But the midwifery perspective was really interesting. I was forgetting about the increased other risks that intervention can trigger, was already just focussing on whether intervention reduces the risks that it aims to address.

wispa31 Sat 07-Sep-13 14:21:38

oooh this is really interesting as i had a very stressful term +1 appt on thurs morn where the consultant pratically shit herself when i told her i didnt want an induction date and wanted to go beyond their 'policy' of term +10. i did post a thread in preg section but its disappeared. dp was with me at the appt and typically the mere mention of stillbirth (though interestingly no actual stats) has had him thinking 'oh maybe we shouldnt be waiting too long then'

Well I took all those links, printed out, to bed with a red pen. Went to sleep feeling empowered!

Woke up at 2am in spontaneous labour, had a nearly 4kg baby at 9am (oh the sweet irony!) at home in a pool with just my breathing and my inner Viking for pain relief.

Community midwives (all 3) agreed there's no way this was an 11 day over baby. Vernix all over bum, beautiful downy skin.

I hope this thread is helpful to other people!

Oh goodness, congratulations! Boy or girl?

StrangerintheNight Sun 08-Sep-13 18:18:47

Congratulations!

Took me 2 very 'overdue' babies for the midwife to agree that maybe mine gestate for longer, and there wouldn't be so much pressure for an induction next time. We'll see...

Shellywelly1973 Sun 08-Sep-13 22:35:43

Congratulations!

Great thread & excellent source of information.

Enjoy your gorgeous baby!

workingtitle Mon 09-Sep-13 07:15:35

Oh wow! Wasn't expecting to come back and see that update!! Massive congratulations, RakeABedOfTyneFilth, that's just wonderful news and sounds like a great birth.

wispa31 Mon 09-Sep-13 12:31:14

Oooh! smile congratulations!! Well done you! Hopefully i shall be snuggling my own newborn once the wee bugger has decided to make an appearance!

Thanks everyone and good luck wispa.

DH bumped in to one of our neighbours today, who had signed for a delivery of flowers earlier. She is a lady well into her 90s and has lived here since the estate was built in the late 40s/early 50s to rehouse people from the East End of London after the war. She told DH today that one of her children was also born in our kitchen, when she lived in this house, which makes me really feel lovely about creating more happy memories in these walls! (She only moved two doors down, but to a 3-bed, when they were all council owned.)

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