Induction questions

[MuddyWellyNelly]

Basically I'm trying to decide whether to go for induction at term or not. This is due to being 40. No other risk factors at all, have had an easy pregnancy so far.

There are two or three main deal breakers for me. The first is staying overnight in the early pessary stages. I've been told it will be an inpatient induction but I'm not doing that. What reasons am I likely to be given for having to stay? I know I can do what I want but would rather have the consultant on my side. What compromises are possible? I don't want to be apart from DH and want to be able to relax at home if it takes a long time.

Secondly can I stop after pessary/gel stage and give nature more time to work? My leaflet says breaking waters would be next but didn't make it sound optional.

Finally can I insist on a section at any point instead of further intervention? I don't want the drip.

[MuddyWellyNelly]

Sorry meant to say I'm 37 weeks tomorrow. So still time for things to start on their own. But if they don't I want to be prepared for what my consultant might say.

[Scotinoz]

Don't know the answers, it's things you'd be better off asking your OB/midwife.

For what it's worth, I'd much rather have the drip than a c-section!

[MuddyWellyNelly]

Thanks yes I'm going to ask the consultant, but as they have a tendency to "tell" what will be happening, I want to know what options might be available in
Advance, so he doesn't railroad me. I want to make an informed decision but I don't tend to get the answer to my actual question when I ask him.

MW is pretty useless.

[IlPorcupinoNilSodomyEst]

Do you feel a need to go for induction? They generally let you go to +12 before induction is brought up, I thought. Perhaps better to wait and see if things kick off naturally...

[MuddyWellyNelly]

It's different if you are old. They induce you at 40 weeks as standard if you're age 40+. I don't particularly want induction no every fibre of my being screams no but there is a very small statistical increased risk of stillbirth beyond 40 weeks if you don't. I'm therefore trying to become comfortable with the idea and to find compromises.

[StarlightMcKenzee]

Have you had a baby before?

There are very few circumstances where I would agree to an induction. It is bad for baby and bad for mum.

Either the baby is in danger or not. If he/she is, then cut him/her out immediately. If not, leave well alone. IMO

[MuddyWellyNelly]

Sorry I should say you are "offered" induction at term, but that hasn't happened with me. My consultant just put it in the calendar and told me.

[StarlightMcKenzee]

'but there is a very small statistical increased risk of stillbirth beyond 40 weeks if you don't.'

Not really. There is an increased risk of death every day that you are alive, regardless of where you are (womb or not). There are risks of death and disability associated with induction.

You can opt for monitoring.?

[MuddyWellyNelly]

Starlight no, first child. In general I agree but I'm currently just trying to weigh up options. There is a statistical risk to not having the induction and as I said above I'm trying to make a fully informed choice.

If anyone can actually answer my questions I'd be very grateful as it would help my thought process.

[StarlightMcKenzee]

You'll be asked to stay because all inductions stages increase the risk to the baby so they'll want close monitoring. You might not have to stay in the ward though.

[NotAQueef]

I was induced (though first stage pessary didn't work and went into labour on my own minutes before I would have been given gel) but was allowed home once had been monitored (after propess) - is there no way they can give you propess and let you go home for a bit? Is being 40+ classed as not low risk?

[MuddyWellyNelly]

The statistical increase is compared to mothers under 40 going beyond term. It's due to placenta failure happening more quickly in those of us who are ancient. I'm twice as likely to have a still birth beyond 40 weeks and this induction policy has lowered the rate. All that said, I don't really want one but I don't know if I can gamble either, given everything we went through to get to this point.

If they won't let me go home then it won't be happening though. I've been told I'm on a ward at first which is why I know DH would have to go home.

I'm already being monitored twice a week even though not a single thing has been found to be an issue with me or the baby

Sorry on phone so apologies if this doesn't make sense !

[MuddyWellyNelly]

Not, that's what I'm hoping and need to ask consultant but wanted to get a sense of other 's experience. Other than an arbitrary age thing I've had a ludicrously healthy pregnancy.

Would be good to know if others were allowed home too.

[MuddyWellyNelly]

Apologies also if I sound cranky. I've been wound up about this induction from the start (from when it got typed in my notes but never mentioned to me) and even now I've never been told I have a choice. I only know that due to MN. But I have form for stubbornness, and just need to be sure I am not going to say no just because I refuse to be told what to do.

[RedKites]

The NICE guidelines on induction (see 1.6ish) certainly imply that outpatient induction is possible, and if you go on a few pages the research recommendations say that some hospitals do outpatient induction in the early stages. It certainly seems reasonable to discuss with your consultant. And hopefully you'll go into labour before then anyway.

[hugoagogo]

It's really hard, but I think you will find the next few weeks less stressful if you accept that you are not in control of what happens.
You might need to be induced, you might not.
You might have to stay in hospital for longer than you would like or you might be in and out in one day.
Stressing about it helps noone especially you.
You always have a choice about what happens to you and you don't sound the type to be railroaded into anything, but remember the staff have seen more births than you and are there to help you.
I hope you are enjoying your last few weeks, but suspect you might be hot and uncomfortable?

[LibrariesGaveUsPower]

In terms of your questions :

Some places do outpatient induction. You can't compel them to though.

I don't know about stopping. you could agree that they will move to section if the pessary doesn't work though. I know people who have said that they will not consent to arm or drip and the consultant has agreed to go straight to section.

Would you consider an elective section instead of induction?

[MuddyWellyNelly]

Redkites thanks for that, I will have a read properly as soon as our internet is fixed. That sounds hopeful.

Libraries I would agree to an elective section if they could persuade me that there was a genuine medical need to get my baby out more quickly. I won't have one at 40 weeks though, just because of a perceived statistical risk. If I get to say 41 I might consider it over an induction. A couple of weeks ago I thought it was a certainty anyway as baby was still breech until 36 weeks.

Hugoagogo (great name!), though you'd not know it from this particular thread, I'm absolutely fine with the ambiguity that surrounds labour. I know that I can't predict what will happen, and that medical realities may intervene. If I need to stay in hospital due to say PPH, whilst it would be awful and not anyone's idea of fun, I'd be completely accepting of the reasons. And if I needed an induction for medical reasons (pre-eclampsia say) then I'd go with the flow. But an induction with no clear medical reason is not the same, and whilst of course they know more than me, that doesn't mean I should just let the doctor decide what is best for me. I get to choose, as you say, and to my mind this is exactly when I should take full control of the decision. That's why I'm trying to understand the possibilities. I am stressed about the induction part, yes, but I'm not actually that stressed about labour. I am seeing my midwife today, but she's unlikely to help my decision.

I'm tempted just to cancel the induction altogether; this would certainly reduce my stress levels back to normal – it really is the only thing that's worrying me. But if I could get agreement to my proposals, I might be persuaded to go for it. So I guess I need to talk to my dictator consultant after all…

Thanks everyone for your thoughts. It has really helped to spell it all out.

[CazY777]

Muddy, here's my experience, which may be of some help:

I was told I wouldn't be 'allowed' to go over 40 weeks as I was 40 which really stressed me out. I told them I would go for monitoring instead. Once I reached 40 weeks I went for monitoring every 3 days, I was completely fine all through my pregnancy and the baby was fine on the monitoring. Once I got to 10 days late they got very jumpy and told me I needed to start working with them (I wanted to wait as my dates were later than the 12 week scan date). I had a scan and DD was predicted to be 9 pounds so I went for the induction as I thought it best that she didn't get any bigger in there!

They started with the 24 hour pessary (sorry I can't remember what they were called) and I went home and came back the next evening. I was contracting when I came back so couldn't have anything else and stayed over night. Contractions stopped so the next day I had the 6 hour pessary and went home again. Contracting again when I got back so had to wait again overnight, then stopped again. Everything took so long and there was still no change to my cervix on examination, and I'd had enough of all the examinations (I'm anxious in hospitals too) so when they suggested a c-section I decided to go for that as it seemed the best option (other than going home!). They also offered the option of giving me an epidural and breaking my waters but my cervix wasn't dialated so I just thought this would lead to more and more interventions and then probably an emcs. My baby was born healthy and I left hospital the next day.

Sorry I can't be more positive but hope this helps a bit with info on what's possible.

[MuddyWellyNelly]

Caz thanks it is helpful actually. Thank you. It's good you got to go home during the process. I think that if they try to start me too early (ie 40 weeks) when baby isn't ready then it's far less likely to work. But I'm prepared to give pessaries a go so long as I don't end up with unnecessary sleepless nights in hospital. At least I'm sure of my dates due to IVF. It feels like if I'm relaxed at home things are far more likely to progress than if I'm climbing the walls with cabin fever/boredom/loneliness/exhaustion/lack of fresh air.

I mentioned it to my midwife today who was indeed less than helpful, but had at least put on my notes that I want to discuss it.

[LibrariesGaveUsPower]

If they talk about induction success stats do ask about whether that is all mothers or first timers. Those with previous vaginal birth are likely to respond far better to induction so can skew the stats. Just so you are armed with questions.

[LibrariesGaveUsPower]

I went far post dates btw with DC3 and had alrwady refused induction at 42 weeks (I am 35) when he came at 41+6. I have had the drip and would take section over that in a second.

[BurningGubbins]

Different circumstances for me as I was induced at 37 weeks due to pre-eclampsia, but for what it's worth: I was on a sort of mini ward (6 beds) with other women in early stages of labour or being induced. Once the pessary was in they encouraged me to wander around and just asked that I checked in at regular points - went went out for lunch and a nose round the local high street (walkable). There was no question that my husband would have to go home at any point.
It all went tits up for me as I had an odd reaction to the pessary and ended up having an emergency c-section, but that was totally fine. If I were to have any more I wouldn't be induced if I didn't go into labour naturally, but that's because it didn't work out for me, rather than the process of induction.

[Boredworkingmum020]

Don't let them break your waters until you are well on your way. If your labour lasts a long time your are at increased risk of passing on infection. My waters were somehow broken when I was 0cm. I was still 0cm 16 hours later my son had congenital pneumonia. See how you feel and how your body is at the time. If it shows no sign of labour induction is unlikely to work in any case

[didireallysaythat]

I was lucky. Induced at 10am at 42 weeks and in full labour by 2pm. Luck didn't really pan out though (DS born 3am in theatre minutes away from a cs - and in hindsight a cs would have been better than the foreceps and 3rd degree but I appreciate they did the right thing for DS).

So some inductions, perhaps the minority, can start things going really fast. Not am overly comfortable experience if I'm honest, but effective.