Handling pressure to be induced on due date

(65 Posts)
Liveinthepresent Mon 03-Jun-13 10:14:57

Hospital policy is to induce on due date as I am 40+.

I am very keen to avoid the pressure of induction looming over me before I am even overdue as this marred the end of my last pregnancy too ( due to waters breaking and no contractions).

Have a meeting next week to discuss the plans - and am keen to arm myself with enough facts to know what my options are and how long it is reasonable to stall this intervention for.

I know I can push for monitoring instead - but last time I was put under huge pressure to stay in and be induced - and I just want to agree as much as possible next week rather than having constant negotiations.

I do understand there is a reason for the policy but would be especially interested if anyone has any access to actual stats relating to an increased risk of going overdue at my age. Is this policy standard at all hospitals?

I'm not advocating making any decisions that genuinely put my baby at risk - I just want to unerstan it beyond my midwife telling me they many give me a few days but not much longer...

Thanks in advance if anyone has any information or experience of this.

YOu honestly don't have to negotiate anything. You don't even have to subject yourself to a conversation about it, let alone pressure.

In a worst case scenario, you send them a letter informing that that you do not want to discuss this face to face and will do so by email/letter. Any attempt to do this will be considered as harassment. You do not want a repeat of your last pregnancy. You will only be attending appointments for basic monitoring and not a discussion on any interventions.

It's a bit extreme, but if you hold that in mind as your baseline then everything else is a bonus.

'I do understand there is a reason for the policy but would be especially interested if anyone has any access to actual stats relating to an increased risk of going overdue at my age. Is this policy standard at all hospitals?'

Surely these are both reasonable questions to ask, in writing, of the hospital before your appointment next week.

I'm in a similar position though mine is due to O.C (liver problem) they keep saying I 'have to be' induced at 40 weeks and 'can't' go over and need constant monitoring and basically can't have any of the things I wanted in my birth plan because of the 'risks'.

Like you I'm finding this quite stressful especially since these 'risks' are based on very little actual research or statistics, I've got my appt to argue with the consultant about it all next week but like you don't know quite how to handle it - don't want to be bullied into things I don't want but don't want to go against medical advice and take unnecessary risks. So I'm afraid I don't really have advice but as someone in the same position just wanted to sympathise!

Liveinthepresent Mon 03-Jun-13 13:27:12

Thanks both - purple sorry you are in same boat but always helpful knowing you are not alone.
Actually last time I did get my natural birth ( with a few compromises) so I guess in a way that makes me more determined this time- I can't help but feel like the stress may have actually not helped the delay of contractions.
Starlight thank you - that's a good point about the baseline - its just so hard being that assertive when you can't help but think they must be doing it for a reason- I felt very vulnerable last time when they had written in my notes 'advised about increased risk of stillbirth' despite no one really actually articulating that or specifying the risk I was taking...
Anyway am waffling now but will keep researching.

quertas Mon 03-Jun-13 15:59:38

I guess policies are very different from area to area. I'm also 40, down for a home birth, and told that there's no reason to think about induction / changing to hospital even until 42 weeks. This may be partly because my last pg went to 42 weeks with no problems though. I think this is quite a useful resource for thinking through the risks involved http://www.theunnecesarean.com/blog/2009/10/3/postdates-separating-fact-from-fiction.html and perhaps gives a framework for discussions. As another poster has said get them to explain why they're advocating it and back it up with evidence. 'It's policy' is a bullshit answer' and should be ignored.

Liveinthepresent Mon 03-Jun-13 18:28:42

Thanks quertas very useful to know your situation and great article.
Good luck with your homebirth.

DD was actually born at 40+1 so this may all be unnecessary worrying if that's an indicator of how it may work out again this time.

StiffyByng Mon 03-Jun-13 18:40:28

One useful thing to ask is the increased risk of interventions with an induction. I found my hospital very willing to talk about increased risk of stillbirth at 42+ weeks but very unforthcoming about the risks of induction. I was tipped off to ask the question by my community midwife and I got a rather spluttered response from a registrar.

See that's part if my problem with it - increased risk of intervention v virtually undocumented, not proven increased risk of stillbirth based on very little research at all. I can understand they're risk averse but I fear it is more about avoiding me suing them rather than my welfare.

glorious Mon 03-Jun-13 19:12:03

Sorry for the stress purple. It's definitely not policy everywhere as a friend over 40 here in London went to 40+13 (was due to be induced that evening). I found the same on risks of induction vs. stillbirth. And don't get me started on the debate I had on accuracy of scan dates (apparently they're never out at all so I conceived 5 days before DTD or ovulating hmm ).

Splatt34 Mon 03-Jun-13 21:24:27

i don't know about the age thing. I was nearly induced at +12 but delivered the night before. The midwife all kept telling me some ladies just spend longer growing their babies and 37-42 weeks all 'normal'. Wish your Edd was 27/4/13 - 1/6/13 then!!!

Liveinthepresent Mon 03-Jun-13 21:51:47

More replies - all useful thank you!
glorious you wouldn't happen to know which London hospital your fried was with? I am in London too - so might be a useful comparison to mention at my appt.

glorious Tue 04-Jun-13 04:25:09

Yes live, it was Lewisham. Good luck smile

I have the same thing. I was 40 in April, due 30/07 according to scan but 01/08-04/08 from when DH was in the same country as me!
In N Somerset and here they also push induction at 40+0.

I've chatted to community MW who seems in agreement with me that if all is well and I have daily monitoring they'll give me a few days. I've tried to follow the BRAN approach when discussing it:

B. what are the benefits of the induction
R. What are the risks
A. What alternatives are available
N. what happens if I do nothing

Good luck and hope you get the outcome you hope for thanks

StiffyByng Tue 04-Jun-13 08:58:34

Friends of mine over 40 have had babies at St Thomas' and Kings and not had the induction at 40 weeks thing. My friend at UCH did though.

This seems odd.

I thought the 'normal' full term gestation was generally regarded to be 37-42wks. Not precisely 40wks. After all it is rare to be able to precisely pinpoint the date of conception.

I thought the average was 40wks...meaning that by the law of averages up to 50% of babies will be born without intervention to induce after 40wks.

Look for yhe WHO guidelines for induction post 40wks. I'm sure someone will be ablr to point you in the right direction. I think those guidelines are evidence based.

Liveinthepresent Tue 04-Jun-13 10:02:16

Thanks Remembering ( like your Nn) I think it's the 'they'll give me a few days' that bothers me most - ie it's their decision not mine and I know from last time it was like having a huge ticking clock making me feel under pressure..

At the moment I feel like saying I will not pre agree to an induction date for this reason - and asking for factual evidence of benefits and risks.

quertas Tue 04-Jun-13 11:52:17

I know what you mean Live and I also think that the chunterring about inductions was the thing that delayed my going into labour with my first DC. By the time i had the induction i dud feel a bit harried into if and it made it harder to cope- ie feeling that that sintocin (sp?) contractions were something the staff were inflicting on me,rather than being productive labour pains. One option might be to either take someone else along to any appointments subsequent to your consultants appointment to run verbal flack (' my client is not prepared to discuss this at this time' style) or respond to everything with either "I'll think over what you've said" (trans 'shut up') or 'my partner/DH will discuss it and get back to you' (trans 'shut up'). I love the BRAN approach! Ghats one I'm going to use in a variety of situations - brilliant! Good luck and stay strong, it us your decision to make, not theirs. (And equally if you decide to have an induction then that's also your choice, not caving into pressure)

quertas Tue 04-Jun-13 11:53:40

Apols for all the spelling errors there - dratted phone!

EldritchCleavage Tue 04-Jun-13 12:06:09

I had the same experience: my thread is here.

I never really got a good answer. Induction was stopped as DD was an unstable lie (still is, the little livewire!) and I had a caesarean.

LaVolcan Tue 04-Jun-13 12:33:50

Mary Cronk's advice might be useful in your situation.

Liveinthepresent Tue 04-Jun-13 22:32:08

Thanks so much for all these extra responses - am just reviewing all the info - so far not found anything specific about maternal age as a reason for induction within NICE/WHO guidelines.
Am feeling my resolve strengthen and have started to discuss tactics with DH.
Really appreciate the Mumsnet wisdom - hadn't discovered it last time around!

What day is your battle with the consultant appointment next week Live? Mine's Thursday, we can compare notes after wink

Liveinthepresent Tue 04-Jun-13 22:44:21

Thursday 9.00 am Purple - good idea!

Ha ha 9am Thursday here too, how unlikely! Know mine isn't related to my age but otherwise it's the same issues really so will be interesting to see how we get on with our negotiations!

I had quite a bit of an issue with my midwives as I went a lot overdue but refused sweeps and further scans etc.

They kept banging on about 'letting me' or if I didn't do something then they couldn't agree to 'let me' etc etc.

I met most of those statement with a non-committal 'hmm' and then when asked to commit to something a simple but polite 'no thank you'.

EG 'If your baby is still in there the day after tomorrow then we'll have to do something about it'.

Me: 'Hmm'.

Then next time it was 'We need to book you in for induction'

Me 'Hmm'.

Them 'We've got Next Monday - okay?'

Me 'No thank you'.

Them 'Well I can't let you go much longer than that'.

Me 'Hmm'

Them 'Well shall I do a sweep'

Me 'No thank you'

Them 'Well what about tomorrow'

Me 'No thank you'

Them 'Well we'll definitely have to do one the day after'.

Me 'Hmm'

etc etc.

Shellywelly1973 Thu 06-Jun-13 11:19:12

Starlight - your brilliant! Im going to use your very calm & collected way of dealing with hcp's!

Just wondering how you got on this morning?

Snowsquonk Thu 06-Jun-13 16:09:28

I love the way hospitals have "policies" on things like induction!

What we need to remember is that a policy is something which can be enforced - so the policy actually relates to the hospital staff and not the patients - because they cannot do anything without our consent.

So a policy for induction of labour if you are over 40 means that the staff have to suggest or recommend this. But you, as the patient, can take it or leave it. Because they cannot MAKE you do anything - what are they going to do, come round and frog march you to hospital?

It's actually a guideline for patients and guidelines are just that !

Liveinthepresent Thu 06-Jun-13 20:48:36

Thanks starlight and snowsquonk more ammunition here!
shelley I am confused and confusing confused - my appt is next weds - not Thursday - so am going to do some notes / prep and rehearse my lines with DH over the weekend!
Found some interesting info about risks of induction in Ina Mays Guide to Childbirth which I may also use.

EldritchCleavage Fri 07-Jun-13 12:54:42

That's key-you are having to balance competing risks here, not pick a no-risk avenue over a risky one (which was how it was presented to me). I had a very ratty consultation with one patronising doctor that got me very worked up at the time. In retrospect I should not have engaged as much, just used Starlight's approach.

And it was verrry interesting how the pressure from the ante-natal clinic folk (unanimous, sustained) was met with quiet derision from everyone on the labour word-midwives, registrar, consultant. Bear that in mind-at least at Queen Charlotte's, there didn't seem to be anything like a consensus about this among the HCP.

Karoleann Fri 07-Jun-13 13:49:06

This is a good and recently published article, in a peer -reviewed journal. I couple of the articles mentioned are just one person's opinion.


Good luck hope all goes well. Incidenally I was induced with my second and third pregnancy at 40 weeks as I had a placental problem with my first child. It was all very straight forward with no intervention)

Karoleann Fri 07-Jun-13 13:50:48
Irishfairy Fri 07-Jun-13 23:24:18

Contact http://www.birthrights.org.uk/
And http://www.aims.org.uk/
Both are really excellent organisations that will help you in whatever way they can and will have the statistics and other info you were asking about. Good luck!

Irishfairy Fri 07-Jun-13 23:25:11

Sorry on phone and don't know how to do the links so you can click on them!

Liveinthepresent Wed 12-Jun-13 12:57:05

Thanks for all the advice and links to data everyone.
Had my appt this morning - was a totally different experience to what I had prepared so carefully for!
Met senior registrar who was lovely - she started off by telling me it was my choice - and did I know why it was recommended - even referring me to the relevant study.
Made it clear there is no medical consensus .
Then asked me how I wanted to play it.
So outcome agreed is if no baby at 40+4 I am booked for a scan ( to check placental blood flow) then a meeting with the consultant to agree what's next - sweeps offered if I want them - no pressure re .induction.
I am so relieved and frankly so encouraged to meet such a refreshing health professional who treated my like a grown up!
So sounds like I am all on track to head to the MLU when it all starts - excited now!
Good luck tomorrow purple - please report back.
I printed off the birthrights PDF from Irishfairy in case I needed to point out my rights - you might find it useful too.

glorious Wed 12-Jun-13 13:21:02

Fantastic live, if only everyone had that kind of experience smile

Really pleased for you Live. I'll let you know how I get on, fingers crossed its as positive an experience as yours!

Well my consultant wasn't willing to be flexible at all unfortunately, I know my situation is slightly different as it's due to a medical condition rather than age but she basically said no to everything I suggested. So I've ended up asking to be referred to another hospital which is further away from where I live but where I should hopefully be able to have some of my requests met. There's still absolutely no shifting them on induction though so I'm afraid that seems inevitable but hopefully I might be able to get at least the water birth I wanted. Just got to wait to be contacted by the new hospital to arrange to go and see them and enter into more arguements negotiations with a new consultant there. They better get their skates on though, I'm nearly 38 weeks and some care trusts have a policy of inducing at 38 weeks for the condition I've got!

'There's still absolutely no shifting them on induction'

What they gonna do, arrest you and pin you to the wall whilst they put a drip in?

If you are convinced of their arguments then fair enough, but it is still YOUR choice, not theirs.

Did you ask the consultant for their concerns on each of your points?

Could you request them in writing?

Liveinthepresent Thu 13-Jun-13 21:12:46

Purple really sorry to hear that. Have you got clear information on why they are recommending it for your condition at least?
As Starlight says you can still decline - as long as you have all the information to make an informed decision.

Hope the new hospital are accommodating - and quick - I found the worst thing is dealing with all this stress in the last few weeks when we should be relaxing!

Thanks Live - I'm kind of ok with it all now that I can hopefully at least have the water birth I wanted I just couldn't deal with the total inflexibility!

Feel like I can deal with being induced if I can have the pool - it was the idea of being strapped up to monitors and stuck in a bed that was freaking me out the most. The monitors in the water doesn't seem so intrusive and restrictive somehow. Waiting to hear from new hospital and go and have a look around but feeling quite positive about it all.

Hope you're doing ok, not long to go now!

Liveinthepresent Fri 14-Jun-13 21:16:22

Glad you are feeling ok about the situation -and that the waterbirth is achievable.
I am feeling so much more relaxed about the birth now - and instead seem to have reverted to fretting about coping with two and newborn sleep deprivation !
Not happy unless I am worrying about something it seems. smile

sleepyhead Fri 14-Jun-13 21:29:03

There's no official guidance on induction at term aged 40+ as you probably know. The Royal College of Obs & Gyn are looking into it at the moment and I think there's a trial underway.

The summary of the current evidence is here.

I was the opposite to you as I requested induction at term (I'm 40) because I'd read the evidence as part of my work (non-clinical) and although the risks are probably tiny I knew I'd fret about it. I was on a midwife led, low risk pathway though and they'd have been happy to go to term +10 before talking about induction.

Anyway, I went into labour 2 days before my due date, 4 hours start to finish and it was great! I hope you get the birth you want - I found birth and the aftermath at 40 much easier than at 34!

How are you getting on Live? I saw my new consultant at the new hospital today and it was a MUCH more positive experience. They were far more ready to listen to what I wanted and were keen to do everything they can to encourage things along naturally (loads of sweeps) rather than blindly inducing because its 'policy' when my body isn't ready and risk induction failing so all in all feel much happier with my situation now.

Hope you're getting on ok, any signs of baby getting a move on?

Liveinthepresent Wed 19-Jun-13 21:04:58

Purple that's such good news - hope you can relax and enjoy the end of your pregnancy now.
I have no signs but am trying to get into relax and mentally prepare mode - just not thinking about what if he/ she doesn't arrive punctually - it's easier to do that now I don't have a deadline date looming.

Good luck - do report back!

Sweep number 2 today and things had improved since last time (which was only tue), next sweep Monday so fingers crossed things get going next week! Any movement Live or is your baby firmly staying put? grin

Liveinthepresent Fri 21-Jun-13 13:51:48

purple sounds promising!

I gave birth to a baby boy last night! Unplanned home birth - a bit scary when I realised how quick it was progressing but am feeling very serene now that he is here safe and sound - with no medical stresses.

Hope you have a similarly positive outcome ( without the 999 call!)

Wow! CONGRATULATIONS! flowers hope it wasn't too traumatic, sounds a bit stressful. Fabulous news though, you've made my day grin

Liveinthepresent Fri 21-Jun-13 15:19:47

Thanks purple it wasn't traumatic - just a bit of a shock - am now in newborn snuggly heaven.

The irony that I didn't even make it to my due date after all that is very pleasing!

Good luck and please let me know when you have more news.

Ha yes, all that worrying about induction unnecessarily, what a fabulous bit of luck!

Aww enjoy your newborn snuggles, I'm not due until 2nd July so you might have to wait a week and a bit for my news but hopefully not, I can't wait to have a newborn to cuddle myself! Look after yourself x

glorious Fri 21-Jun-13 16:06:21

wow well done live , what a shock! Does DS have a name yet? thanks

Good luck purple

Ushy Fri 21-Jun-13 16:18:03

Live in There is a ten year old study that has these stats:

"When calculated per 1000 ongoing pregnancies, the overall risk of pregnancy loss (stillbirth + infant mortality) increased eight-fold from 0.7 per 1000 ongoing pregnancies at 37 weeks to 5.8 per 1000 ongoing pregnancies at 43 weeks of gestation."

Age wise, the risk of stillbirth seems to be put at about 1.32 for 35-39 then 1.88 over 40.

So not a huge risk but equally not non-existent.

Personally, if you go for induction, I would not let them do more than one method of induction - if they start ramping up with drugs to speed up labour and then multiple ways of induction you're got a much higher chance of ending up with a long traumatic labour ending in emergency c/s or nasty instrumental or both - not to mention a distressed baby.

I'd go for one attempt and then get them to agree a c/s if that fails. One of my friends did this and it worked out fine for her - they agreed with her plan and she was roughly your age. It did end up as c/s but was quite calm and non-traumatic - everyone was fine and she was up and around in no time.

Good luck

Ushy Fri 21-Jun-13 16:19:00

Oops - just crossed. Congratulations and glad it all worked out so well.

Quick update for Live - saw consultant this morning and was booked in for induction Sunday morning when I'd be 38+5 but my waters just broke so fingers crossed I might just get the natural birth I wanted as well!

Hope all is well with your little one.

glorious Fri 28-Jun-13 17:40:30

Ooh exciting purple , hope things get going quickly smile


Liveinthepresent Fri 28-Jun-13 20:34:38

Very exciting news purple really hope you get the birth you hoped for now .... Ooh a baby on its way!
Look forward to more news.

Little girl was born at 1am, did end up having to have the drip and didn't get water birth or any of the things I was after - it all went a bit wrong! Doesn't really matter now though as it all seems worth it in the end anyway!

glorious Sun 30-Jun-13 18:49:40

Hooray congratulations purple thanks Sorry it didn't go as you hoped but I'm glad you're feeling ok. Have you decided on a name?

Liveinthepresent Sun 30-Jun-13 22:07:37

Congratulations purple - yes the main thing is you have your baby now - and weirdly the birth that is so all consuming in the run up becomes a moment in time that you will probably remember for all the positive reasons regardless. Hope so anyway.
Enjoy your well deserved newborn snuggles - and hope you recover well.

Thanks! Yes the actual birth seems distant already now I've got a baby to distract me! She's a little treasure and I named her Lucy. Thanks for all of your support x

glorious Mon 01-Jul-13 21:17:25

Yay, Lucy is a lovely name and I've never met anything other than kind ones smile . Awh, slightly jealous of newborn cuddles and mine's only 5 months! Well done you smile

ANJALI777 Tue 02-Jul-13 23:44:48

If there is nothing else wrong, then why induce? I am high risk and going to be induced next week, so a completely different situation to yours, but I still managed to convince my OB that if there was nothing wrong, then to aim for spontaneous labour.

Maybe tell your doctor that you would like to wait and see. You may go naturally before your due date, and if you don't then maybe a sweep instead of full blown induction??? Or come 40 weeks, you may be begging to be induced.

Make your doc justify how it is safer for you and your baby to be induced. There may be a good reason. It's not unreasonable to ask why. Just in a matter of fact way, say 'i'm sorry, but why exactly does this hospital have this policy??? I don't quite understand why you are planning this if I am fit and well?'

Good luck and let us know how you go xx

steffnexis Sat 20-Jul-13 13:38:08

hi purple and live... i hope your lovely chats with your doctors went well for you... i found this with my little one but for a different reason,... my baby was breach and i was 28yrs old.. they after a battle said they would LET me go full term without c section but at exactly 40 weeks i had to have a section... they made me feel like i was putting my baby at risk and i panicked for the last two weeks of my pregnancy... I have already written my birth plan for my next one which is due in 9 weeks as i am refusing to be bullied again xxx good luck and i hope you get everything you want from your births x

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