Mumsnet Talk

My midwife seems very against inductions and/or sweeps. At our antenatal class she said that she doesn't recommend induction as all babies come eventually when they are ready so why mess with Mother Nature? She didn't give any opposing arguments in favour of induction.

Tbh I'm less sure of her views on sweeps (I'm also doing all this in a second language so don't always understand her perfectly) but I think it is more or less the same.

She hasn't given any reasons FOR sweeps or inductions, but I have read on here that if you go too far overdue there is a risk of stillbirth due to the placenta beginning to break down. I asked her about this privately and she said once I'm overdue (36 weeks at the moment) I'll be monitored every two days anyway and if there are signs of trouble, then she would presumably recommend induction, but only if the baby seems to be in trouble.

I'm a bit confused to be honest - is she right? In the UK (I'm in Germany) sweeps and inductions seem to be given as standard and I'm not sure whether to go with her and take the view that the baby will come when good and ready, or to insist on an induction or sweep if say I go a week or more overdue.

Can anyone advise?

Thanks

I posted earlier on today whether to have a sweep or not, funnily enou!
I think you're in a interesting position in Germany in that the midwife seems to do what a lot of women would like to happen here in the uk, in that if overdue, you are monitored increasinly frequently post due date, for signs of any concerns either to yours or the unborn baby.

For example I now have one appointment at 41+2 next Friday at which I can have a sweep and discuss my induction but it seems a policy they would induce me on the following Monday - 41+5 - as baby would be then 12 days over.

I'm watching any other comments with interest too, as women have definitely been allowed similar close monitoring after the typical time for induction at around 12 days over, and allow to progress naturally, which ties in with your midwives approach...

I was induced last month at 41+2. Induction was incredibly painful, and it took 3 days and a lot of hormone drips to get baby to arrive. She clearly wasn't ready. I will not be agreeing to induction again but insisting on what the German system provides - regular monitoring and allowing nature to take its course.

Sorry that should say 41+12!

Ok, thanks for your responses, very interesting!

I can see what she is saying - she actually said that no mother has ever, in the history of babies NOT had her baby i.e it has stayed in forever!! So I thought "fair enough!" but I don't want to risk my baby's health by going too far overdue and her not getting the nutrients she needs from the placenta. I suppose if I am being monitored then that is less likely to happen.

My midwife currently comes to my house once a fortnight, and will come every 2 days after (I think) 40 weeks. I'm also hoping for a home birth so it would just be me, DH and the midwife.

Things generally seem a lot more "hands off" here. The Germans don't use gas and air at all (they think it is antiquated!) and a homebirth means no drugs at all...

Why then does the UK perform so many inductions?

As an aside, in everything I have read, it has said that the baby may come any time from 38 to 42 weeks. It therefore seems insane to induce before 42 weeks? Unless there's a medical reason that I'm not aware of?

They induce people if there is a medical reason eg pre-eclampsia, and also generally with multiple births, before 42 weeks, but I agree it is mad to induce for dates before 42w. I think the UK do so many because of the risk of placental failure; presumably the German system is based on different research or a different mindset around managing the risks of placental failure.

I think thiet system would suit me better EXCEPT they are soooo missing out re gas and air! Tis wonderful stuff! How is pain relief antiquated??

DS3 came 12 days late and I was seen twice in those 12 days (second time at hospital to have sweep and be booked in for induction at term + 12 which wasn't needed in the end).

Monitoring every 2 days did not happen, which might explain the increased rate of induction - if they're not monitoring frequently, they need to encourage delivery?

When I had DS2 I was told I would only be allowed to go 7 days over my due date before induction would be started. I was made to feel that I had no choice over it as "that was protocol". Thankfully it all happened on the 7th day by itself . I do wonder if all the intervention ultimately means a higher rate of caesarians and forcep deliveries.

I had a sweep at 41 weeks which was uncomfortable and did nothing, i was already 2 cm dilated. don't think i will be having a sweep again, as it just got my hopes up of something happening which then didn't. at 42 weeks I was induced, tbh I didn't like the idea of being induced but as I could only wear my hubbies t shirts and jogging bottom at this point, I had entirely grown out of my mat clothes and couldn't do more than move from the tv to the fridge to the toiletvfor the last week it was nice to have a definite end point. I had also been reading a lot about how awful inductions were and was frankly terrified. I went into labour after the second pessery and my son was born 2 hours later, all very controlled. I am pregnant again and if I go 2 weeks over i will be going for an induction again, actually kinda terrified of going into labour naturally and of having to get to hospital etc, which I know is kinda silly as most people manage this fine.

funchum they call it "laughing gas" and are convinced it affects the baby. Same with any pain relief in fact - the ideal is none, but they will give you some if you need it.

If you think you might want an epidural, you have to do a half day course before delivery to advise you of the risks! Then you basically sign a disclaimer.

Interesting view "eltish". As I'm hoping for a home birth it seems to make sense to me to wait until the baby is good and ready. I'm sure you are right bubbles about the increased intervention rates - those poor babies seem like they are being dragged into the world ready or not!!

sorry eltsihT total fail there!

Balance of risks. There is a small but significant risk to the life and health of a baby that remains in utero for too long post-term, largely due to placental failure (also other reasons like a larger baby raising the risk of birth complications). It is NOT just a convenience thing and I would raise my eyebrows at the "no woman has ever not had her baby in all history" comment - plenty of women throughout history have delivered babies that are sadly not alive. Monitoring can help but does not eliminate the risk.

On the other hand, pushing a uterus to contract and expel the baby before it's "ready" can make labour more difficult and birth complications more likely (though not inevitable).

The exact "cut-off" when the first risk overtakes the second is disputed, which is why policies vary between hospital and country. In the UK it's commonly agreed to between 10 and 14 days post-term, but many people validly question whether this is too early.

A good midwife or obstetrician will be able to give you the figures and help you decide what risk YOU are comfortable with.

I'm not saying anything about the necessity of otherwise of inductions, but they do have all the kit and drugs in German hospitals and you are allowed to use them, even though your mw will try to dissuade you.

I spent my late pregnancy in Germany and hated it. My mw was dismissive of my enquiries about pain-relief. I came back to the UK and was in fact induced at 42 weeks and very very happy with the labour ward who got him out safe and well. I was 42 though, so more chance of a failing placenta.

I had a sweep which did nothing and then an induction, which made my baby go into distress when I started contracting and had to have an emergency c section. The induction was awful. I heard afterwards that something like 70% of inductions end in c sections, which must say something about them not working and putting mothers and babies through unnecessary stress....

Btw- I had pre-eclampsia, that's why I was induced etc....

Your midwife sounds very different to any of my midwives. They are all for inductions if necessary no one will argue it's better to go into labour naturally but sometimes it is less risk to induce.

I was induced with DS at 39 weeks after having 3 large bleeds it was unnatural and painful but after he was born they found a problem with the placenta. Due to the induction procedure and educated risk they had doctors on hand and my blood type ready which saved my life after delivery. If they has left me it is likely my DS would have struggled and I could have been at risk.
Sweeps, from what I'm told, only really work if labour is close and just a helping hand prob like they say sex can induce labour will only work if your ready.
I don't think the UK - or many areas- have the staff to monitor that closely once you go overdue so they have to consider that in the risk factor. I hadn't heard 70% of inductions end in c section that is a pretty scary stat! X

i have researched this alot

i will not consent to induction until at least +21 by MY dates
(I am happy to consent to monitoring after + 14)

if you look at the stats the still birth rate between +14 and + 21 are only slightly higher, and still very very low risk over all.

and i would still have baby at home at +21

(if there was ever any medical reason to be induced or need to be in hospital then i would consent to going to hospital for it, just to be clear )
I dont consider the date being a day or 2 after yesturday to be a reason to put myself and my baby through the risk of induction and the resulting complications that often arise

Very interesting Nannyl
I agree with you am pregnant again and ideally will go naturally as long as I can if safe for me and baby - although many mums by full term get a bit desperate to have the baby so keener to consent to induction.

I didn't find out I was pregnant until I was about 17 weeks, so my dating scan wasn't accurate. I was due 19 Dec according to that. I was monitored every day. I had 3 lots of prostaglandin gel on 26 and 27 Dec but didn't dilate beyond 1cm.

I decided to have a c-section as OB worried about large size of baby. I'm only 5'3" and he put baby at over 8lbs. He was 10lb 11oz.

Turns out my placenta was almost totally calcified.

Stillbirth risk goes up steadily day by day after term+14 but not a sudden massive increase. We induce here before this as benefit is generally thought to outweigh risk at this point and most women agree with this as there is nothing worse than getting this far, coming in in labour and finding out your baby is no longer alive. It's very difficult to be definite about dates as nothing (other than IVF) is completely accurate but it's generally agreed to do whatever is most likely to give you a healthy mum & baby. Induction increases risk of needing additional analgesia, if you have an epidural that increases risk of instrumental and if IOL fails it may mean CS but as said, many will take these increases in risk to avoid the small increased stillbirth risk. I always tell people that we're adults & can make the decision that is right for us and it is different for everyone but the healthcare teams job is to inform you about their guidelines, why they exist and risks vs benefits.

It's all about weighing up risks isn't it? A woman in work went overdue, think she went in for an induction, and the baby had just died. So just knowing that story means I'm v unlikely to dispute the hospital telling me I should be induced, increased intervention risk or not. But that's just because of hearing that storyrather than statistical analysis. Increased monitoring would surely reduce risk.

I was induced on my due date due to GD and it was a disaster - she obviously was nowhere near ready and it ended in an EMCS.

BUT at the end of the day I brought home a beautiful live baby so its not something I will ever complain about

Thanks for commenting everyone. I'm really hoping for a home birth with as little intervention as possible (in an ideal world ). I think by the sounds of it if I'm being monitored every two days I'll be happy to go to 41 weeks and beyond. I think once 42 weeks have been and gone, then I can see a case for induction....

I'm also pretty sure of my dates which also gives me a bit more confidence. I can see that if you get to 41+++ AND your dates are a weel out, that could be a risky situation.

week obvs...