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Pressure to induce at 41 weeks due to 'policy change'

(16 Posts)
Marecrow Fri 21-Nov-14 14:57:20

I have just got back from my due-date appointment at hospital, and I am fuming. I think my experience was tainted by the fact that I had to argue with the first person I saw, a midwife, because she read my notes wrong and insisted I was 33+6 and not 40 week pregnant. I had to physically go over to her and point to the date she was reading wrong on my notes...

Next the obstetrician comes in and says 'There are two things we are going to do today, offer a cervical sweep and book your induction for 41 weeks'.
I was like 'WHAT? No! I don't want an induction at 41 weeks. I thought you didn't induce until 42 weeks'. She seemed really shocked and argued with me, suggesting that I would be putting my child at risk but then seemed to accept that I didn't want it. I felt really put out at having to discuss an unwanted induction at only just 40 weeks.

We continued the appointment and then she brought it up again this time suggesting that because I had a borderline low PAPP-A I should be worried and I should have an induction ASAP. The link to low birth weight/placental problems is very low for low PAPP-A but I had been monitored with extra scans- and everything has been absolutely fine. I asked her if she had any research to back up this correlation, and she said- NO. So I felt like suddenly she was making this personal, but when pushed she said that they had a policy change and 41 weeks was the standard day they offered to induce women now.

I really want to go into labour naturally if possible, and the doctor has actually said nothing to me which suggests that it is necessary to induce at 41 weeks instead of 42. I just feel like I have been manipulated as well and that she was trying to bully me into something by repeatedly trying to persuade me. Obviously I will do what I can for my baby to be healthy, but I see nothing that suggests inducing at 41 weeks is necessary for that!

HAs anyone had any experience with this?

littlejohnnydory Fri 21-Nov-14 19:35:28

Similar position here, induction offered routinely at 40 + 10. I'm currently 40 + 6 and have declined to see the Consultant until 42 weeks, at which point I will ask for monitoring instead of induction. I intend to go armed with my info about the risks of induction and some sensible questions about the relative risks. Expectant management should be offered as an alternative to induction and information given about both options.

Stuffofawesome Fri 21-Nov-14 19:41:24

Don't be bullied. Call this lot www.aims.org.uk/

littlejohnnydory Fri 21-Nov-14 19:41:42

Should mention that my second child was born at home at 42 +2, and I went for daily monitoring from 40 + 10. The Consultant was quite relaxedabout not bbeing induced and agreed that there is no evidence that induction leads to better outcomes. I was strongly encouraged to have herin hospital but I'd looked into the risks carefully and was happy that iin my case a home birth was as safe ashhospital. Sorry about crap punctuation and double letters, it's my phone!

Ihatechoosingausername Sat 22-Nov-14 03:48:32

I'm 40+9 and I've opted for an induction as I'm worried about meconium poisoning

Marecrow Sat 22-Nov-14 10:12:47

I just find it very pressured and it irritates me that I was given both false information which the obstetrician admitted was incorrect, and limited information. It really annoys me to be condescended to in this way.

I just want to make an informed choice but I have not been informed so this is not possible! I will obviously choose to induce if thi is genuinely the best thing to do but I also really want to wait for a natural birth as long as possible... everything I have read suggests most women go into labour naturally by 42 weeks, and the (very small) risk only emerges after this point...

Induction is not famous for being problem free- for you or your baby....

Schoolaroundthecorner Sat 22-Nov-14 10:23:54

I was induced at 42 weeks, well 40 + 13, he didn't arrive until 40+15. I wasn't showing any signs of natural labour though so I'm not sorry I went for induction in the end. Hung on as long as possible.

I'm pregnant again and the obs has already made noises about likelihood of similar situation. My history and my mothers (induced on both her pregnancies including one with twins at 42weeks.....) seems to make it more likely.

Chunderella Sat 22-Nov-14 10:42:25

Induction at 41 weeks on average reduces the likelihood of EMCS, but that's not really the point here. They ought to have communicated that to you, assuming it's the reason for the recommendation, rather than simply said 'policy change'. This was very poor care.

ohthegoats Sat 22-Nov-14 18:18:18

I went to 42+1, arguing with consultants from 39 weeks onwards. There are no maternity police, no one will come and drag you off to be induced. Just stand your ground.

CountingThePennies Sat 22-Nov-14 18:28:19

I was induced at 40 weeks exactly due to severe SPD. After 22 hours of having intense pains every 4 mins lasting over a minute each time, i ended up with a c section.

If i have another child there is no way im being induced unless there is something very wrong.

redexpat Sun 23-Nov-14 12:24:04

Perhaps she is under pressure to not let women go so far over so was pushing induction on all fronts.

However, that doesnt wxcuse her misinformung you about risks. Id mention that informed consent means exactly that and any further misinformation will result in a written complaint.

Is it possible to see another consultant? Because i wouldnt have any faith in this one.

Marecrow Sun 23-Nov-14 15:02:17

I have decided after reading evidence regarding both meconium poisoning after 41 weeks and reduced cesarean sections with inductions before 42 weeks, to go ahead and book an induction for a week after my due date or thereabouts, which is next friday. Thanks to chunderella and Ihatechoosingausername for mentioning these things. I found this website helpful, www.childbirthconnection.org/article.asp?ck=10652#method which is a very informative website of a US campaign group for better childbirth, but I also had the privilege of talking to my old schoolfriend who is now a GP. Apparently a lot of hospitals will probably switch to recommending induction at 41 weeks.

However, from what I can find, there is no evidence of increased risk of placental deterioration after term in women with low(ish) PAPP-A. Basically, this was a possible marker for problems that have not occurred, and really should not have been brought up at all. It appears I was being lied to by a doctor who was panicking that she was not going to be able to persuade me to induce before 42 weeks.

I see no reason to lie to me... Other than to put emotional pressure on me to make a decision there and then. I don't think she banked on me doing my research. One of my best mates is a GP and my mother teaches medical students english in a hospital in the middle east... ironically she focuses on doctor patient relations and communication grin

So anyway, I have both access to research and people I can ask who I trust implicitly. I don't much trust doctors namely because of the pressure on their time and resources but also because I have experienced serious failures in their hands before. But stuff like this makes me trust them even less. As you say redexpat informed consent should mean just that... and instead of informing me this doctor has pressured me by lying to me... she even admitted she was talking rubbish!

What a waste of my time, if I had just been given the correct information to start with this stress could have been avoided... I just hope I go into labour before friday next!

Chunderella Sun 23-Nov-14 17:28:16

Glad you've found a path you feel happy with, and yes let's hope the issue of induction doesn't arise. But really, if you'd been given adequate information in the first place there wouldn't have been a problem. Instead you were treated like a naughty child not an adult, and have had to deal with unnecessary stress at a time when you ought to be resting.

DinoSnores Wed 26-Nov-14 20:01:01

"The Consultant was quite relaxedabout not bbeing induced and agreed that there is no evidence that induction leads to better outcomes."

How odd that they said that. There is plenty of evidence that induction after 41 weeks does lead to better outcomes.

www.ncbi.nlm.nih.gov/pubmed/21501456

"Induction of labour appears to be an effective way of reducing perinatal morbidity and mortality associated with post-term pregnancies. It should be offered to women with post-term pregnancies after discussing the benefits and risks of induction of labor."

StarlightMcKenzie Wed 26-Nov-14 20:27:23

I always felt that:

1) if the baby was in danger, get him out, instantly, with a knife. If not, leave us both the hell alone.

2)Induction is not a way of getting out of delivering good quality monitoring.

StarlightMcKenzie Wed 26-Nov-14 20:31:24

I never argued with Consultants. I refused to see one for my last two pregnancies and I pointed out to the midwife who was trying to insist, that she should not expect me to face a profession responsible for my suffering abuse in a previous delivery this close to giving birth.

She was incredibly supportive in the end.

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