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Induction recommended at 39 weeks - your thoughts please

(28 Posts)
sazzybee Mon 26-Feb-07 17:13:40

I've got clinical polyhydramnios - too much amniotic fluid. I'm 37+4 now and measuring 41 weeks. I'm very breathless and my consultant wants to induce me at 39 weeks. At the moment, the baby is cephalic but not engaged and they think he is unlikely to engage because of all the fluid. Also if my waters break on their own, I'm at much greater risk of umbilical cord prolapse or placental abruption which obviously would put both me and the baby at risk.
I've got a week to decide whether I want them to go ahead with it and wondered if anyone had been in a similar situation or had any take on the matter. I understand that induced labour can be more painful and that it will mean that I won't be able to have the water birth I'd wanted. At the same time though, I'm nervous of carrying on if it's going to put the baby's life at risk. Would welcome any opinions. Ta

Mumpbump Mon 26-Feb-07 17:18:05

I was induced at 40+2 and the labour lasted 8 hours. I was hoping to have a water birth, but tbh don't think it made that much difference as I kept having to change position - couldn't get comfortable - and that would have been tricky in a birthing pool. Ds was my first child so no idea whether it was more painful or not. Inductions are risk-free of course and people seem to think they carry a higher risk of intervention.

The decider for me was when I didn't feel ds move one morning. It scared me so much, there was no question about having an induction.

Not really an answer, but hth.

bizzi Mon 26-Feb-07 17:26:35

I was induced with first of my 3 at 40+10 and labour was definately the worst. Whether that was due to the induction is difficult to say. Why can't you use the pool if you're being induced? My 2nd was born in the pool and was definately the best labour/birth. If it was a life/death situation I would be doing as doc says...

USAUKMum Mon 26-Feb-07 17:58:12

sazzybee, I was induced with DS at 38 wks. My consultant to check to make sure things were "favorable", cervix softening, etc. Things looked good 4 days prior to induction, so we went for it. And my induction was pretty straightforward. First lot of drugs at 1pm. Couple of checks, was due second lot of drugs, but MW didn't think they were needed, labour started, MW broke waters at about 7-7:30, DS born at 8:40. But I had had 2 quick labours before (8hrs & 4 hrs). I didn't have any pain relief with DS. I was just going to ask for it, when I had to start pushing -- and then it is too late

I was induced as the risks factors for DS were better for him to be induced than to stay in. As I had lost a DS previously to a failed placenta and my placenta was showing signs of age. IMHO if the baby is safer out than in, then I'd rather have the baby than a birth that I want.

hoxtonchick Mon 26-Feb-07 18:01:57

i absolutely agree with usaukmum's last sentance. i have been induced with both my children at 39 & 38 weeks respectively. i have diabetes, & once you reach term the liklihood of a stillbirth rises. so i was sure that the potential unpleasantness of an induction (& they weren't that bad, especially the 2nd one) was better than losing the baby.

BuffysMum Mon 26-Feb-07 18:06:14

I've had 4 inductions and they were all very different. They were all very worth it as I had 4 live births and who knows the outcome if I hadn't. Even my worsts labours (went on for days) were only a few days of my entire life, I'd rather go thru them then a pregnancy again! HTH

lulumama Mon 26-Feb-07 19:05:12

i wonder what they would say if you did not want to be induced at 39 weeks, but went in for besdrest / monitoring

i guess it will depend also , how favourable you are for induction

in these circs, they would do a controlled rupture of the membranes, i wonder how much freedom in terms of being allowed to walk around until something happens, rather than bein confined to bed, you could get?

worth asking about the induction protocol

also, cord prolapse is a risk and is an obstetric emergency, so it is worth a carefully thought out decision, with full explanations from the medical team

a water birth is unlikely, but i know a friend induced for GD at 38 weeks and she had a water birth...so ask!!

Judy1234 Mon 26-Feb-07 19:26:27

Any chance of getting a second doctor's opinion? My hospital induces all twin births at 38 weeks. I didn't agree. My independent midwives let me wait and they came of their own accord at 40 weeks but we were checking them very carefully very regularly. I was glad they had the extra 2 weeks in there and came when they chose in a sense but there were no strong medical reasons twins have to be born at 38 weeks and your case looks more medically indicated to have them sooner.

DimpledThighs Mon 26-Feb-07 19:29:35

I was induced at 38 weeks, 2 pessaries and nothing happened - ruptured membranes and Ds born 3 hours later with quick but painful labour.

It is always different.

liquidclocks Mon 26-Feb-07 19:38:14

sazzybee - I had an artificial rupture of membranes at 40 wks on the dot for clinical reasons. It was a very painful labour, quick-ish at 6 hrs, but I had an epidural 2 hrs in as I wasn't coping. ARM can bring on contractions that are long and with no break in between. I think if you do go for it you shouldn't expect yourself to do it without pain relief. Be open to all possibilities as you don't know how it's going to go - if you manage on G&A then great but it's hard going. They also wouldn't let me walk around as I had to have the baby monitored constantly which made it much worse.

You can ask that you are induced at a time when there is an anaesthetist on duty if you don't have 24hr one just to be certain the option is there.

Having said all that though - my second labour was 'natural' and just as painful but it only lasted 1hr and 40 mins - and I just used gas and air. I think the difference is that I was 'eased' into it - they started slower and it took about 45mins to get to the 'no-break' point and then only had 30 mins of that before transition. See how it goes...

Sorry for my lack of real help!

BuffysMum Mon 26-Feb-07 19:40:32

have to admit the arm is not pleasant (2 out of my 4 inductions ended up needing an arm to get going) but a painful labour is a very small price to pay for a healthy baby??????

USAUKMum Mon 26-Feb-07 19:50:17

agree with lulumama in that you should have a long discussion with the consultant about the induction. I had been under the consultant from the start and we had been discussing induction since 26wks with my past history. So by the time it came around to serious discussion at 32 wks. I knew the procedure, what would be done, how much montioring, when they would do different interventions if req'd (didn't need any of this), pain control and such. Also I was induced on a Tues which is quieter than a Mon as alot of people opt for Mon for paretnal leave reasons. Though I would've liked a Sun (if the anaesthetist was avail.) as that is even quieter -- but my Mom was flying in that day, so didn't think she'd like a translatlantic flight followed by watching DD all day while excitedly waiting for her baby to arrive

DollyPopsOut Mon 26-Feb-07 20:12:10

Hi Sazzy

I had this with DD1. I saw the consultant and her view was that, in my case, the baby was better in than out. She said that the risk of abruption, whilst there, was small. She had only had one person abrupt on her in 15 years. The risk of cord prolapse was greater if the head wasn't engaged (i wasn't either) but again she felt that she would rather let the baby go to term and then see rather than induce early. My cervix wasn't favourable and she had 2 unsuccessful attempts at sweeping, so once I went to 41 +10 I was induced.

Your situation may well be very different to mine, but I agree that the outcome is far more important than the journey, IYSWIM. My induction was not the high spot of my pregnancy but it was OK and I took lots of drugs to help me cope. I can't remember if you are UCH or WHittington but you are likely to have access to an anaesthetist at all times in either of those places, and if you need an epidural you can have one.

I am sure someone like Mears would be able to tell you for definite but my consultant said that the amount of monitoring etc you need would depend on how your body took to the induction. I wasn't ready and so I had 2 pessaries and then a drup - once the drip was in I had to be continuously monitored, but if the pessary had got things going, I could have just had intermittent monitoring with a doppler and kept mobile. Several friends have just had a smiff od the pessary and been underway so you might be lucky.

The other thing to bear in mind if you are worried about prolapse is that if your waters go you need to get to hospital asap (by 999 if necessary) and if you thnk cord has prolapsed get on your hands and knees with your bum in the air whilst waiting for the ambulance to arrive. THis will take the pressure off the cord.

I am sorry not to be able to offer you any more reassurance, but you know from the march thread that I have signed up for DB2 even after my first labour so it can't have been that bad!!

HTH

sazzybee Mon 26-Feb-07 21:09:27

Thanks for all your posts - very interesting and really helpful. I have had two consultants discuss it with me together. The chief consultant at my hospital specialises in pregnancy complications luckily so I trust his opinion.
Also the hospital I'm having the baby at (neither royal free nor whittington dolly - st mary's ) has anaesthetists on 24 hour standby and you can have an epidural within 5 minutes.
They have looked at my cervix and say it's favourable so expect the induction to go relatively smoothly.
I'm on my own (single mum) so I am quite worried about my waters breaking at home and things going wrong. Thanks dolly for that info about what to do if I feel the cord - I didn't know that.
I think I probably will go ahead with it - I don't want to do anything that might put the baby at risk and if I carry on gaining fluid at the rate I am now I don't think I'll be able to cope on my own if I go over my due date. I can't breathe as it is Thanks again for all your posts - I feel a lot better. I think I was a bit shocked when I got back from the AN clinic.

hoxtonchick Mon 26-Feb-07 21:49:45

oh, i had ds at st mary's, they're lovely .

lulumama Mon 26-Feb-07 21:51:11

sounds positive ..! and yes, excellent advice from Dolly !

hoxtonchick Mon 26-Feb-07 21:55:41

my consultant was mr teoh.

sazzybee Mon 26-Feb-07 22:09:14

My consultant is Mr Teoh too. He's lovely isn't he?

hoxtonchick Mon 26-Feb-07 22:16:43

really lovely. i'm sure he'll look after you well.

DollyPopsOut Tue 27-Feb-07 19:39:29

Hope you are OK today Sazzy. I haven't been over to the other thread yet but will catch up on the news in a minute.

If your cervix is favourable, you might well get going after a pessary, so could keep mobile etc and simply use the induction as a kickstart. Incidentally, Mr Teoh delivered Trinny and Susannah's abies, so you arere in good company!

OFf to March thread now. Keep us posted

XXXXXX

BuffysMum Tue 27-Feb-07 19:55:21

oh yes if your cervix is favourable it may be a doddle! My cervix was never favourable hence why they took a while and needed 2 arms! If you like the consultant and he listens to you and discusses things properly that's a very good start! I can also recommend asking the midwives to be your birthing partners ie I had written on mine dp will be here with me as I've got no-one else to ask but I don't want him to be my birthing partner - it was fab, they got so much more involved than at my previous births

mears Tue 27-Feb-07 20:07:31

sazzybee - DollyPopsOut was correct in what she told you. The level of monitoring depends on the level of intervention. If the baby's head settles into the pelvis and your contractions start after ARM - you should ba able to mobilise. It might be though that the consultant will want the baby monitored because of the amount of extra fluid. Just ask him what he recommends and tell him you would like to be moblie.

There is a possibility that the baby's head will not be engaged at 39 weeks - ask him what will happen then. IME, if your cervix if open enough, they would break your waters while in theatre. This is called a controlled ARM. That means the doctor can slowly release the water and make sure the cord does not come past the baby's head. If that happened they would do an immediate caesarean section.

As this is your first baby it is most likely that you would start on a drip straight away after your waters have been broken unless your contractions started straight away.

You never know - the baby's head may engage before then and you might go into labour on your own. Write down any questions you think of and ask your consultant. There are lots of varied protocols and guidelines in different units - best that you discuss them with him. The good thing is that you can get pointers here to ask. Good luck.

sazzybee Tue 27-Feb-07 22:20:46

Thanks all - very reassuring stuff.

What does ARM mean?

mears Tue 27-Feb-07 22:25:27

Sorry sazzybee - ARM means artificial rupture of membranes. It is when the bag of waters is broken by the doctor or midwfe and is part of being induced. It can stimulate contractions but not always. The waters must be broken before the hormone drip can be started to induce contractions.

sazzybee Wed 28-Feb-07 07:28:39

Ah thank you Mears. It came to me in the middle of the night and then when I woke up I couldn't even remember what the acronym was! The pregnant brain is a strange thing indeed
I'm going to rewrite my birth plan today taking all this into account - thank you so much everyone who's posted - it's been really helpful

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