Induction at 40weeks

[morethan40mum]

Am 40 and 30weeks pregnant and last two appointments with doctor at antenatal has been centred around ‘we will induce you at 40weeks regardless’ Their reasoning is placenta failure but from research I’ve done the stats don’t show placenta is necessarily an issue for older women, stillbirth risk is higher over 35 and 40 years old, but they don’t know exactly why yet. Don’t won’t to be induced when I hit 40w just because, others experiences??

Just bumping this thread for you, OP. Hopefully there'll be some MNers along shortly with some advice and support.

and again!

Don’t have any induction experience but maybe ask about a sweep pre 40 weeks. I had one at 39+4 (not dilated) and 39+6. Went into spontaneous labour at 40+1. It was my second birth but might lessen the need for induction.

Have you got low papp a? I'm not allowed to go over 40 weeks because of that?

You don't have to be induced at all. You may refuse if you wish.

I was 35 years old and 40+4 when I was induced for reduced fetal movement, when my daughter was born they discovered my placenta was "ragged and fragmented" and that the cord was round her neck. I was relieved that she was out once I heard that.

If I had another baby and they offered me an induction at 40 weeks then I'd take it.

What is it that you're not keen on? If you don't fancy induction because it can be painful, would ELCS be an option you'd consider?

If you really don't want baby to come out via induction or ELCS, would you agree to regular monitoring on the FMAU (or whatever your local foetal-maternal assessment unit is called) once you go beyond 40 weeks?

If your doctors are concerned about your baby's wellbeing, I'd take that seriously. Remember, the worst case scenario here isn't having to be induced. The worst case scenario here is stillbirth.

Suggest monitoring instead.

My local hospital has this policy. Every woman I know (1st this is, it does tend to work a bit better for subsequent babies) has been admitted, then left, for DAYS. Of course it’s low priority in a busy ward but literally 1 day pessary, it does nothing, someone might turn up the next day and try another etc etc. All have taken 4-7 days and I reckon most babies would’ve just come by then, and it makes a bit of a mockery of all their concern if they’re happy to just leave you on the ward waiting lol. I think the policy and reality are very different and wouldn’t go for an induction under those circumstances

Because the pain of induction is definitely not worth it to decrease the risk of still birth? I will never get women who are so anti induction that they will risk still birth. One of my friends had a still birth at 41 weeks due to placental failure. But hey, just roll that die.

I’m not sure OP said it was about pain?

Do you have some statistics that bear out the risk of going over 40 weeks at 40 and the increase of still birth? Because IIRC, it’s negligible.

I was induced at 39wks with DS as they were unsure of his growth (2 scans gave different results). It wasn't a great experience as despite him being engaged & starting to dilate he had other ideas & went back up & laid oblique! Ended up with a CSection. It was better than the alternative or what happened with my DD birth (3rd degree tearing, massive pp bloody loss, transfusion & retained placenta needing GA for removal!)
See how you go - you may go into spontaneous labour prior to 40wks. & talk over your concerns with the consultants but at the end of the day to goal is both of you coming out healthy.

I was induced at 42 weeks with Dd. My waters were manually broken, and labour started right away. 1 hour 50 mins later I was cradling dd. So mine was a positive experience.

I was in same boat, 40 and with a higher risk pregnancy and was induced at 39.4,
ended up with failed induction and c section 40.1. I was terrified of a stillbirth and heard a few horror stories so just went with it. It’s not going to be that much fun whichever way you go about it but a healthy live baby is worth an early induction in my book

@DonutCone that was complexity unnecessary.

I was induced at 40 weeks OP due to macrosomia (large baby) and it was not the most pleasant experience. I lost a lot of blood and my kidneys failed due to dehydration. Labour was 55 hours from start to finish.

That was just my experience however, I know others that have had a much smoother induction.

I was very ill and stayed in for 4 days after having my baby. @DonutCone it is perfectly natural to be fearful of an induction; it is putting your body into labour when it isn't necessarily ready. Don't be so quick to make nasty comments. OP if you want any induction info (albeit only from my experience) please feel free to message.

What are your concerns? I’ve had 4 inductions. 1 was at t+10, the next 2 at 39 weeks because of precipitate labours (under an hour), the third at 37 weeks (had been planned for 39 weeks but I had it brought forward at my insistence because growth was borderline slow- turned out to be placental issues. I was 36. Severe haemorrhage in labour, glad I didn’t wait!) Induction isn’t bad. I didn’t need the drip, longest labour (last one) was 3.5 hours

I was induced at 40 weeks exactly (due to preeclampsia) but was monitored every day in the 2 weeks preceding. Baby had slight destress at one point which is why induction was necessary. Despite not wanting induction, once I saw the distress baby went into when I laid on my back etc and that was with a healthy placenta I didn’t want to risk baby when I assume that labour in any method is painful.

The pessery wasn’t effective at dilation as I stayed at 1cm after 24 hours (had been for a few days), but it may have thinned the cervix so they could break the waters and baby arrived swiftly after that.

I had a few sweeps in the week before, I think it must have helped slightly. And if your anxious about induction pain and having to be on the consultant led side rather than midwife led, I honestly didn’t appreciate any “difference” as it was first baby so nothing to compare it to.

You must be having regular monitoring so you can see baby’s heart beat and movement. Ultimately you can refuse induction (any medical treatment) but perhaps you could consider why you’re so hesitant?

Good luck OP

I loved my induction. I liked the control I had over when the labour started and the fact I'd be in the hospital in good hands from the very beginning. From breaking waters to birth was exactly 4 hours (literally to the minute) and just gas and air.

Try not to have expectations, as long as the baby is born healthy, the birth went "to plan" Good luck! PS take snacks and a laptop to watch TV on, 99% of the time it's a 24 hour pessary before anything. My hospital allowed us to order dominoes to the ward!

HI OP. Have a look at the RCOG guideline for labour at term for older mothers.

Obstetricians are very risk averse and will always try to induce at term for older mums, however it's your body, your baby and your choice. The research behind it is pretty poor quality, TBH, but that's not going to change as it's unethical to carry out research on pregnanct women these days.

Have a think about whatyou'd be prepared to do induction-wise. You could ask your consultant to agree to sweeps from 39 weeks onwards, you could agree to go in for daily monitoring from 40 weeks. But ulimately, monitoring is a snapshot in time, and just tells you that your baby is ok at that minute, and it might change the moment they take the monitor off.

I'm a midwife, and I've supported women over 40 to decline induction - up to term plus 17 days was the longest. As long as they are fully informed and making their own decision, then it's fine. Almost all of the obstetricians I've worked with have been respectful of the women's wishes.

Do your research - the RCOG guidelines are useful, as are NICE guidelines, and you can ask about hospital protocols too. Ask your midwife to advocate for you, and be if you want to decline an intervention, you absolutely can.