To think there might be a slight overkill of inductions?

[Mrsknackered]

Firstly, I am in no way blaming anyone for this. Both of my pregnancies have been induced.

When I had DS1 nearly 5 years ago, I was the only induction at 42 weeks - everyone else I knew expecting had gone into labour naturally (minus 1 who had placenta praevia, so had an elective)

Since having DS2 late last year I've made a lot more 'parent' friends and my own stepmum and a good childhood friend have also delivered.
SM and 4 friends have all delivered in this past fortnight and have ALL been induced because they were overdue and it's ended in Caesarian. One of the five had a C-section after failed induction for RFM at 41+4, so not quite the same reason for induction but all was fine at birth (thankfully)

Is this an oddly high number? I've spoken to a few people recently about it and they too have said it seems that failed induction/C section is much more common now. Am
I missing something?

Is there a chance that if these overdue babies were left a little longer that perhaps the mother would go into labour naturally and avoid all of this medical intervention?
I often wondered this with DS1. If I had had monitoring once a day for say another week would he have perhaps come naturally? (I know there is a higher chance of stillbirth after 42 weeks)
I suffered severe tears with my births and again a larger amount of women I know who were induced and didn't have to have CS also tore more than those who went into labour naturally.
Is this all just coincidence?

• I start Midwifery training in September, so I'm not MW bashing!

The problem is we just don't know enough about why babies are stillborn and why/when/how a placenta fails.

We do know that inducing will extract a healthy baby (even if eventually by CS) whereas waiting is a 'just don't know how safe' scenario.

I do think that women should be informed of the high failure rate of induction, the % chance of ending up with a CS after being tortured induced for hours or even days and the % chance of having an instrumental delivery. They also should not conflate the statistics fro first time and subsequent births - subsequent births have a much higher induction success rate and this pushes up the overall stats.

In terms of monitoring, a recent report just recommended better monitoring in birth to avoid adverse outcomes (serious injury and death) in Scotland - monitors might be inconvenient but they are also life-saving - perhaps investment in monitors that don't fall off might be a better recommendation.

It's dangerous to imply that being able to move around is the cure to all birthing problems - we cannot know whether the lack of movement caused further necessary interventions or the reason behind needing to be monitored in the first place was the actual cause.

I've posted this before - I wasn't induced on time (I was 42+1), but unfortunately my placenta had already began to degrade and I had a huge abruption, which landed me in HDU and DS in special care for a few days.

Subsequent pregnancies were induced at 41 weeks and were straightward

Risks of still birth at 42 weeks are almost twice those at 41 weeks, I would much rather have a section than lose a baby.

This study conducted in the UK on 10,000 women explains the risks.

www.ncbi.nlm.nih.gov/pmc/articles/PMC3719843/

Ds2 was born at 41 + 10. If labour had not started naturally I was down to be induced at 42 weeks. He was 10lb 8oz and I was told that, if a subsequent pregnancy looked as though it would result in a large baby elephant , I'd be induced at 40 weeks next time.

Fine by me.

I think this is a really hard one. I was induced at 42 wks. It was horrendous. My DS got into trouble which resulted in him suffering brain damage (cerebral palsy, learning difficulties) however I know two people well who have both lost babies full term because they went overdue for too long.

Is there a chance that if these overdue babies were left a little longer that perhaps the mother would go into labour naturally and avoid all of this medical intervention?

Of course there's a chance. More than a chance, even. It's just that for some people, not incurring a higher stillbirth risk is a bigger priority than a chance at avoiding medical intervention they might not be that bothered about avoiding anyway (some women actively want some interventions) and thus when they get the opportunity to get the baby out one way or another, they take it.

I agree with the pp who talked about more information and better access to ELCS in this situation though. Both my labours started naturally well before the point at which induction is offered, though I did have some augmentation in one of mine. But if I did go to 42+10/12 with an unripe cervix, a CS is what I'd be pushing for. No pun intended.

Its not just about danger to the babies either. The potential complications resulting from giving birth to very large babies are greater and, on average, damage to the mother more. 4th degree tears are no joke (actually 3rd degree tearing isnt either), nor pelvic damage.

I was induced with DC4 and it was hell on earth. In every way.

Previous 3 DCs births were all natural, around their due date and much less hellish.

I was induced purely because of my ''age and the associated risks with going past term'' (Which no one could actually pin point for me).

I agreed to induction the night of my due date and i wish wish wish i'd given DD just a couple more days to come on her own. I try to put it behind me. She's healthy (although fetal distress caused a panic at birth) and it's in the past now. But still i wonder about it all.

Oh, and she was just under 7lb and the placenta was fine.

Placentas are very weird things and we don't know nearly enough about them. There are some that are calcified as fuck way before term, and some that could probably go on for ages past 42 weeks. So we end up doing this guessing game based on broad averages. It's shit really.

This really interests me as I've always said I would refuse an induction as I'd heard so many horror stories. But then you hear about placentas failing and so an induction would be necessary..

Ugh.

Are you able to request a C section if they start talking about induction? Would rather that I think

I was induced at term +12 and it was very straightforward. One pessary, and I was off and had an intervention-free delivery. If anything, I wish they'd done it sooner as my SPD was awful after I fell down some stairs at 39-ish weeks! I was desperate for the pregnancy to be over by that stage to be honest.

I would very much hope that I'd be induced a bit earlier next time but goodness knows if that would happen. I'm sure that having had SPD so badly contributed to my PND. I was in so much pain.

What I don't understand is why women aren't offered a straightforward choice between section and induction, if it comes to it, and why they're strongly encouraged to have inductions. I suppose it's cost, but inductions have a high failure rate, a high rate of instrumental delivery, often end in c-sections anyway, and they're extremely painful.

Had an induction at 39+6, due to obstetric choleostasis. Had the pessary, it fell out after 12 hours, new one put in, started to dilate, after 20 hours was given the drip and an epidural. DD was born 43 hours after the start of the induction, her head had to be turned but no other intervention, no tears. First time mum. To be fair, the itching from the choleostasis was so horrific, I was just glad to get things started. Only one other induction in our NCT group, ended in an emergency CS. Felt very lucky, but the midwife team were amazing and so supportive. Although I was on my back after the epidural, I could still move my legs and shift about, and after a day and a half with no sleep, it did give me a chance to sleep! Also, knowing that DD was being continually monitored helped immensely.

Perceptions, not necessarily accurate, of cost. And ideology.

Because it isn't a straight-forward choice maybe Pigface? Some inductions work brilliantly, some are very painful, some don't work at all. Without that information it's pretty hard to decide if induction is more/less risky.

It's all quite complicated, because so much depends on things like the age of the mother, the size of the baby, whether it's the mother's first pregnancy and so on. I just had a look at RCOG advice on induction of labour at term in older mothers (www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_34.pdf) and it says:

"A Cochrane review has found that induction at 41 weeks of gestation results in improved perinatal outcomes without increasing the caesarean section rate."

Link to the Cochrane Review here:

www.cochrane.org/CD004945/PREG_induction-of-labour-in-women-with-normal-pregnancies-at-or-beyond-term

I agree, I was induced with my DD at 40+14. They totally guilt tripped me into it, I really did not want to go in. They ignored me entirely for a day! Literally showed me to the bed and did not check on me until questioned what on earth was happening - why did I have to come in so urgently to sit in a horrible ward being completely ignored (no checks for me or the baby at all).

I was induced with the pessary the next day, wasn't allowed to go home to do the early stage of labour there, even though I'm less than 10mins from the hospital. Had to stay in a horrible ward, labouring behind a paper curtain with random guys (obviously other DHs but to me complete strangers) less than a meter away.

I very nearly ended up with a c-section, I only avoided it becuse in the wait for theatre to be free I actually dilated (having been stuck at 6cm for 15hrs). It was a horrible experience, it could have been miles better if they'd allowed me to labour at home - I think I wouldn't have struggled as much either. At least you should have your own space to labour rather than being on a ward.

My friends have had similar experiences, being guilted into it and hating every minute.

It's such an imprecise science. A study a few years ago found that the length of pregnancies (excluding premature births) varied by as much as five weeks:

www.bbc.co.uk/news/health-23594668

I can't find it now but I also remember reading that they work out when to induce based on the average length of a pregnancy - but of course the average length of a pregnancy is brought down by the number of inductions.

It doesn't help that they can't always get the dates exactly right either. It may just be a few days, but that might be the difference bateeen going into labour naturally vs induction. I was so sure my dates were physically impossible - we'd not DTD that early. So they took my dates forward 5 days and then guilted me into an induction when I think I was only 41 weeks.

*between

See with DS1 I really don't believe he was ready. I had 3 unsuccessful sweeps, wasn't effaced or dilated at all, engaged - anything! It took 72 hours and a 3rd degree tear. He was still only 7lb and his placenta was perfect.

DS2 was induced at 38 weeks due to lack of fetal movement on a growth scan and when they pulled on the umbilical cord for placenta delivery, the cord snapped off the placenta and the placenta was breaking apart inside of me.

He was pretty lucky (the placenta also weighed nearly 5lb and he was only 7lb too) they were going to send me home as they were very busy and the pessary hadn't seemed to have worked but as I stood up my waters broke and there was very thick meconium so I was put on the drip immediately.
It's not a nice feeling knowing that perhaps had my waters not gone there and then he may have been in a lot more trouble due to the deterioration of the placenta and that was at 38 weeks. DS1 also had mec in waters after a pessary, I think they were both due to distress.

I'm not saying that baby's should be left,I'm just interested in the correlation and others people's opinions on it

I refused induction at 41+3 which is routine round here. Got badgered into an induction at ever appointment after this. I politely declined.

I went into labour naturally at 42+3. Still ended up with a crash section

I wonder if there's also a link (purely anecdotal here btw!) between the number of failed inductions and the number of people who have their dates changed at the 12 week scan to 13+ weeks. This happened with two of my babies, and has also happened to probably 6 or 7 women I know- many of them actively ttc- who were told the date of conception was on or around a date that they know it wasn't. They estimated the dates of my pregnancy to mean I'd conceived while in the middle of a heavy period while dh was away (Jeremy Kyle, eat your heart out). This meant when I was induced for GD at 38 wks, I was actually only 37 weeks- no wonder it failed. The purpose of the pessary is only to open the cervix enough to break waters and this can't be done if babies aren't engaged and in various other situations, resulting in a 'failed induction'. In some cases the pessary with induce actual labour but this is definitely not every woman every time.

Ultimately, eventually the baby will be born, but there's obviously a reason why they don't like you to go over 42 weeks. With mine it was GD do induction was at 38, and dc3 was an elective section after my previous failed induction ended in c-s anyway.

Induced at 42+1 ended in a succesful and calm c section. Based on the position of my baby's head when she was taken out they remarked she would never have come on her own as her head was in a funny position which would not have been picked up via examinations.

That's a good point averagebear. My EDD was brought forward 8 days, and we were actively TTC. However, I suppose you can never be 100% sure when you ovulated, even when symptom spotting. I do wonder if I would have gone naturally if allowed another week. It's not a risk I was willing to take though.