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AIBU?

To think there might be a slight overkill of inductions?

77 replies

Mrsknackered · 28/06/2017 06:45

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!
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TheDogAteMyGoatskinVellum · 28/06/2017 20:50

I didn't think you were saying babies should be left OP, but I do think if you're going to do midwifery training it's useful to reflect that avoiding intervention isn't an aspiration for every woman. Some are delighted to be induced at 42+10/12, I assume at least partially because they're completely fed up by then!

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Dinosauratemydaffodils · 28/06/2017 21:02

A couple of my friends are due soon and have all been told they will be scheduled for induction at week 41 if they haven't already gone into labour. When I was pregnant with Ds (2 years ago) the same Trust didn't talk about induction until week 42.

Personally the only positive induction story I've ever heard was my DM describing my birth. Everyone else I know who was induced from cold so to speak ended up with some combination of the following forceps, emcs, NICU stay, 3rd or worse degree tear. Half my ante-natal class were induced for various reasons and their descriptions were horrific. Although to be fair, I think our ante-natal class was cursed in some way as I went into labour naturally and still managed to have a dreadful experience involving forceps, an emcs I hallucinated through and a NICU stay.

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thenewaveragebear1983 · 28/06/2017 21:08

Sadmum no, but with two small children already I can tell you to within a ten minute time slot when we actually dtd. A few days out maybe, a few days after sure, but not 9 days before we had sex!! It was a very rare occurrence in our house in those days!

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EC22 · 28/06/2017 21:18

It's more than slight.
Obstetrics saves many many lives but it also causes so much unnecessary suffering for women. It would seem our summering doesn't really matter and when we end up a section we thank the Drs for saving our babies, when if they'd just left us alone many of us would have managed it without the hero Drs.

More babies die in utero at 35 -36 weeks than do at 42-42+I don't agree with'post dates' inductions when everything is otherwise well.

Leave well alone unless otherwise indicated.

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EC22 · 28/06/2017 21:22

And monitors are life saving? If you are talking about CTGs there's absolutely no evidence they save lives. The only thing they were shown to reduce were benign neonatal seizures. They provide false reassurance and more often than not invasive further testing and unnecessary operative and instrumental deliveries.

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TheDogAteMyGoatskinVellum · 28/06/2017 21:58

Not really for you to agree or disagree with post dates inductions per se though, is it? For yourself, absolutely, but for everyone else myob. Same would be equally true if you'd said you didn't agree with expectant management too, of course.

And really, the 35-36 weeks stat has nothing to do with anything once you're past that point in the pregnancy. The figures that matter, at 41 weeks, are those for 41 weeks as against waiting. The risks of stillbirth are higher after 41 weeks, and higher still after 42 weeks. They're also still fairly low, so that, rather than comparisons to 35 weeks, might be a reason to decide against it.

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underneaththeash · 28/06/2017 22:11

EC22 - I don't think you have actual data on that.

Believe me - women suffer much more when their babies are still born, than from an "unnecessary" c-section.

I had two friends who lost babies in the same year I had the abruption with DS - both would have lived if they've had a section.

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EElisavetaOfBelsornia · 28/06/2017 22:14

I went past 42 weeks with both of mine, refused induction. Had natural, intervention free births with both. My mum went over with all her kids before induction existed, maybe we just carry long in my family. Both my babies were quite small so I'm glad they waited until fully baked before the oven went ping.

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underneaththeash · 28/06/2017 22:35

EE - but why? I'm quite relaxed about things...but why would you risk it with a baby?

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herethereandeverywhere · 28/06/2017 22:38

EC22 Re: the monitors: this is the RCOG report I was referring to earlier, monitoring is a major recommendation for saving lives:-

(On phone so not sure if link will work)

www.bbc.co.uk/news/amp/40339024

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herethereandeverywhere · 28/06/2017 22:44

Sorry, I should add that the link goes to an article about stillbirth and brain injury as a result of birth (and a RCOG report into 700 cases) in case that is triggering for anyone Flowers

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sycamore54321 · 28/06/2017 23:01

UK has until very recently had a disgraceful rate of stillbirth and the fetish for "natural" has led to dead babies. Using a word like "overkill" in the title when speaking about literally a life-saving intervention is hideously insensitive and shows you don't understand at all that the practice of obstetrics is or should be preventive care. The only way to know that an induction or a section was truly necessary is not to perform any and see which babies die. The profile of mothers is also changing - older, heavier, with pre-existing conditions that may not have previously survived childhood (like heart conditions), all sorts of risk factors have gone up across the general profile of mothers.

Inductions save lives.

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Mwnci123 · 28/06/2017 23:04

I was induced just after 37 weeks with my first. It went well and wasn't actually horrendously painful (this may be the oxytocin talking, obviously). At the time, my consultant told me rates of c section were no higher for inductions after 37 weeks than for spontaneous labours, but maybe this was based on a conflation of first and subsequent deliveries as mentioned by a pp.

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DontLetMeBeMisunderstood · 28/06/2017 23:20

The most recent research suggests that induction in a low risk pregnancy at 41 weeks doesn't increase the likelihood of a caesarean (as compared to not being induced at 41 weeks and either (a) going into labour naturally at a later point OR (b) being induced or having a caesarean at a later point because a problem develops or the mother decides she doesn't want to continue being pregnant). Lots of hospitals now offer post dates induction in the 41st week of pregnancy and the caesarean rates have not increased as a consequence.

The risk of stillbirth does rise after 41 weeks, by just under 1 in 1000; so most babies would not be affected if their mum continued pregnancy at 41 weeks BUT the problem is that it's very difficult to predict who would be affected. Different women have different tolerance of risk, some would consider that increase to be insignificant and others won't accept any risk. Induction should always be a choice that women make rather than a routine; no one should be told that induction is routine or that they won't be allowed to go over X weeks of pregnancy. Similarly, all women should be given good quality information on which to base their choices.

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NotAnotherUserName5 · 28/06/2017 23:36

I was induced on Friday at 4 days overdue due to reduced movements.

Went well, no tears, grazes or interventions.

Was the right choce for me, although the labour was slightly longer and more painful than my previous births.

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YerAWizardHarry · 28/06/2017 23:47

My local trust has also changed from 42 weeks to 41 weeks for overdue induction

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AgathaMystery · 29/06/2017 00:16

Inductions save lives. Have a look at Each Baby Counts & see what we are trying to achieve. We want the stillbirth rate to decrease and we want more women to go home with live, healthy babies.

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AgathaMystery · 29/06/2017 00:20

Pigface you are talking utter nonsense. Have a look at the latest evidence. You will find that IOL amongst women, especially primigravidas at 39/40 >35yrs reduces EMCS, instrumental rates & stillbirth.

Trust me, IOL is boring & expensive for everyone involved. We don't do it on a whim. Ever.

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QuackDuckQuack · 29/06/2017 00:33

I was induced - starting on 40+12 and ending on 40+15. I massively wish I'd had an ELCS instead because my pelvic floor was wrecked by forceps. The savings made by not offering ELCS are short-sighted as the cost of fixing that sort of damage isn't take into account.

One thing I wonder about is the measurement at the 12 week scan that is then used for dating. Unsurprisingly 12 week old foetuses aren't all the same size and if you use the average size of a 12 week one then in gestation terms they will actually range by about a week either side. So for some women when you induce at a policy driven 40+12, some are actually 40+5. My DD was obviously overdue as all her skin peeked later, but I'm sure many babies don't show any sign of being overdue as they aren't really.

The other thing that I'm a bit Hmm about is the actual process. I considered delaying induction and the hospital wheeled out a junior doctor to give the 'your baby might die' lecture. However when my induction was delayed due to the delivery suite being full, that wasn't a problem. That doesn't make much sense.

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AgathaMystery · 29/06/2017 00:46

DuckQuack Women are now given individualised GROW charts. The NHS is very serious about reducing stillbirth.

And yes, most 12 week foetuses are almost identical in size! Here is some light reading:

Fetal Growth
Fetal growth restriction is associated with stillbirth, neonatal death and perinatal morbidity. Confidential enquiries have demonstrated that most stillbirths due to fetal growth restriction are associated with suboptimal care and are potentially avoidable.

A recent epidemiological analysis based on the comprehensive West Midlands database has underlined the impact that fetal growth restriction has on stillbirth rates, and the significant reduction which can be achieved through antenatal detection of pregnancies at risk.

Customised charts

The Perinatal Institute administers the Gestation Network www.gestation.net which provides tools for assessment of fetal growth and birthweight by defining each pregnancy’s growth potential through the Gestation Related Optimal Weight (GROW) software, including

GROW-Chart: customised antenatal charts for plotting fundal height and estimated fetal weight.

GROW-Centile: for calculation of customised birthweight centiles for each pregnancy, or a database of pregnancies (bulk centile calculator)

GROW-Service: GROW chart, centile and reporting via an API with Maternity Information systems

Customised assessment of birthweight and fetal growth has been recommended by the RCOG since 2002 and their use has been re-emphasised in the recently published 2013 revision of the Green Top Guidelines.

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QuackDuckQuack · 29/06/2017 01:11

I think that the GROW information is about growth later in the pregnancy, not part of the 12 week dating information.

If you look at the CRL against gestation in days on this paper (and other similar ones came up), you can see that the CRL does have significant variations at 12 weeks. If you look at 84 days gestation, the average CRL is about 60mm, so that would be the measurement used to date to 84 days. But on the graph you can see that at 60mm you got foetuses with gestation ranging from about 78 days to about 94 days. So those ones would all be recorded as 84 days. I don't think that all 12 week foetuses are about the same size, looking at the data available.

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Mrsknackered · 29/06/2017 01:20

Sorry for offence caused by the wording of my title. It was completely unintended.
Don't think it's very fair to say I shouldn't go into preventative care or whatever your exact words were I can't be arsed to scroll back through the thread and quote.
No where in my OP did I say I was against induction. It quite possibly saved both my children's lives. I just wanted to know more on it. You can't expect people to just know without being educated.

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Pigface1 · 29/06/2017 07:26

Sorry agatha - just going by the 'complete nonsense' spouted on the NHS page about induction. See 'what induced labour feels like' - it states both that induced labour is more painful and that it has a higher rate of instrumental intervention.

But please do get in touch with the NHS to tell them your findings.

And of course inductions reduce stillbirth. That's usually the whole point of offering them, so that's a non-statement. But a ELCS offered at the same point in pregnancy would obviously have the same preventative effect.

www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx

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TheDogAteMyGoatskinVellum · 29/06/2017 07:28

Did anyone say you shouldn't go into midwifery?

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Doublechocolatetiffin · 29/06/2017 07:33

Agatha have you experience IOL personally? One word I would use to describe my experience is boring!!!

Maybe policies are different in different hospitals, but I don't remember any charts (my DD is 1 so it wasn't a long time ago) to give me an informed decision. What I do remember is a lot of doctors pushing me to have an induction and telling me how risky was to leave it each day. No one gave me any other option. Quack agreed with the fact that they give you a talk re your baby dying and then sit you in a hoipital bed and do absolutely nothing.

I'm sure IOL is a good thing, but the way the NHS deals with it at the moment is not good at all.

Re dating, even if babies do grow at a similar rate to 12 weeks, surely operator error can account for variations in Edd? It can't be 100% accurate to measure a wriggly baby to the nearest mm surely.

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