Induction for overdue to be moved from 42 weeks to 41 weeks

[Glassofshloer]

www.dailymail.co.uk/health/article-10166493/Pregnant-women-England-inducted-just-ONE-week-overdue.html

Just interested in your thoughts really.

Surely this will add to the already enormous number of women that are on wards being induced?

Cuts the risk of stillbirth

Don’t understand how it can reduce number of caesareans, when induction makes it more like you will need an emergency caesarean… if anything there will be more?

I don’t think induction increases the need for c section at term does it?

My first thoughts are concern that the already overflowing induction wards will literally burst in a puff of smoke…

Induction increases risk of needing assisted delivery or emcs

@Glassofshloer well they will only fit a woman in when they can fit her in. My induction was delayed because they had no space. Didn't need it in the end but that's another story as I practically had an induction ending in c-sec.

I think it's best for mother and baby. Having read the original article months ago by who ever it was WHO or BMJ not sure who it was but it's definitely better for the mother and in my experience would have been better for me. Would have saved me the horrendous experience I went through.

I’m
Not a fan of induction having experienced a horrendous one and I think they are given out liberally here but on the other hand if it reduces still birth and risk then 🤷🏻‍♀️

Seems like it’s based on good evidence

I just hope everyone is clear that it is OFFERED to women, and their decision

Cuts the risk of stillbirth

From what to what, statistically?

My first thought is that it’s a bad idea. Induction, as I understand it, works if your body is nearly there anyway. If it isn’t induction is likely to be a multi-day extravaganza comprising pessary, another one a day later, perhaps a third 72h in, artificial rupture of waters, being hooked up to a drip and a higher likelihood of instrumental delivery (hello, chance of prolapse and incontinence) and also a higher risk of an emergency section.

If the measure was “we will examine all women at 41 weeks and discuss the merits of induction with those meeting x requirements as well as those requesting induction”… absolutely. Otherwise I think it’s a shit idea.

It’s not mandatory it will just be offered. Don’t know the exact stats hopefully someone will be along who does

Not great evidence that it does cut the risk of stillbirth. Your risk of still birth at 42 weeks is the same as at 37 weeks. Stillbirth is statistically least likely to happen around 40 weeks.

www.aims.org.uk/journal/item/induction-at-term

It’s not mandatory it will just be offered.

It’s all in the detail though, isn’t it? Or the execution? My notes say that I was offered an induction at 37w (twins). In practice this consisted of the registrar letting me know the date he’d booked me in for my induction. I had to do quite a lot of advocating for myself to get anything like a birth I was OK with, with what seemed to me to be an appropriate management of risk to me and my babies.

I think it is needed but the thresholds are different in every country. In the US, many hospitals induce at 39 weeks for slightly frivolous reasons, and I think that is too soon, but I also think 42 weeks can be too long for many women. My friend was not induced until 42 weeks, and she ended up giving birth at 42+2 and baby had an infection due to meconium aspiration. There has to be a middle ground which accounts for full maturity AND full safety.

Great, even more pressure on women to have a medicalised birth 🙄

I was induced at 42 weeks as DS showed no signs of coming out on his own accord.

The waters were brown, he was born with skin peeling off and had troubles with keeping his temperature and blood sugar stable.
5 APGAR points when he was born.

I’m glad I consented to it. All the risks were explained to me- the ones resulting from failed induction and the ones when placenta starts failing.

Everybody make their own choices of what’s best for them.

Without reading that article, just from my general knowledge, there are two recent studies (from America and Sweden) that both show good evidence for this. At 41 weeks the risks of induction are no higher than at 42 weeks, you're not more likely to end up needing an instrumental delivery, for example (whereas they are at 40 weeks) - however the risk of adverse outcomes such as stillbirth at 42 weeks is significantly higher than at 41 weeks. One of the studies was actually stopped for ethical reasons due to the very high number of stillbirths in the later than 41 weeks induction group.

A doctor friend of mine was explaining it to me (I'm not medical but I am expecting) and her assessment was that induction at 41 weeks should probably be routine. Obviously for some women this will turn out to have been a bit over cautious but this is balanced out by the reduction in stillbirths etc. It's a balancing act but if you're going to draw a line somewhere then 41 weeks apparently looks like the place to draw it.

Long overdue. My friend’s DD was stillborn at 42 weeks. No one needs to be going 2 weeks over.

My youngest is 16, I had to meet with the consultant to go to 42 weeks. As she was my 4th and they were all overdue she was happy to agree to 42 weeks (no more) and I was in the diary when I was only 16 weeks 🤣

Later on the midwives pushed me into agreeing 41 or 40+10 and I got outside after the appointment and burst into to tears. Rang my midwife team and they pushed back to my original 42 weeks.

41 weeks has been standard where I lived for at least 17 years.

@Glassofshloer

My first thoughts are concern that the already overflowing induction wards will literally burst in a puff of smoke…

A relative of mine is a doctor and told me to ask for induction if I reach 40 weeks as after then the chances of a live birth start to decrease and definitely not to go past 41 weeks. I think its positive to move to 41 weeks. It will help save more lives

@Outfoxedbyrabbits

Without reading that article, just from my general knowledge, there are two recent studies (from America and Sweden) that both show good evidence for this. At 41 weeks the risks of induction are no higher than at 42 weeks, you're not more likely to end up needing an instrumental delivery, for example (whereas they are at 40 weeks) - however the risk of adverse outcomes such as stillbirth at 42 weeks is significantly higher than at 41 weeks. One of the studies was actually stopped for ethical reasons due to the very high number of stillbirths in the later than 41 weeks induction group.

A doctor friend of mine was explaining it to me (I'm not medical but I am expecting) and her assessment was that induction at 41 weeks should probably be routine. Obviously for some women this will turn out to have been a bit over cautious but this is balanced out by the reduction in stillbirths etc. It's a balancing act but if you're going to draw a line somewhere then 41 weeks apparently looks like the place to draw it.

Absolutely this

It’s an evidence-based change in the clinical guidelines to reduce the risk of still birth. I can’t see how this can be a bad thing. Obviously it’ll only be offered earlier, women still have the option to decline induction with increased monitoring.

I went into labour hours before l was due to go in for an induction at 12 days overdue.

I was quite far into labour when my waters broke - they were green. DD was OK but briefly had problems with her core temp, had to go under lights. I was anaemic from blood loss. I don't agree with scaremongering but l am sure most mothers would pick intervention over risk.

I think it needs to be made clear women have the choice. I was point blank told by my midwife both times around that my complication-free pregnancy would not be going on longer than 40 + 10 as I would be induced then. I had to tell her that no, it was actually my choice.

The key thing is that placenta scans and proper decent daily monitoring need to be offered.

There are routine scans in other countries that we just don't do here.

@RandomMess

The key thing is that placenta scans and proper decent daily monitoring need to be offered.

There are routine scans in other countries that we just don't do here.

I agree.

Inductions increase risk of complications and interventions and should not be done by calendar but in conjunction with relevant scans, monitoring and accounting for the woman's ethnicity, family history and body type, all of which can influence their "normal" time for going into labour.