Please talk to me about refusing induction

[Cosmosis]

I am 40+5 with DC1 and had a sweep yesterday, where I was told my cervix was still pretty closed, so no real hope that it would work. They don't want to see me next week, she just booked me for an indiction a week tomorrow (so 40+13). As far as I can see, this is just because it's "hospital policy" to do an induction at 40+12, and not for any good reason.

I'm very low risk, I haven't had a single issue during my pregnancy, my midwife even commented that I'd had the most boring pregancy in the world and she couldn't think of anything to write in my notes :) Both DH and I are pretty frightened of an induction as we think it highly likely to lead to a cascade of interventions we really don't want for a number of reasons, so I'm thinking of making an appointment for next Thursday for another sweep (just in case!) and to discuss not being induced.

What I want to know is, what do they actually do re monitoring you if you refuse an induction, and I suppose how long it's realistic to leave it? I know what I'm like and I get bullied into things if I am not armed with all the facts, so want some facts to arm myself with!

Can you check your hospital's website? Mine has information leaflets on the maternity bit including info on going overdue and what their policies are on monitoring, etc.

www.royalberkshire.nhs.uk/pdf/prolonged_pregnancy2008.pdf

Try not to stress too much about it - stress can retard labour hormones! Chances are you'll go into labour next week anyway. But arranging for a consultant appointment to discuss expectant monitoring instead of just booking an induction date may make you less stressed - it would for me.

I hadn't even thought about checking their website, good idea. I will try not to stress and keep hoping it comes before I need to do anything :)

Hi Cosmosis

I was eventually induced at 42 weeks, but my hospital's policy was to induce at 41 weeks. I made an appointment to see the consultant MW and arranged to have extra monitoring - heart traces daily and an ultrasound to check on the blood supply through the cord - and they were fine with waiting with that in place. Maybe ask your mw if this is an alternative?

Good luck and congratulations!!!!

I'm in pretty much the same boat as you cosmosis. 40+8 today and booked for induction at 40+14 (normal policy here is 40+12 but she let me push it to 14). Really don't want to be induced though and have had no complications so far. Not sure how resistant the hopsital will be to delaying it though and not sure if I'm up for a fight.

Sorry this post is no help to you at all!

You can refuse induction and monitoring altogether, or opt for expectant management with a scan every few days to check on the health of your placenta. It gets tricky to ignore when people start coming out with horror stories of stillbirth etc. But some people just carry their babies longer - you might expect about 10% of women to go on past 42 weeks completely normally.

The other thing of course is, are you completely sure about your dates? First trimester dating scans are supposed to be fairly accurate, though some people have questioned that if the parents are, for example, really tall.
The homebirth reference site has some good info about induction here.

Thanks all. Have done a bit more reading, and think that I am going to ask for an appointment next Thursday to try another sweep (as it stands they don't want to see me at all between now and 4th) and to discuss at least delaying induction until say Tuesday, just to give it all a bit more time.

I'd found that homebirth site in my googling, and interestingly note it says about labour not starting on its own if baby isn't in a good position, well my baby is still currently back to back, despite best efforts to turn it, so perhaps this is a reason. I'll keep trying to turn it and hope!

good luck marzipananimal I hope you go into labour soon!

I thought that after some time the placenta starts to detiriorate? hence better induction than, well worse?

I think (and I am heading into late territory myself) I'd rather be inducerd than risk baby's health

Don't be frightened of being induced, it's not that bad. I was induced at 10 days over with my first child, now 3, and the only downside was that it meant I couldn't go to the Birth Centre as had to be monitored, ie had to go to normal Labour Ward.

My labour came on quite intensely after a 2nd pessary and was only 9 hours including 2 hours of pushing ending in a ventouse delivery - that was because he was big - 9lbs 6.5oz! Because it seemed to be going quickly it made me manage with gas and air because I didn't want to slow things down by having anything else.

I am 39wks + 5 now with second child, and will be asking to be induced at 10 days again if I go over, I don't want to wait any longer than that. And there is the advantage that you are in the hospital before labour starts so none of that 'not sure when to go in'. I haven't read that induction is more painful, I just think it can be more intense because quicker, but surely better not to last for days? And I was very happy with normal Labour Ward and am going there this time, induction or not!

Good luck, and don't worry.

After 42 weeks, the risks of the placenta deteriorating increase. But there are outliers on any statistic - some women give birth at 40 weeks and have some placenta deterioration, some give birth at 43 weeks with perfectly healthy placentas. Hence why some women go for expectant management, even after 42 weeks.

The risk doesn't go up until after 42 weeks, but it is still standard in many areas to induce before then and induction carries its own risks, so inducing before 42 weeks purely for being post-EDD isn't actually evidence based. Obviously if you have issues, then earlier induction may be evidence based, but that's a different scenario.

porca, that's why when you refuse induction you get monotoring - CTG and ultrasound instead, to check on the placenta and fluid levels. The risk does go up, it's true - from 1 in 1000 to 2 in 1000.

There are various personal reasons that I really don't want any intervention if at all possible, and inductions do lead to more intervention - the Dr was extremely pessimistic when I saw her, she said that because it's my first, the gel won't work and I will need the drip, so won't get my waterbirth blah blah blah and it really frightened me. Seeing as I have no medical reason at all for the induction, just hospital policy, I don't see the need for it.

A friend of mine and his wife absolutely refused induction and went a full 4 weeks over their EDD! They felt harrassed by the hospital and were left feeling very jaded about the whole thing. They agreed to daily monitoring though. They believe that the placenta doesn't deteriorate until much later according to some Australian research.
Throughout the whole pregnancy she was absolutely fine. She had a natural birth with no interventions and their baby had a great APGAR score and continues to hit all the growth milestones in the top percentiles.
I'm going to try and hold off induction until as late as possible myself and only agree if there is a very definite risk to the baby or myself.

Wow 4 weeks over!!! crikey!

Interestingly though my NCT teacher is scandinavian and she said in Sweden your due date is always 42 weeks, not 40 as here, so potentially could go to 44 weeks there as well.

I asked my midwife about this as I went pretty overdue - the thing I thought was interesting was that if you are a low risk pregnancy and following that care path, and you refuse induction you immediately become high risk and follow that care path.

i.e. no waterbirths/minimal intervention births etc

thankfully I went by myself at 41+4 :)

hmm, that's somethign to consider when I talk to them next week then, thanks for that - it may be a case of damned if you do, damned if you don't.

Fingers crossed baby will come before I need to address it all properly.

Cosmo
The Dr is talking b**cks by saying the gel won't work.
Similar to Blondemumma, I had gel only to start both mine off and fairly normal labours thereafter. Although I consented to the pessary, once labour was started I was very firm about who was in charge - i.e. me not the Registrar. So even if you do end up being induced, you just need to remind them that you are in charge of your own body and are not there to comply with whatever standard procedures suit them. BTW the midwives were very supportive and were glad I stood up to the Registrar! Just go with your instincts.
Good luck.

Hello - I've not given birth myself but if you want to be proactive in the meantime there's advice on the internet about helping your baby move into position:

www.pregnancy.org/question/what-will-encourage-posterior-baby-turn

www.homebirth.org.uk/ofp.htm

My Mum had a 'back to back' labour with me - expect you'll be told this but ideally you want to be on all fours if you go into labour with the baby still in this position.

Once s/he's in position maybe you could try acupuncture to induce labour more gently? I have heard some people find it effective.

Hope it all goes well.

Hi Cosmo I am 40+4 with my first and tryin not to to worry too much about induction yet ... but its difficult not to isnt it? Im booked in for a sweep at 41 weeks and a consultant appt at 40+10 where I plan to talk to them about dating my pregnancy properly. I do not want to give in to hospital policy to induce at 40+14 just becuase that is their guideline - they do get severe about how you are 'going against medical advice' but I feel that they could be out on my due date by at least a week, allowing for dating scans being reasonably accurate (my own dates tell me they are wrong by 2 weeks so I will split the difference!!!). Im interested in this thread as I think that monitoring should be perfectly adequate - but gawd - really dont want to go toooooo long after my EDD. Will be totally fed up! Tis a problem I will deal with when I get to it. Good luck to you and remember we could still have our babies at any time now!!

Thanks dreamylady, already trying all the things they advise, but baby is very stubborn!

Good luck Helena, hopefully we'll both have non induced babies soon :)

Here are the NICE guidelines, which I think all NHS hospitals/staff etc should follow - they make it quite clear it is your choice, so I hope that makes you feel more confident in putting your preferences across.

www.nice.org.uk/nicemedia/live/12012/41272/41272.pdf

"You should be given plenty of time to discuss induction with your partner
or family before making a decision, and your healthcare professionals
should support you in whatever decision you make. If you choose not to
go ahead with induction, your midwife or obstetrician will discuss your
care options with you."

I have always wondered about the accuracy of dating scans, given babies come in such a variety of sizes, how can such an early measurement be a reliable indicator of a due date? Therefore I am dubious of any policy that states a specific date for induction as it is based on a rough estimate at best... As my baby only dropped on Tuesday - ie a day after I was due - I don't think sticking to a timetable is very likely for me!

I am 40+5 now and apparently the midwife will ring me on Monday (bank holiday?!) to offer a membrance sweep, but not sure what they will offer in terms of induction. I'd prefer not to be induced myself so interesting to read this thread and find out how we all get on.

ooh i shall bookmark this thread, preg with my 5th and i ALWAYS go more than 14days overdue! i held out till term plus 3 wks with no 3 and then went in to be induced as i was FED UP and it was almost xams (he was born 23rd dec)

slightly more complicated for me as i am allergic to the prostin gel and i can only be induced by ARM, luckily it has worked each time :)

with no 4 i went in at 15days over and had ARM and then i delivered him in the birthing pool.

i had to battle registrars etc, but was lucky enough to have very good midwives each time who helped me stand my ground etc.

good luck and hope all goes well, i am guessing i will be on here again in oooh 15wks (am 27wks now)

btw i went in for monitering every other day etc and had an extra scan to check fluid levels all was fine and each time the midwives have said my babies werent overdue for me, ie no dry peely skin, the placenta looked fine etc they have all been big tho!

hi cosmosis, i completely understand your desire not to be induced. When i was pg i felt the same. I had done a bit of reading and was prepared to refuse induction and opt for monitoring. Like you i had a low risk pg. I had read (but can't source now, may have been the ina may gaskin childbirth guide, which is invaluable) that risk of placental deteriation is greater in later pg's, ie pg3, 4, 5... And yet when they work out the risk they don't distinguish between first and fourth pg's if you see what i mean. So as this is your first baby your statistical likely hood of problems is actually lower than the risk stated. I recall discussing this with my mw so trust she had it straight.

Also there is a statistical relationship between your ethnicity and gestation, so this may well be worth looking at too. And as someone else pointed out dates are not that accurate. I knew mine were out as ds is a honeymoon baby so there is no way if was conceived when they reckoned, he's just a whopper!

Try and relax as stress hormones aren't helpful to labour. In the end went in to labour spontenentsly, well, after a hilly walk, orgasmic sex a bath and a curry...all in one day. did the trick

Good luck! Let us know how you get on if you can, i'd be interested to know.

I've already read the NICE guidelines and as far as I can see they have already broken them as they are supposed to discuss alternatives when offering induction and they didn't at all, didn't really offer it as a choice, well unless "can you make the 4th" is a choice :)

Any way, am much more relaxed about the whole thing now, so hopefully that will help!

its interesting that both France and Sweden have later EDD than here. I dont really want to be induced either, I just beleive what I am told!!!!!

I am also B2B, great......

are you sure your due date is right? Often people who need to be induced aren't actually as overdue as the hospital thinks they are.
If you are sure your due date is right, then ask for an appointment with a doctor and ask them to explain why they want to induce you. Its up to you whether you are persuaded by their answer.

the due date they gave me is only 2 days out from the due date I had worked out myself, so yes am fairly sure it's right - by my date I am 41 today, by theirs I am 41+2 today - it is one of the reasons I was hoping to at least delay induction though, just in case that extra couple of days does the trick!