Induction - does it make a difference when?

[nancydrewrocked]

I am currently 25 weeks with #4 and for various reasons (convenience and anxiety) I am considering being induced.

In theory my consultant is happy to do this from 36 1/2 weeks and I certainly don't want to go beyond 39 weeks.

Is there any evidence that leaving it as late as possible will make it easier or is it a case that all indictions are going to be hard?

Hi nancy,

I am pregnant with my 3rd baby and have never gone into natural labour only ever induced so i have nothing to compare to.

I honestly didnt think being induced was that bad at all. 1st baby was 2 weeks over dude, once labour started it went really quick.
2nd baby i had gestational diabetes and was induced at 38 weeks again all was fine (apart from her being back to back) which made it more painful, it was fine.

I have been in with my sister twice when she had her babies and i cant say i struggled anymore than she did.

Yes, it can make a difference, because if your body is already gearing up for labour naturally, then you'll go into labour easily.

TBH I'd very surprised they'll offer you early induction for psych and convenience reasons only!

I have OC so have had early induction as a possibility since the diagnosis. The hope was that if the OC was well enough controlled, this wouldn't be necessary and this had luckily worked out to be the case, though I'm booked for induction at 40+3 in case I go over (which none of us are happy about because of the OC).

There are definitely increased risk with induction and early inductions are more likely to need more interventions, so are a bit riskier still.

And then there's the risks of being born early for your child, especially looking at some recent studies on development.

I was induced at 36 with dd and she was in scbu for nine days simply due to being so early, as fed up as I was of being pregnant I would never, ever want to have to go through that again. Plus the induction was pretty awful, ten hours of lying on a bed not even allowed to get up to go to the loo, no epidural allowed, hormone drip horrible, forceps delivery in the end. However as it is your fourth I would expect it to be a nice quick birth, but please hold out as long as you can so you can have your lovely baby in your arms straight away :) Good Luck

Thanks katy I was induced at 36 weeks with my first and it was horrendous. She just didn't want to come out and the entire delivery was fraught so I am fearful of a repeat performance.

With my second I went into labour spontaneously at 38 weeks and I am almost envangelical about the birth - it was wonderful and that is what I would wish for this time

however DS2 was stillborn so for that reason I have been offered an early induction (although his stillbirth was nothing to do with gestation) combined with the fact my DS is overseas and I would very much like him with me (esp due to my last delivery).

But I am totally conflicted as to what to do. I don't want a horrid labour (and I was fairly traumatised after DD's), I do want my DH there, I don't want to cause my baby any difficulties by being too early or too late, I would love to replicate the lovely experience of DS1's arrival but frankly I'll birth her out of my nostril if that's what it takes.

sunndydays do you mind me asking why you were induced? I have to be honest I had never heard of a baby being in scbu at 36 weeks so it simply didn't occur to me.

i'm sorry about your ds2 it must have been very hard for you.

i would still say though avoid an induction, because having one doesn't take away the liklihood of a "horrid labour" in fact it probably makes it a bit more likely, as the risks of intervention increase with induction (though of couse many inductions can be fine, the stats are clear, induction increases risk of intervention)

have you tried hypnobirthing or yoga? i did the latter and have heard great things about the former so will be doing this if i have dc2. these will help you cope in the labour.

my understanding is that before 37 weeks a baby is considered to be born premature so i really dont think its wise to induce before then out of choice if you do go down that route.

So sorry to hear about your DS2 :(

I looked into this as my consultant was keen to induce me from 37 weeks as I had PIH/intermittant protein and he was convinced I was pre-eclamsic and would become very poorly.

From memory (unfortunately haven't saved the papers I looked at) particulaly as a first timer it was fairly unlikely I would have a natural birth if induced at 37 weeks (far much higher risk of forceps/EMCS) as my body just wouldn't be ready to give birth and there was a higher risk of the baby going to SCBU with breathing problems even though it would be 'term'.

I wasn't convinced so hung on till 40 weeks (bar a couple of sweeps as I reckoned they were unlikely to work if DS wasn't ready to come anyway), DS then came by himself on his due date, the day before the scheduled induction :)

Balancing the risk of possibly getting pre-eclampsia (which I minimised by checking my blood pressure/protein/monitoring symptoms) vs the risks of trying to get DS out maybe 5 weeks before he was ready to come out I thought 40 weeks was fairly safe.

Most hospitals only do ELCS from 38/9 weeks now due to risk of the lungs not being developed enough and babies then needing special care.

As you are not a first timer though I suppose your risk would be lower; personally if I really wanted to avoid a horrid labour I would wait till 39 weeks and then go for an ELCS.

Hope everything goes okay.

Thanks

Muslimah I realise the chances of having a horrid birth are higher if I am induced and that is my primary reason against having an induction.

I suppose I am trying to balance the risk of an earlier baby (to their health) and also the likely complications in labour against my fear of going over 38 weeks. Every single mum from my sands group who has gone on to have another baby was induced bang on 37 weeks and whilst not all of us lost our babies because they were "late" it is a big fear, which even if unlikely will cause me anxiety after 38/39 weeks which in turn will (I believe) cause a stressful labour.

Added into the mix that DH can only guarantee being there if I am induced...well I just go round in circles.

I will speak to my consultant re the risks to the baby at 36/37 weeks - but interestingly it hasn't been raised by her.

Oh and the idea of a section terrifies me (and would be very complicated as DH would be returning overseas after the birth and I need to be able to drive)

With early induction, you definitely need to be prepared for the possibly of a CS IMO. It's probably far less likely for you as you're on your fourth, not your first, but I know that if it's your first, early induction does mean further interventions, up to CS, are far more likely to be needed so you have to be prepared for that.

If you did have to have a CS, could your DH postpone his return or do you have family nearby who could drive you everywhere and help out at home?

I know with OC, they like to wait until 38 weeks ideally (even though risks with poorly drug managed OC rise after 36 weeks) because before then, the baby is more likely to need a bit of help.

Sorry to hear about your DS2.

So sorry to hear about your DS2.

I am being induced in a week and a half at 38+2 with DC2 and I have been told by my consultant that the risk of CS is far far lower for a 2nd or subsequent baby than for a 1st baby. I think he quoted something like 25% of 1st baby inductions end in CS and only around 2% of 2nd/3rd/4th etc baby inductions end in CS IYSWIM!

He also seemed to think that intervention such as forceps or ventouse is far far less likely for a 2nd or subsequent baby because your body has already stretched once and will have far less trouble doing the same again.

Obviously there are no guarantees, but I felt reassured by what he said. Hope this helps.

Japhrimel it would be virtually impossible for DH to dealy his return overseas and I have no family who could help more than occassionally with school run (2 fab sisters but both work FT) which is my main concern.

fredfred that is interesting re the instrumental deliveries and subsequent babies - my body ceratinly feels stretched so maybe I'll be OK

It is all so frustrating looking for info - there seems to be two quite different camps, each with their own agendas.

Hi Nancy, I was induced at 34+3 due to preeclampsia but they said i wasnt favourable as my body knew baby wasnt ready, they tried twice but neither worked and contractions didnt start and i didnt dilate at all so DS had to be born by cs and ventouse. They said the further you are along the easier it is as your body is ready for birth. I dont know if the 2-3 weeks would make a diff to babies health but obviously the longer hes in there the more developed he will be. Hope it goes well for you xx

It sounds like it's a very different ballgame with subsequent babies. As its my first, I obviously haven't been told the difference in stats!

fwiw i was induced twice at 40+12 and my labours were very quick and easy ish apart from positioning problems with dc2.

at 37 weeks i would say the baby is likely to be ok and your body may have started to prepare itself, remember too that youve laboured before.

i think going over 37 weeks would - understandably - be very very traumatic for you and i would personally consider that as detrimental to my health as for example, having a 'bad' labour or needing intervention but obviously only you can decide.

ps im very sorry for your loss

I am sorry for your loss and can complete understand your desire to not go mentally past the point at which your ds died. The fact you have previously gone into labour at 38 weeks would go in your favour I should think.

I've been induced 4 times and IME the overdue ness definately influenced the speed of getting into established labour:

dc1, 7 days over, 3 day event
dc2, 17 days over, 1 pessary born 10 hours later
dc3, due date (due to my mental state), 2 day event
dc4, 14 days over, 2 pessaries, born 11.5 hours after 1st pessary.

I am clearly meant to be a 43 weeker in terms of gestation length but I was happy to be induced at 42 weeks with my last because I didn't want to live with my choices being the cause of a stillbirth - rare I know but the anxiety was there.

Nancy. Tough deicision, but I would recommend you do whatever you feel most comfortable and calm with. Yes, the induction process can lead to a more complicated labour with an increased probability of medical intervention. However, I think you need to weigh this up against the levels of anxiety you may feel associated with your previous labour and birth..for which I really feel for you and you DH. Have you had the opportunity to speak in-depth to your midwives about your previous experience and fears for your next labour and birth? You sound like you loved your DS1's birth and your body CAN do that again, but I really think you would need support to help you envisage and visualise that kind of birth again without becoming too anxious. I wish you all the best.

Thanks everyone for your comments - they are giving me something to think about

DoulaKate I haven't spoken to my MW's yet about the delivery although obviously plan to. I sort of wanted to get my ideas clear in my head before I start those discussions and there is so much to consider.

Perhaps strangely my ideal would be to have this baby at home, but I would need confidence in the MW's that they would transfer me if there was any indication of a problem - so perhaps that suggests I am not cut out for it now.

Will keep mulling it all over.

As an aside cargirl I cannot believe you went 17 days OD - full credit I think I would have been climbing the walls

I was very pee'd off had a homebirth booked, couldn't have it, hospital was packed due to post 9/11 baby boom. By the 4th I was just resigned to induction at 42 weeks and had it booked in from 16 weeks made for a very very positive birth experience.