Can anyone help me with some questions about the timing of induction?

[thefurryone]

Hi, currently 38+5 and although I'm not quite at this stage yet, my MW has told me that at my full term appointment I'll be advised about induction at 40 +10 should it be required. This seems to be the standard in the hospital that I'm going to.

I'm not particuarly comfortable with this and don't really understand why when pregnancy can legitimately last up to 42 weeks it is so common to induce before this.

I'm also concerned that despite knowing that I can refuse induction and ask for monitoring and feeling quite strongly about this, that as soon as I get in front of a medical professional telling me I'll be induced on such and such a date I'll lose my nerve and end up just agreeing.

It doesn't help that whenever I mention refusing induction in real life I'm told that I'm putting my baby at risk, but is wanting to get to at least 42 weeks pre-induction that much of a risk?

Now fingers crossed this won't be a problem but if anyone has any insight into the timing issue or advice on how I can handle this I'd be most grateful.

TIA

Is this your first baby?

If so search risks in first time mother inductions.
I feel very strongly on this issue, and wish someone had told me the truth before I had my child.

REFUSE any form of induction. Its not natural, not good for your body or baby, and is much more painfull.
If they are genuinely concerned about baby, tell them to give you a c section. If there was a real risk, they would.

I think the 40 +10 is the current NICE guideline which the majority of hospitals use. Induction beds tend to get booked up and midwives often think they're doing women a favour by booking them at 40 weeks, but many women experience it as being pushed around.

In addition to null's suggestions, you could also research reasons for induction. Statistically, the risk of stillbirth increases from 41 weeks, though remains very low, but some women are more comfortable with this than others.

As you say, hopefully you won't get to that stage, but you're right to start researching now so that you feel clear what you're agreeing or not agreeing to if the time comes.

I have been induced twice, once for waters breaking without labour and once for post dates. First was with a drip, 9 hr labour, healthy DD. Second time was with pessaries, 4 hr labour, healthy DD. Both times I had some monitors on but was still able to walk around and did not need an epidural.

In fact, the second time I asked to be induced at 40+8 because it worked so well the first time. And I felt I'd much rather have a bit of advance notice of the birth, rather than a 4 am rush to hospital.

The reason doctors do induction for post dates is that the risk of still birth increases past 41 weeks. It is a small risk, but still worth avoiding. why not ask your midwife more about what induction involves in your hospital? And there is a high chance the baby will arrive on it's own and you won't need to worry.

www2.cochrane.org/reviews/en/ab004945.html

Here is the cochrane review (gold standard medical review) on induction of labour. Inducing at 41 weeks ish has better outcomes than waiting.

I'm 40 weeks tomorrow and would much rather be induced before I get to 40 +10 for a few personal reasons, knowing someone who went 12 days over due date and her baby was still born - rare I know but having seen it happen I am more aware/paranoid about it. Also, from research I have seen the Placenta could become less efficient after 41 weeks, you can ask to be monitored, scans etc for this but again I would not want the panic of finding out something was wrong when I could have opted to be induced. I've also struggled in the last 10 weeks with extreme discomfort due to SPD and general late pregnancy aches and pains...

I think the point is you need to make a decision that is right for you and your circumstances, every pregnancy is different and at the end of the day you and your baby's health and well being is whats most important.

Good luck with whatever you decide to do :)

My midwife knew I wanted a homebirth, so booked my induction in for 40+14, which was fine by me. I considered asking for monitoring and not being induced but I was getting a little bit anxious about having my baby by that point and also I felt my body was ready to give birth and maybe just needed a pessary to kick it off. In the end I had a sweep on 40+13 and went into labour that night, and had my homebirth, baby born 40+14.

These figures don't suggest much increase in risk of stillbirth as the weeks go on: www.ncbi.nlm.nih.gov/pmc/articles/PMC28178/table/TN0x8a59820.0x9aa1e68/
And you need to remember that induction is not risk free, see this opinion piece by a midwife:
midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/
It's a hard decision to make and one only you can decide.
WRT to talking to medical professionals, it may be best not to think about being argumentative. You can get what you want by smiling, being very gracious, but also steely with a backbone, not giving way:
dr "don't be silly, we will induce you on x date"
You "thank you very much for your advice. I will need to take time to think about it and my my own decision. Perhaps you could tell me what the absolute risks are for each option, as I understand induction is not without its own risks such as fetal distress, uterine rupture, c section and low apgar scores. I presume you are up to date with the best research evidence?"

Very good post calminsomniac

I know my answer probably seemed a bit drastic. I dont want to scare you.

But please read the links above from other poster.

You are relying on there bieng good, well informed midwives / staff in general once you start this off. If you are really unlucky, like me, not only will you have all the complications from bieng induced, your labour will be bieng managed by morons.

I have to live, forever, with the consequences of allowing them to induce me, when they really didnt need to. I wish I had stood up and said "NO"

Thanks everyone for all the advice I will spend the afternoon researching and making sure I'm as aware as I can be about the subject

What is making me most uncomfortable with the 40+10 option is the assumption that if I haven't gone into labour by this stage this is what will happen, it's seems to be a decision based on statistics rather than specific medical care that my baby or I needs IYSWIM. If a doctor or midwife examined me and told me that I needed to have my baby now because of xyz then it would be a much easier decision to make.

I was induced about a week before due date with both dc due to high blood pressure.

DS - induction in the evening and he was born at 1013 the following morning.

DD - induction at 1010 and she was born at 1129.

I was obviously lucky, but had no real problems with either birth.

Well good luck thefurryone hope all goes well for you.

Dont let the white coats pressure you. Baby may come by itself before then. :)

i was induced at 40+12, failed so had emcs ds2 is now 4.4:)

I was induced at 40+19 for dc 2 and booked for induction at 40+21 for dc 3 who came on his own on induction day. I left it so long because dc1 was a c section and i was told that i would only be able to have a single pessary to start labour - if that didn't work it would be straight to c section again. Had regular scans, kept a close eye on movements etc. I think the key is to be informed and sensible and then most healthcare providers will respect your wishes. I just think that sometimes inductions fail because baby just isn't ready to come out when the powers that be decide. Fwiw, both my very late babies were a good size,8lb and 9.7lb, and did not appear to be as late as they were - plenty of vernix and dry and certainly not skinny!

I would not wish to panic anyone BUT I think all women being offered induction need to be aware of the risks. It is not without risks for mother and baby. A couple of weeks ago I read a horriific case of a helathy young mum dying after being induced. She died in agony when her uterus ruptured and she had a cardiac arrest. Staff tried to save her baby but it too had died as a result of the rupture. She was pleading for pain relief which was denied and the lawyer handling the case described as the most distressing she has ever dealt with. These days patients can and must question HCP closely and ensure that they are confident with advice being given.

google bishops score - an index of how ready your cervix is for labour, and ask your midwife what your score is, if nowhere near ready then induction going to be more arduous I would guess