41+3 with first baby, planned home birth and terrified of induction- advice please!

[Ali79]

Please help! I have had an uncomplicated low risk pregnancy, and am now at 41+3. We are planning a home birth. At my post dates appointment today the monitoring confirmed my baby is doing well. The hospital will ultimately support us in whatever we choose to but made clear today that the legal liability lies with us from 42+1 should baby die. It was not a pleasant conversation. Our suggestion that we have strong evidence to suggest I am actually 40+6 today was dismissed, and we had all of this discussion with the most senior registrar on the maternity ward.

I also had a first sweep today- turns out I am 1 cm dilated- and I'm planning another at 41+5 (sunday) and 42+0 (tuesday) We've agreed to daily fetal monitoring from 42+1, plus a U/S scan on that day, should I not go into labour before then.

But we are now spooked and extremely confused:

• Should we agree to intervention at 42+1? Later? Not at all?
• If so, induction or C-section? Does anyone have any good stories about induction or would I be better off just asking for a C-section straight off? I've heard so many awful things about induction. Not least, the idea of having to labour from the off in hospital feels like absolutely the worst thing to do, worse than electing for major abdominal surgery. Is that crazy? What do others think?
• And how on earth can I now calm myself down enough to maximise my chances of going into labour? I've spent most of today crying.

Any advice extremely welcome.

it's never a pleasant conversation, but remember that wherever you give birth it is your responsibility iyswim? whilst the hospital would be liable if they were negligent in any way (and that includes if you go over 42+1) ultimately you are the one making the decisions about your care iyswim?

it freaked me out the first time i had a homebirth and my doom-and-gloom midwife did the whole "it's your responsibility" talk. but then i thougth yes, it IS my responsibility and it should be and I know why i am doing this and it's an informed decision.

and breathe. if you have strong evidence to suggest you are not as far along as they say, and if you are happy with monitoring etc then go with that!

personally if it comes to intervention i would much rather be induced than have a c-section. if your pregnancy up to now has been completely straightforward then there is no reason to think you would need a c-section is there?
i mean, looking at it only from the baby's perspective then a vaginal delivery is best, so i think that's what i would do

What a dilemma, and i can't advise you what to do, but I wanted to let you know that I had an induction last year (40+12) and it went absolutely fine.

I had the first pessary, came home, started mild contractions, went back to the hospital for the second pessary, but just had another (fairly vigorous) sweep and the contractions speeded up. No further intervention and DD2 was born 3 hours later.

I wasn't allowed to have the waterbirth which I'd been planning (had one with DD1) but as it turned out, DD2 arrived within 10 minutes of me being in the labour suite so they wouldn't have had time to run the water anyway .

Good luck with whatever you choose, and here's to hoping things start progressing very soon.

I feel for you

I too am planning a home birth... in "from about 9 weeks time."

I have already made the decision that should i go over 42 weeks, i will insist on daily monitoring and (unless there is reason, ie placenta looks like its degenerating) i will NOT be agreeing to an induction. (escpecially as i am certain my dates are correct and my dates are 2 days behind hospitals)

At least not for another week or so (with regular checking that everything is fine of course)

Im a great believer that baby will be born when he / she is ready, and yes while the risk of baby mortality is higher, (double they like to say) its about half of 1% rather than a third of 1%, so still very small over all.
and i do NOT want to have baby in hospital, and i certainly do not want to be induced.... im planning a home hypno water birth, and just because im 42+3 or similar, its still what i want and what i will try to have.

Good luck

Well, the big thing I would say is that you don't have to make all the decisions now. If you're sure of your dates, you actually haven't reached the average for first time mums (which I read somewhere is 8 days over) and there is an extremely high chance you'll go into labour before you reach 42 by anyone's dates.

Also, you could agree induction at 42+1 and then change your mind if you feel happy to keep going. That would get everyone off your back in the meantime and maybe relax you enough to get things going?

Mine were 8 and 9 days 'over', so I feel your pain...

Just to give you a bit more hope that things will start on their own, I was very reluctant to book my induction appointment and was convinced a sweep would work at 41 weeks ( it didn't) I went into labour naturally at 41+5 the only thing that had changed was that the day before I had accepted that the induction would have to happen if I didn't go into labour spontainously. Just keep telling yourself you'll have your baby soon.

First point, please don't be terrified of induction. It is not something you have to do, and if you choose to go down that route then IME it is not worse than a naturally starting labour - just different. Getting very focused on induction, and becoming fearful, may actually make it harder for your body to go into labour.

Secondly, I'm not sure why you seem to be making the leap from spontaneous labour to C-section and seeing induction as 'worse' than C-section.

The first step of induction would be some gel applied to your cervix. This can be enough to start your labour - which would then progress exactly like a naturally started labour. Perhaps you may have your waters broken, which is uncomfy (from what I've heard) but may also be enough to encourage labour to get going. It is only if you have an IV syntocin drip that you will need continual monitoring and may want an epidural as some people find these contractions intense from the get go.

My first childbirth was induced. I was in hospital for several days (things were slow to get going because I was being induced early - not once I was overdue) having the gel, walking round etc. I remember it is quite a serene time. My waters went naturally. I dilated to 3cm with just the gel, before needing a syntocin drip to speed things up. Baby arrived 8 hours later and I am hugely proud that I pushed her out myself (with a little help ).

Good luck with whatever you decide.

I was induced at 42+2 and had been doing yoga/hypnobirthing cd etc before. Couldn't believe I was so overdue and would need intervention anyway after being so patient! But thanks to all of that I absolutely enjoyed the last few weeks of my pregnancy and went into the hospital with a trusting and go with the flow attitute, seeing what I could learn. I was with domino midwives who were quite low intervention in general. It ended up being a very positive induction!

I had been pre labouring for about 24 hours myself before I went in, so was very favourable when we got there so needed only minimal intervention, no gelnor anything. started the drip around four in the afternoon. Followed my instinct, stayed upright in various positions and managed to get to six cm in by seven pm. Without gas and air, just breathing. And singing! Then I requested pain relief as the contractions were not bad but I felt pressure and wanted to push but thought it was too early. Suddenly I was full dialated! From six to ten in ten minutes! I needed a bit of pain relief to help with delivery as she was so big and also the placenta didn't come out! But it was a wonderful birth really! All worth it!

Next time, this was my first, I think I will recognise how close I am and get thru without pain relief, the mdwife wasn't expecting things to have progressed and thankfully hold back from doing many internals during the process, it didn't help for the birth but it had kicked in by the time the surgeons had to deliver the placenta, so everything happened for a reason.

Am bf my one week old daughter at this moment, still can't take it all in!

Good luck, hope you get a lovely birth!

that the legal liability lies with us from 42+1 should baby die

What a callous and unfeeling thing to say. And innaccurate to boot ... the legal liability will lie with whoever (if anyone) has been negligent.

I think you have got to follow your own instincts ... hopefully the monitoring and u/s will be reassuring. I have no experience of induction ... my son was a footling breech and my insides were in a twist because I have multiple fibroids so I had no choice but to have a cs; that was a huge disappointment to me because I had really wanted to do the proper thing and push.

But I can honestly say that 10 seconds after the birth I couldn't have given two hoots how he got there ... he was there and that was unbelievably wonderful.

I ended up in tears several times after the cs because of run-ins with midwives and other staff ... it's now more than 12 months and I still get cross with myself for letting them upset me during that time. Health professionals are not angels, some are good and some are less good and some are downright bad, but don't let any of them get you down.

I hope things go well and you get the birth you want, and if not everything goes well.

I also had the harsh 'legal liability' lecture from my consultant along with alot of 'entirely your risk' ' and 'against my professional opinion' comments thrown in. For good measure she also spoke about still birth stats and said the risk factor was 'significantly higher' after 42 weeks. In fact DH picked up the detail of what she was saying and the risk is .02% stillbirth rate before 42 weeks and .03% after that so in reality and extra one death per 1000.

DH and I had a long talk and agreed the best thing for me was to calm down, and retune into my own instincts and body. There is no question of me risking the life of our baby but my gut is telling me at the moment that induction is not for me and my time is spent better relaxing, producing oxytocin and not adenalin. I may review it at 42 weeks but until then I will concentrate on my own well being and building trust in my body to do the right thing at the right time without getting distracted.

Hope this helps and I hope you get the birth that is best for you.

I'm in pretty much the same boat- I am 8 days over by my dates and 11 by the scan. I had to see the consultant (who didn't read my notes through so didn't know about the home birth- and I didn't mention it!) and she too was pretty direct (the words 'dead baby' were said!).

She wants me to have a scan and CTG at T+14 by their dates and another at T+16 by their dates. I have agreed for the time being but will review how I feel at the time. I'm booked for induction at T+14 by my dates and T+17 by the scan date...

It's not easy is it and I too have cried a fair bit! At the end of the day it is your decision but when faced with persuasive drs that's easier said than done.

Not very helpful but just wanted you to know you're not alone!

It's so mean of them to say things like that. You're probably fed up enough as it is waiting around for baby without people making that sort of comment. There's a tiny bit of extra risk perhaps, but not loads. My DS was 10 days late. By 7 days over I was under massive pressure to book an induction. I refused it and they acted like I was the only person who had ever refused and had to really fight for a monitoring appointment.

Maybe I'm cynical, but I think they want to get you off their books by inducing. It's probably much cheaper to get your birth over with than to get you in every day for monitoring.

Fortunately I went into labour on the day I was supposed to have my first 'monitoring' appointment. They even called me to see why I hadn't shown up!

I found it very stressful and put in a complaint aftewards about how I felt bullied, but they weren't able to investigate as I couldn't remember the midwife's name who I saw at a week overdue.

Please try not to stress and don't be pressured into something if you really don't want it.

Consultants tend to scare you, as, by the nature of their job, they see the cases which do go wrong. Which biases their view somewhat. But if you look at the stats (quoted by others above) it's actually not that bad.

Induction does increase your risk of side-effects/more interventions, so I almost always think it's a bad idea. The baby will be born when it's ready.

There may be a very good reason labour hasn't started (e.g. baby not in optimal position yet etc), so if you start it artificially, you run the risk of a more difficult labour than if you'd left well alone.

Plus, the theory on the increase in stillbirths/neonatal deaths after 42 weeks is that it's most often due to congenital deformities etc in the child. I.e. there is already something wrong with the baby; that's why it's gone overdue, and that's why it has a higher chance of dying.

have you tried acupunture/reflexology to help start labour???

Has anyone been told by their consutlant that monitoring appointments are a waste of time? I forgot to say that when I said I would prefer to come in every day to be monitored, mine said that they couldnt tell anything from monitoring apart from the baby is still alive. I wasnt on the ball enough to challenge this and ask why they bother monitoring above just listening to heart beat. Anyone got any comment?

Follow your instincts - go for expectant monitoring and have a scan. Your placenta will be "ageing" as it has done so from about 32 weeks but you sound like you've had a wonderful pregnancy and you need to optimise the oxytocin now and not the adrenaline.
I waited until I was 42+6 and went into spontaneous labour. I told the MWs / Consultants etc. that I knew my rights, I was not to have any further discussions about "my baby dying!" and they were to support me in my decision (as per their policies!).
Good luck

Try acupuncture - I have gone overdue with all 3 DCs and gone on to have homebirths. Had acupuncture at 41+3 with DS1 and at 40+4 with DS3 (because we thought my waters might have broken so I was looking at going into hosp for induction if labour didn't start naturally). Had the baby within 24 hours in both cases so it's either coincidence or it works - I think it works! Please try to take one day at a time (ridiculously hard I know)

Poor you, its awful when you are heavily pregnant, feeling so awful and tired, waiting for things to start, especially with your first.

FWIW I planned a homebirth but in end was induced at 40+1, because DD's amniotic fluid levels were very much reduced. It wasn't an emergency, but they said it was best practice.

I had the pessaries and then the drip, which did get quite painful quickly so I had an epidural and then a last bit of help with forceps for the last two pushes as I was exhausted.

It was totally not the birth I had planned, but it was FINE, really. Quite an intense experience, but fantastic midwives - one of whom stayed four hours over her shift end to see DD born.

Better still the recovery was good - yes, having had an episiotomy it was a bit sore to sit down for a few days, but nothing not manageable. I was up and walking around, able to hold and feed DD from the off etc.

This is so much easier than trying to bond with and feed your newborn after a CS, when you can barely sit up for a few days afterwards and the baby is not delivered straight onto your chest.

I would definitely take induction over a CS, anyday!

Hang in there my love, it will all be over soon, and try to hang on to the fact that, however it all pans out, the main thing is getting baby out, and once your son or your daughter is here, the actual process of birth isn't too important. You'll be fine if you are induced, I am sure. Dont be scared of it, because this will make it worse - yes, it can be painful but you can take the drugs if you need to. It really isn't horrendously bad, at least not in my experience.

Best of luck!

How was your sweep today Ali?

My friend just had HB in the birthing pool the day before she was due to be induced so there is still hope yet.

Having had EMCS I would say if you can do it naturally with induction that would be better. CS recovery is difficult with a newborn, especially getting out of bed and breast feeding. Haven't been induced though so have nothing to compare it to.

Here is a link to the HB website page on being overdue and HB that might help reassure you.

So many wonderful helpful replies here- thank you so much. This is definitely making me engage with the idea of induction and how I can be as positive as possible about that- which is taking away some of the anxiety.
Quick update: had my second sweep yesterday, which put me at soft cervix, 1 cm dilated, 2cm long but still posterior. I also lost my mucous plus 5 hours before the second sweep, although I know that isn't really a sign of much, at least it helps me feel my body is preparing in some way! Today I've had a first session of acupuncture which felt very powerful, and I am feeling quite positive and relaxed. Have definitely been feeling 'crampy' for much of today, if that tells me anything...
I only hope I can get my boyfriend into the same position- he is still very anxious and I worry that our hospital appointment on wednesday, if we get that far, will set me back a lot. The consultant did try to tell us that monitoring doesn't give them any information- so I think asking them why they bother is a reasonable point! I will also ask for a further sweep, and insist on CTG and scan every other day provided all fine on wednesday. Someone earlier also suggested pressing the sonographer, during the scan, on whether she could see anything that might be 'blocking' baby's path, so I will ask that too.
I very much hope my next post here is to announce baby's arrival. Thank you everyone for taking the time to read and respond to my message, and any advice continues to be welcome!

try reflexology as well, I was in the same position with DS, 8 hours after reflexology and the sweep of my life went into labour, 10 hours before I was due to go in for induction!

Good luck, all those signs sound like your body is preparing itself

Yes, I've heard positive things about reflexology too.

My friend went in for induction, they told her to eat ice lollies, drink v cold drinks and go for a walk up and down the hospital stairs for a while. I think she wandered around for 2 hours and then they broke her waters and that was all the intervention she had (previous cs so drug-free induction).

I don't know how much of this is replicable or if she was just ready but it sounds like a nicer alternative perhaps?

Anyone know why the cold stuff and stairs helped?

Ali

That all sounds very good - losing your plug, cramps etc. I am sure things are on the move!

Keep walking around and traipsing up and down stairs!

Best of luck!

How are you Ali79

Hope you got your homebirth Ali