Alternatives to induction? What to ask at hospital tomorrow?

[PrincessJenga]

I'm 41+6 and due to be induced tomorrow. I really don't want to be. My uncertainty about it is partly because my NCT teacher was so negative about the 'cascade of intervention' and partly because I just think that baby will come when he's ready. If he's not here yet, surely he needs to stay where he is for a little longer? Also, we'd planned a homebirth, so going for a highly medicalised birth simply isn't what we'd wanted.

So, first off, am I being naive? Is it really dangerous to wait longer? Should I just accept the induction tomorrow and look forward to meeting my LO? If so, how can i make induction as positive as possible?

Or, are there alternatives? What questions should I be asking tomorrow? Is there any way of checking how well the placenta is working? Is there any way of estimating when labour may start?

Anything else I should be considering?

Thank you!

Sorry to hear it hasn't happen naturally yet - I was induced with my first and then had a stand up row with the consultant when they wanted to induce me with my second! see if you can delay a bit by finding a midwife with very long fingers to do a sweep - it will be uncomfortable but it may work - did for me second time.

I was still very anti-induction but tbh I now know so many medical people who've had to deal with the situation when things don't work out well IYKWIM - so although induction isn't the preferable way to get things going getting baby out safely is the main one and the placenta does get much less efficient when you go post dates.

there is no way of anticipating when labour may start naturally

they can see how well the placenta is working by doing a doppler scan of it - there are NICE guidelines on what you can expect if you refuse induction and go for expectant management

good luck - hope all goes well and baby comes on his/her own

I've had three and all were great but before my first I was so so very scared...also because of nasty NCT teacher who was so anti she put the fear of god into me.

The term "induction" covers a huge variety of interventions....starts with sweep, then a pessiary, sometimes manual breaking of waters, then if you're still not going a drip......You can insist for a sweep from a midwife first (though with my second she laughged when she started as said I was lke concrete and abomb wasn't going to get me going .....I've had loads of sweeps(!), ...get oldest most experienced mid wife to do it as they know what they are doing.....and breath out through any pain/discomfort.

I had epidurals with all mine (cos I hate pain and always say yes to any drugs that are being offered!). Consultant recommended it as the first time you go into an induced induction labour pains can come on quick.

Oh, and be prepared to wait....took them 48 hours to get me going with my first! Spent two days wandering round hospital car park with an ipod waiting for action.

But honestly, they are often so fine, honestly.....I live overseas where you can ask for anything and was so bored waiting for my third child I just asked to be induced (an elective induction!)

If you want you can ask to wait. See much fluid you have in your placenta. If you have loads you may be able to wait a bit.

But my best advice is not to listen to the NCT teacher....they only hear/recount when things go wrong. I know lots of people who had great ones! Relax. baby coming soon. Good luck

Thanks. I'll have a look for the NICE guidelines.

I've already had two sweeps. Do you think it's worth trying for a third or would it have worked already if it was going to?

Quick one from me incase you do go for induction - I was induced with dc3 at 42 weeks and had a very quick, easy labour with no intervention. Good luck with whatever you do.

Btw I had 3 sweeps and didn't work. No harm in trying tho.

I was induced for 3 out of my 4 births at 42 weeks, 41+5 and 40+1. It was never that bad, all big babies over 10lbs and were born 'naturally'. The only one that required any intervention was because she tried to come face first, not head first.
With one of them, I had prostin that didn't work at 41+3 and took myself home for a couple of days, and dilated quietly at home. I went in for monitoring each day and agreed to be induced again if I made it to 42 weeks, as the chance of your placenta failing after 42 weeks does increase.
I don't know you'd be allowed a home birth after 42 weeks but may be wrong about that.
I'd ask your consultant the questions you've posed above. If you do end up being induced, just go with the flow. For quite a few people, induction is not at all a negative experience.

re my 48 hours comment I meant they started the induction and then I was just waiting for my body to do something, not that the hospital was inefficient

you could try old remedies like walking up stairs, lobster, curry and sex....but if you feel like sex at 41 weeks plus I'd be surprised!

and no interventions on any of mine.....blimey I should think before I post so you don't get it all in dribs and drabs...sorry

good luck and keep us posted...we are all holding your hand

Oh and my longest labour was the first, it took 6 hours. The two subsequent inductions took 1.5 and 2.5 hours.
I always had an epidural too, get them to site it at the same time as they start the drip if you get that far. That way they can top it up as quickly and easily as possible.
We had a horrid NCT teacher as well. She told us if we had any medical intervention at all, we had failed at 'giving birth'.

And lastly, my 4th came naturally and I didn't have time for an epidural. Was pissed off!

Have always wondered why there haven't been eons of threads on MN re "rubbish your NCT teacher told you". I had a nightmare of one. They should really consider the effect of what they say sometimes.

mymumdom me too! Anaesthetist was outside knocking and mw shouting 'you're not needed' and me shouting don't go anywhere yes you are' and mw saying 'no musttidy it's too late you are crowning' etc.

I did a lot of research into avoiding inductions when I was expecting DD2. If you google 'ten month mamas' you'll find a lot of helpful stuff. Ask to speak to a consultant if you can and print off the NICE guidelines so you can tell them what they are meant to be doing Best of luck with the birth whatever happens.

Thank you. Thank you. Thank you.

I really appreciate you sharing your stories and giving me so many tips. DP and I have just properly sorted my hospital bag (hadn't been planning on using it) and are managing to stay positive. We're finally going to meet our baby!!!

Another question though... I've just been told to go to the delivery suite tomorrow morning. Will I see a consultant and be given the opportunity to ask all these questions or will I just be expected to have the pessary? (I know I can ask to see someone, just wondering what's 'normal'; this is obviously all very new and strange to me and while I'm assertive in every other part of my life I have what DP calls 'white coat syndrome' where I just nod and agree to anything doctors or nurses tell me!)

Finally, I really should say, my NCT teacher was lovely. She made it very clear that birth plans are 'preferences' rather than 'plans' and certainly wouldn't suggest that induction (or anything else) was wrong, but I did find the 'cascade of intervention' stuff very scary. Ironically, every couple on my course has ended up being induced for various reasons!

I don't want to scare you, but I also swallowed all the NCT BS and was anti-induction because of the 'cascade of intervention'. Unfortunately I was unlucky enough to have an ob consultant who was very laissez-faire. I trusted her, thought I was being monitored (didn't get any scans/doppler scans/monitoring which I now know I should have had).

I ended up having an emcs at 42+3, 30 hours after they finally did a scan at 16 days overdue which revealed the amniotic fluid level was down to zero. Literally no fluid left at all around the baby, just a tiny pocket in front of the head which is what they could feel when they did the sweeps, and only because the baby was only 2/5 engaged. When it finally came, the c/s was due to fetal distress - heart rate plummeted because of cord compression. DD was born with plagiocephaly (basically her head had been jammed into my pelvis with no protective fluid, causing one side of her face to be squashed, one eye to bulge out and not close properly, and the other to be pushed in and barely open) and torticollis. It took a year of physio to heal the neck muscles and allow her to turn her head fully and freely. She also has severe reflux which is apparently more common in post-term babies due to insufficient fluid/swallowing of meconium, etc, though there could be other causes.

In my case, induction wouldn't/didn't help - I was already having contractions every 3-4 mins when admitted, but they decided to induce anyway. Just meant that they put stronger pressure on DD. Nothing happened because she was well and truly wedged but they appear not to have considered that option (head turned out to be 98th centile though she was below average weight even for term, due to placental insufficiency - it had failed and started to degenerate to the point they couldn't actually remove it, it just fell apart inside me).

We were really lucky, we found good therapists/paediatric consultants (mix of private and NHS), helped by our excellent GP, and after 6 months of repositioning DD every 45 minutes during the night (yes, I had a stopwatch going off) and a couple of hours of physio exercises a day, the plagio improved so it's nowhere near as noticeable and after the year of physio the torticollis was resolved. She still has severe reflux at 2.

Anyway, I didn't want to scare you but you asked the question whether it really is dangerous to wait. Yes, it can be. I was naive. I never, ever want to be in that position again, and I wouldn't wish it on my worst enemy. I honestly thought we'd lost the baby when I was lying in operating theatre and was told they didn't have time to wait for my husband and didn't have time for the anaesthetic to take effect before starting. It never occurred to me you could get past 42 weeks and then not be able to wait an extra 2 minutes for anaesthetic. It's EXTREMELY unlikely you'd have the same circumstances (unless you're at the same shit hospital I was), but one thing the NCT teacher never told us was that there's a downside to waiting, and actually sometimes there's a reason that baby's not coming out. I'd definitely be pushing for full monitoring/scanning before induction though, just in case. I'd rather go straight for the c/s if that's the way it's going to end up anyway. If fluid levels are already low, they should not induce, it's too stressful for the baby.

Sorry this is so long but I was in exactly the same position as you and I really wish I'd known then what I now know. I still wake with flashbacks every night, and we were lucky with the outcome.

Gosh Wingdingdong, that sounds awful. I'm so sorry you had to go through it and so pleased that DD has made such a good recovery. Thank you for sharing; it's given me something else to think about and I've just scrawled 'ask them to check fluid levels' across the NICE guidelines and Bishops Score information that people had recommended I print out.

I went 15 days overdue before induction, prssary then broke my waters... Plenty of waters but bubs was not engaged enough and I had a cord prolapse and crash CS! Wish I'd waited and opted for scans, etc, hindsight blah blah blah as kiddo was fine where she was. Most people are fine with inductions though, it seems. Best of luck.

I'd want to understand better why the baby might be delayed rather than just blindly trusting them, tbh.

Scans, check ups, etc.

personnally, i don't think the baby is "delayed" as such

40 weeks is just the average....am sure we all know lots of people who had babies at 38 weeks, and lots have babies at 41 weeks or beyond....all 3 of mine were 41 weeks plus.

apparently in France 41 weeks is considered average (tho that may be an urban myth)

good luck and hope all goes well.

Like you I'm planning a home birth but there's some likelihood I'll need to be induced (too boring to go into reasons why) so have done a lot of thinking and questioning about it.

First, it's your birth so you get to choose how to go about it - it's not a question of being 'allowed'. There's no mother on the planet who puts their unborn child in any danger deliberately and it's worth reminding yourself that the reason you want to avoid the cascade etc is because those bring very real risks with them.

Second, because if the prevalence of inductions at 42w there's very little known about the risks/consequences of waiting beyond that. The main concern is the placenta deteriorating and they measure this ina very unscientific way by guesstimating how much fluid you have - the placenta priduces the fluid. You'll be lucky to get a scan that tells you how much fluid you have (every woman is fifferent anyway), you're more likely to get a tape measure check which is very subjective according to position of baby etc. Also, at my hosp they only check the placenta/fluid twice axweek at 42+ because if the placenta does start to go then itbusually does so slowly. So the point is you can take some time to decide what suits you ypu haven't got to make an immediate decision unless there's a pressing evidence of something wrong (in which case CS is more likely).

Finally, are your dates crystal clear? If there was any noticeable gap in your dates by period compared to dates by scan then you could (if you wish) say you want to wait and see. You can also go into the hops every day if you want to check the heart rate - that's a much more reliable indicator of the baby's health than anything else. Of course the hosp will discourage that but you can still insist.

Finally (again) there are a lot of positive induction stories around so if you decide to go for induction then great. Make it as homey as possible, especially by taking control of the environment with lots of your stuff. Maximise ways to stay mobile (eg try to avoid continuous monitoring) and stick to what's important for you as far as possible.

Best of luck. Please report back!

Yes PrincessJenga, update please! Am very interested to hear what you decided and how you got on as I'm booked in for induction this afternoon but am going to fight to have it put off until Monday to give baby more of a chance of natural birth. Midwife isn't happy but I think they've dated baby wrong at scan as it's EDD jumped forward 6 days and now they think I'm 13 days overdue and are piling on the pressure for induction!

Sorry for the delay; it's been a busy few days!

We decided to go with the induction on Wed (42 weeks, so two days later than midwives orignially booked us for) partly due to some of the comments on here, but also as baby wasn't showing any signs of coming himself so we thought he might need some help.

I had my first contractions about five hours after the pessary was inserted, but didn't really believe I was in labour so only used TENS & paracetemol. I was examined a few hours later & to our amazement i was already 5cm dilated. We were quickly moved to the delivery suite, where I discovered the joys of gas & air (how amazing is that stuff?!) & reached 10cm a few hours later.

Unfortunately, this is where it went wrong. After a few hours of pushing i had a really strong sense that things werent 'right'. Baby's heartbeat had been fluctuating all day & after various examinations the docs said he was distressed & so badly positioned that they'd like to take me to theatre. This was so far from my home birth plan that I admit I did have a little cry, however the docs & midwives were amazing & made sure it was as positive as possible. Baby was born safetly, DP was able to cut the cord & cuddle him almost straight away and I was given skin to skin as soon as I'd been stitched up.

We'll obviously never know what would have happened if we'd decided against the induction, but now that LO is here safetly we really don't mind how he got here. If I'm lucky enough to get pregnant again I won't be so worried about how to get baby out & will simply look forward to meeting him or her.

Thank you to those of you who shared info & stories. good luck to any of you deciding what to do.

Oh, ps, you'll be pleased to hear that I didn't just blindly follow all the 'rules'. I busted out of hospital a day earlier than recommended & am so pleased I insisted on that. Baby and I are much happier here than we were on the post natal ward

Congratulations PrincessJenga! I too have been a bit rebellious and managed to persuade the midwives to let me wait 2 days extra before induction, but as there's still no signs of baby it looks like I'll be going in tomorrow at 42+1. I would fight to put it off longer but find their bullying tactics and attitude so stressful that induction is starting to feel like the easier option. After your lovely post I'll try to concentrate on the arrival of the long awaited baby instead of how it gets here! Well done you!

Congratulations PrincessJenga and welcome BabyJenga :)