Induction versus Going 42 weeks+

[dannigirl]

Having a bit of a dilemma weighing up the options of induction versus going over 42 weeks.

I am 41 +3 today, have had a sweep on Tues (41w) and yesterday (41+2)...sweep on Tues produced some brown blood, yesterday nothing. Dilated 1cm, cervix apparently a bit softer yesterday, but does not look promising.

Getting regular BH and they have gone up a tiny notch in terms of feeling them but only very slightly. Have been having regular BH for a LONG time so don't think they are very significant.

This is DC2, first pregnancy I had pregnancy induced hypertension and was induced at 39 weeks due to growth concerns (which were pretty much unfounded as she came out 71b 8oz but we followed medical advice at the time). Awful induction process over three days, pessary, then progressed onto drip, got to 5 cms and my body just started to push and all out of sync so had epidural then fairly straightforward vaginal birth with no further intervention (thankfully).

So being overdue is very unchartered territory for. BP has been fine but is now creeping up I think mainly due to the anxiety of everything. Monitoring BP at home, have been "released" from consultant care to community midwife team with plan to go to home from home unit. NEVER thought I would get to this stage but am now having to make some serious decisions about where to go from here.

I will have another sweep tomorrow (not hopeful) and then we have to make some decisions....am quite anxious and confused.

Preference would be to go to home from home unit but have no major objections to going onto labour ward, as mentioned previously my induction was handled badly last time but the actual birth experience was fine. Feel like we would be much more assertive this time, first birth did not feel very empowered or informed - ward very busy, some staff great, some dreadful.

My biggest fear is having the drip again, I think if I got to that stage I would opt for having the epidural put in at the same time as the confusion/out of sync experience was awful. My body basically thought it was time to push even though I was only 5cm dialated, I became quite disorientated and confused. I do not want to experience that again!

I don't have any strong views regarding going 42 weeks +. I realise that the risks of stillbirth increases (very slightly) and that there are concerns about the placenta. The problem is it is very difficult to get any concise information about what the risks are, as it seems to be very unchartered territory after 42 weeks and the NHS policy as I understand it is to offer induction. I realise you can refuse inducton but then it feels like I am making a huge decision when I don't feel fully informed. I understand I can go for increased monitoring after 42 weeks but going over 42 weeks means I have to go onto labour ward (if induced) and can only go onto home from home if pessary 1 works ASAP.

Sorry if this is very wishy washy but I don't feel STRONGLY about which way to go. I have had no complications in pregnancy, but am getting very impatient and quite anxious now.

I am thinking at the moment, have another sweep tomorrow, then look to induce Sun/Mon....then I can begin (if there is a bed) at the home from home unit and if need be progress to labour ward.

If I leave it until next Tuesday 42 weeks, then I go straight to labour ward.

Not sure if I am brave enough to refuse induction after 42 weeks as it feels like a huge decision I don't know enough about.

At the same time I am petrified that the pessaries won't work and I will have to go onto the drip and then it feels very managed from there on.

Anyone have any similar experience and care to share some (hopefully) positive experiences with me. Sods law means I will have the bloody drip which is worst case scenario for me, but not sure I feel I know enough to refuse induction.

Any advice or insight much appreciated. Sorry for the epic post!

I have no advice, but if I get to 42 weeks with this pregnancy, I shall refuse induction and take expectant management as I will not risk the cascade of intervention and damage that I sustained last time.

If expectant management shows a problem then I will agree to a caesarean but not induction - if they're worried enough to want to get baby out, then they can get baby out now through the sunroof.

Just my own thoughts mind, and certainly I think everyone has to weigh up the pros and cons of any route for themselves :)

Hi

40+6 today (first baby). Had sweep yesterday - baby still quite high (3/5 engaged), cervix quite posterior - but slightly shortened, and slightly softened (unmodified bishops score of 2).

Because the baby's head wasn't up against the cervix, when she tried to get in there - the cervix pushed up a bit rather than being held in place by the baby and letting her have a good rummage. Got partly interrupted by someone knocking on door - she said it wasn't best sweep ever - had a bit of spotting afterwards.

She wanted to book me in for an induction - but I said i'd prefer expectant management/ monitoring - she therefore booked my induction for next friday (which she said I could cancel), and first available consultant appointment (to discuss risks of expectant management is on Wednesday). Midwife appts are only Thursdays - so that's next opportunity for a sweep (unless i ask the consultant??).

As I understand it with the monitoring, you would have daily(?) scans/ fetal checks - checking baby's heart rate, and using doppler imaging on the ultrasound scan to check the blood flow in the placenta. In my mind the time at risk is acceptably low, because with each day the chances of going into labour naturally increase.Obviously need to think about options if monitoring indicated an immediate issue.

The thing about induction is - I wouldn't mind trying pessary (if cervix was favourable) - but they don't seem to let you leave after that, and if it doesn't work on it's own they rupture your membranes (which then starts the clock for risk of infection) - which if that doesn't precipitate labour seems to lead inexorably to the evil drip.

Let's hope for natural start before then eh!!

with my last baby i went 40+18 before i caved in to induction...i am currently doing a hypnobirthing course in order to try to clear my mind of my now negative birthing thoughts before this baby is born.
in my experience the expentant management is absolutely fine, the midwives were lovely, very reassuring....it consisted of listening to baby's heartbeat/movements and then a scan to check water/placenta/baby are all looking fine. the midwife was always happy to perform a sweep if i wanted. i was only once forced to sit through a doctors spiel about risks of overdue...of course they never mentioned the risks of interventions, that was my own research....and to be honest i felt very much damned whichever option i chose.
with hindsight, i would suggest that you trust your gut instinct on this so long as you do have facts behind you.
best wishes for a happy birth and peaceful baby

The only thing I would say from personal experience is that my baby was really big at 42 weeks (10lbs), therefore making natural childbirth more difficult. He would have been big anyway, but that extra 2 weeks must have made a difference.

The thing is for me, the induction date offered is only 1 day before 42 weeks, so the benefits of induction (less big baby, less risk of aspiration of meconium, less risk of still birth) aren't that great. Or rather the risks of monitoring/ waiting, although they increase with time, aren't going to suddenly increase massively in a few more days.

Form previous experience of induction, I'd go for expectant management. But I'd also be requesting an immediate appt with a consultant so that you can ask any questions you have about the associated risks, so that you can make an informed decision. good luck.

Thanks for all the responses...no sooner had I typed out that message early labour commenced! DD2 was born that evening, so maybe it was getting it all out of my head onto "paper" so to speak. Still not 100% sure what I would have done......probably induction as I was getting pretty fed up!