Why are so many women now induced when they are classified as 'overdue'...?

[babysaurus]

More of my friends than not have been induced when they have got to 41+ weeks, none of whom made it to 42 weeks. This got me thinking several things:
Firstly, the EDD is just that 'estimated'.
Plus, isn't the gestational period in France considered 42 weeks rather than 40 - so going up to 42 weeks there would not be considered the wrong thing to do? (I read this on MN so apologies if this is actually wrong!)
Lastly, have inductions been responsible for a massive improvement in sucessful births in this country?

Are they really as crucial as you may be led to believe...?

I'm trying to find a link, but I think it's because the risk of stillbirth rises quite significantly after 42 weeks.

Yes, it's to do with stillbirth risk as a result of possible placental failure. I guess they take the view that whilst induction of labour increases epidural use etc, stillbirth is such an awful thing to happen that they'll do a lot to prevent it, even if the risk is tiny.

There isn't actually a great deal of research or statistics available on the effects of going past 42 weeks, as so many women consent to induction before that.

From what I have managed to read, there is a rise in the number of stillbirths post 42 weeks - something like 3x more likely - however we're still talking tiny numbers, and one article I read showed that the number of stillbirths at 43w (approx 6/1000) was not hugely different to the number of stillbirths at 37w (approx 3/1000) yet 37w is considered to be full term and perfectly safe. That means even at 42w+, 994 women and babies are subjected to the risks of induction without medical reason (although of course, there's no way of knowing who is going to be one of the 994 and who is going to be one of the 6).

Personally, I was induced at 42+1 with DD. In the event that I reach 42w this time, I will not consent to induction again and will go for expectant management.

I think perhaps more frequent monitoring should be available for ALL women who want it after 37w, which could then separate those women who should consider induction or EMCS from those who are still having a healthy pregnancy.

The main issue I think is that induction is not presented as a choice - many, many women still believe that if they get to 40+7/+10/+12 then they MUST be induced as that is policy in their area and they don't question that, even if there's no medical reason for them to be induced. There are so many posts on here that say 'my hospital only let you go X days over' and that's quite simply not true.

btw- you are perfectly entitled to refuse induction. It's up to you.

I think they need to look into this more. Some countries "let" women go for a lot longer - I have learnt from other threads on here - and presumably that works fine. Also interestingly they think that different races have different gestation periods and the 42 weeks is too early for women with some ethnic origins but too late for others, it's not "one size fits all".
You can ask to be monitored rather than induced but women a. don't know this and b. find it hard to "stand up to" HCPs.

My situation is that with DD1 I was induced at 42+2 and it was rubbish. Had a sweep a couple of days before, cervix not changing at all to prepare for labour. So I was induced with cervix "tight as a drum" as they put it - well just the prostin pessaries, waters broke, OK overnight, next day the pain was not so much unbearable as just "wrong", I was vomiting with every "contraction", meconium coming out, midwives saying "you're not even in labour yet", no pain relief and the feelings were so peculiar that I couldn't bear them and was considering knocking myself out against a wall to make it stop. Anyway luckily they then decided to do an EMCS and that was fine.

I donated my cord blood and the HCP who drained the blood said that there was loads of lovely bright red blood and placenta was in tip top state. So obviously not on the verge of failure and my body was obviously not ready to give birth.

So from my POV I do think that induction is just too black/white and they should take other factors into account as to whether it is appropriate for that woman rather than just 42 weeks bish bash bosh.

I read somewhere - which I can't immediately find the reference too - that the study showing the rise in still births was based on only 8 (yes 8) women. Some of these were at 43 weeks, so of no relevance to the situation at 42 weeks, and at least one was diabetic so again not indicative of what happens with an otherwise healthy woman.

I believe that the still birth rate hasn't changed much in 20 odd years, so whatever the rise in inductions is doing, it doesn't seem to be making much difference.

Whilst you are entitled to refuse induction (you can refuse any medical treatment), several of the medical staff I have met so far have told me that if I go to 42w I WILL be induced, and that 12 hours after my waters break I WILL be put on an intravenous antibiotic drip. They presented it in exactly that way - as though I have no choice.

Fortunately I am a stroppy cow very self assured and well informed... But a lot of people won't know that they are allowed to refuse.

I went 11 days 'overdue' with both mine. With DD1, the MW lied to me and told me that I wouldn't be allowed to have expectant management, bullied me into a sweep that I didn't want and booked me in for induction even though I said I didn't want one (fortunately I went into labour before the day arrived).

With DD2 I did a lot of research and found that the risk of going over 42 weeks is quite small. I wish I'd kept the links but if you google you will find all kinds of information. I would also suggest reading the NICE guidelines (which my first MW trampled all over) which state that mothers should be informed of choices.

Inductions are not risk-free so for me I felt that the better option was to refuse induction if I was offered again. Fortunately my MW with DD2 was much nicer!

VikingLady I wonder what their response would be if you cheerily asked them what would happen to a woman who just refused to turn up for the compulsory induction at 42w? Would they be sending round an ambulance with several burly men waiting to bundle her in and force her into hospital against her will?

I expect the response would include some sort of catsbum-mouth and being told that no-one refuses induction at 42w (possibly with some bosom hoiking for good measure)

why on earth would you refuse an induction? (just curious)

I was glad when they offered me one, i wanted that baby out!! (also i'd been leaking fluid for 2 days so big risk of infection)

Chrononaut I wish I had if you look at my post a little upthread.

apologies SQ

it's OK!

Benefit of hindsight and all that.

Be wary of stats about the number of stillbirths at 43 weeks. Those who go over 42 weeks are comparatively few in number, have argued hard to be in that position and are being intensively monitored at that point. And even with that, the number of babies who sadly do not make it is twice the numbers quoted for earlier deliveries.

It is still a very small number though, and I don't mean to be alarmist. But the consequences of this small risk are just so horrendous that it does not surprise me one whit that women would take steps to avoid it.

People do refuse induction at 42 weeks. I did. No ambulances or burly men involved. I went to 43 + 3 and then had an induction. Cervix completely unready, baby not engaged. Had a VERY hard induction, forced every step of the way. Healthy baby and beautiful, healthy, happy placenta still chugging away.

I don't advise my way of doing things. I understand that when the placenta goes, it goes very quickly and that is dangerous. Obviously, the longer you leave it the more likely it is to give up. Perhaps I was just lucky. Or perhaps my body cooks my babies a bit longer.

Same thing happened with baby #2.

Am now overdue with #3, but not planning to go to 3 weeks+ this time :).

I've been induced with all 3 of mine. DD1 was 42w and i went into labour so easily i expect i could have waited. I was only 23 and had no idea i could refuse!

DD2 was 39w and srom, no labour after 72h, then another 4 days till birth. No way i could have said no.

DS was also 42w, and the placenta was grainy. It's unlikely it would have gone on much longer. That was also another 4 day attempt! I've come to the conclusion that my body simply does not produce the right hormones for labour. :(

Agree that it should not be presented as a fait acompli, a lot of mothers would have no idea that there was another option!

I was induced with DC1. I knew I could refuse it, but decided on balance not to. When I had my appointment to discuss induction I acttually asked the registrar what options there were. He didn't seem to understand the question, and said none, you have to be induced. I said what if I don't come and he just gave me a face that said "does not compute".

I regret being induced. My dates were likely wrong because I don't ovulate on day 14, and Dc1 was not at all overcooked. I had been scared by repeated scans in pregnancy, which were also likely not needed in retrospect.

With DC3 I declined the offer of an appointment to discuss induction. DC3 wa born at 40+9 (my dates), and I hadn't decided whether or not to go in for daily monitoring if it was recommended. I was scared they would manufacture a reason to keep me there and bully me into induction (which I would likely have refused and asked for a c-section instead). The midwives thought Dc3 looked only just ready to be born, no signs at all of post-maturity and perfectly happy and healthy placenta.

After DC1 I too looked up all the research papers on stillbirth for long pregnancies and it is decidedly dodgy. V v small sample sizes and included some babies with known problems before birth. It is shocking that standard practise was changed to induce before 42 weeks decades ago on the basis of such poor evidence. even if you accept the evidence, as has already been said, the risk of stillbirth doubles from a tiny risk, to a still tiny risk.

It is worth remembering that induction and the cascade of intervention that often follows is not without risk to both the mother and the baby.

In France they're taking the start date from a different point (before date of last period rather than start date of last period I think?) so their 42 weeks would not be the same as our 42 weeks.

I was born 2 weeks late myself, in the mid-70's, and wonder what the situation was like then - as far as I know my mum went into labour naturally so not sure she had all the induction process as it exists now. Of course I could just ask her, but a bit squeamish about asking her those sorts of things.

I've been told I'll probably go full term as I have a 'nice long cervix' but really hope I'm not TOO overdue. Don't like the sound of the induction process at all.

My mum was induced with me, early 70s.

"It is worth remembering that induction and the cascade of intervention that often follows is not without risk to both the mother and the baby."

This is v pertinent.

The almost inevitable cascade of interventions following induction is precisely one of my worries! I think the chances of ending up with problems following that are significantly higher than any issues that may come up due to refusing induction.
Hmmm.

One thing I noticed was that my MW counted my DD based on 28 days standard and didn't even ask what my normal cycle was. It's 35 and guess what I was 10 days late when I was eventually induced. Just wondering if that's a factor.

Sooty it's likely yes. The EDD calculated from PML is based on ovulation occurring on day 14 of a 28 day cycle. Even some women with a 28 day cycle won't ovulate on day 14, and with a longer cycle it's likely you'd be ovulating later than that. Ovulation is usually 10-14 days before your period, so in your case it'd most likely have been on day 21-25, making your EDD more accurately 7-11 days after that which would be calculated by the standard LMP estimate.

With DC2 I gave my MW an LMP date that was 4 days later than the real one, because I ovulate on day 18. This was confirmed accurate by dating scan (DC1's dating scan made him 3 days behind the LMP estimate, but they stuck with the LMP ). DC2 was born at 39+6 by my dates.