What is overdue and WHY the hassle when it happens?

[StarlightMaJesty]

Okay, I've seen and researched the arguments but, until now, it hasn't been something that has happened to me.

Now that it has, and I am experiencing it first hand, I'm wondering WHY it is such an area for battle.

I mean, I KNOW my rights etc. that no-one can force intervention or refuse hb etc etc. but I also know that this kind of pressure isn't conducive to getting the baby out spontaneosly.

My midwife with DD spent at least an hour nagging me when I was 40+8 about being induced when I was 40+10, then she took my bp and said it's a bit high (no, surprise, surprise!) which she then tried to use as an argument for induction. I agreed at 40+10 to be induced at 40+12, but only because I was already having twinges and was sure I was going into labour that day. If I had got to 42 weeks and no baby, I just would have "missed my appointment" and waited it out. A friend of mine had an induction which sounded horrific and I didn't want to go through all that myself.

Sorry you are still here Starlight. You know what you have to do don't you. Book ferociously expensive, non-refundable tickets for something tomorrow night. I almost guarantee you will go into labour . But seriously, am thinking of you. Hope the appointment tomorrow goes well.

as ever , the nice guidelines come into play.

previous versions had a line stating 'the risks of induction do not exceed those of going post-term until +14' which has now been removed. as there hasn't been any new research (due to the policy being so widely applied) i don't know why that line was removed. maybe so we don't quote it at HCPs :)

from the evidence tables, the risks are -

Probability of intrapartum stillbirth (per 1000 live birth):
At 37 weeks: 0.7
At 38 weeks: 0.3
At 39 weeks: 0.2
At 40 weeks: 0.3
At 41 weeks: 0.3
At 42 weeks: 0.4
At 43 weeks: 0

so the risk from induction would probably be 0.4 per 1000 at 42 weeks, or only slightly less. seems like a very crudely applied statistic though to be fair, the research is really old, and i haven't managed to find current details of how it was done.

these Norwegian stats -

Fetal complications
Meconium aspiration (per 1000 births)
At 37 weeks: 2.5
At 38 weeks: 2.3
At 39 weeks: 1.8
At 40 weeks: 2.9
At 41 weeks: 5.1
At 42 weeks: 4.7
Intrauterine fetal death (per 1000 ongoing pregnancies)
At 37 weeks: 0.35
At 38 weeks: 0.25
At 39 weeks: 0.43
At 40 weeks: 0.51
At 41 weeks: 0.84
At 42 weeks: 1.55

different again...

i think since then average gestations have increased (taller, fatter mothers cooking larger babies...) and it is hard to know if the +42 stat is still accurate, if it ever was....

problem is, only 3% of women go past 42 weeks....and what i didn't find was a re-study showing that inducing those women reduced their chance of stillbirth. (ie, was the fact of going post-term at that point an indication of a problem that induction wasn't going to help?)

I'd be interested in a study that followed women to 42 weeks, and compared those spontaneously labouring at +14 with those induced ...there does seem an element of iatrogenic disturbance to these 'late' labours, e.g my sisters friend who turned up in established labour to be told they still wanted to induce her! the argument was so stressful her labour stopped and she went home. In the end she went back in when contractions returned....forceps delivery...possibly avoidable without the initial crap.

if spontaneous labour was found to be safer, then maybe +15 could be tried...etc etc...it seems otherwise they are stuck doing this for want of more recent evidence, without being sure it improves outcomes.

ooh this is really interesting

www.ranzcog.edu.au/publications/oandg-magazine/doc_view/343-19management-of-prolonged-pregnancy.html

I have never given birth in the UK so I don't know but I think that often hospital/medical staff policy is to go the way of least resistant: I had a multiple pregnancy and the doctors wanted a cesaerean at a certain point as they prefered to have a "normal" cesaerean before any of the values for child or mother showed any abnormalities and they would then have a more complicated birth. I don't know if that makes sense in your case.

I also found that pure administration played a role in when they wanted you to give birth: availability of beds/rooms (incubators in my case), staff etc. all were considered.

Great article, thanks Edgar

Thank you Edgar, that's helpful.

Mw appointment today confirmed head 'free'

My dates 40+5, theirs 41+2

Midwife excellent and respectful but still got a bee in her bonnet!

Oh no. Mw has booked a consultant appointment at hospital on Tues.

Dunno whether to say not going or just not turn up!

Yes, I suppose, but I still would want urine, wee and heart rate done etc.

So, would have to tell mw.

Why do they think I'd do anything to risk the well-being of the baby though?

that's where my mw lives! The homebirth ones work ou of the children's centre.

Sadly, I had such a positive mw appointment that I started to get frequent BH so decided that being listened to meant baby okay for coming out now, but since her phone call they stopped.

She said I can't just do what I want without telling people. I have no idea what she meant.

She said I can just go to the appointment and say that I want to go by MY dates.

Maybe I'll just ask for the consultants email address instead then if that's all she wants me to do.

Well she phoned back and tried again. She said she just wanted to make sure, given my preference for c/s over induction shoukd the baby be in difficulty, that I was on the consultants caseload/radar so that communication would flow is something happened at a weekend etc.

She offered to come with me. She offered a consultant midwife to come with me.

I'm quite tbh.

that second phone call sounds more postive, yes if she wants to come with you and be supportive that cant be a bad thing? sorry they are stresssing you out so much, i am sure it is NOT conducive to going into labour :(

what can you do to de-stress, you fave relaxing and pampering things? :)

I feel a bit awful about what happened next tbh.

I told her exactly that. I told her that being forced to diary an appointment face to face with a profession that previously assaulted me was hardly going to bring on spontaneous labour and that given it was unnecessary due to my true dates best just leave well alone.

She sounded genuinely upset and backed off and told me that I was entitled to request a midwife other than her for my next appointment which made me very as she's the best midwife I've ever had.

oh starlight i dont think that was unreasonable, as a midwife she should KNOW this kind of stress is NOT going to help! you are in your rights to decline an appointment with a consultant ( i did numerous times!) that doesnt mean you dont want to see her, but maybe she took your tone and upsetness personally? in which case its worth saying to her that you dont mean anything to her personally and that she is indeed lovely, just that you dont like feeling under pressure to see a consultant as there is no need to at this stage? :)

just be honest with her, and explain its nothing personal, just the situation and the pressures you are receiving, i think she HAS to offer you the appointment as part of her job and by offering to go with you was maybe meaning to be supportive? but you are entitled to decline the appointment and you should get no further pressure on the issue :)

I did try. I told her that I was very happy to keep her. I knew she was genuine in her interest and that her thoroughness made me feel well supported. Then I wondered if actually she wanted me to have another midwife for her own sanity , so left it at that.

well there is that! but if she sounded upset it could be for any number of reasons, she probably doesnt want you upset! and she could just be having a bad day.

will you make your next appointment with her? speaking over the phone is always a bit crap anyway with regards to judging tone/body language etc.

fingers crossed this baby puts in an appearance before you next need an appointment!

Yeah, - already made an appointment with her. Poor woman!

The midwife is professionally accountable for your wellbeing and that of the baby. The 'standard' procedure is for post-dates women to be seen in clinic to discuss future plans. If your midwife ignored that procedure and just let you alone then if something went wonky (which it won't but just saying) then her professional neck would be well and truly on the chopping block AND she would feel crap too as she's obviously a very caring HCP. It's your right to attend hospital if and when you wish to but she did have to offer it to you. By saying that she would come with you I think she's trying to assure you that they won't try and railroad you.

Ah well. Tis all sorted and my BH have come back.

Unfortunately head not engaged at all though.

starlight in subsequent deliveries the head often doesnt engage till properly in labour, thats quite common and normal, all mine engaged but i think thats cos they were big, very long bodies like dp! and i am small so even with head engaged their bum was still right up under my ribcage, they just didnt have the space not to engage, but my midwife commented on how unusual it was a 3rd/4th/5th baby to actually engage before labour.

fingers crossed the bh are the start of things :)

thanks for that.

Was expecting to feel a bowling ball between my legs at some point but perhaps I never will. Won't say I'll be upset.