where is the evidence for inducing "post term" pregnancy at 42 weeks

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Hi, I'm a first time Mum and am 41 weeks today. I'm feeling under pressure to have an induction but believe the official date is one week off and that I am only in fact 40 weeks today.
I'd like to look at the scientific evidence for not going over 42 weeks (I have a background in science) and wondered if anyone could point me in the right direction?

that makes perfect sense :) and thankyou for answering :) xx

your dd's are beautiful btw, your dd2 is named Erin? hope i remembered that right?! lovely photos, sad but filled with love xx

I am all for letting things happen naturally. Am overdue myself right now and waiting it out, albeit frustratedly. However my Uncle was born during the war very overdue at 44 wks approx. He has learning difficulties that have been put down to mild oxygen starvation in the last few days.

I agree you need to hold out for now. A bit of gentle excercise migh tjust help bring things on naturally - that or a bit of how's your father!!

if and I repeat if baby is struggling at all then according to our consultant they stand a better chance outside the womb than in cos they can do so much more to help

Bitter experience tells me that things can change so quickly towards the end ...i was told at 10pm everythng was fine .. by the morning my boy was gone .. I just personally think its not a risk worth taking

but its not for me to suggest what other people should do... and I hope whatever you decide op that your baby arrives safe and well and that you are ok after it too.
remember any birth with a healthy mum and baby at the end is a success whether its 37 weeks and a c-section or 42 weeks and a natural birth or something in between

Thank you 5madthings yes she is called Erin. How lovely of you to remember. I just hope and pray I can add a happy photo of dd1 and a healthy dd3 in a few weeks

Sorry for mini-hijack op

its a lovely name :) and i occasionally lurk and read the angel babies threads or the rainbow babies one, i have posted occasionally just to pass on my best wishes but never really know what to say and they seem personal and somehow private threads? that i woudnt want to intrude if that makes sense? but i do follow them and look forward to hearing of your new arrival :) xxx

yes op a sweep is something to consider as well, ask your midwife.

pregnancy and birth are horribly anxious times, its all to easy to take it for granted that we will end up with the happy outcome, but no-one is guaranteed that, all we can do is find out as much infor and arm ourselves to make an informed choice that we are comfortable with and that isnt going ot be the same for everyone, what is right for one person isnt right for another.

my thoughts are with frasersmum andwhatever its beyond awful to loose a baby at any stage and all women should be aware of the risks and be aware of your babies movements etc, the count the kicks campaign could do with a bit more highlighting actually i think, anything to help lower still birth rates which are quite high in the uk i think statistically?

fwiw, Gemma did say "maybe I am more precious about it" (going overdue) rather than that her baby was more precious than others.

Both my babies were 12 days overdue, with no signs of overcooking when born, so I just figure that's how long I gestate for. It's not an exact science after all - only 5% of babies are born on their due date, and my midwife always said to think of it as a middle of a 'due window' rather than the expected date itself.

But it was a worrying time, plus very difficult being so huge and slow and unable to sleep etc. Good luck!

Thanks for the various links to studies, folks - I was looking for this previously, out of interest (and nervousness: currently 35-ish weeks pg myself). I'd like to see more (much more) information broken down by (as someone else said upthread) maternal age, ethnicity, and other relevant factors - that information seems to be very sparse.

It's a worrying time for everyone but particularly for those who have had such very sad experiences, I appreciate. But some of the views on this thread seem almost to imply it is surprising that anyone ever got born safely at all in the past, before inductions existed... In particular I can't see how we can be quite so definite about the 40 week due date when it's calculated via a method that hasn't changed since 1812 and takes no account of different sorts of relevant variations (maternal age, ethnicity, cycle length, etc). Yes, the ultrasound scan at 12 weeks (if we have it done, which not everyone will do) will also establish dates but if the estimated date by ultrasound is 4 or 5 days different to the calculated due date then your official date isn't likely to be moved, so there's one factor right there that means that it's all a bit of a guess if you base a policy of induction on the exact number of days from due date.

As a generalization, I also can't believe that the placenta deteriorates massively from before the due date in the way suggested upthread. Links to studies? Proof that (or a good reason to suggest why) any placental insufficiency wouldn't have happened anyway? More detailed analysis of appropriate risk factors? I'd like to see all of those before lending much credence to this because to me it so much feeds into the "how did we ever survive as a human race" view of things.

I am really sorry to all those who have lost babies, what an unimaginable tragedy, my heart goes out to you .

I think what this thread illustrates is that we all assess risk differently based on our personal views, understandings and experiences. There is no one size fits all. Very sadly, some babies do die during pregnancy and birth. In retrospect it is sometimes possible to see things that might have been done differently that could have saved them, like induction/c-section earlier. Sometimes not. The process is not risk free, and death of a baby is not the only risk. Some people will consider it the only one worth thinking about and even a miniscule increase in that risk would be totally unacceptable to them. Others will weigh up other factors too, such as the risks to both the mother and the baby of induction (which include the risk of emergency c-section, one of the rare complications of which is maternal death). Whatever you do, the risk of death or injury to the mother and/or baby remains, however small. There is no way to make the process risk free.

I would absolutely support someone who requires a c-section at 37 weeks or earlier because of anxiety about the health of their baby following a previous c-section (or other circumstances). Absolutely, no question. I totally respect their decision and wish them well. Likewise for mums who decide to be induced at 41 weeks, 41+3, 41+5 or whatever is right for them in their personal circumstances.

I think it is unfair to not allow those of us who might want to consider expectorant management the same courtsey and imply that we are somehow playing russian roulette with our unborn babies' lives . NICE and many other clinical guidelines recognise watchful waiting as a valid choice, and make the point that for the overwhelming majority of accurately dated pregnancies up to 42 weeks the babies will be absolutely fine. According to some studies, the risk of stillbirth increases (though several are flawed), but the absolute risk remains very low. No pregnancy is technically overdue according to the World Health Organisation until it has passed 42 weeks. 37-42 weeks is the defined length of normal pregnancy. Beyond 42 weeks, the evidence available is much more limited, but very few accurately dated pregnancies reach that stage.

All we can each do is assess what we think is important and make the best decisions we can for ourselves and our babies . After all, that's the essence of the whole lifetime of parenting we all have ahead of us.

Meant to say following a previous stillbirth, not c-section. Sorry

OP This is the link to the pdf of the review article I mentioned upthread, which I have now found . The title is "Routine induction of labour at 41 weeks gestation: nonsensus consensus" and it is from the British Journal of Obstetrics and Gynaecology from 2002.

fwiw, Gemma did say "maybe I am more precious about it" (going overdue) rather than that her baby was more precious than others.

Thanks, that is exactly what I said. I am being very pfb about my baby because of what we went through to get her. At no point did I suggest that my baby was more precious than any others.

And for those who have asked, this is where the stats come from: The British Medical Journal. You will notice a sharp increase in stillbirths from 40 weeks onwards.

Gemma fwiw either way you are inferring that other who had an easier time care less. It is frankly insulting and callous of you. It is one thing having an opinion on what you would choose for your child and why. It is another to cast aspertions on other parents perfectly reasonable choices, and to infer they care lessa bout thier offspring as - well it was easier for them to concieve. Just think through a bit what you are saying.

sharklet, I am absolutely not! Being 'precious' does not necessarily mean caring more. Or maybe you would like to go back through all the other pfb threads on here and accuse those women of the same thing?

It is how it reads to others though Gemma. That is why I was asking you to think through what you are saying. When I read it I wanted to stab you with a blunt spoon for being so thoughtless. It is clear others felt the same. The use of precious as in "being more precious" means either more caring, more careful, more worried, more paranoid, more concerned, more mollycoddling all of which infer you care more or are more concerned or do more than others whom you your self said had perhaps had an easier time than you. It is certainly not used to say you care the same amount, or less... So I am not really sure how you think that your inference is less insulting.

When I read it I wanted to stab you with a blunt spoon for being so thoughtless. It is clear others felt the same.

This has upset me so much, I am going to delete my Mumsnet account. I came on here as the OP was asking about the risks of going overdue. I gave her some statistics that she (and others) didn't like.

To add a bit of background, I explained that we had done IVF for our baby, and that maybe made me a bit more overprotective than normal. I was not inferring anything about anybody else's parenting.

Goodbye.

and you know nothing of others circumstances either. I find it easy to concieve, but lost 7 babies in early pregnancy, but the inference that I am less precious about them because they were concieved more easily made me very angry and upset. Of course I would not stab you with a blunt spoon, the turn of phrase is used to illustrate how angering and upsetting people's responses to that kind of accertation is. You are not thinking about what you are saying and what it means to others. you did not simply give facts, you cast really really vile aspertions on other people's value for thier children's lives on them deciding wether to go over 40 weeks or not. I am 40+2 right now, and I have doen my research and I disagree with your choice. it does not mean I do not value my baby's life. He is my only chance at having a second child after 7 years of failure. I do not mind you disagreeing, but I do mind being told that to you I clearly hold my child's life in less value than you do because you had IVF and I did not.

Sharklet. What you said was really out of order. As you were saying it in response to your own offence at what Gemma said it was also hypocritical.

I got what you meant Gemma and can see the comment you made was more about your own feelings rather than any slight on anyone else.

"And I am sorry, but these people who bleat on about the risks of induction piss me off. You can't possibly compare the two."

Really? So if induction has risks and going past "term" has risks, you don't think you can look at the relative risks of the two.
Another enlightened post from someone who completely misundersands risk benefit analysis.
Good luck OP. I'm on your side, in that you want to look at the EVIDENCE and come to some conclusions, in light of the recommendations.

Amber, what I said was neither threat nor intimidation. It was an illustration of the type of anger you will bring out in a parent when you tell them that you are playing russian roulette with your kids lives, but they understand why because they value their kids life more than you do, as they had to go through IVF and clearly as you did not your pregnancies are 10 a penny. Their bond and feelings for their children are more special, or that they value their children more than you do based on that.

You didn't give her any balance. You gave her a biased view and said the risks on my side mean that I am right.

OP my Dr here informed me he would "feel happier" if I were induced before 39 weeks. Any probing I made as to why I was met with vague assertations of "we just prefer it" turns out he is away on holiday when I am due (different system here). I was really unhappy with that as a reason for early delivery so switched providers. There are so many reasons for not inducing early. As the MW earlier said monitoring is the key and most pregnancies are not monitored enough to be accurately dated to the exact day. At the advice of my midwife I have chosen to wait it out for the moment. I have no intention of going over 42 wks, but the risks of induction and the higher liklihood of danger to myself and the baby in a very interventionist birth is something I would rather avoid. My family tend to deliver at around 41+4 beautiful healthy babies. My dd was delivered as a natural birth, then with no probems at all.

It is different for everyone, but whatever your choice make sure you are well cared for and that you and baby are being carefully and properly monitored.

I had 3 inductions. One at 39+6 (small for dates) one at 35+3 (stopped growing) and one at 38+6 (sudden drop in fluid).

All were short problem free labours.

I had to argue hard with DD2, because the registrar said they see babies with much poorer size for dates. However, when I asked her if:

-she was sure my baby was ok.
-she knew why my baby had stopped growing.
-she knew my baby would be ok the next time they monitored me.

She had to admit the answer was 'no'.

She still wouldn't act, so I asked for review by her consultant. She came, and agreed that they had no way of knowing if DD2 would be ok, that they didn't know why she had stopped growing, and that it was quite reasonable of me to want to get her out.

It's all anecdotal, but induction is not an agent of control.It is a process to bring a baby out of an environment that may not be suitable any more.

I promised myself I'd leave this thread but just wanted to ask those who would rather wait - what risks of induction are you worried about? Genuine question; no judgement.

I was induced at 40+1 with dd1 as my blood pressure suddenly went up. Had 2 pessarys then 12hrs later DD was born naturally, a textbook first labour once it began. So I guess as well as the experience with losing dd2 I have had a positive induction experience so I doubly can't understand the reluctance to be induced.