To induce or not to induce?

[Shortninbread]

Does anyone have any thoughts on whether inductions lead to more difficult labours?

My mum went to 43 weeks for her second labour and no one batted an eyelid back then.

I am 41 weeks this Sunday and will be offered a sweep on Monday and again on Wednesday to get things going. This is is exactly what I did with first DD. It did help start the labour, but was a very long and drawn out affair at 4 days from first contraction to last.

Should I wait for the pessary (offfered at 41+6) and hope that this kick starts things properly or do the milder sweep approach? Or leave entirely until any medical reason crops up to be induced? Any thoughts appreciated.

I personally wouldn't go down the medical route until I'd had a few sweeps. It just gives your body an extra chance to start things itself, if conditions are right. I didn't find my (3!) sweeps uncomfortable at all, however, none of them worked. That is my personal experience however, so bear in mind some women find sweeps extremely uncomfortable (though not as uncomfortable as labour I bet!)

I opted for expectant management with DS2 (born 11 days ago) and this was under the care of a consultant midwife who I met with to discuss my care. Baby was scanned to check fluid levels, placental functioning and blood flow was also assessed. I agreed to daily CTG monitoring for 5 days before a further meeting and ongoing plan would be put in place.

In the end I chose induction (2 days after the meeting!) because I was becoming anxious about baby's well being beyond 42 weeks. My labour was quick once it started (after ARM) - 3.5 hours and VERY manageable pain-wise. I am a second time mum though and DS1's birth had been a straight forward water birth.

HOWEVER, the induction was not without complication: my baby's heart rate dipped on 2 occasions during the process and we were twice whisked into theatre and I narrowly missed a crash c-section twice. I'm afraid I don't know if the dips in heart rate were due to the induction as the midwives and obstetrician were not able to say, but I think it's always prudent to bear in mind that any medical intervention can often lead to more. Induction does mess with what is intended to be a physiological process.

I share the general concerns. I am a 0+3 parity mum-to-be, and due to history and age (41) I have not been advised to exceed my 40 weeks, so we are going for IOL bang on the 40 week date.

However my consultant agreed to (my ask) and tried membrane sweep at 39 weeks, no luck! So here I am at 39 weeks 5 days hoping that things kick off naturally very soon - I am concerned that IOL will be long, drawn out, and possibly end in EMCS anyway!

I share the general concerns. I am a 0+3 parity mum-to-be, and due to history and age (41) I have not been advised to exceed my 40 weeks, so we are going for IOL bang on the 40 week date.

However my consultant agreed to (my ask) and tried membrane sweep at 39 weeks, no luck! So here I am at 39 weeks 5 days hoping that things kick off naturally very soon - I am concerned that IOL will be long, drawn out, and possibly end in EMCS anyway!

Badgerina, funnily enough I had just been reading your birth story before I started this thread. Pleased to hear it all worked out, but quite a roller coaster by the sounds.

I think I'll go for a couple of sweeps again but perhaps delay a bit longer.

Fifitrix, I've heard several stories about pessary induction (is this same as IOL?) that have been very straight forward and resulted in strong med-short labours. I was actually thinking I'd go straight for the pessary instead of sweeps to get things going more strongly. Still unsure.

I had a (painless) sweep on Friday and nothing has happened since. If all goes to plan, I am getting induced on Monday (40+12). It was not what I planned but I will go for it as I am getting too anxious about baby's movements etc (it's my first). I will ask for an epidural though.

I had 2 sweeps with DS2, then on a 3rd look at me down there they saw I was 4cm dilated so didn't need to give me a pessary and just broke my waters instead.

I was induced for dd1 and dd2 at 40+13 both times. First induction took about 2 days, and I had the whole lot - pessaries, arm, drip, epidural, and eventually forceps and episiotomy as I was knackered. We were both fine afterwards.

Dd2 went straight to arm (no pessaries) as cervix was favourable. Labour started immediately and lasted 2 hours 20 minutes. No time to get in the pool as I was pushing by the time they filled it and managed on gas and air.

Completely different but both labours classed as induced. I loved my second labour! Another benefit of being induced is you don't have to travel to hospital in labour.

Good luck!

Crochetcircle, I love the upside of not travelling to hospital in labour. I did that twice last time and remember it was rather horrendous.

Early labour contractions kicked off all last night with a show this morning, so I didn't have a sweep today. All stopped now though, but hoping it will get going again.

I've just come back from my first sweep at 41 weeks - feel like I could cry. My cervix was so high she couldn't even reach it. Induction is really not what I want and despite not being offered alternatives, I've managed to arrange another sweep on Friday (so will be 41+3) and an appointment a few days before 42 weeks to discuss a care plan.

I feel like they're not offering me alternatives - I just want a bloody conversation discussing options. They just assume they'll book me in for an induction. I had a HB booked, with the idea I'd go into the MLU if I wasn't coping at home. If I have an induction, it's goodbye to all of that - the MLU, the pool - everything.

I know people who have gone to 43 weeks but I feel like I need to arm myself with information about post dates so this thread is very timely :) Shortinbread you posted this last Friday - how are you now/ how far along?

Oren IME you have to be proactive and make an assertive point of saying you want expectant management. It's rare for women to want this option so they don't suggest it.

They will probably want to scan baby to check placental function, size and fluid levels. They will also probably want you to meet with either a Supervisor of Midwives/Consultant Midwife or a Consultant Ob/Gyn. Could this be what your scheduled meeting is?

Hi badgerina - most likely yes. I think I need to re-read as much info as I can about going over.

Also, are you certain they won't support an induced water birth on the MLU?

It varies from hospital to hospital, but I started my induction (at 42+4) on the MLU at my local hospital, with the intention of birthing in water. This was fully supported by the "powers that be". The understanding was that induction via pessary and/or ARM with intermittent (hourly) CTG and 15 minute doppler checks (as is typical in ALL labours) was acceptable on the MLU, but that if the Synto drip was required, I'd have to transfer to the CLU, as its higher risk.

Pretty certain - I was quite shocked about it. I will definitely have it confirmed though. When I went to the MLU talk/walk round, they were quite strict about their requirements for being there, one of which wasn't induction. When I spoke to the MW last week at 40 weeks, she said the induction is done on the labour ward - the very last place I hoped to be.

Definitely make a point of asking. Our hospital doesn't "advertise" low-risk induction on the MLU, but it does happen.

Having said all this - I booked a home birth, opted for expectant management, then decided I want an induction on the MLU. I had the pessary on the MLU but ended up needing to transfer (before labour started) to the CLU due to decelerations in baby's heart rate and HONESTLY: it was absolutely fine.

I had a doula who was brilliant at creating the right atmosphere, despite everything - she turned ALL the lights off in my room, put LED tea lights around the place, used aromatherapy oils on me, made sure I had a birth ball and remained upright and active, kept my room private, and reminded everyone to be quiet, and reminded me to eat and drink.

It is possible to cling to "normality" even in hospital It wasn't what I planned (neither did I plan pushing my baby out in a an operating theatre under stress - decelerations again ) but I've decided to remain pragmatic about it all

Badgerina this is all such helpful things to ask, thank you :)

My mum also suggested asking if they would break my waters and it made me realise - they haven't given any indication of how things build up - no mention of a pessary or escalation and it's made me realise they've given me no information whatsoever.

Just to report that I went into spontaneous labour at 41 weeks, baby born on Tuesday. Seriously thought it would be induction factory, but there you go. No pain relief, no stitches, on labour ward but may as well have been birthing centre the midwives were so hands off and encouraging of no intervention. Such a brilliant team and much happier experience this time.

Orenishii, my mum went to 43 weeks before spontaneous labour and it wasn't given a second thought. Expectant mgmt if you have had an uncomplicated pregnancy could be the way to go. Good luck and try not to worry (much easier said I know) as the stress may only make things harder on yourself.

Orenishii, Let us know how you get on too.