Handling pressure to be induced on due date

[Liveinthepresent]

Hospital policy is to induce on due date as I am 40+.

I am very keen to avoid the pressure of induction looming over me before I am even overdue as this marred the end of my last pregnancy too ( due to waters breaking and no contractions).

Have a meeting next week to discuss the plans - and am keen to arm myself with enough facts to know what my options are and how long it is reasonable to stall this intervention for.

I know I can push for monitoring instead - but last time I was put under huge pressure to stay in and be induced - and I just want to agree as much as possible next week rather than having constant negotiations.

I do understand there is a reason for the policy but would be especially interested if anyone has any access to actual stats relating to an increased risk of going overdue at my age. Is this policy standard at all hospitals?

I'm not advocating making any decisions that genuinely put my baby at risk - I just want to unerstan it beyond my midwife telling me they many give me a few days but not much longer...

Thanks in advance if anyone has any information or experience of this.

YOu honestly don't have to negotiate anything. You don't even have to subject yourself to a conversation about it, let alone pressure.

In a worst case scenario, you send them a letter informing that that you do not want to discuss this face to face and will do so by email/letter. Any attempt to do this will be considered as harassment. You do not want a repeat of your last pregnancy. You will only be attending appointments for basic monitoring and not a discussion on any interventions.

It's a bit extreme, but if you hold that in mind as your baseline then everything else is a bonus.

'I do understand there is a reason for the policy but would be especially interested if anyone has any access to actual stats relating to an increased risk of going overdue at my age. Is this policy standard at all hospitals?'

Surely these are both reasonable questions to ask, in writing, of the hospital before your appointment next week.

I'm in a similar position though mine is due to O.C (liver problem) they keep saying I 'have to be' induced at 40 weeks and 'can't' go over and need constant monitoring and basically can't have any of the things I wanted in my birth plan because of the 'risks'.

Like you I'm finding this quite stressful especially since these 'risks' are based on very little actual research or statistics, I've got my appt to argue with the consultant about it all next week but like you don't know quite how to handle it - don't want to be bullied into things I don't want but don't want to go against medical advice and take unnecessary risks. So I'm afraid I don't really have advice but as someone in the same position just wanted to sympathise!

Thanks both - purple sorry you are in same boat but always helpful knowing you are not alone.
Actually last time I did get my natural birth ( with a few compromises) so I guess in a way that makes me more determined this time- I can't help but feel like the stress may have actually not helped the delay of contractions.
Starlight thank you - that's a good point about the baseline - its just so hard being that assertive when you can't help but think they must be doing it for a reason- I felt very vulnerable last time when they had written in my notes 'advised about increased risk of stillbirth' despite no one really actually articulating that or specifying the risk I was taking...
Anyway am waffling now but will keep researching.

I guess policies are very different from area to area. I'm also 40, down for a home birth, and told that there's no reason to think about induction / changing to hospital even until 42 weeks. This may be partly because my last pg went to 42 weeks with no problems though. I think this is quite a useful resource for thinking through the risks involved www.theunnecesarean.com/blog/2009/10/3/postdates-separating-fact-from-fiction.html and perhaps gives a framework for discussions. As another poster has said get them to explain why they're advocating it and back it up with evidence. 'It's policy' is a bullshit answer' and should be ignored.

Thanks quertas very useful to know your situation and great article.
Good luck with your homebirth.

DD was actually born at 40+1 so this may all be unnecessary worrying if that's an indicator of how it may work out again this time.

One useful thing to ask is the increased risk of interventions with an induction. I found my hospital very willing to talk about increased risk of stillbirth at 42+ weeks but very unforthcoming about the risks of induction. I was tipped off to ask the question by my community midwife and I got a rather spluttered response from a registrar.

See that's part if my problem with it - increased risk of intervention v virtually undocumented, not proven increased risk of stillbirth based on very little research at all. I can understand they're risk averse but I fear it is more about avoiding me suing them rather than my welfare.

Sorry for the stress purple. It's definitely not policy everywhere as a friend over 40 here in London went to 40+13 (was due to be induced that evening). I found the same on risks of induction vs. stillbirth. And don't get me started on the debate I had on accuracy of scan dates (apparently they're never out at all so I conceived 5 days before DTD or ovulating ).

i don't know about the age thing. I was nearly induced at +12 but delivered the night before. The midwife all kept telling me some ladies just spend longer growing their babies and 37-42 weeks all 'normal'. Wish your Edd was 27/4/13 - 1/6/13 then!!!

More replies - all useful thank you!
glorious you wouldn't happen to know which London hospital your fried was with? I am in London too - so might be a useful comparison to mention at my appt.

Yes live, it was Lewisham. Good luck

I have the same thing. I was 40 in April, due 30/07 according to scan but 01/08-04/08 from when DH was in the same country as me!
In N Somerset and here they also push induction at 40+0.

I've chatted to community MW who seems in agreement with me that if all is well and I have daily monitoring they'll give me a few days. I've tried to follow the BRAN approach when discussing it:

B. what are the benefits of the induction
R. What are the risks
A. What alternatives are available
N. what happens if I do nothing

Good luck and hope you get the outcome you hope for

Friends of mine over 40 have had babies at St Thomas' and Kings and not had the induction at 40 weeks thing. My friend at UCH did though.

This seems odd.

I thought the 'normal' full term gestation was generally regarded to be 37-42wks. Not precisely 40wks. After all it is rare to be able to precisely pinpoint the date of conception.

I thought the average was 40wks...meaning that by the law of averages up to 50% of babies will be born without intervention to induce after 40wks.

Look for yhe WHO guidelines for induction post 40wks. I'm sure someone will be ablr to point you in the right direction. I think those guidelines are evidence based.

Thanks Remembering ( like your Nn) I think it's the 'they'll give me a few days' that bothers me most - ie it's their decision not mine and I know from last time it was like having a huge ticking clock making me feel under pressure..

At the moment I feel like saying I will not pre agree to an induction date for this reason - and asking for factual evidence of benefits and risks.

I know what you mean Live and I also think that the chunterring about inductions was the thing that delayed my going into labour with my first DC. By the time i had the induction i dud feel a bit harried into if and it made it harder to cope- ie feeling that that sintocin (sp?) contractions were something the staff were inflicting on me,rather than being productive labour pains. One option might be to either take someone else along to any appointments subsequent to your consultants appointment to run verbal flack (' my client is not prepared to discuss this at this time' style) or respond to everything with either "I'll think over what you've said" (trans 'shut up') or 'my partner/DH will discuss it and get back to you' (trans 'shut up'). I love the BRAN approach! Ghats one I'm going to use in a variety of situations - brilliant! Good luck and stay strong, it us your decision to make, not theirs. (And equally if you decide to have an induction then that's also your choice, not caving into pressure)

Apols for all the spelling errors there - dratted phone!

I had the same experience: my thread is here.

I never really got a good answer. Induction was stopped as DD was an unstable lie (still is, the little livewire!) and I had a caesarean.

Mary Cronk's advice might be useful in your situation.

Thanks so much for all these extra responses - am just reviewing all the info - so far not found anything specific about maternal age as a reason for induction within NICE/WHO guidelines.
Am feeling my resolve strengthen and have started to discuss tactics with DH.
Really appreciate the Mumsnet wisdom - hadn't discovered it last time around!

What day is your battle with the consultant appointment next week Live? Mine's Thursday, we can compare notes after

Thursday 9.00 am Purple - good idea!

Ha ha 9am Thursday here too, how unlikely! Know mine isn't related to my age but otherwise it's the same issues really so will be interesting to see how we get on with our negotiations!

I had quite a bit of an issue with my midwives as I went a lot overdue but refused sweeps and further scans etc.

They kept banging on about 'letting me' or if I didn't do something then they couldn't agree to 'let me' etc etc.

I met most of those statement with a non-committal 'hmm' and then when asked to commit to something a simple but polite 'no thank you'.

EG 'If your baby is still in there the day after tomorrow then we'll have to do something about it'.

Me: 'Hmm'.

Then next time it was 'We need to book you in for induction'

Me 'Hmm'.

Them 'We've got Next Monday - okay?'

Me 'No thank you'.

Them 'Well I can't let you go much longer than that'.

Me 'Hmm'

Them 'Well shall I do a sweep'

Me 'No thank you'

Them 'Well what about tomorrow'

Me 'No thank you'

Them 'Well we'll definitely have to do one the day after'.

Me 'Hmm'

etc etc.