Induction - yay or nay, I need some advice!

[BeQuicksieorBeDead]

I really need some experienced advice on this one.

I am currently almost 22 weeks with my first. My midwife has offered me the chance to take part in a research study on inducing ladies of 35 years and over to see if it reduces the chance of a stillbirth. I need to give them an answer shortly and I don't know what to do!

If I sign up, I will be induced at 39 weeks if I have not already begun the first stage of labour. I have been advised that this could be more painful than an 'un-induced' labour, but that most women find it okay. Are they chatting me up there or is it really alright?! Should I be asking for an epidural on my birth plan if I go for it?

I really want to help with the study and would like to think I had helped to get some legislation passed that would stop some people suffering a horrible time, but at the same time, I don't want to sign up for the study without knowing exactly what I am getting myself into! I am also aware of course that I could end up being induced anyway, even if I don't sign up!

Sorry if I sound incredibly naive.

Just to add to my post - my induction didn't work that well either, several hours of labour, lots and lots of pain relief (gas and air, pethidine and an epidural) but no dilation, so ended up having an emcs anyway.

Although weirdly you really have to look to see the "recruiting stats" as they are partially blocked from visibility

Hi there - there was a thread on pregnancy about this. Also I have been asked multiple times (I am 41) to do this. I have/had multiple concerns about this.

1). I am a research scientist and I don't understand the research design given that I was assured that I would always be given the best clinical advise based on my condition
2) the evidence suggests that it is already known that going to full term increases the risk of still birth
3) given 2) I went from not wanting to be in the intervention (induction) group to not wanting to be on the control group. I am being induced next week at 39 weeks by request partly due to what I have learnt reading material about this study and partly because my baby is huge
4) I was offended by the participant information sheet that went with this study. It said something along the lines of 'more women are choosing to have babies later' which, having spent 7 + years trying to conceive stuck

Darn phone.... Stuck in my throat a bit.

They were also asking at around the same time as I got a 1:4 risk on the combined test so a research study was simply not a priority for me.

This study will have passed a review by an ethics committee. All I can say is that I wish the ethics group I have to get my relatively trivial studies passed by were this lax.

Yy lozster. Also I can't be the only one who found it hugely patronising, with the whole "gee, we don't know what early induction will do, but hey, let's find out!" thing it had going on.

And what about the fact that they are surely exposing some comparatively low risk women to unnecessary epidurals, tears, forceps etc??

Am actually quite shocked and reinforces my view that some obstetric practice is quite misogynistic.

www.rcog.org.uk/news/rcog-release-induction-labour-older-mothers-may-reduce-risk-stillbirth-say-experts

I had a lo

Again I apologise for my fat fingers.....

www.rcog.org.uk/news/rcog-release-induction-labour-older-mothers-may-reduce-risk-stillbirth-say-experts

I have had a look at some of the scientific citations and in think in this instance the experimental study is superfluous. The meta analysis cited in the link above already shows that there is a strong reason to induce early. Yes, an experimental study can prove it but in this instance, with the research design that is employed, I don't think this work is necessary.

Re: whether induction is best or going with 'nature', I hear what is being said but i did a complete about turn when i read the evidence pointing to better outcomes for baby's of older women delivered before 40 weeks.

I've had 3dc and for entirely medical reasons, the first 2 were induced. My first was 9 days overdue but my waters broke and nothing happened naturally. My 2nd was an unstable lie (so just somersaulting round and round) and they induced me while he happened to be head down 5 days early.

I can say without any doubt whatsoever that my 3rd and only natural labour was by far the most relaxed and stress free. I couldn't actually believe the difference between the two, mainly due to the natural gaps in contractions given by your own body.
The "evil" induction drip just ramps up and up until your contractions are at their strongest every time and with hardly any gaps between them at all.

Without meaning to scare anyone who has to be induced I also became very ill after dc2 due to an unexplained massive haemorrhage. My womb just gave up contracting after dc2 was delivered and I can't help but wonder if it was due to being forced into a fairly quick and aggressive labour when my body just wasn't ready yet.

I think your intentions to help future women is admirable but like the PP, I agree that you must first look out for yourself and your baby. It seems that labour and birth is such an unpredictable event but from my experiences i can say that when your own body chooses the time, it appears to be a whole lot smoother and works really nicely.

Good luck with the rest of your pregnancy and if you do have to be induced anyway, don't let us put you off. No matter how the labour goes, hopefully at the end you will be rewarded with a perfect little being!

Interesting.... Can't get that link to load - sodding iPad - do you have a rough sense of how much more likely a baby is to be stillborn with a mum over 35?

lozster and rp thanks for doing some research for me. I also found the tone of the info sheet a bit grating as we didnt decide to wait either, we have had a few set backs too.

Part of me thinks that reduced chance of stillbirth has got to be something to leap at, but then hearing all the stories on here, I might not be choosing the lesser of two evils. If they know the stillbirth chance already, why do they need the research? Is this just to find out if reducing the chance of stillbirth outweighs the other risks of induction?!

Revolting peasant - I think by definition of age, all women who would be recruited for this study are high risk. I know I am high risk so would rather accept interventions than increase the risk to my unborn child and, having looked at some of the evidence, I believe the increased risk is real. I know my perspective will be different to younger mums and it is driven in part by seven years of interventions to get me to this stage and the realisation that mother nature can be a bit shit if left to her own devices.

Sorry I'm on my phone and struggling with links. This is the info you want I think.

Data from these studies show the risk of stillbirth at 39-40 weeks gestation is doubled for women aged 40 years or over, and at 39 weeks gestation these women (40+ years) have a similar stillbirth risk to women aged in their late 20s at 41 weeks gestation.

This is from epidemiological studies. This seems an acceptable source to me as the experimental study has so many confounding factors that I am not sure it is practical or will add any meaningful information on causality.

Thanks addicted I am guessing that having a reason to be induced might curtail the bitterness that I might have towards my would be researchers!

Lozster I am really interested in your about turn on this - so the research really supports early induction? I will have to follow the links when not on stupid smart phone. Thanks all for your input.

Sorry cross posted... Food for thought lozster thank you.

Be quick - my baby is also very big and there is a question mark over whether he will be deliverable vaginally or not anyway. If he were small I might be more inclined to wait.

I totally respect znybd

Someone remove my phone from my hand - this is just embarrassing now!

I totally respect the right to choose but I think many of the women on here had inductions at an earlier age when different factors were at play. Whilst i know no one willingly puts their baby at risk, my aspirations for delivery extend no further than bringing home a healthy baby. My baby exists because of medical intervention - lots of it - so my belief in nature is not strong.

I was induced at 39 weeks, I had to have a controlled start to my labour because I was on anti-clotting medication.

The induction was fine, started slowly with sweeps, then gel pessaries etc. Finally had a syntocin drip which meant that the contractions were painful and I needed an epidural and some sort of morphine injections.

It took days - the induction started on the Wednesday and the baby didn't arrive until the Sunday. The bit with the syntocin and epidural was only for the last 8 hours. I rather enjoyed wafting around the hospital serenely for a few days. But even so, I wouldn't have done it without a damn good medical reason.

I subsequently has DC2 with no pain relief except 10 mins of gas and air at the very end - the pain level was completely different without the syntocin.

This is a subject very close to my heart. I'm primip at 38weeks and just turned 40yo. Was told at 12 weeks in no uncertain terms I WOULD be induced at 40+0 if no natural labour by then as risk goes from 1:1000 to 2:1000 of stillbirth.
Thinking I had a say over my own body and birthing I asked for benefits, risks, alternatives etc and it took weeks to get to agreement that as long as placenta is functioning well then they will allow me more time. But I've had to fight hard!

http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/ article has helped me recognise I've been doing the right thing. The risks inherent in induction are far higher than the slight elevation in stillbirth risk. Especially if the placenta is functioning well.

OP It sounds like you've decided against the study - I'm so pleased. I'm shocked and appalled at the study tbh!
Good luck with your pregnancy

Yes, I think induction at 40 + 0 is standard at the moment for older women. It's been hard to establish for me as this study has muddied the water. My experience is that mid wives are much more laid back then drs and assume that your birth will be straightforward. I think this is as, at my hospital at least, there is a mid-wife led section and a dr led section with high risk patients going straight to dr led section. So mid wives lead the lower risk deliveries. Over 35 is immediately high risk. For me, there is the added factor of having a large baby. Re: the placenta - I don't think you can tell how well it is working very quickly so a generalisation is made that it stops working well sooner in older women, hence the need for an earlier delivery.

All this apart, I think we are all cross about this study for similar reasons. We can't see what it adds beyond current reviews, it has raised anxiety about a serious matter beyond what it normally would have been as we have been exposed to enough information to raise concern but not to make any of us experts and it has muddied the water about what standard practice is and what we have been told because of this study.

I think I found the article PFE (actual link doesn't work on my phone). It contains exactly the sort of info about induction that I asked the study recruiter about when they tried to get me on this. The nurse was not particularly forthcoming.

However, this article does not consider the role of age as a risk factor. The figures it gives are for women of all ages. Personally, I am convinced that age generally elevates risk hence going ahead with the induction. On a less logical note, I personally know a disproportionate number of women who have had a still birth so I was already concerned about this. Also, again this is my personal pov, although the article is correct to highlight the range of risk factors that come with induction, my concern is severity. ie i may wish to have a positive birth experience zoned for the baby not to be jaundiced (cited negatives) but my desire to reduce the risk of still birth trumps these factors.

How individuals perceive risk and arrive at different decisions about our births will vary but I think we all agree that this study has not been helpful.

I was in my 40s when had my children. Was induced at 42 weeks with the first and they were prepared to leave me to 42 wks with the second. He came at 41weeks. No one mentioned early induction. This was only 3 years ago.

Hi BeQuicksieorBeDead - you already seem to have picked up from the responses not to do this study.

I have an excerpt from something called 'The Physician's Desk Reference' in the US - a kind of manual/guide for doctors about all types of drugs and treatments. When it comes to the artificial oxytocin that is prescribed in induction (when pessaries and breaking waters don't work and sadly something you can't decline once you've started the process), it says:

?Because of the risk-to-benefits considerations, gels & artificial oxytocin are not recommended for the induction of labour and should be used to initiate labour only when there is genuine reason for concern for the welfare of the mother or baby.

'Precautions: Chemicals used to bring on artificial means of induction are not the same as what the body naturally produces, nor are the uterine contractions that result from their use comparable to those seen in normal labour. They can skew the effects of labour from the onset and can result in further interventions.

'Overstimulation of the uterus can be harmful to both mother and fetus. Even with proper administration and adequate supervision, hypertonic contractions can occur if the patient?s uterus is hypersensitive to oxytocin. This must be considered by the parents and the physician in exercising judgment regarding the absolute need for induction or augmentation in the absence of true medical urgency. The decision to accept either of these should not be made lightly.

'Except in unusual circumstances, oxytocin should not be administered under the following condition: ??any condition in which there has been previous major surgery on the cervix or uterus, including cesarean section'

It may be medically necessary to be induced and if so, then induction is important and helpful to protect mum & baby, but never should it be used when not medically necessary as you don't know how your body will react.

I'm shocked about this study and the way you've been treated but hope all of these posts will help you be confident in responding to the docs next time they ask! Well done for questioning too - informed decisions are always the best ones!!

Good luck when your labour does begin (hopefully naturally!) and enjoy the rest of your pregnancy! x

lozster thanks so much for all your posts. They are really helpful!

I am interested in the idea that all women 35+ are automatically high risk, as that is not what I understood. E.g. I know a woman who is 36 who just had a homebirth for her first DC as she was classified as low risk by the midwives. I am wondering if the criteria is used differently in different parts of the country?

I am also unsure about the doubling of risk point, as if you're doubling a very small risk then it is still not much of a risk, iyswim.

However, all for maternal choice, and good reasons on both sides!

OP having read everything, I think my final position is that there are some very possible negative outcomes for you and the baby from induction, and the info given so far doesn't really adequately explain those. Plus as lozster says, the info about early induction already appears to be available from epidemiological studies. Versus, a small increase in safety for your baby from refusing automatic induction at a set date, regardless of your personal situation.

It has been an interesting thread!

Sorry, 'increase in safety from HAVING induction on set date', obv!

I just want to say a massive thank you to everyone who has posted on this thread. Yesterday when I posted I was feeling quite pressured to take part - most of that pressure coming from me I think - and was mainly considering the ethical choice of helping other women or being selfish.

Your posts have made me realise that there is a lot more to induction than simply being given some drugs and the process being faster - and I am quite angry that if they already know that this link exists, that they need to carry out the study at all; shouldn't everyone have the option of being induced if they want to? I have a friend who was left to go to 42 weeks and ended up having an EMCS, no one mentioned inducing her even though she is nearly as old as me.

I am going to have a good think about my birth plan and write it on my terms - not because of any study that might be going on.

One thing that still puzzles me slightly is why they are only accepting participants who are having their first child - they haven't mentioned that they think there is an increased risk to first timers compared to 2nd or third births...