1st baby at 41 - hospital induction policy

[Edamame]

I had a consultant appointment on Thursday. I'm completely fit and well at 20 weeks but seem to be in a high risk group because I'm over 40. Hospital policy is to offer inductions at 40 weeks to older mums because of the higher risk of stillbirth in this age group.

I'm absolutely terrified of being induced (the syntocinon drip in particular) and it's absolutely the very last thing I want if it's not medically necessary for my baby. I understand the reasons why it's offered to older women as a group. Am I being selfish / stupid?? Will I even care once I get to 40 weeks, or just want the baby out??

It's the first time it's come up - the midwife I saw before said I'd be fine for a water birth / active birth in the MLU (which is just one floor up from the level 3 neonatal unit at UCLH) assuming everything else was normal which it is (same hospital therefore same policy, surely??). The midwife was quite senior and obviously hugely experienced - the consultant was actually a young registrar, definitely going by the book.

Can you help me weigh up these two bits of quite different advice?

I think the key is 'offer inductions' this doesn't mean this is something you have to comply with based on age alone.

I don't have experience of UK hospitals (I'm overseas) but I do understand your thoughts about this as I'm currently 40+2 and 41 years old. There are a few things to consider I think - yes, do find out what the situation is to the extent you can, for example is there really a fixed hospital policy or rather case by case review? My experience is things are not always what they seem. Try not to put all your energy into thinking about this though - it may not come to it at all. I will have no intervention this week, I was offered extra monitoring and the doctor double checked that I didn't want an induction at my last appointment. I'm sure we'll review again at 41 weeks if it comes to that, but I'll cross that bridge when and if. As to if you will even care or not, all I can tell you is I have a lot of (non physical but circumstantial) issues that mean a late baby is tricky, I'm also fed up and uncomfortable, much more so than last week even. Still kind of care though. Good luck.

I may not be the best person to advise but didn't want to read and run.

I understand your concerns about wanting to avoid induction however what exactly is bothering you about it? Is it that you are wanting an active/water birth or are there other reasons. If you don't want to be induced because you are thinking of a water/active birth you need to clarify with the hospital whether you are going to be allowed to be in the MLU as I am confused to why you are seeing the consultant if you are midwifery led. As you have been given conflicting advice you might want to clarify this.

As akuabadoll has said you will only be 'offered' an induction. However, I think it is important to think about two things. Firstly, how far overdue would you be prepared to go if you declined an induction at 40 weeks? You could still be pregnant at 40+12 which is when most women would be offered an induction and you could end up then deciding to have an induction anyway. Secondly, I really don't want to sound horrible but you do need to remember what the increased risk is. I agree being induced may be far from what you want but this has to be balanced against the fact that the risk of not being induced is a higher risk of stillbirth. No matter how much you don't want to be induced it doesn't carry that risk. Sorry to be blunt.

You could try talking to the consultant/ midwife about any different options. Would they do an early sweep? I'm not sure if they would but it may be worth asking. Hope I haven't sounded too negative. Good luck!

The problem I've had refusing to go with policy though is they refused to admit me to the MLU, so it was homebirth or labour ward

I had 2 babies at age 31 and 34, both at 40+4. Dd1 looked very 'overcooked', dd2 the midwife said placenta v gritty for the dates.

If I had another one I would be pushing for induction at 40 weeks. All of this 'overdue is 42 stuff' is right for a lot of people, however some women do not effectively support a pregnancy that long. You don't know if it's you or not. Age seems to increase the still birth risk.

I also was desperate to get them out by 40 weeks almost as if I 'knew' it was time.

I'm 33 with my third and 40 +4
I'm so tired and fed up honestly and feeling very disheartened at going over.
I have induction appt next Tuesday. by then I Will be willing to go through whatever to get this baby out.
I ll chose the first date possible!

Thanks for sharing your experiences. I'm going to try to get my head around the induction idea so it's not so scary to me and then hopefully be in a better place to make a sensible decision when the time comes, whether that is at 40+0 or 41+ Obviously my objectives are the same as everyone else:

• Healthy baby, absolute no 1 top priority
• Happy mummy (nice to have)

I am confused to why you are seeing the consultant if you are midwifery led.

Not wanting to speak for the OP but to answer this, I am older but have no other risks. I currently have MW led care but because of my age a consultant appointment is made as a matter of course.

OP you should also be getting additional scans towards the end of the pregnancy to ensure your placenta is still OK. That should guide your decision.

I personally will be happy to be induced at 39 / 40 weeks as I went massively overdue last time and hated the waiting. I also don't want to waste Maternity Leave and pay on the period before the baby is born.

You can always wait and see how you feel at the time. They will want to follow their policy, but remember you can still ask questions and ultimately make the decisions - I'd want to know what would happen if you don't accept the induction (what actually is the increased risk?), what are the alternatives (daily monitoring?) and what the process would be if you do accept it, and what risks the induction itself brings.

I was induced at 42/40. The induction itself was not as bad as I thought- contractions were 2 mins apart from the start and fairly intense but I had convinced myself it would be horrific and it wasn't. The scary bit was that DD's CTG was awful- heart rate kept dropping, consultants kept having to come running then it would get better for a bit.
She was very overcooked when she was born and her placenta had just about had enough. I think I might ask for an earlier induction next time.
I would have loved a natural water birth but DD is healthy and that'll do!

Im 40. The hospital im booked into has a policy of inducing mothers over 40 on EDD. Im 28 weeks now. I am due in January.

I can't actually understand why anyone would want to be induced. I will need medical evidence that I need to be induced before I am. I've given birth 5 times. Only dc5 was late...by 2 days.

Good luck op.

Yy to induction being 'offered' at 40+ weeks, no obligation to have it.
You'll have extra scans for expectant management if that is what you wish - they monitored blood flow to my placenta towards the end of my last pregnancy (I was 44 - DS4 arrived on his due date and was the smallest of my lot).
There is no reason why you should not have a great pregnancy with a healthy baby in the end, but there is no point in arguing with biology and the risk of placental dysfunction IS higher in older mothers.

Try not to fret too much, stay active, eat well (I presume you don't smoke) and then see how you feel about induction when the time comes.

FWIW, I had an induction with DS1 (I was 37, T+15) and it was fine, really it was.

Good luck

I was induced with the drip for different reasons, but I had a very quick birth with no complications and a perfectly healthy ds 6 weeks ago. I was happy I had the drip. Not all inductions are bad. And like others said you don't have to have it.

Here is my thread on the same topic. I had one 9 hour labour on the drip and one failed induction and CS. Both experiences were fine though.

Hello OP another one who has been in similar situation I am typing while BF my DS my thread has loads of great info I think

www.mumsnet.com/Talk/childbirth/a1770717-Handling-pressure-to-be-induced-on-due-date

Good luck!

Thanks so much for all these helpful thoughts, especially the links to your own experiences, Eldritch & Liveinthepresent.
Exactly, Schwarzkopf, it's midwife-led but consultant appointments are made as a matter of course if over 40 at my hospital.

Thanks Pacific - I did not know that the placental blood flow can be monitored by scanning.

Eldritch, on your thread, you were talking about balancing risk - this is the thing I am really struggling with. Not only is is hard to get your head around risk in general, the piss poor information available about certain risks makes it kind of impossible! When I asked for info at my appointment, it was just an A4 sheet about possible pessary side effects. But I did find the RCOG recommendations on induction of labour at term for older mothers on the internet.

The other thing that has helped is realising / admitting a couple of days ago that I am absolutely terrified of being in hospital full stop. So I can work on that too.