I don't understand why women have inductions when everything is perfectly fine?

[TheBreastmilksOnMe]

I'm trying to understand why women have their labours induced, usually at term + 10, when there is no medical reason and mother and baby are doing fine?

Having done lots if reading up about it, the benefits and risks of induction versus leaving nature take it's course it seems to me more risky to induce then to leave things be.

Term is considered 37-42 weeks so why do medics need to interfere before then? It realky gets me annoyed tbh and it seems a lot of women feel they don't have the choice to sit and wait. No one stays pregnant forever. I personally would prefer a c-sect to induction if there was a medical reason for it. Forcing the body into labour using artificial chemicals sounds so wrong and painful to me.

I'm not judging women's personal choices rather I'm questioning the nhs protocols and the way women are often made to believe that there is something wrong with their bodies if they don't go into labour by term+ 10 and are made to feel fearful that something bad work happen to their babies if they go 'overdue'.

The highest rates of tillborth are at 37-38wks I read somewhere, but we dotn routinely induce to avoid this.

It's is balancing of risks amd the who said there is not enough research and good evidence based advice but it recomends induction by 42 wks on the limited research there is.

I was induced on due date as my waters had gone and had not gone into labour 48 hours later so the risk of infection had increased.

Was out the next day.

My mother had stillborn twins because her placenta packed up and they died. Ds showed no signs of arriving at 2 weeks overdue so I was induced and was happy to take that option.

Oh, and I had long long labour with DD but bounced back really well.

Had badly managed induction with DS that ended in a crash CS and it took weeks to get back on my feet. I couldn't get out of bed unaided the first few days.

I'd take a well-managed induction over CS anytime.

the risk of stillbirth is relatively small, about 4-7 deaths per 1000 deliveries. By comparison the risk of stillbirth in pregnancies 37-42 weeks is 2-3 deaths per 1000.

Yeah, but that is the risk of your baby dying not of a scar or a bit of pain.

What is interesting is that are risks with a c-section too - I would certainly be researching them before I demanded one over induction!

Do they OP?

I know it is many years since I was a practising midwife, but even back then I never came across anyone being induced for anything other than medical reasons.

One lady sticks in my mind (over 20 years ago). She was in hospital being monitored carefully because her placenta was failing. Everyone from the consultant to the student nurse begged her to allow induction of labour. She didn't believe in induction and steadfastly refused.

So, we sent her home. It was pointless to keep monitoring the baby. It was distressing for everyone. She came back in in spontaneous labour, but her baby was already dead.

She and her husband then tried to sue the hospital.

The thing is, that you can't tell everything is "fine" at beyond 42 weeks. Foetal monitoring & scans are only snapshots of that moment in time.

Until you are "the statistic" you think it won't happen to you.

I have been "the statistic", not with stillbirth (mercifully) but with other pregnancy-related conditions. I have subsequently become very risk-averse (with good reasons) in pregnancy.

Hospitals offer inductions automatically at 40+10/+12/+14 depending on their policy, rather than because a specific medical issue has been identified 3littlefrogs.

Yanbu. I wasn't having any of it and always refused induction. Had easy, quick labours and healthy babies.

Things must have changed a lot. I would have thought an induction would be more expensive than a spontaneous labour.

The alternative would be offering monitoring rather than nothing though, which presumably is more expensive than routine induction.

I think most women are fully aware of the risks and benefits of sitting it out v induction v ELCS dependent on their specific experience and circumstances.

Many of us would love to go into labour naturally and have a low risk vaginal delivery but because of their medical history / age / previous labours etc this can be an unlikely outcome - weighing up the risks of ELCS versus induction and when to make that decision is very hard given the reams of conflicting data. Judgmental attitudes do not help.

Also hospital induction guidelines are guidelines only - you don't have to follow them.

I was induced at 39+6; 35+3; 38+4 - all for medical reasons (small for dates; static growth; low amniotic fluid).

Labours were 4 hours, 8 hours and 3½ hours.

I wouldn't be prepared to submit to alternate day monitoring once a problem was identified - if there's a problem, get the baby out.

Perhaps it's my time working in NICU that influences me, but that's how I felt and I was particularly forceful when DD2 stopped growing at 35 weeks. When the registrar wanted to watch and wait I asked to see the consultant. They couldn't guarantee that DD2 would still be alive when they next scanned, so I respectfully told them that induction was my preferred mode of management.

Does OP really think that "forcing...labour using artificial chemicals" is worse than major open abdominal surgery, forcefully extracting a totally unprepared baby from an unprepared uterus? At least if an induced labour is happening there is transmission of hormones & chemical messages within the mother's and baby's body that tell them what is biologically happening. & if the baby is eventually born vaginally then it is more likely to experience the physical compression of the lungs/nasal passages to facilitate mucus removal. Bleeding is also more likely with a CS as the body's natural mechanisms for blood-clotting are not pre- primed. Obviously there are risks with all aspects of childbirth but in terms of starting with the least accepted risk scenario and working up, then trying induction first seems most sensible ( in general ).

Expectant management and monitoring g won't always pick up a problem.

I remember once someone who was been induced at 40+10. Had gel, later that day it was possible to break her waters but couldn't be done as labour ward full. Same the next day. She was having two monitoring a day. The next day went to put her on the monitor and no heartbeat.

I agree with both of the 2 above posts. I entered this PG with a lot of plans and ideas. Water birth, hypnobirthing, home birth, no continous monitoring... I'm leaving it with a lot less!
DD has a serious hole in the heart. She will be born when and how she NEEDS to be. I will deliver in the best way for her and be happy that she is here.
It's ok to have an opinion, but don't judge and WTF would you get annoyed.
People do what they think is right.

The above posts I meant were Idle and Lougle.

I was induced with all 3 of mine
42 +2
39 (medical reasons early induction)
41 +3

With dc1 I was like you OP, let nature take its course, wait till 42 weeks etc.
dc1 was 10lbs 1oz, he had the biggest head I have ever seen on a newborn, and I was pushing for 2 hours, his head was stuck.

With dc3 I pushed them to induce once I went over and finally got a date for 41 +3. She was 10lbs and 7oz, and labour was 1.5 hours after breaking my waters. I felt as if I was being ripped in half.

So, while I think that my pregnancies probably naturally go late to 42 weeks, it means that I have huge babies, which is far more dangerous in labour. If I were to have any more (no chance) I would definitely want to be induced at 40 weeks.

As to the chemicals, with dc1 I had lots of medicine to induce. With dc2 it was gel and then natural labour, dc3 I had my waters broken, no chemicals. Not all inductions involve a chemical hotchpotch, and I was up and very active within 24 hours with dc2 and dc3, unlike if I had had a C-section

What I wish more than anything is that the media in general would stop portraying that having a baby is some wonderful easy thing, with the perfect birth, breastfeeding is a doddle and it's all about buying the "right" fashionable pram.

Getting pregnant, staying pregnant, giving birth and those first few weeks all have risks with uncertain outcomes. I think there needs to be more realism and openess on these matters.

I'm being induced on my due date, no option. It's because I'm over 40 and the risk of stillbirth is higher. I'll just turn up where and when I'm told and surrender myself by the sound of it! But I'm grateful that the hospital is doing it's best to minimise any risks.

I'm not sure that the reasons for labours not starting despite the placenta breaking down beyond sustainability are understood. Most babies trigger their own births when the placenta stops providing everything they need, and whilst they are still small enough to make it out.

Sometimes this goes wrong, and the baby grows too big or the placenta breaks down too much before labour begins. So post-dated babies whose labours haven't self-triggered are a little bit of a self-selected group in terms of risk. It's not being post-dates per se that's dangerous, it's the underlying reasons for labour not starting. For some (many?) babies it could simply be that they are not "done" yet and they are perfectly healthy, but as time goes on, the proportion of babies who have any actual problem increases and with that proportion the chance of things not going well. Unfortunately until the baby is born you can't get a proper look at their placenta, nor assess their true size.

So medics (who aren't in the business of having poor outcomes) tend to want to play safer in cases where intervention might save both mother and child. It may seem unnecessarily interventionist but most people would rather save most children at the expense of a bit of intervention than put up with a % of stillbirths.

Womma- Of course you have an option. If you, or any other mother, chooses to accept the plan of care that is offered that is your choice. What is the right choice for one mother may not be the right choice for another. All the very best for the birth of your baby.

Duchesse- I agree with much of what you say but I think you may be niave when you say that medics are not in the business of having poor outcomes. There are many poor outcomes due to iatrogenic causes in medicalised childbirth.