Don't want induction, but not sure what I want!

[blushingmare]

This might be long, but don't want to drip feed so will give a bit of history if you can bear it!

I had a large PPH with DD as a result of atonic uterus and 3rd degree tear. It was all quite traumatic and I'm really hoping for a calmer, intervention free birth this time, but I'm realistic and know this doesn't always happen and just want what is safest for me and baby.

I had some mild faecal incontinence symptoms following the tear and had 6 months physio and now have no problems. I have had a pelvic floor scan in this pregnancy and have been told a vaginal delivery is ok, with no recommendations for csection at a certain weight. Obviously a csection would carry a greater risk of PPH too, so that's another reason to go for vaginal birth.

I had a scan 2 weeks ago that showed baby is 9lbs already. I know this isn't 100% accurate, but don't know how much it can be relied on.

According to my due date (obtained from dating scan) I am now 40+5. However, that due date would mean I had a 29 day cycle the month I conceived and I have never had a cycle less than 32 days, normally 36-40 days. So according to say a cycle of 36 days, I would be 39+3 week pg today.

I had a failed sweep yesterday as cervix was too high and posterior. My midwife will try again on Weds and is talking about induction at 40+14 (according to due date).

I really really don't want to be induced. Just talking about it yesterday made me burst into tears and I am not really an emotional person. But I'm getting quite worried about the size of this baby now. If it was 9 lbs 2 weeks ago, then what is it now and what will it be if I decline induction?!

I know I am within my rights to decline intervention. But I want what is safest for me and my baby too. But I am not at all sure about the accuracy of my due date! I feel like I need to have a plan in my head to go to my next midwife appointment with, but I'm not sure what that plan should be.

So I guess my question is WWYD? Or do you have any similar experiences to share? Part of me feels I'd rather have a csection than be induced, but I don't know if that would even be an option or if it's a clinically sensible course of action.

Thanks for sticking with me if you made it this far!

Hi blushing I had a severe PPH with DS2 and am now 35 weeks pregnant. There have been several recent threads on the subject and it might help you to read other experiences.
How big was your DD and when did she arrive? Did you have the same discrepancy in EDD with her?
Your cervix doesn't sound like you are gearing up for labour at the moment, which I'd take to mean your baby is not cooked, and it also means an induction is less likely to be successful. Look up Bishop's score, which is something that should be done pre- induction to give you an idea how likely it is to succeed. If you are ready anyway then just inserting the pessaries can be enough to kick things off, if you are not ready then you are more likely to end up with a failed induction and EMCS. You could ask MW to score you as part of next scheduled sweep?
As far as the predicted weights go, from other threads they are not at all accurate, can be out by several lbs, but sensible to assume you will have a big baby.
Are you consultant led as a result of the PPH? Have you had an opportunity to talk through a birth plan with an obstetrician? I saw them this week for a growth scan, debrief with my notes (4 yrs later) and to discuss a birth plan, and it was very helpful. I finally felt listened to and all my concerns were addressed, and I came away feeling much calmer and more positive.
I hope you go into labour naturally or after a sweep in the next week and avoid the decision, but otherwise make sure everything is discussed so you reach a decision you are happy with.

I had a pph and 3rd degree tear with dd1 but didn't suffer any continence problems. I had an elcs 18 days ago for dd2 and it was wonderful. A massive difference from my first birth. I'm not trying to push a cesearean on you by any means, just don't be scared if intervention is needed, it may well turn hit better than fine.

Blushing - I feel for you, this wait at the end of pregnancy is tough! I have posted about this before too, so if you do look, you might see my advice rehashed too.

I was really, really upset at the idea of an induction because of my experience first time around. The second one four years later was so different, the set up and the procedures had completely changed and it was so much better. So the second time I just had a propess (sp?) pessary and that was enough to kick start labour. The rest was like a spontaneous labour, no drip, no continuous monitoring.

I think I would advise discussing it thoroughly with your midwife, eg what are the exact steps you will go through, and could you have the pessary and if that doesn't work, then have elc? Being well-informed will help you feel a bit more in control.

Good luck

Risk of stillbirth increases after 42weeks. Hence all uk women being offered inductions at around 12days overdue. I understand you feel there is a discrepancy with dates but the uk guidelines stick rigidly to the dating scan. I was about a week out too based on conception dates (we only had sex once so was certain of conception date) but went with dating scan as it was too complicated to argue it out. My only advice is not to lose perspective. Most important thing is that you're both well. Don't get hung up on natural birth etc if it means putting the pregnancy at risk!

I feel for you. My first baby was large and had a a shoulder dystocia so with my second they really pushed for induction, my growth scans put him at 8.9 at 37/38 weeks and estimated well over 11 at 40 weeks. I refused an induction and baby was born after my 4th sweep at 40 weeks weighing in at 8.8 so nowhere near the estimates.
Do what you feel is best for you, they can monitor you daily once past 42 weeks and induce at 43 weeks if you wanted to wait an extra week. It's totally your decision, they will advise you to listen to them but you don't have to be forced into anything.
Good luck. I hope your labour goes well!

My sil was induced a couple of years ago, i can't remember the finer details, but one thing that really stuck with me was she was 'put on a drip for an hour' ie it wasn't 'you're not progressing, you need a drip and that's it', which is what i'd always presumed ie you're on the drip till you've got a baby.

They'd already broken her waters (i think) and there was meconium in them, so i guess there was more urgency than usual.

It seems the drip just sped up the labour a bit, then they turned it off and she got on with it. Perhaps that's how they do it nowadays, could be worth talking about it with your midwife.

NB i got from your OP that you want to avoid induction because it involves a bigger risk of damage to the mother, which is where my response stemmed from - ie less drip = more freedom and control = less damage.

I would ask for an ELCS. NOW!

Thanks all. Plenty of food for thought there.

Bakingtins - I noticed you on the recent PPH thread as it sounded like we'd had some similar experiences. I'm glad you're feeling more reassured now. I haven't been under consultant led care, but have ended up seeing a consultant a number of times for various reasons. The plan was just for low intervention vaginal delivery, with cannula in for 2nd stage and drip & bloods at the ready. I haven't really discussed the size issue with a consultant though and whether this should be a reason to be considering csection.

DD was born at 40+4; my forewaters broke and started having some contractions on 40+2, but then they broke my hind waters on 40+4, which is what really got it going. Don't think that counts as induction though - it was a "normal", no intervention delivery aside from that, until the sh*t hit the fan once she was out. She was 8lbs6 and no discrepancy with dates.

I think maybe I'm going to talk to my midwife on Weds about being induced one week after what I think my due date is. This would only be 4 days after when they would want to induce me anyway, so perhaps a reasonable compromise? Obviously am hoping my body does it for me first though!

I'm v unsure about requesting a csection. I'd obviously rather not have surgery and the atonic uterus is a higher risk with a csection. And having a toddler and a newborn to deal with whilst recovering could be difficult, especially as DD is very needy of cuddles and being picked up right now and that's not going to get any better with a new baby on the scene Emmac - why would you be so adamant for a section?

blushingmare I would go for the ELCS just because of my own experience. I had my DS 4 days over and he was 8lbs (even though they had been telling me my bump was tiny / measuring small) but got stuck and after 3 hours pushing I had to have both suction and forceps and a large episiotomy, I was literally on the very of an EMCS I bl&&dymindedness got me through. I really want to try for a VB if we have another BUT the second I start to go overdue or they tell me the baby is big (or even anywhere near the size of my DS) I am opting out and going for an ELCS (even if I have to do it privately). So, I do not want to put my personal demons on you (i really don't so many apologies if it comes across that way!) - it's just that if I get to the point of thinking there are going to be any complications I am going to opt for the relative tranquility of a planned procedure. I REALLY don't want a C-section but I also don't want a repeat of last time and the traumatic recovery period that went with it (I could not have looked after a toddler for a least 3 weeks last time I don't think). Its a tough one I confess as I genuinely think there is no 'perfect' option - you just have to do what you personally would be happy with.

Thanks emmac - that's really interesting to hear. Actually the main thing making me think I would rather have an ELCS is that, although major surgery, in some way I think of it as less scary/potentially calmer to be a planned procedure rather than all the unknown quantities that go with induction. I had been thinking that was an illogical thing to be thinking, but hearing what you say seems to be along those lines too, so maybe I'm not entirely illogical. I'm pretty sure no one will be too keen for me to have a section though and I'm not too good at being pushy, especially as I'm not sure it's the right thing myself anyway.

If your DD was 8 lb 6 at a few days overdue, I'd be sceptical that this baby was already 9 lb at 37-38 weeks. Are you measuring/ do you feel bigger?

I do feel bigger and have a lot more pelvic pain than I did with her, but that could just be second pregnancy. I have slightly increased amniotic fluid levels too, so that makes me a bit bigger, although have been measuring to date with fundal height (although that measurement is so unreliable anyway!)

I was told that the 'normal' fundal height measurements and the 'average' HC, AC, FL on a growth scan are all based on an 8 lb baby at term. Neither is that accurate though.
If you take predicted size out of the equation how do you feel about the induction?
An additional week 'cooking' might increase weight by half a pound, but it doesn't turn a biggish baby into a giant.
Ask what your Bishop's score is at the sweep. It sounds to me like you'd be quite happy to have labour kicked off with a sweep ( simplest form of induction?) or pessaries, or breaking waters, but that what you are worried about is a "failed induction" leading to an EMCS.

I just wanted to reassure you that having a larger baby doesn't necessarily equal a horrific birth and/or a cascade of intervention. I delivered 9lb9oz DD with just gas and air and was shocked when they told me how big she was. But her head circumference was average so, if anything, her weight may have helped because I was mostly upright so gravity was lending a hand.

Good luck with everything whatever you decide, OP.

Just wanted to add, my eldest was stuck and after 4 hours of pushing they butchered me and use a vontouse to get him out and then his shoulders got stuck. It was very traumatic and I lost quite abit of blood.(10lb baby)
My second they said he would be massive but I actually had a very easy 3 hour labour with 10 mins pushing and no issues at all and home the same day (8lb baby).

Scans are often very wrong at judging big babies and second labours are usually easier!

If you want to go natural I really would, chances are you'll be fine this time :) good luck though with whatever you decide.

I will definitely ask about the Bishops Score thanks Baking. I'm mostly concerned about induction either failing and leading to EMCS, or (possibly worse in my mind) a cascade of intervention involving emergency forceps etc, lots of panic and general loss of control, plus greater risk of damage.

It's good to hear some safe delivery of big babies on here too - thanks.

And yes, I'd be ok with having waters broken, pessary inserted, but it's when we start getting to the stage of needing continuous monitoring (and inevitable epidural) that I feel things could start to get out of control.

I felt the same as you, blushing, and declined induction at 40+14 and had some monitoring. The plan was to go back in to discuss induction again two days later but DD was born the next day. (The fact she was so late may explain why she was so big!)

It is your decision, OP. You cannot be induced against your will. Although sometimes hcps can give the impression that there's only one course of action, it is your body. Read up on the guidelines and research so you feel comfortable that you are aware of the risks either way. That way you can be happy you're making the right decision for you and are armed with information.

And try not to worry - soon you'll meet your baby :)

Is it going to be a boy or girl?
I had to have both ventouse and forceps for 7 lb10 girl.
She was back to back to larger part of head etc plus im only 5'4.
DD still had large head though 75%. So it was probably large at birth

Hello
Just thought I'd fill you in as I had my lovely little boy on Wednesday . I've done a full update on the recent PPH thread here www.mumsnet.com/Talk/childbirth/2059163-Pregnancy-birth-experience-following-PPH? So won't repeat myself, but thought I'd let you know I didn't need an induction and DS was big (9lbs 10oz), but came out quickly in a 3 hour labour with just gas & air and only a small 2nd degree tear.

Had a few complications after delivery, but now home, well and extremely happy

Thank you for your support

Congratulations blushing I read the full story on the other thread - good to hear it was all handled well and you are feeling ok.

I'm as calm as I can be about the whole thing - que sera sera!