Induction at 40+2 due to possible problems with baby's bowel

[genome]

I'm booked in for induction at 40+2. My baby was found to have a possible bowel problem (imperforate anus) which is likely to require surgery in the first week of life, although the condition is not immediately life threatening but will mean they are nill by mouth till the surgery is completed. They also have a small hole in their heart although the specialist heart consultant has said this is very unlikely to cause any problems.

The induction is booked for a Monday so that the NICU and pediatric surgeons are on hand. But im becoming increasingly anxious about the prospect of induction and the additional intervention that it is likely to entail. I obviously want the best for my baby but part of me wants to just wait for natural labour to begin. The consultant agreed to delay the induction already as he was originally suggesting 39 weeks. He said that a NICU bed etc could be found if I went into labour before the induction.

Just wanted peoples thoughts on waiting for natural labour?

Just thought I should add this is my second baby. With my DD I was 40+7 when I went into labour. I was planning a home birth and was at home till 8cm but got a premature urge to push resulting in transfer to hospital, epidural, forceps and a 2litre PPH!

Genome, sorry, haven't got any qualified advice but didn't want to read and run; likewise probably not going to be helpful to go into 'what I would do'. Hope you do go into labour earlier than expected, and if not you feel comfortable with whatever decision you make.

While what you choose to do is obviously your choice at the end of the day if it were me I would probably go for the induction.

It sounds like their reasoning is that delivering you on a week day (rather than approaching a bank holiday weekend) will mean that all the staff they need will be around for those key first days. While there will be paediatric doctors and likely surgeons around at all times the staffing during the week will be better.

If you are concerned maybe leave a message with your consultants secretary and see if you can talk to someone?

Please don't panic about the induction. I had on at 37+6 and I promise you it was fine. I didn't need 'the drip'.
I also have experience of the nicu with another pregnancy. Have you asked them if they will let you have a tour and so you can ask the doctors there any of your questions.

Good luck tomorrow x

Thanks for the replies. I'm booked in for induction on the bank holiday Monday (I didn't remember it was one till now!) so I may phone and have this checked as it seems silly to induce me on a bank holiday given the reasons for the induction in the first place!

I was somewhat nervous about birth in the hospital environment after my first birth. I'm also anxious for minimal intervention so I can be mobile and out down to Nicu asap.

I was feeling positive about it working but a sweep this week (consultant suggested them to help induction hopefully!) I was at a bishops score of 2 which I guess has knocked my confidence of my body and baby being ready for labour.

I'm being induced at 40+2 as well as my bp has been shaky, like you I've managed to delay them (though might change my mind if my cervix looks favourable this week) - they booked me in on the 1st of June (Sunday) with the reasoning that the pessary will take a good long time to work and there will be staff on hand on Monday to take care of the delivery.

I have to say the ward sister wasn't happy and there was a half hour discussion between her, the reg I was with and the consultant but that's what was decided in the end. Give this is your 2nd baby I'd hope your labour would be a bit quicker than that so maybe DO ring them and see what their reasoning is.

Hello! I had to delurk so I could respond to this. My son was born premature at 31 +1 weeks. Because he was doing so well they didn't discover until two days old that he had an imperforate anus. It's not as uncommon as you may think right now and in your journey you will undoubtedly meet many people who's children are going through the same thing.

We were transferred up to St Thomas Hospital in London where he has had fabulous care. The first year is an adjustment. He had a stoma put in and was in the NICU for a couple of days before being transferred to SCBU.

You will be given a stoma nurse who will teach you how to change the colostomy bags, etc. It's really daunting at first. But soon it will become second nature. I have a plastic chest of drawers where I kept all his supplies next to a changing table (a must) pre cut and ready to just clean him up and slap a new one on as quickly as possible.

When he was 4 months old he had what is called a pull through. That will be at least 4-7 days in the hospital. It depends on the severity of the imperforate anus as to how intricate this can be. Your baby will keep their stoma in for awhile (months) afterwards until they feel nerves etc will have recovered and then they will close it up and you will spend about 3-5 days in the hospital waiting for your baby's first poo!

Poo will consume your life as children with imperforate anus suffer a lot from constipation. My son is on two different medications for it at 15 months old.

Children with this condition often have different abnormalities so after your baby is born they will have lots of ultrasounds and tests to check. Heart problems can be one but with a small hole in the heart they aren't concerned about (my son had one too that closed up on it's own) that's probably not an issue. My son's showed up as a tethered spinal cord which in itself isn't too bad of an additional issue and eyes are being kept on it now that the imperforate anus is mostly dealt with for now.

My son's case was quite bad and he may suffer from incontinence in the future BUT he is the happiest child in the world. Really amazing considering everything he has been through. Obviously it will be a bit different for your baby as they won't also be dealing with being premature. And I'm sure the doctors have already been over this all with you. For us it was a surprise as it hadn't been picked up in ultrasounds previously.

But if you have any questions or want to talk to someone who has been through it and finally coming out the other side please feel free to PM me. I felt really isolated and unable to talk to anyone about it and of course it was me suddenly having a baby who needed a lot more care than I had expected.

It is so worth it though and really made me a stronger person.

p.s. To your original question... if they are happy to wait for natural labour and that's what you want then go for that. I wouldn't think they'd wait too long though as they may worry about trapped metanium. But that would just be something to talk to them about. I had a c-section and it -did- hinder my ability to spend time with my baby in NICU/SCBU as I couldn't sit there with him for long.

Thank you for the lovely reply wenchly :)

It's good to hear from someone who has been through a similar experience! The surgeons we spoke to hope to be able to 'reconnect' everything in the first operation (not sure if its different hospital proceedure or because the baby will be term?!) I'm prepared incase that doesn't go to plan. The imperforate anus wouldn't have been picked up if it wasn't for spotting the heart hole on the second 20 (23) week scan. I got referred at that point and they had another look around and spotted the dilated bowel at that point.

I'm going to ring the specialist midwives at the hospital today to ask about the induction date (once my 18 month old dd goes for a nap!) I don't want to risk anything with the baby but induction seems to be likely to be stressful for both of us and want to make sure the baby is 'fully cooked' to avoid any extra problems hopefully.

Oh that's really interesting, I hadn't heard of them doing that before. They must suspect that it's not very serious then. It's a very involved procedure and my son was in the hospital for quite awhile after it but then he had some complications after surgery and was only just 8lbs by the time they did it at 4 months old! They also had to go very far up to be able to reconnect and did other tests at the same time to ensure that bowel/bladder weren't in some way connected etc. Are you having a surgeon who is specialized in gastro paediatric surgery and has experience in imperforate anus? I am sure you are as I can't imagine anyone else would attempt to do it.

I know that they put a stoma in for us and other people I have met because they do tend to want to do investigations before they operate. They don't know how much, if any, muscle is there to make things more 'normal', etc. And for a newborn to be whisked away to have a general and 4hr + surgery is mind boggling to me. My surgeon told us that they really only have one chance to really get it right so they want as much information as possible. A stoma really isn't a scary option so it comes to that don't be concerned. It wouldn't be permanent.

BTW I had an induction with my daughter and it was lovely and stressfree. My body was ready for labour though. :)

Hi Genome
I just came across this thread and was wondering how you are getting on with your little one. My DD (4) was born with IA, partial cloaca and 2 holes in the heart and pulmonary stenosis so I understand what you are going through!
Rachel x