AIBU not to see the consultant/be induced?

[KokoLoko]

Hi everyone,

Quick backstory. I’m due my 4th baby in 4 weeks time and my midwife dropped off my homebirth kit today. As background DS1 was 2 hours active labour at 39+5, DS2 was 1 hour at 37+4 and DD was an unplanned homebirth in 21 minutes at 40+0, hence the planned homebirth for DC4.

The midwife has told me that as I am now 41 it is preferred that I see a consultant and that they induce at 40 weeks as policy.

I have said I prefer not to do either of these things and want to go into natural labour as I did for the other 3 but do you think this is unreasonable given my history? Can anyone who has given birth before and after 40 give me any insight into how different the births were?

Thanks for your time and for reading!

Can you not see the consultant and then take it from there? Get the right level of monitoring in place to ensure risks are kept to a minimum.

I think to completely ignore the advice would be wrong, but to question things is fine

Sorry, I should have said in my op that seeing the consultant is tricky because I’d have to go to the big hospital, which is a drive away and I can’t drive right now, and I’d have to take the other 3 with me unless it can wait until school is back. I’ll ask my midwife, you’re right. I was looking at it as being a pain but you’re right, covering all bases might be the way to go. Thank you for replying xx

And whilst I’m rambling and thinking about all of this I confess I’m a bit scared of being induced, having had 3 ‘easy’ deliveries with only gas and air (for the first 2, nothing for #3) I’m going down the rabbit hole of what ifs. And as we have no family help within 2 hours a homebirth also solves the problem of childcare when I’m in labour, although I guess an induction would be planned so my parents would be able to be here.

And when I spoke to my midwife and asked what she recommended she seemed to hint it was a waste of everyone’s time for me to see the consultant, but maybe I just heard what I wanted to hear? I find myself so indecisive at this stage of pregnancy that I just doubt myself in everything..

Yeah, I agree to just speak to the consultant and see what they think. See if you can arrange to do a telephone consultation with them?? What age were you when you had your previous 3? Given the short labour times I would expect preparing for homebirth is best option as likely it won't be long if you do go into labour. 40 weeks seems a bit early for induction, can you maybe agree to 41 or 42?

I'd ask for a telephone consultation. I was told in no uncertain terms that I would NOT be allowed to go overdue with dc2. I'm old, and had elcs with dc1 due to breech. I had booked an elcs for dc2 but was undecided and changed to go in and have a sweep then waters broken. This should have happened on my due date. Instead it happened at 40+9!!! I had been told over and over that I wouldn't be able to go over. So take it all with a pinch of salt.

Also my DD was induction after waters broke (only birth at age 20) and it is apparently more painful than normal labour however baby was out after 5 hours- things speeded up after I got my epidural (which was amazing btw) going from 4cm to crowning in 45 minutes. It might make you feel more secure to have it booked however I don't think your age alone would justify it as a high risk pregnancy unless there has been any other pregnancy issues??

I second definitely seeing the consultant, I know it can be a pain. I was recommended not to transfer when I moved house as too high risk, and now I have to travel an hour away for consultant appointments, which were weekly and birth (due in 6 weeks!!). My consultant is amazing, extremely knowledgeable and couldn't have provided better care. You may find that when you explain your concerns and wishes they are happy to let you have your planned birth given your history, if not there will be a really good reason why, for example age may increase certain risk factors ect but it will all be explained and you can ask questions, so it won't be just 'policy' which will hopefully make you feel better. Ultimately it's your choice but better to make it fully informed I think.

I think 4th babies are considered higher risk. My first 3 were born on time, each one quicker than the last. Baby no3 was about 30 mins from start to finish. But no4 was 10 days late, had to be induced.
Induction was fine btw - not more painful imo, although because dd took her time, I was contracting for longer, so more uncomfortable over all.
I'd see the consultant if recommended - I am very risk averse. Hopefully you will habe given birth by then and it wont be necessary.

I waited till 42+2, then my waters broke, they tried to induce me (refused hormone drip, only pessary), didnt work so I asked for a section rather than ending up with an emergency one (she clearly didnt want to come out!) This time, they have booked me on for an elective c section at 42 weeks exactly if baby doesnt make a "natural" appearance. You don't have to be induced at 40 weeks. They do a bit more monitoring to make sure baby still fine. There are no associated increased risks before 42 weeks (after which risk of degredation placenta of and other issues increases). I think some babies just bake for longer! Assume no other risk factors x

It’s a little unclear from your post, but it looks like you are 41yrs old? If this is the case there is a significant rise in the risk of the placenta failing after 40 weeks. It’s likely that they would want you to be scanned every few days to check the placental function if you went overdue. Seeing the consultant to discuss your specific risks would be sensible.

Thanks for your replies and insights everyone. This pregnancy has been textbook, going through the homebirth forms today the midwife honestly couldn’t find anything of any concern in my notes at all. I think I’ll ask for a phone consultation (genius idea, thank you all for suggesting it!) and take it from there. Feeling so much better now, thank you all xx

And obviously if there were any problems with the baby I would do anything at all to protect it, please don’t think I’m as selfish as I sound in this thread 😬

That’s interesting, and concerning, Shelby, the midwife didn’t mention that. That’s a bit more worrying then. I was 41 last month

OP they have a tendency not to, to not worry you. Unfortunately I've found that midwives tend to gloss over complications if they mention them at all, there as both the GPs I've seen and my obstetrician don't.

All my friends regardless of risk even if they had a baby at 39, once they were 40+ were induced at due date +1.

Just to echo what Shelby said, that is exactly the reason why they are suggesting induction at term. As far as i know it's policy in most Trusts for people over 40 as the risk goes up statistically at a population level of the placenta failing. So they're not just saying it for the fun of it. However, it doesn't mean your specific pregnancy is higher risk at an individual level. You may find that they'll agree to increased monitoring of the placenta/baby if you decide to let it go over 40w. With three kids, I'm not sure how easy it will be to traipse backwards and forwards to the hospital for scans and CTGs though. But no one can force you to be induced at any point regardless of what their policy says.

As far as induction goes, you do statistically have more chance of having further medical interventions which I guess is a downside. Because once you start something artificially then you can't just stop and also baby might get distressed if you tried to suddenly hold it up. Also just because you're induced, it doesn't mean baby will arrive straight away. if they start with a pessary it could be over a couple of days. I'm not sure about the pain as I was induced and had an epidural because we got to the induction stage of the syntocin drip and epidural was amazing!

OP it's worth asking exact how they do inductions for women 40+ in your hospital. Some hospitals only allow you to have one pessary followed by a syntocin drip with the aim of ensuring you deliver within 48 hours.

4th baby I was 40yo. I refused to see the consultant at 34 wks (had an argument over phone about it, them trying to say "We can't let you..." & me pointing out they couldn't tell me what to do). Our hospital had an induce at 40+10 policy, so I just didn't even book to see MW at 41 weeks to avoid more arguments. Baby born after spontaneous labour at home at 40+11. MWs said the placenta didn't look in least bit overcooked.

So that's what lots of rigid policies can do. Lead to less antenatal care. I know my story is just anecdote. You have to decide what risks to live with. No one can tell you that. The 4th baby was the easiest delivery for me, btw, by far.

@ragged I was born when my mother was 42, 6 days overdue in an area that now has a 40 + 1 policy for those 40+.

The reason they insist on inducing women 40+ at a particular time is due to research that shows there is an increased risk of stillbirth and they just don't want to take that risk regardless of whether it's a first birth or a tenth birth. Now if you are happy to do it they will just put it on your notes so you can't turn around and sue them later.

I refused induction with all of mine. I had monitoring from 41 weeks for placental viability but longest was my son who was 40 plus 23 days. My youngest was 40 plus 17 days. I just had a very long cycle, so it wasn’t particularly overdue for me. Consultant was very reasonable and agreed with me that it was fine to hold off. None of us is a statistic and our bodies are all different.

YANBU, it's totally your choice, but a phone consultation would be a good compromise. Do your research beforehand though, so that you're well informed, and check how up to date the research is on these "risks". I honestly don't see how you can go from being low risk straight to high risk as the result of a couple of birthdays Unfortunately home birth can be a bit of a touchy subject with some consultants too, so worth bearing in mind. Good luck!

I just thought I’d pop back on to thank you all for taking the time to respond, much appreciated!
Things took a slightly sinister turn this weekend when I woke up looking like a demented hamster (my midwife’s words 🤣) and she put me straight onto the OOH dr service. After a long trip to hospital turns out I’ve got mumps, and one of the complications is premature labour so now I’ve gone from worrying I’ll go over 40 weeks to hoping I even make it to 37. Every Braxton Hicks I feel I’m worrying this is it and, tmi, my body has started clearing itself out, which was the first sign of labour for the other 3.
On the plus side at this stage of development there is no risk to the baby and all the others are fully up to date with their vaccinations so I’m so thankful for those points.
Sorry for the long post, I’m on bedrest and got a lot of time on my hands 😆

Poor you . What a hortible way to spend the rest of your pg. Have your kids and dh had it already? With some luck, they will all escape it!
Hope you feel better soon.