Induction near to due date

[ml01omm]

Hi

FTM - so no experience with childbirth.

Baby is classed as "large for dates" ( currently on 93rd percentile and for context I am only 4ft 11) so have been speaking with consultant re: options. They originally wanted to induce me at 38 weeks, but I felt that was too soon.

Having gone away and read about Shoulder Dystocia and other risks etc, I then got quite worried about leaving it too late ( e.g going as far as 42 weeks).

As a compromise, we've met in the middle and I will be induced at 40+3.

Worried I am making the wrong decision and wait it out, but equally, I am so huge and uncomfortable I can't cope with another 3 weeks.

Am I naive in thinking that Induction at 40 odd weeks will be easier than induction at 38 weeks? Or is it all the same?

Has anyone got any positive stories re: being induced due to large for dates to put me at ease?

To be honest if I was you I would do it at 38 weeks as the baby would be smaller and it’s painful trying to deliver even a small baby . I‘m petite (just), was induced at 39 weeks but with a small baby 5lb 15oz. Of course it depends what pain relief you are thinking about but I’d also be thinking about likelihood of tearing, needing forceps or a kiwi cup etc.

The thing I've learnt about inductions is that your Bishop score is important. A score below 5 means it's far less likely to be successful. Could you discuss a plan where they check your score at 38w and, if it's unfavourable, check again in 5 days, etc., until a pre agreed point? But if it is favorable at 38w you give it a shot? If you're not in labour or ready to be induced by #-weeks, have you discussed those options?

I was induced at 39. I don't want this to sound sarcastic as it's a genuine question- why are some people worried about being induced early if it's within the 37 -42 week bracket which is normal for due dates? I had the most straight forward labour being induced at 39 weeks so try not to worry x

Firstly, growth scans are notoriously inaccurate. The consultant midwife I spoke to recently said they're only 50% accurate. How many scans have you had and at what gestation? What centiles are the head circumference and abdominal circumference?

Secondly, inductions carry a higher risk of further interventions. As a PP said, it would be wise to ask about your Bishop's score; with a high score it's more likely to be successful and go reasonably smoothly, with a low score I would decline the induction tbh. There are different methods of induction; pessary, drip, ARM (some or all of these might be used) - look into each one, the pros and cons and risks of each.

If you haven't yet done so I would suggest that you do your research into the RCOG and Nice guidelines for macrosomia (I think that's the name for large babies?!), shoulder dystocia and early induction. Make an informed choice.

My personal experience is that DC1 had mild shoulder dystocia when he was born, he was born 11 days past his due date and weighed 9lb4 (can't remember what centile I'm afraid). He wasn't badly stuck and it was resolved very quickly and simply (McRoberts manoeuvre) and tbh I think the reason was my position, I was lying on my back on the bed because the bitch midwife had insisted.

I am now pregnant with DC2 and I've had several conversations with various HCPs (including a consultant obstetrician and consultant midwife) about the risk of shoulder dystocia. Because of having it before, the risk is slightly higher this time around. Baby is also measuring big according to a recent scan (82nd centile). However, I am not hugely concerned and I'm confident that with the right positioning (ie not on my back) I will be able to birth this baby just fine! Women give birth to huge babies without issues all the time.

However, that is just my situation and my feelings on it. Everyone has a different attitude to risk and different preferences. So my advice is just to do your research and make the decision that feels right to you.

FWIW, I think you're right to wait longer for induction (ie decline at 38 weeks and consider it after 40 weeks if bishop's score is favourable) but i haven't done all the research that I'd do if it was my decision, and as I said it's your decision.

From RCOG's patient information leaflet about shoulder dystocia:

"Shoulder dystocia occurs in about one in 150 (0.7%) vaginal births."

"Shoulder dystocia is more likely to occur if your labour is induced."

"Shoulder dystocia is more likely with large babies but nevertheless there is no difficulty delivering the shoulders in the majority of babies over 4.5kg (10lb). Half of all instances of shoulder dystocia occur in babies weighing less than 4kg (about 9lb).
Ultrasound scans are not good at telling whether you are likely to have a large baby and therefore they are not recommended for predicting shoulder dystocia, if you have no other risk factors."

Full leaflet at www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-shoulder-dystocia.pdf

Do you have diabetes?

"If your midwife or doctor suspects your baby will be big, she may recommend that your labour is induced early. If you don't have diabetes, ask why this is recommended for you. For most women without diabetes, inducing labour early doesn't have any proven benefit for mum or baby."
www.babycentre.co.uk/a1015615/macrosomia-big-baby

And this infographic of a Cochrane review is quite interesting
pregnancy.cochrane.org/sites/pregnancy.cochrane.org/files/public/uploads/induction-for-macrosomia%20%28screen%29.pdf

I was induced 5 weeks ago (40 weeks +11) and my baby was measuring between 95th-100th percentile DS weighed 7lb 12oz...not the huge baby everyone predicted! I found induction fine but it was my first baby so don’t know how it compares to going into labour naturally! I wasn’t very happy that the midwives let me go so overdue but it ended up being totally fine! Apparently lots of babies measure big because of their position, including mine!