Induction for small baby - really don't want it

[WombatStewForTea]

I'm almost 34 weeks. Was having regular growth scans anyway and consultant led for other health conditions. Currently under foetal med as this baby keeps dropping down centiles on growth scan (was 10th, then above 3rd now below 3rd) and preeclampsia test is back as a higher risk so I'm in twice a week for blood pressure and CTGs but all is fine.

Midwife last week mentioned that with small babies they tend to want to induce around 37 weeks. I've always been really adamant that I don't want to be induced. I can't find any actual evidence to back it up but I believe the risk of birth injury and needing interventions are much higher. Also just anecdotally it seems to either take days or be super quick and intense.

I've always said I'd rather have a section than an induction but overheard my consultant talking to another lady in a similar position and saying neonatal don't like sections on small babies before 39 weeks as they don't get the good old squeezing of the lungs.

I'm seeing my consultant for the first time tomorrow since growth scans have started to go south so I know we'll be discussing birth plans.
I'm going to ask for how many inductions ended up as emergency c sections anyway but is there's anything else I should ask to arm myself?

[IDontDrinkTea]

With your baby dropping centiles that quickly, I’d be asking for more regular monitoring if they want you to go another three weeks. It sounds like your placenta is failing.

[FloofCloud]

Yes I'd be asking for support regularly, a friend had the same where the placenta was failing, so they're better out then in sometimes

[ditzzy]

Hopefully people will come back with lots of ideas for questions for you to ask! Which is definitely the right thing to do - get as much info as possible.

I just wanted to add that a lot can change in the next 4 to 5 weeks! Try not to overthink things and look after yourself so that you’re ready for anything.

Baby might start growing more again (scan measurements can vary quite a bit between sonographers!) and it might turn out to be not a problem at all; but it’s great that they’re getting the consultant care in place so you’re in the best possible hands.

I was induced at 37 weeks due to pre-eclampsia which ended up as an emergency c-section. I don’t know how common it is though. She was born on 7th percentile for weight (despite scans suggesting she’d be average size).

[Meadowbird]

Induction really isn’t that bad. It’s another of those things that isn’t our preferred choice when all is going well but in certain circumstances is the best choice - an option we are lucky to have in this country and time. The health of your baby is the mist important thing.

[Killerqueenie]

My first baby started dropping down centiles when I was 36 weeks. I had symptoms of pre-eclampsia but my blood pressure had always been fine so they dismissed it. One day when I went for a regular check up my blood pressure was all of a sudden through the roof. My placenta was failing rapidly and they induced me that very same day. I dread to think what would have happened if I had waited any longer. Sometimes they are better out than in. I can understand refusing induction if everything is fine, but it sounds like they have concerns about the baby.

[CormorantStrikesBack]

Growth restriction like this can be sadly a cause of intrauterine death. If they get to a point where they think baby is safer out than in I’d take the induction/section. You can ask them about steroid injections to mature the lungs.

[WombatStewForTea]

@IDontDrinkTea and @FloofCloud I am being very closely monitored. I've got low PAPP-A so having regular dopplers and so far placenta is ok but that's obviously the worry!

[Gertrudetheadelie]

Sound advice from @Meadowbird . I'm sure there are lots of women here (including me) that has successful inductions and now have healthy babies. It wasn't my first choice either but my baby was in distress and sometimes you gotta do what you gotta do. Hopefully the consultant will give you lots of information about the choices you have and what's best for baby now.

[WombatStewForTea]

Should add I'm not worried about baby coming early I would just strongly prefer a C-section rather being induced.
They mentioned about getting baby out to save them having to work hard but then a quick induction labour can also be traumatic

[CurlewKate]

Are you checking your own blood pressure and urine?

[Meadowbird]

i can’t really understand wanting a c-section instead of induction- a c-section is a much bigger deal with a longer recovery?

[CormorantStrikesBack]

@WombatStewForTea

Should add I'm not worried about baby coming early I would just strongly prefer a C-section rather being induced.
They mentioned about getting baby out to save them having to work hard but then a quick induction labour can also be traumatic

And you can definitely say that you’d prefer a section. You’re right in that a labour can be hard work for a baby, particularly one which is SGA/growth restricted and would be starting that event without much reserves.

[luckyfaith]

I also had low PAPP-A in my last pregnancy and my baby dropped to 5th centile after the 20th week. I was under a consultant care and like you had regular Doppler checks. I was advised to have an induction which I had at 38 weeks and 3 days. My DD was born on the 13th centile but quickly gained weight and she's now on the 50th centile. I genuinely felt the consultant had my best interests at heart and she did say that with low PAPP-A the placenta can fail very quickly towards the end of the pregnancy. In all honesty I just wanted the baby to be ok and didn't mind whichever method she'd be delivered. I was induced at 8pm on Wednesday and was born at 6am on Friday. I only felt the contractions properly kick in about 8pm on Thursday so didn't feel they dragged for ages. At the end of the day it is your own decision and whatever you're comfortable with. The consultant is there to guide you but can't force you to do something you don't want to. Wishing you all the best in whatever you decide.

[CormorantStrikesBack]

Also is it your first baby/labour? If you’ve given birth vaginally before an induction is more likely to be successful and labour likely to be shorter. But if not then it would all take longer/less chance of a successful induction. Worth considering when choosing induction vs lscs.

[Killerqueenie]

@WombatStewForTea

Should add I'm not worried about baby coming early I would just strongly prefer a C-section rather being induced.
They mentioned about getting baby out to save them having to work hard but then a quick induction labour can also be traumatic

I should have added in my previous reply that mine ended up in an emergency c-section as my own health was deteriorating rapidly. The induction was awful, I had back to back contractions, and both me and baby were very distressed. If you could ask them to plan a c-section, then I would, but that's only from my experience as I know every labour is different.

[newmum1976]

I had an induction on a drip with my first due to small bump. It was by far my easiest birth. All done in 3 hours
and no complications. I’d literally fully recovered after a couple of days.

Second time round I had a spontaneous birth which was absolute agony and baby came out with hand above head and cord wrapped round neck.

Third time was c-section and the pain was immense that first week after and recovery took ages.

[MississippiAF]

I had an induction due to obstetric cholestasis at 37 weeks and it was absolutely fine; try not to worry

[00deed1988]

At 37 weeks if this is your 1st baby the induction would be less likely to be successful.

I am a midwife who works in a low risk setting and if I were to have another baby I would decline an induction for most things but IUGR is one thing I would definitely accept either induction or an elective section.

Small babies have less brown fats that is what they use as energy in labour so small babies have a higher rate of getting distressed in labour (which is why continuous monitoring is recommended). So although their lungs aren't being squeezed throughout labour, they can be born tired and potentially distressed if labour has stressed them out!

As well as the obstetrician I would ask to speak to consultant midwife as in my personal experience, obstetricians tend to give quite a but if one sided advice. The one at my trust is excellent and will give you stats and figures for both sides and is very non judgementenal.

[GoodnightAdeline]

I would go for the induction. Your baby is very small, and you have markers for pre eclampsia.
Monitoring only tells you how the baby is in that moment - it’s no guarantee they’ll be fine for the next few days/weeks. Your baby’s life is of paramount importance, I understand the disappointment about the birth mode but that’s just icing.

[Clomid1]

You can ask for a c-section and if they give it to you then brilliant. If they don’t I wanted to share my positive induction story to help put your mind at ease. My baby born at 2kg 2 months ago via induction. I had severe IUGR diagnosed at 36 weeks and was in hospital every single day for monitoring until they decided to keep me behind and induce at 37 weeks.

They used the balloon method which got me to 3cm dilated. They then broke my waters and I was left to walk around. Contractions kicked in within 10 mins. I couldn’t stand the pain so I asked for an epidural (thank goodness that exists). Baby arrived no issues within 5 hours of my waters being broken. Other than her being born on 0.1 centile, she was fine 🙂

Ask for a c-section if that is what you would like but if they deny it try not to worry.

Edit: Forgot to add that they told me that the criteria for an emergency c-section with me would be lower. So if anything went wrong in that induction they would intervene quicker.

[ProjectKettle]

@00deed1988

At 37 weeks if this is your 1st baby the induction would be less likely to be successful.

I am a midwife who works in a low risk setting and if I were to have another baby I would decline an induction for most things but IUGR is one thing I would definitely accept either induction or an elective section.

Small babies have less brown fats that is what they use as energy in labour so small babies have a higher rate of getting distressed in labour (which is why continuous monitoring is recommended). So although their lungs aren't being squeezed throughout labour, they can be born tired and potentially distressed if labour has stressed them out!

As well as the obstetrician I would ask to speak to consultant midwife as in my personal experience, obstetricians tend to give quite a but if one sided advice. The one at my trust is excellent and will give you stats and figures for both sides and is very non judgementenal.

Totally agree with this. I've always found the consultant midwives to be far more practical, detailed and open than the obstetricians, who i felt really tried to rush decisions in both my pregnancies. (Recent experience of trying to get me to consent to an ECV within about 10mins is particularly on my mind!!)

OP, the other thing to ask about is how baby would cope with a induction/labour if they were very small. With DD1, i had pregnancy induced hypertension and she had been dropping centiles since 28w. By 36w she was below the 10th and i was also asked to consent to induction. In the end, i went into spontaneous labour before the induction could take place, but during labour itself, she started to really struggle in terms of recovering between contractions and it very nearly ended up as an emergency (the midwife basically told me that she needed to be born now and push like I'd never pushed before). That was never even flagged as a potential risk by the obstetricians and if I'd known, I'd have liked to factor it into my decision making.

Good luck! My very tiny 0.4th centile baby is now 75th for height and 75th for weight at 2.5yrs old so perfectly in proportion and more in line with DH and my heigh / weight. So they can very soon catch up after birth.

[110APiccadilly]

I had an induction which ended in an EMCS for DD2 because she was small. I had lots of discussions with the consultant and midwives about induction Vs section, and they would have supported me in either choice (I was told this explicitly on more than one occasion), though in my case I had had a previous section which made the induction more difficult.

The advantage of induction is that baby gets some warning that they're going to be born, basically. This means they're less likely to have trouble breathing. I was told this is still true if you've gone into labour but baby is ultimately born by a section (which was the case for DD2).

But if you'd rather have an elective section then they should support that.

[WombatStewForTea]

@00deed1988 @ProjectKettle
Thank you that's really interesting and what I'd worried about re baby being tired/distressed. I'll ask to speak to a consultant midwife if I don't feel confident after my appointment Tomorrow.

To everyone else it's not that I don't want baby to come early and I'm happy to just be monitored. If that's the safest thing to do then absolutely fine. I just don't want to be induced. I would rather have a section particularly if there's a lower threshold for emergency C-section anyway. I know so many people who have been induced, had a very quick labour and severe birth injuries and then not had adequate care after to fix the birth injuries.

This isn't my first baby. I had a straightforward vaginal delivery with my first

[CurlewKate]

@WombatStewForTea Are you checking your own blood pressure and urine?

[WombatStewForTea]

@CurlewKate I'm not no. It's not been suggested