Post term induction with Strep B

[ImpatientlyWaiting26]

Currently 41 weeks and have booked induction for 41 + 5. Baby has sinus bradycardia (low heart rate) and a minor heart defect not believed to be affecting him.

Really desperate to go into natural labour and avoid induction. There seems to be so much negativity around induction and I am keen to hear positive stories if anyone has one?

My predicament is that I have Strep B. Sweeps are not advisable due to risk infection and stillbirth. Dilapan (rod insertion) has also been suggested but this again comes with conflicting advice as passing the cervix has a theoretical risk of ascending Strep B infection. Despite research saying it's fine, I also have concerns about the Foley Balloon which also passes through the cervix.

The propess pessary seems to be the least risky option to me. However I understand that AROM is the next step and I am also very worried about the infection risk. Is it possible to simply have the pessary without AROM?

Ideally I wouldn't have induction at all because of all the infection risks and baby already having a low heart rate but the risk of stillbirth after 42 weeks also terrifies me! I feel trapped into a situation of now having to choose a path to take, all of which carry significant risk. Any guidance, experience or words of encouragement will be most welcome!

Take the induction. Without a doubt it sounds like the best option for a safe and healthy baby as the end result. I really wouldn’t entertain high expectations of a “natural” vaginal delivery with a bradycardic baby and GBS. Inductions do come with a risk of cascading interventions but the risk of stillbirth and placental failure increases from 42 weeks. It’s a horrible position to be in, believe me I’ve been there.

I was GBS positive with both my pregnancies and induced both times at 40+10 with the pessary and syntocinon drip, plus the IV antibiotics. Was labour a complete shit show? Pretty much. But I’d make the same decision again in a heartbeat for my children.

I would also take the induction.

I've not had GBS, or at least not known if I had GBS, but I thought the protocol was once waters are ruptured you're placed on an antibiotic drip to minimise the chance of infection. Then regular temperature checks for you during labour and for you and baby for a short period afterwards.

I've had two inductions. Both at 37 weeks. Both I view as very positive experiences though I will admit the second one ultimately ended in a C-section. However, I do not blame the induction in the slightest. We knew baby was OP going into the induction, and we hoped he would turn (as most do). He did not (still stubborn). As with PP I would make the same decision every time.

I had my waters broken both times, then the drip. Waters being broken was to get baby's head in direct contact with your cervix in the hope it would trigger labour by itself. I was told the drip would be much less effective if waters were still intact.

I have a query for you. From my own experience with CTG, I know it's all based around baseline and how rapidly after a contraction the heartbeat returns to baseline. But the magic number seemed to be 100bpm. With an already low heart rate, has anyone discussed with you if there would there be allowances and expectations for your baby to regularly be below that limit, or even a lower limit altogether? Or would fetal distress (part of the reason for my C-section) still be diagnosed at the regular values?

Have you discussed how your baby's heart rate will be monitored in labour and how your care team will interpret this?

It is possible to try the propess pessary and have a caeserean section if you don't go in to labour just from the pessary.

Have you taken antibiotics for the strep? I had Group B Strep with both my previous pregnancies yet still was given sweeps with them and babies were fine. I was also obviously given the IV antibiotics during labour as a precaution and nothing was passed onto them.

They’ll just give you IV antibiotics for the strep risk. It’s a precaution anyway. Having strep doesn’t mean your baby will catch the infection if nothing is done, but prophylactic IV antibiotics fixes most of the rare bad outcomes. Ask your midwife what the protocol is. I had an induction with all the possible methods and the antibiotic drip was just built into the protocol. They might have given me the first dose when they did the balloon thing, I can’t remember. And there was a second dose at the same time as the hormone drip. But that was a while ago and not in the UK so your protocol might be a little bit different.