Induction at 41 + 4 - why?

[Salme101]

Hi again,

Just had my post-date appointment and I agreed to call the delivery suite on Sunday if nothing has happened, with a view to coming in for induction. I'm not really happy about this, and only agreed because I felt very put on the spot, not to mention being desperate to go home after spending 7 hours in the hospital in order to get 2 heartbeat traces - the first was fractionally fast but the 2nd fine.

I really haven't been given any medical explanation as to why induction is necessary. This is my first pregnancy and it has been completely normal and healthy, with no issues. I get the impression that the hospital just applies a 'rule' of 40 + 10, and the staff seem too overworked to look into the matter any further. My concerns are that induction is likely to lead to me spending much longer in hospital than I would do otherwise, with a greater likelihood of intervention. Should I just go along with it, on the basis that at least it provides some certainty, or should I try to hold on until 42 wks - any thoughts?

Many thanks in advance.

This is a tough one and only you can decide. I remember being in a similar position with ds1 and, in hindsight, this is the first of the many "do or don't" impossible decisions your baby/child will put you through!

Basically, if my understanding is correct (and more knowledgable people will be along with the details I am sure), the placenta that keeps the baby alive has a finite shelflife and will, eventually, start to degrade. If this happens when the baby is still inside it can sometimes cause stillbirth (or be a contributory factor?). I think statistically, research has shown that in some women, this starts to happen at around 41-42 weeks of pregnancy. Hence most hospitals have a general policy of not letting people go much beyond 41 weeks.

Of course on the flip side, you are imo quite right that induction is more likely to lead to a medical birth and less likely to result in a calm, natural birth. I completely understand why you feel the need to resist this pressure. I did too but luckily my baby came along on his own at 41+1 (day before third scheduled induction - had cancelled first and not turned up for second they had booked against my wishes).

It's a tough one. I really do not want to be induced if at all possible (ds2 helpfully came on his due date). But unfortunately ignorance is bliss and since ds1 I know 3 women who have lost their babies very late on due, probably, to problems with the placenta. Saying that, my SIL has 5 children and went just over 42 weeks with all of them. That is obviously what is natural for her body. The problem is, how do you know how far to push your luck?

There is a third way called Expectant Managemnet which you could try and get the hospital to agree to. I think this involves regular scans to check the placenta and blood flow to it and a regular assessment of whether the pregnancy is still safe (as far as they can tell) to be left another day or two to come naturally. This is what I would opt for, personally, if I got to 41 weeks again. They are not keen as there is an overhead to them and, in my experience, at this point they just want to get you processed safely. Trust your instinct?

Thanks, barbamama. Now I have had time to sleep on this, I've realised that really I have got nothing to complain about here. I will await developments and go with induction for safety's sake if nothing is happening by Sunday. After all, a healthy baby at the end of it is what matters

I had an induced labour with my son at 41+4 I felt so tired at that point in my pregnancy I just wanted the day to come so I could hold my baby so I was glad that they were inducing me. I booked an appointment with the hairdresser, somehow managed to shave my legs (don't know how I managed that now!)all things I wouldn't have been able to do it i'd have gone into labour naturally.I've never heard that induced births tend to need more medical assistance unless your getting induced due to medical emergency (which being overdue is not) all an induction does is breaks the waters around the baby & your labour proceeds as it would if your waters had of broke naturally. barbamama is right hospitals won't let you go over 42wks as the placenta does weaken at this point & doesn't provide everything the baby needs which could lead to stillbirth (not that I want to frighten you!) I found it scary being pregnant for the 1st time I think because midwives see thousands of pregnant women every year they forget to explain things fully & you end up scared stiff. Midwives are there to help you so ask questions if your not sure about anything. Hope all goes well with the birth!

It is a fact that inductions increase the medicalisation of the process actually Anngeree, in fact, 50% of first timers being induced when not ready (with a bishops score of less than 3) will end up with a c-section.

I was induced at 40+12 with my DD and it did start a downward medical spiral ending in a c-section, my body was just not ready, the whole process from admittance to hospital to baby was 5 days. With hindsight I would have asked for a scan to check placental efficiency and held on for another few days as I "felt" everything was ok even though I was sick to death of being pregnant!!

If you don't feel comfortable with it then say so and speak to your midwife about expectant management. If you do decide to go for induction then just prepare yourself for monitoring and your movement being limited - this came as a big shock to me! However, woman opposite me in ward had one gel pessary and baby was born 4 hours later, first baby.

Good luck, hopefully you'll be like the woman opposite me in hospital and it will all be nice a quick for you, just make sure it's your decision. I remember all too well how bullied I felt!

Make sure you post a birth announcement too

Ignorance is bliss! It wasn't explained to me that having an induction could lead to complications needing medical intervention. My waters were broken then I went into labour not long after & my labour progressed naturally not needing any medical assistance even though it was my first pregnancy. Never heard of Bishops score before today either!

Hmmm, speaking as one of the first timers who had a Bishops Score of I think 0 or less, 3 days after my waters sprung a leak, and was induced with syntocinon and then given a section 18 hours later because, funnily enough, I wasn't dilating much despite the whacking doses being administered I am somewhat anti induction unless medically necessary.

I am still carrying around a lot of anger, perhaps misplaced, from the way my first birth was managed and I wouldn't wish that on anyone.

I would urge you, unless you are given a very good reason to resist induction. I know its uncomfortable and you just want to get on with it but really, it isn't a good way to start labour.

Salme - I went to 42 + 1 with DS3 and had monitoring once or twice at the hospital by a consultant and a midwife to check the efficiency of the placenta and Ds3's heartbeat etc. I wanted to avoid induction as I had a homebirth booked. In the end, he just came of his own accord (very speedily.) You can ask not to be induced and just be monitored as others here have described. Good luck.

i was 42+1 weeks with my ds, 41+3 with dd. Wasn't induced with dd she just happened to arrive then and for various reasons I hadn't been seeing a lot of my midwife. With ds I was under huge pressure to be induced from about 9 days over due. Held out to 42+1, had had 3 sweeps with no action, had waters broken pretty uneventfully and he was born 1hr 47 mins later. My experience was uncomplicated apart from endless waiting around for staff when getting discharged and admitted. Had homebirt with dd who was my first then hospital with ds, obviously induction scuppered home birth plans.

Normal term is 37 - 42 weeks so in an uncomplicated pregnancy there is absolutely no reason why you should not go to 42 weeks. That extra four days might be the difference between a nice normal birth and a medicalised nightmare. (not all inductions are bad but a lot take a long time and end up with other interventions.)
As a midwife myself I decided before I even got pregnant that I would only be induced at 14 or more days over unless there was an extremely good reason. Of course there is a good chance that it will happen for you before then anyway. Hope it goes well.

if you are not happy don't do it! it's your body and your baby, if you are both healthy and doing well then their is no reason to be induced other than their hospital protocols. induced labours do have higher levels of intervention.
don't be bullied into induction. You can always go in for moniotoring every couple of days.

Hi Salme - I was in your situation a couple of years ago - you don't have to feel forced into anything. I was 10 days late with dd2 and 12 days late with no 3! I was not induced with dd2 as I finally went into labour the day before I was booked for induction. I did go for the induction with our 3rd - mainly because dh had to be present at a court hearing for his company the following week and I wanted him with me for at least a couple of days after the birth! A lot can happen between now and the weekend - keep trying all the usual natural remedies - lots of curry and sex!

Even if you are induced it does not have to mean medicalised delivery. I was lucky that a dose of prostin gel and 3 laps of the hospital grounds finally kicked off labour and from then on was a completely non medical water birth. I did not have my waters artificially broken - although I think that was the next step if I had not started contracting by the afternoon check up. There was about 6 hours between dose of gel and contractions starting - during that time I walked round and round the hospital and kept as far away from the antenatal ward (and all the monitors!) as I could. I think once they have started you off they prefer you not to leave the hospital grounds but that does not mean you have to be strapped to the bed.

Good luck - hope all goes well and enjoy your new baby!

MissingMyHeels and others have really conveyed what I meant about trusting your instincts. I was too scared to do this first time but second time I really felt that everything was fine and healthy with my baby and pregnancy (when they were trying to induce me at 37 weeks due to a slight raise in BP which setled down anyway) and felt fine to let things proceed naturally - even though I now knew about all the things that can go wrong and the fact that my friend had just had a full term stillbirth . My second birth was entirely natural and normal and did a lot to repair the damage from the first time bullying. I am not saying that leaving it a bit longer is necessarily the right thing for you - it depends on your attitude to risk etc, but just make sure it is your decision and not the doctors - listen to their opinions but make your own decision. Good luck, hopefully you are in labour now anyway!