Re. "Are you really suggesting that mothers are happy to accept risks of placental failure?"
Every intervention we do or do not make in managing a pregnancy has implications. For example the decision to 'advise' a post-dates induction at 41+5 to 42 weeks has implications. The risks and benefits of each intervention have to be weighed up against the associated risks and benefits of an alternative management (eg. waiting and seeing if natural labour will start). As healthcare professionals it is our responsibility to allow couples to make an informed choice by providing them with available information/data regarding these aspects.
For example the available evidence suggests that between 3 to 14% of all singleton pregnancies will extend beyond 42 weeks and 2-7% would extend beyond 43 weeks in the absence of any Obstetric interventions. The perinatal risks (the no. of stillbirths and early neonatal deaths)is twice as high after 42 weeks compared to 39-41 weeks. However the absolute numbers are not high ie.respectively 4-7 deaths per 1000 deliveries compared to 2-3 deaths per 1000 deliveries. The risks after 43 weeks show an approximately 4x increased in this risk and beyond 44 weeks a 5-7x increased risk. These risks have to be weighed up against the implications and associated risks of induction (ie. long labour/failed induction/increased chance of a CS).
The issue with expectant management is that placental failure cannot reliably be predicted with current techniques for fetal monitoring.Ultrasound/doppler scans and electronic fetal heart rate monitoring are not infallible in detecting a failing placenta.
Some parents are more comfortable than others in 'acceping' these limitations and the incumbent risks with expcetant management in an effort to avoid an induction.Other parents do not feel so strongly about induction, many are fed-up by this stage and just want it all over. We therefore have to assess and manage a wide variation in the wishes and expectation amongst our patients.
The decision is ultimately upto the parents, as Dr's and midwives,we are there to support them making that decision and and in trying to ensure their wishes are followed.
We cannot force any mother to have an induction against her will. Every single stillbirth and neonatal death is a tragedy that has long term effects upon a whole family as well as the us as the carers of that mother. I can see that sometimes Dr's & midwives can seem rigid in their views but they have often been through unfortunate circumstances in the past which affects their perspective but also goes to building their personal and professional experience. Thankfully such sad circumstances are usually few and far between. Those of us who have been working within this field for a considerable length of time have all seen a small minority of such instances, where albeit at the cost of an earlier IOL /an extra CS or assisted delivery a small number of these stillbirths may have been prevented. This is where it gets very difficult for us, especially when we are sitting in a consultation room counselling a grieving couple who have had an unexplained stillbirth of an apparently well grown baby at 41 or 42 weeks.
Hope that gives a more balanced perspective and explains my previous comment.