Induction at 39wks - do I really need it?

[hanabanana]

Just come back from a scan and antenatal consultation (I am 38+1) and the consultant said that because since my last scan at 35+3 the growth (HC and AC but not FL) seems to not be increasing so fast (just about above the bottom line but only just) he wants to induce next week.

I really don't want to induce, this is my 2nd, last one also had extra scans (though wasn't so small on the chart) and borderline low amniotic fluid but came out naturally at 41 wks with no problems though long labour so I feel like I would rather wait till this one is also ready to come out on its own.

What are the pros and cons of inducing at this stage? I really wanted a home birth up to this point though that obviously looks virtually impossible now. I hate the idea of inducing when I and the baby aren't really ready, and then the whole thing taking ages/requiring furhter intervention (last time was really long and I was hoping this time would be shorter). The consultant obviously mentions 'scary' things about whether the placenta is calcifying/whether the baby is going to get enough nutrition and is making me go in every other day for the next week for a heart trace. But it is a really active kicking baby and I feel really well myself so I can't really believe that it is not doing well, the blood flow in the cord is really good, and heartbeat strong at the moment.

Sorry for posting all this detail but would really appreciate others advice/experiences of early inductions/assessment of the risk? My lovely midwife is sadly on holiday till Sunday so I can't ring her and talk it through with her

sounds like baloney to me, and if it's above the bottom line, then it's ok, otherwise why do they have a bottom line? I would definitely not let yourself be pressured into it. sure others will be along soon with more experience. I would really wait until it comes on its own. sounds as if consultant is scaremongering..

Can you ask for a second opinion. It would seem that the consultant is concerned about your baby but the question is whether or not this concern is justified or not. Whilst we like to think of ourselves as well informed I think the medical profession have our best interests at heart and if you can speak to someone else you can maybe gauge how urgent things really are - or are not and make a more informed decision. Not all pregnancies are the same so although your first was fine it does not mean that this will definately be the case this time, though of course I do hope so. Good luck.

I'm not medical either. But I do know that poor growth is a risk factor for stillbirth. Many many babies are fine despite growing poorly in utero. Of course they are. But some are not. My understanding is that it's hard/impossible to tell which babies are going to be the unlucky ones, and in this case the consultant is likely to be cautious.

I really hesitate to post on threads like this, but I do sometimes feel obliged to describe my experience. I lost a baby at full term - baby was normal weight, so no-one really knows what happened. It happened about 12 hours after an antenatal appt and couldn't have been predicted, probably (though was low risk so no-one scanned me post 20 weeks, no-one really knows how much amniotic fluid I had or what the blood flow through the cord was like) Second time round I had growth scans, was monitored daily for the last few weeks, and induced at 38 weeks. The placenta was calcified which no-one really expected because there were no indications there despite all that monitoring. Because of this, everyone agrees it's a good thing for me to be induced at 38 weeks in any subsequent pregnancy. I guess what I am saying is that if there is a problem in utero, monitoring may not be enough to pick it up, though in most cases it will be. Mine is just one anecdotal experience, for sure, but your consultant will have seen cases like mine alongside boatloads of cases where everything goes fine despite some dodgy indicators. S/he has to go with a gut instinct to some extent, and if your consultant is worried, I would take that seriously as part of your decision making.

Hi Hanabanana

How would you feel about going in every day for scans to check the placental function and blood flow at the end of next week? If your baby is active and blood flow and fluid levels are good, there's little reason for induction that I know of (however I'm just a well-informed doula, not an obstetrician).

Remember that the decision is yours - even if you ask for a second opinion, they tend to come from one of the consultant's colleagues. Nuff said?! It's good to be cautious when it comes to childbirth but there is such a thing as being over-cautious. If you were refusing scans I'd tell you not to be so daft but you're not!

Thanks for the advice and mrsg it is amazing and cautioning of you to share your experience so openly. The trouble is my nice normal consultant was off this week so I had a stand-in who had never seen me before and didn't have the best personal manner in terms of explaining the whys and wherefores...

I wouldn't mind at all going in every day for checkups/scans so that's a good idea which I will try to suggest, although I did ask whether I could have another scan to check the growth next week before any induction and the consultant said there was no point, he just wants CGT monitoring every other day.

I just hate now worrying that something really is wrong at the same time as my instinct is that everything is fine inside. DD1 seemed to follow a really similar pattern to this pregnancy although she obviously didn't trigger quite the concern of this one, and she came out just fine and lovely having, I felt, benefitted from the extra week to gain a bit of weight.

on the other hand if this one's growth really is 'tailing off' will it actually gain much more weight in the next couple of weeks?

Also - how accurate are the growth scan measurements anyway? How come this baby seems to have long legs and small tummy/head when they were all in proportion 3 weeks ago?

I think mrsgboring's right when she says that there simply isn't anyway of knowing which babies are doing absolutely fine but just on the small side, and which aren't doing okay in utero, even with scans etc. I can understand your concerns about a possibly premature induction, although a significant factor in 'successful' inductions is how 'favourable' the cervix is. I was induced at 39+3 weeks having lost my first baby - apparently, my cervix was 'favourable' and I had a straightforward 8 hour labour and delivery with no complications. Again, this is just one person's anecdote, but if I were you I would definitely go for as much monitoring as possible and ask for a midwife's or obstetrician's opinion as to how 'favourable' things are looking at the mo.

P.S Good luck whatever you decide.

Growth scan measurements are known to be an inexact science - they got all my babies spot on virtually to the ounce but I know of many instances where they were as much as 2lbs out . The proportions can look different according to which angle the sonographer is using. It's very different trying to decipher a scan in the last weeks of pregnancy when compared to, say, a 12 week scan.

If you want to consider the option of induction and make an informed decision on it, ask what your Bishop's Score is and make the decision on that basis. If it's not favourable, you could be going through induction for up to 3 days and then end up with a CS for the classic "Failure to Progress", coupled with foetal distress. Don't want to be a doom merchant but sadly that's often the end result of trying to induce when your body just isn't ready. If you want to know what a Bishop's Score is have a look at this link

My growth scans were very out. From one week being told she was tiny and likely ill, to next week being told her head would get stuck on the way out as it was so big. I had SPD, didn't know any better and was induced at 38 weeks.

According to that link my Bishop's score would have been -3. It took me one pessary and was very quick. I too had thought it would be a three-day job, but it was actually frighteningly speedy.

My baby was 6lb4oz and would probably have been ok with another two weeks cooking. She was ventoused out and then got jaundice.

Everyone's different. Ask for another scan on the day they've planned to induce you. Try to get the same Doctor!

sorry to hear what happened to you mrsgboring. i agree with mrsgb that the consultant is making an informed decision with yours and baby's needs in mind, and i would listen to him/her,

Thanks - we will see tomorrow when we have another appointment - I just don't understand how supposedly the baby's head circumference has actually shrunk by 1mm over the last 3 weeks while its femur is 6mm longer?? and it is the wriggliest baby ever (just spent the last hour and a half continuously working out inside me)...

but really appreciate the advice re Bishops Scores and will definitely ask about it when I see the doctor again.

I was induced twice, once at 37 weeks and the second at 36 weeks. In both cases the babies did turn out not to have grown, so it was probably the right decision.

The good news about the first induction was that my body was actually ready to give birth at 37 weeks, so it swung right into it and I didn't have the scary crash experience some people describe from inductions.