40+3 and head not yet engaged - should I be worried?

[daisietaylor]

Hi ladies,

I wondered if any of you more knowledgable peeps out there can give me some advice.

I'm 40+3 with my first baby today and as far as I understand (although could easily be wrong!) the baby's head is not yet engaged. At my last check the midwife said that she could feel most of the head still so it wasn't in the cervix yet. I am due to go to the hospital on Thursday to see someone although I am not sure what to expect or what I should take if anything.

I suppose my big concern is that I will end up being induced way before my body is ready and I will end up having a very 'medicalised' birth experience rather than the natural active bith that I would prefer.

I know I can technically refuse induction but they keep talking about the increased risk of stillbirth and I have no idea how big this risk actually is. Obviouisly I dont want to go through this whole thing and not have a healthy baby at the end of it.

I haven't had any symptoms of labour at all, the odd period pain type thing for the last few weeks on and off, back ache at the end of the day which I have put down to baby being back to back and me doing a bit too much. As far as I know I have never had any Braxton Hicks. I just find myself getting more and more emotional at the prospect of a full scale induction. Crying all the time isn't helping me to stay calm and visualise a positive labour and birth either!

Not really sure what the answer is, I guess I just wanted to vent and ask if anyone has any advice or has had a similar experience?

Thanks in advance x

I had a similar experience with my DD. At my last mw appt the head was hardly engaged at all, got told some guff about possibly needing a caesarean. I think she was trying to make it more dramatic for the student midwife who was there. She also booked me in for a sweep a day earlier than was normal policy which I was determined to decline (would have been 40+3) and as it turned out DD was born 40+4 and I never did find out whether her head had engaged or not- before labour I mean. Labour from start to finish was 25 hours but I was 9cm dilated after 18 hours and then various issues not related slowed stuff down.

My advice is to give it a bit of time you have ages and as long as the baby is not in distress and your bp is fine I would wait until you want an induction or labour starts.

I know how horrible it is trying to glean information from the little that is told to you and trying to separate opinion from fact. Time is on your side though.

Just my experience though - obviously not medically qualified!

Unless there is a true medical reason to induce...of which going passed your due date or possibility of a big baby are not considered medical reasons...you have some time still. Much can change in the next couple of weeks. Try your best to focus on taking care of yourself....go for walks, rest, take care of any last minute details around the house, spend time with family and friends.

The risk of stillbirth becomes more of an issue once you get to 42 weeks and beyond...even then, while the numbers increase, the majority of women will not have any problems. You can ask about what sort of testing will they do, if any, such as non-stress tests. As long as baby and you are doing fine, there would be no reason to induce.

If it came down to needing an induction, you can still have options for comfort and movement...it does not require you to stay in bed...so, while not as much as without an induction, you can still have an active birth.

My first two never engaged until partway through labour. I don't know if the fact that they were both posterior presentation influenced that. If your baby is posterior, a lot of time on all fours can help to correct that. Otherwise it's still perfectly possible to deliver vaginally with the baby in OP- in my case the labours were longer and more erratic (very different and random gaps between contractions in the first stage of labour) followed by very quick and efficient second stages. Mine were all 10-13 days "overdue", even the one that wasn't posterior. Good luck, hope it all goes well for you.

My first was OP and never fully engaged before labour (i don't think - it's a bit fuzzy three years on!) I went over my dates but had a sweep at 41 weeks and that got things moving. He was born 10 days over. I also wanted an active birth but, 20 hours down the line, my knees gave up, contractions slowed to a crawl and I ended up with a drip and epidural. it was absolutely fine tbh. Am currently 38 + 2 with dc2 and again, my body isn't giving me the slightest clue that it wants to push this baby out anytime soon. don't worry - whatever happens you'll have a baby in the next fortnight! take the opportunity to lie on the sofa and watch a dvd all the way through xx

40+3 is way too early to be worrying about induction. Your baby is probably trying to find a comfy position so lots of crawling around might help.
When describing the engagement of the head it is divided into 5ths. 4/5 palpable means the head is starting to descend into the pelvis, 1/5 palpable can hardle be felt abdominally. Sounds like you are heading in the right direction.
I hate it when Midwives and Doctors don't explain what they find ...............it's part of our job to do it! So ask away next time, it's your right to know.

Thank you for all your messages, I do feel a bit better!

It doesn't help that the NHS are not being helpful with another unrelated pregnancy problem... it just doesn't fill me with confidence you know?

Good to hear that some babies seem not to engage until the last minute though too, I didn't realise that was the case so thank yu for the reassurance!

Daisie sounds like your MW is not good at communicating ! Remember that up to 42 weeks is considered 'normal' so plenty of time yet and that you don't have to say yes to an induction - you can be monitored daily instead.

I was induced with DD1 and refused it for DD2 and am really glad I did (both were born at 12 days +) although I am not a HCP so couldn't tell you the full facts and risks associated with going over the 42 week mark. I just think it's interesting that I had my 2 DC in 2 different trusts who had 2 different policies for induction (1st one was induce at 10 days, 2nd at 14 days) strange eh?!

DD wasn't engaged at 39 weeks so m/w sent me for a scan to check things out. She turned out to be breech and despite trying everything to turn her (frozen peas anyone??) I had a c/s a few days later.