To Induce or not to Induce

[ItsAllGoingToBeFine]

A wee bit of background:

First baby is due in 2 days but is likely to be late so starting to think properly about options around induction.

I have a real problem with vaginal examinations of any sort - I have in my birth plan that I don't want any. I am sure that to me a sweep would not be in any way a minor procedure.

Saw a midwife today - she had a quick scan of my birth plan and said "you won't be wanting a sweep today then"

I have read all of the NICE guidelines on induction and am aware of what is likely to offered re induction and in what order.

I want a happy healthy baby at the end of this and would never refuse essential procedures. I have so far had an entirely trouble free pregnancy and am considered very low risk.

---------
Am not very good at reading statistics anymore . Am I putting myself and baby at much extra risk by refusing induction? (when compared to e.g. the additional risks of induction). I understand that if I do refuse induction that I would have additional monitoring. How long can I put induction off for?

Is it possible that they could hoick the wee one out by CS rather than induce - I know this sounds extreme but I almost think I would prefer this to potential repeated cycles of induction.

Obviously I will discuss this all with a MW at my next appointment which is when I imagine it will become more of an urgent issue. I'm just hoping to get this all a bit more clear in my own head before I do and I have always found the differing views of MNers very useful in the decision making process.

Thanks in advance...

Personally I wouldn't bother with the sweep at all until 2 / 3 days before induction date. Yes its not that nice but only lasts a couple of minutes and if it avoids either induction or CS definately worth it. If you have induction will be much much worse in terms of VEs than a quick sweep. Of course its up to you....

I think it seems unlikely to be offered CS instead of induction (unless they think real medical need eg prev CS/prev bad labour, big baby etc).

Why do you think you'll be late? Anyway shouldn't be any pressure to have induction until 12/14 days late and even then you can have monitoring (doesn't involve VEs) and wait.

Try all the labour inducing stuff, lots of threads on this.... although probably doesn't work!

I had no VEs with my DS and will not want any this time - although they did have to have a check afterward to be sure I hadn't torn (I hadn't).

Have you specific fears about inductions?

Do not feel that you have to have a sweep. I gave birth to my two DC in Germany and a sweep is unheard of there.

I completely understand you. I'm 41+1 today and already have refused a sweep. My induction is booked for Saturday (I'll be 41+3) but I honestly don't want to be induced (I'd rather have a CS...), so I'll ask for a sweep (it's uncomfortable but won't harm the baby). I'm feeling constant period pains right now, so maybe I'm in early labor, I don't know. I went to a reflexology section yesterday, I highly doubt it actually works but at least I relaxed and got a nice foot massage!

I went 2 weeks over with DD and was then induced.

The most important thing, imo, with an induction is that it is done gradually. That is what happened with DD. Very gentle, meant a long labour but with an epidural and afterwards I immediately said it was a lovely birth and I could imagine having more DC.

With DS it was a different matter. The midwife kept bumping up the dosage, within two hours I was asking for an epidural and then had to have a crash CS as DS was in distress. It was very traumatic.

Speak to your midwife and outline your concerns. An induction need not be a terrible thing, but it has to be well managed.

MmeLindt I think my fears are around the vaginal exam aspect of the induction process, plus the fact that induced labour can hurt a lot more thus starting a whole cascade of interventions which I would rather avoid if possible.

Have you spoken to your consultant about your fears. It is more that a reluctance to have a vaginal exam, is it not? More like a phobia?

I am sure you would not be the first woman he has seen with this problem and he may be able to advise you how they proceed.

You'll be surprised at how long they let you go overdue when you say you'll only accept a c/section.

TBH it sounds like you are as informed as you can be and only you can make the decision. Most of the problems in late pregnancy don't just occur but slowly deteriorate and with appropriate monitoring can be picked up in plenty of time.

I suppose the tricky bit is if your placenta declines from excellent to very very good, then what?

good luck with whatever you decide. My own very very personal opinion would be to refuse induction as an absolute, go as overdue as I felt safe and then c/s if necessary. I also would refuse (and did) all internals.

hth

In that case refuse induction, and say you'll have CS if any risk to baby, good chance you'll go into labour before 40+14 anyway. Monitoring is just sitting on a CFM (band round tummy) and scans so you'd probably be ok with that.

Have you spoken to your hospital about VEs on arrival - the hospital I was originally booked at said they needed to do one to access MLU check you were in established labour. I have changed hospital and new MLU in slightly further away hospital (5 miles rather than 4 miles so not much difference really) is supportive of my birth plan not to have any.

I also found labouring & delivering in a pool great as it was very private, no one apart from me could see what was going on at all. Midwife wanted to put mirror on bottom of pool but I said no need as I will tell you of progress, which I did.

If they do internal its just to see how close you are to going into labour not to determine health of baby.

MmeLindt I don't see a consultant as I have a low risk pregnancy - midwife I spoke today seemed fine about me not wanting VEs - she is happy that I am realistic enough to understand that there may be occasions when they are necessary - I'm not going to refuse them at all costs.

AngryWasp Yes, I figure that'll be a hard decision - I'm not against induction at all costs so if things started to deterioate then I would definetly consider it - but I guess that might be too slow so would need a CS anyway - guess I'll just have to play it by ear. I plan on refusing all internals unless they give me a very good reason.

MumNWLondon I'm hoping that the whole question will never arise and I will go into labour naturally. Just trying to get my head around things in case MW starts trying to book inductions etc next week.

I don't think VEs should be a problem getting into the MLU - hospital policy is that everyone with a healthy pregnancy that doesn't want an epidural goes to the MLU.

Am hoping to get a birthing pool but there is only two so will be pot luck

I have to say I am amazed at you guys attitude towards a CS rather than an induction. I didn't think it was actually a viable option and thought I would get flamed for even suggesting it! I am feeling a lot more confident about negotiating this stuff now if necessary.

The thing is, either your baby is in trouble or he/she isn't. If he/she isn't you don't need to be induced, if he/she is, you want them out asap.

That was my argument anyway.

I know you're not after a homebirth, but check out this on the homebirth website - might help with some of your questions.

Looking for your statistics, reading from here:

"Bergsjø[7] gives quite a different picture of perinatal mortality in the above table, quoting large scale statistics from Scandinavia 1979 - 81. Commenting on these tables he concludes that in this population, perinatal mortality is lower post term than at 37 - 39 weeks, with a drop between those times. The highest perinatal mortality is 6.7 per 1000 at 37 and 38 weeks, and 5.7 per 1000 over 40 weeks."

"Ahn and Phelan ( 1989 ), in quoting McClure Brown's study ( 1963 ) states that:[15]

1. Perinatal mortality increases after 42 weeks, doubles at 43 weeks, and quintuples at 44 weeks gestation;

1. In quoting Sachs & Friedman ( 1986 ) they also state that " perinatal mortality rates were not significantly increased among postdate infants, but for small for gestational fetuses, the perinatal mortality rate was 6 to 7 times higher " .

This last statement reflects other authors comments that the fetuses showing growth retardation or " postmaturity syndrome " are at greater risks than fetuses who continue to be well nourished by the placenta."

OP: As someone just pointed out on another thread if you have a CS they'd put a catheter in and would that not be similar for you to internal examination?

link

re: the internal examinations - I think on justified if baby is a bit distressed and they need to make decisions OR if you are having a long labour and not coping - again to make decisions about whether to have epidural (but thats up to you I guess).

I think though best to turn up at hospital as late on in labour as possible so there is no doubt that you are in established labour.

MumNWLondon I hadn't thought of that, but bizarrely I am much more comfortable with the idea of a catheter over VEs.

I plan to stay at home for as long as possible - I'm pretty close to the hospital so I'm not worried about getting there too late

Just to reassure you, I hope, if you do end up going the induction route for whatever reason... I was induced with DS and consider that birth a lovely and indeed holistic experience. I was induced at 39 + 4 for a host of reasons that don't apply in your case... but it was a necessary induction for me and baby... was high, closed and posterior prior to the induction with prostaglandin gel overnight only (i.e. not favourable for labour). Next morning, went into labour hard and fast at 11, c-x every few minutes or so until got overwhelmed and had epi at 6pm. At this stage, I was only 3cm, but dilated to 10 in three hours, pushed DS out (yes, I could feel all the pressure, knew when to push, just had no pain) and he was out in half an hour. The only bad thing was the almost three degree tear, but even that healed up nicely in the next 10 days.

Sorry if this is irrelevant story - just wanted to post my experience to say that inductions can be quite gentle, and don't have to lead to lots of intervention (though, admittedly, the epidural is obviously an intervention!) More to the point, the staff were so caring and supportive, and DH so fab, I really feel like it was a great birth - despite not being my plan.

(Now that I'm about to give birth again, I'm worried about the pain of natural labour v. induced - but that's a whole other thread!)

If it makes you feel any better about sweeps, they don't use that horrible metal things to hold you open, it's just a finger. It's a bit uncomfortable, but I'd say it's better than a smear test.

I was very anti-induction, but I was in early labour for 5 days and was getting fed up of being hassled about it (and also of the contractions getting me nowhere). I had a sweep and that night I went into proper labour and had the baby the next morning.

Sorry - I meant to put "just" in inverted commas. Didn't mean to trivialise it.

How are you doing, anything happening yet?

Nope, nothing yet but I was only due yesterday I' not worried yet though - baby will come when ready