Induction at 40 weeks - thinking of refusing?

[FatimaLovesBread]

I had my consultants appointment earlier this week and despite it starting off well (they've agreed for me to go to the MLU rather than the CLU) she then said that if I get to my due date without spontaneous labour then they would be inducing me.

I am happy to be induced if it is medically necessary and they can show me some evidence that my baby is at risk, but I do not believe there is. I also suffer from health anxiety and so feel that having my due date as a sort of deadline for induction will not help me with this during the last few weeks of pregnancy.

Has anyone been successful in refusing induction? How did you go about it?

I'm currently looking through lots of scientific papers and compiling a rough birth plan to discuss with my midwife at my next appointment.
I'm thinking of putting that I will only induce at 40 weeks if they scan me and show me medical evidence of risk and that I may revisit the decision at 41 weeks.

Usually (in my experience) they wait to discus induction until you are approaching 42wks. It's only then that there are health reasons for helping things along (the placenta also has a life span and can begin to deteriorate at this time).

Their reasoning is it's an IVF pregnancy.

I have been unable to find an evidence to support early induction for IVF pregnancies.
My pregnancy has been, so far, completely textbook and low risk. No different to a spontaneous conception. Only difference is they know the exact date of conception

Ah yes, the good old induction-for-IVF This is a very common but totally baseless reason for induction - it's because it's a "precious baby", yet there is no evidence that you are at any increased risk of stillbirth vs any other pregnancy. Just decline, you don't need to give a reason - my friend had an IVF pregnancy last year and held out til 42 weeks (at which time she was fed up and agreed!).

What Bue said.

If you had a normal pregnancy and have no particular risk factors, then I can not think of a medical reason why you should be agreeing to induction before 42 weeks.

And just saying 'thanks, but no thanks' is absolutely fine. You will get a lot of information re risk of stillbirth which is of course terrifying but which is only v rarely balanced with the risk of induction .

FWIW, I was induced at 42+1 with DS1 (after 4 MCs and me being an 'elderly prim - I was 37 ) as he was considered a 'precious baby'. It was fine, a good delivery, but after an emCS with DS2 I then opted for increased monitoring with the last 2 and had lovely VBACs - the last one at 41+10, aged 44 .

V best of luck to you .

I was induced with DC1 and was adamant I wanted to not go this route with DC2 (unless medically necessary). Im in the USA were they are a little more aggressive I think and while it was very hard work, I DID succeed in not being induced with DC2 and delivered spontaneously at 41 weeks. It was a very stressful experience (actually started maternity leave one week early just to keep on top of all the advice I was being given). Had to sign AMA (against medical advice) forms countless times to leave the OB office. Dealt with snotty US techs exclaiming that they didnt think they would see me again after they tried to send me to the hospital for an induction for the SECOND time. Oh God, looking back it was just so infuriating! But it all worked out well - I just had to REALLY fight for it. Oh they wanted to induce because my fluid level was low (although it is notoriously difficult to measure fluid accurately in an US so thats why I didnt want to play along). There was one OB on my side (or at least on the fence) and he explained later that he could have been reported for medical malpractice for not inducing me. Crazy!

Oh, the whole ob/gyn thing in the States is just crazy - the litigation culture is bad enough in other areas of medicine, but in obstetrics it is insane!
I used to know a gynaecologist who after several years in practice gave up obstetrics altogether (continuing to work in gynaecology only) as her malpratice insurance presmiums were 100.000 dollar/year ! She felt the amount of time she'd have to work (and be away from her family) to make that kind of money, never mind any kind of surplus, was just not worth it.
Defensive medicine is dangerous to patients, and needlessly stressful for doctor and does not actually improve outcomes. Grrrr!

On a more constructive note, I found this Canadian guideline link.

Please note the use of the phrase "... after 41 weeks the woman should be offered induction...". 'Offered', not 'harangued about it'.

Fwiw, my consultant who had supported us through recurring MCs, the diagnosis of a genetic problem, done all my amnios and who is Prof for Fetal Medicine, was entirely supportive of me wanting to go to 42 weeks before I would consider induction. IME more junior drs are more likely to get twitchy, go straigth to the top, listen to their advice and then make sure that whatever you agree to is documented on your records.

Our baby was conceived using ICSI and PGD. I haven't seen a consultant since before our treatment started and we were signed off by the clinic after a 9 week scan. I'm not sure any of the midwives I've seen understand or are particularly interested in our treatment. I'm now 39+3 and Boone has mentioned induction. At my 38 w appointment she said we'll talk about sweeps if I see you at 40w that was it. I've been classed as low risk right from the beginning. I've heard of other women being told they can't give birth in MLUs because of IVF. Seems bonkers that they have different rules for different women who have had the same treatment and depending on where you live. Sorry no advice. Just wanted to wish you luck getting the birth that you want!

Here's a good thread on this www.mumsnet.com/Talk/childbirth/842445-VBAC-a-positive-and-informative-chat-with-consultant-MW-today

Your due date is an estimate. It is not a scientific date when your baby is absolutely expected to be born. The fact that only 5% of babies are born on their due date says it all.
In France that give you a due date that is 41 weeks. That is because MOST babies are born between 40-41 weeks.
And as for it being IVF pregnancy - once you're pregnant, you're pregnant. It doesn't matter how you got pregnant.

I raised this with my MW as I've heard that some hospitals have a policy that they will induce you at 40+2/3 days if you are 40 or over when giving birth. Luckily ours doesn't. They would take you to 42 weeks unless there is a medical reason not to, but even then I have the right to decline. They will simply monitor more closely after that.
I've been given the same options for birth as all other mums (even home birth), seen as I am considered to be low risk (at least for now), even if mine is an ICSI conception. In fact, my MW said that because of the journey we have had, it is even more important that I get to make the choices that make me feel comfortable.

The decision of course will need to be yours and you need to feel comfortable with whatever you and your OH decide. Congratulations on your pregnancy and I hope you get to have a positive birthing experience.

To clarify... do medical professionals really consider some babies to be more precious than others? That sounds completely insane.

Thanks for all your input. I have written some birth plan notes and will discuss them with my midwife on Friday and see what she says.

I've basically said that I won't consent to induction at 40 weeks just because it's a "precious pregnancy". I will only consent if they can show me medical reasoning or true risk. I'll allow expectant management. And I MAY revisit this decision at 40+7 weeks.

What little scientific studies I've seen are about still birth risk but not induction. I've found a few that say IVF pregnancies have an increased chance of some problems one of them being induction, but that's to be expected if they're telling people they have to be induced at 40 weeks.

Do you think they might give me a sweep earlier to try and encourage spontaneous labour?

I had an iui baby and had a Dr refer to her as more precious which I corrected: all babies are precious.

I had her a 40+12 (after a sweep) the day before my appointment with consultant to 'discuss induction'. They wanted to do it earlier, but I politely refused.

I reckon ask your mw re sweep, although they're only 50% effective AMD sposedly only when your cervix is ripe

I'm in the same situation as you Fatima. IVF pregnancy, due on 17th Aug. The hospital wants to induce on that date, i.e. at 40 weeks. Yesterday I had an appointment to attempt a sweep, but the consultant couldn't do it because my cervix was still closed and high. She couldn't reach basically. And the baby has not engaged fully. So conditions were unfavourable as she put it. Which I guess is not strange at 38 weeks... So why do they insist on trying I'm asking myself... They will attempt a sweep again in 12 days which will then we just 2 days before the planned induction. Now I'm having doubts about the whole thing. It's difficult challenging the plan when they tell you there is a higher risk of still birth in IVF pregnancies when going over 40 weeks. I'm searching for scientific evidence for this as well.

IreneDK So far my midwife has been very supportive, although I've still got 16 weeks to go. I have another consultant appointment at 32 weeks when I'll tell them I'll be refusing. I'm happy to do it if they show me medical evidence of risk but not just because I'm 40 weeks.

I've also looked for research and the only ones I can find are about IVF and still birth but it doesn't state at what point in pregnancy the still births occurred, so no idea if they were post-40 weeks or not.
I've found a study about increased risks in pregnancy after IVF, apparently induction is higher but if they're telling you that you have to have one at 40 weeks then it's kind of obvious that induction rates are going to be higher

Fingers crossed things happen for you before 40 weeks!