Any midwives or other knowledgeable types for induction questions

[PenguinsLoveFishFingers]

I have my 41 week appointment tomorrow and I know the MW is going to start talking about induction, which in my area would be pressed at +14. I'd like to be armed with a bit more information beforehand.

I want to resist induction at +14. I am 99% convinced that the NHS has my dates at least 5 days wrong (The 1% being that I did actually conceive on a date when we hadn't had sex for 10 days...). I also have a strong history myself and in my matrimonial family line of going post-dates. I have gone quite overdue with my previous two children, as did my mum, her sisters and my Grandma. All by around 8-12 days.

So my questions are:

• I know that if I go ahead with a homebirth officially post+14 it will be a 'homebirth against medical advice'. What are the actual ramifications of that for me? Is the supervisor of midwives still likely to be supportive of sending out a midwife, for example?

• If and when I agree to induction, I know that they normally start with a pessary. What are my options if that doesn't kick things off? What do they try before the drip (I have had drip and epidural before and for various reasons it was very traumatic for me, so I'm dreading that possibility). Can you say that you won't consent to anything more than the pessary and want to discuss a section if that doesn't get things going?

Thanks. As you can tell, this whole thing is making me rather stressed. I am so bloody annoyed that my dates were shifted and the NHS places such emphasis on a technology with a known margin of error to the exclusion of all other information.

Hi penguin
Ah the dreaded induction. I too went way over and was induced with DD 6 months ago. I'm not a midwife but ill put my tuppence worth in to hopefully help you...
As far as I am aware, going post-dates in an otherwise uneventful and healthy pregnancy is not a contraindication to a home birth. The induction process starts with the insertion of a prostaglandin gel or pessary, depending on how favourable your cervix is on examination. If favourable and things progress (ie. waters spontaneously break/contractions start) then I see no reason for a home birth to be an issue. If things don't get moving they can break your waters for you before considering the drip. If they do break your waters for you (known as ARM) then please be mindful that if you still do not start contracting after an hour of this being done then they will likely press for the drip to be commenced due to increased risk of infection. Obviously here there may be a problem with a home birth, particularly if the midwives are not comfortable with this course of action (there may also be trust protocols in place about use of oxytocin drip in home births).
You have my sympathies as I was very frustrated at the dating issue also, but for different reasons (I felt and still feel that I should have been induced earlier). Always remember OP that you give your consent to any treatment, no-one can force you to do anything without your consent.

Sorry for the essay xx

Hi,

Thanks for answering.

The appointment actually went better than expected. I don't need to see anyone again until I'm 41+12. My MW has already talked to the supervisor of midwives about me and they'll see me some time in the day or two after that to talk about delaying induction, monitoring/scans in the meantime and documentation.

Have you thought about acupuncture? They can do induction points which can be really effective. I had acupuncture with both my 2 and gave birth on the day after the acupuncture. Both were born in the water completely naturally with only gas and air.

That is great. You can opt for daily monitoring instead of induction. This is a good blog from a midwife that goes through calmly and clearly the risks and benefits of induction.

When you say overdue do you post dates so like 40 +17 or do you mean 40+11 (which would be within due)? If it is the later your probably likely to go into labour soonish and it wont be a problem.

I wish you luck

Thanks both. I've not tried acupuncture but maybe I should think about it. Tried reflexology last time but it didn't do anything (except make me very relaxed and sleepy, which quite frankly was quite a result at that point).

Hazchem - I've had both my previous children before 42 weeks, so overdue in the colloquial sense, not post dates as in post-42 weeks. Not so sure about my wider family - my Grandma (much as I love her) likes to tell tall tales so she'd probably claim she was 5 weeks over or something!

The issue I have this time is that, when they think I'm 42 weeks, I think I'm 40+9 ish at most. I think I'd resist induction until their 40+19 because that's when I think I could possibly be 40+14 (if that makes sense!).

I really hope that I go into labour before this becomes too much of an issue. The problem is that if I add my usual +9 to the (at least) +5 by which they messed with my EDD, I get to +14.

Still, at least I don't have to worry about any of this until after the weekend now (thank you lovely midwife!). She also didn't even raise the issue of sweeps after I indicated last time that I wasn't interested. I may agree at +12 if I'm getting desperate!

It sounds like you have a good plan in your head. maybe talking to the lovley midwife saying you would prefer to wait til 40+20 for the induction. that would still be 42 weeks not 43. From memory risk levels go up after 44 weeks.
Oh it's good she didn't raise sweeps. I have been hearing lots of anecdotal evidence that they can bring on a long latent labour which just tires you out.
Acupuncture is worth ago. Or gosh what about having a motherway/blessingway.

Thanks Hazchem.

I've thinking of telling them that I'll go in on their +19 if nothing happens on its own.

I am very ambivalent about sweeps. I find all internals incredibly painful and last time a failed sweep 24 hours before I went into labour (cervix so closed and posterior she couldn't even reach it) left me in floods of tears. I'm not sure that that is a great help for my emotional state!

Not heard of motherways. Off to Google!

I had a homebirth at 12 days past MY date (which was 5 days past theirs).

I believed that it was the safest place for my baby and me, and the only way I could ensure the safest birth protocol.

I refused an appointment with a Consultant as these things are always pressed on women far far to late and I wanted to relax into my last few days to get my body ready for labour, not charge around defending my choices.

I refused all internals and therefore sweeps (no evidence for them except risk of infection and quite honestly WHY would you want to start labour before your body has agreed baby is in the right position and is ready. That increases the risk of prolonged labour, malposition and potential problems). This also stretched to any form of induction.

I had in my birth plan that if at any time my baby was in danger, get him out asap through the sun roof. If he wasn't in danger, leave him the hell alone.

I also refused to discuss induction at such a late stage. I'd had it in my birth plan FOREVER and pointed out that that would have been the appropriate time for a discussion, not when raised adrenaline levels were likely to stall the trigger of labour further.

"I had in my birth plan that if at any time my baby was in danger, get him out asap through the sun roof. If he wasn't in danger, leave him the hell alone."

That's exactly how I would feel, except for the fact that a section and the subsequent not driving/lowered mobility would make things very difficult as DH has to work away a lot (after the paternity leave) and the school run on foot would be 5 miles a day. So I think I'll accept induction eventually in the hope of avoiding that.

At the moment they aren't suggesting a consultant appointment as I've said I'm happy to see the supervisor of midwives and she's happy for me to extend the induction date a bit past the norm. We'll see what happens when I say +19!

Thanks for the response.

Do you want us to try to find some research papers that point to the inaccuracies of dating scan? So you can say. I understand your concern but there is evidence to suggest my date is more accurate then from the scan. Not sure if it's relevant but there has been talk in Australia recently that saying I decline X procedure is less confrontation to HCP then I refuse this procedure.

Starlight That is a good point about induction discussion. I found discussing it at 40 weeks really irritating that and the instance that I needed to book in for it 10 days in the future.

Thanks for the offer. My MW is ok with the dates thing though. I explained that we'd been staying with the inlaws and definitely didn't conceive in the window the scan puts me having conceived in. She found that fairly convincing . I think probably the 'it would need to be basically immaculate conception" argument is probably less confrontational than trying to argue about technology. And as you say, the last thing I want to be is confrontational.

I have been trying very hard to be totally reasonable. My argument isn't that I won't be induced. It's simply that I want to delay induction until I think there is a potential I am +14. So I've talked about delaying induction, not refusing it.

If the supervisor of MW's is half as good as my MW then I think I'll be ok. Fingers crossed this one puts in an appearance over the bank holiday!

That is so good you have a supportive midwife.

That is probably a good way to discuss it with the Supervisor of midwives but hopefully either your midwife makes the case for you or baby arrives this weekend. :)

She's brilliant . Bit of a change from London where I never saw the same person twice.

The libido limiting powers of staying with the in laws seem fairly convincing too!

Lol!

Just remember though that actually you don't have to have a reason at all or at least not one that anyone agrees with. It is your body.

Thanks. I know. And some things I am very clear on (like no one is breaking my waters to 'help things along', no matter how much they want to, unless they come out with a very convincing rationale). With the dates thing, I'd just like the team to be comfortable with the plan. Don't want a panicky MW who doesn't think I should be at home in the first place and is itching to transfer me!