Early Induction?

[OhBergine]

I'm 37 weeks with DC2 and have been having regular growth scans as my fundal height tape measurements were trailing off a bit. Sonograoher noted at my scan that abdominal circumference growth has tailed off a bit and I've got another scan today as tape measurements have slowed again.

MW is now starting to talk about early induction if the scan today shows the same thing. I understand this is on the basis that it may indicate a problem with the placenta not functioning properly. Obviously I will ask all my questions at my scan today but has anyone been induced early for this reason? Blood flow through the placenta and fluid around the baby were both absolutely fine at last scan so I'm not sure what the benefit of an early induction is?! Can anyone help?

Thanks!

Hello! I had problems with the placenta starting to fail at the end of both my previous pregnancies which was monitored closely with scans and CTGs.

With DD1 they induced at 40+5 because of this and low amniotic fluid.

With DD2 there was talk from 34w of an early delivery. This was because the US showed problems with the blood flow through the placenta which meant her growth slowed and she was dropping under the 10th percentile. I then decided to go on mat leave early (I was working a lot and chasing after a 2yo) and she had a growth spurt and arrived spontaneously at 38+1.

I expect the MW was just advising of the possibility. As you say, if the US shows the blood flow through the placenta and amniotic fluid is fine then there would not be any reason to induce I expect.

Personally I get a bit irritated that in the U.K. so much stress is caused by MWs with their goddamn tape measure. I live in Germany and it's
not something that's done over here.

Good luck with your scan - let us know how you get on!

If growth is stalling, it indicates a problem. Once you are at 37 weeks, the risk calculus is quite clear; baby is better off out than inside with growth restriction and/or a possibly failing placenta.

I was induced at 37wks due to growth on scans stalling. I was hoping for a homebirth so I wasn't happy at first, but it was a totally fine delivery and now baby is here how he arrived doesn't matter in the least.

Can I ask what you mean by growth stalling? I had a scan at 31 weeks that showed the baby a bit under 10th centile, so had a follow-up scan last week at 35 where he'd gone up to 20th - I thought that would be end of matter as now 'normal' and growth seemingly accelerating, but they booked me in for another scan for next week (37) and the midwife said she thought they'd still want to induce me before term. I'm very, very anxious and want to do whatever they think is best for baby, but was very surprised that induction was an option for a baby that is on a 'normal' centile and was hoping someone in this thread might have more insight into how this works - is my baby considered at risk because he had a previous big drop down the centiles, even though things seem to have been going better since? My placenta has also looked fine on scans, but I have had a couple of incidents of reduced fetal movement (not in last couple of weeks, though).

Sorry, I didn't mean 'induce me before term' - I'll be at term when I have my next scan - I meant 'induce me before my due date'.

In my case, it was no apparent change in measurements in scans 10 days apart. I did have high pressure in the cord as well though, which was why growth was being monitored. I was only a few days shy of 37 weeks at the time of the second scan, so the recommendation was induction as soon as 37 weeks was reached. Continuous growth, even if not perfectly matching a centile line, is not a concern in the same way unless baby drops below the 10th centile on your personalised growth chart (this is the criteria for diagnosing intrauterine growth restriction).

Bottom line is that we know that stalling growth and IUGR raise stillbirth risk significantly, so when a woman is term when these issues arise the recommendation will always be to induce Asap.

OP I recently was induced for exactly this at 35 w but they waited till there was a problem with cord flow not just abdo circumference.

In your shoes I would ask to speak to a dr not just a mw and I would also ask about the likelihood of an induction going smoothly at 37w with a singleton pg. When I was induced with my twins I was already 1cm dilated. If you are not looking favourable and they want to get baby out, ask about elcs.

Thanks queenaravis - that's helpful. I think I've just been getting a bit confused - as I said, I thought that if he'd reached a 'normal' centile by the last scan that would be the end of it and evidently not, and I can't quite work out what's of concern now and what it means.

Hi I got induced at 36+6 as ds's growth had stalled I had him at 37+1 and all was fine, they couldn't find a reason for the stunt in growth and he was a healthy 7lbs so about the same as the average 40wk baby. My labour went amazingly smooth once things got started up and you'll be monitored throughout so try not to panic about that. I think they do it just to be on the safe side as not all problems can be identified through a scan. Good luck

To add a bit to that: from an obstetrician's POV, there is no disadvantage to inducing once you are 37 weeks if there is any reason whatsoever to think things may be awry in there. Their primary concern, understandably, is a live birth.

From your POV there may be a disadvantage especially as a FTM, because induction closes certain doors and usually means continuous monitoring which rules out water for pain relief, and induced labour can be intense. The latest data indicates it doesn't increase risk of a CS though.

These decisions can be difficult to make because although you can decline the induction recommendation, it's very hard to quantify the risks and say how much risk you may be taking by choosing "expectant management". It may be a miniscule amount, it may be quite a bit. Some women might be happy to take a little more risk and wait a bit to avoid induction, some might understandably want to focus on minimising risk to baby.

I would also ask about the likelihood of an induction going smoothly at 37w with a singleton pg

I don't know if there's any data breaking down success rates at 37w vs 40 or 42w but it's certainly worth asking. Overall picture is that a FTM has a 75% chance of an induction ending in a vaginal birth. A woman who has already given birth vaginally has a 90% chance of induction ending in vaginal birth. This did affect my decision as I'd already had an uncomplicated vaginal delivery, so my odds of another one were very high. I'd probably have consented anyway once I'd talked to the consultant if I'd been a FTM though - I'm very glad not to have had a CS when having my kids. But these are V personal decisions - the best you can do is understand the risks and benefits as best you can and weigh it all up, then decide what your preferences are.

Thanks so much all, your replies are so helpful!

@chloechloe DH is German and his sister is a MW in Munich - she said they don't use fundal height as a measurement anymore so had similar advice!!

@QueenAravisOfArchenland you've hit the nail on the head really. I'm not so bothered about the fact that an early induction will mean I can't have my planned homebirth (DC1 was 7lb 15 and a lovely waterbirth), it's more that I cannot quantify the risks of turning down induction if that is what is recommended.

As PP have said, good blood flow through placenta and Good fluid levels make me question the reason for the slowing of growth of the baby's AC. It has increased in size over the last month but whereas it was on 90th centile, it's now on 50th (whereas every other measurement is tracking the line).

Aravis I would be more worried about the likelihood of an instrumental delivery as the injuries can be lifechanging. I would specifically ask about that.

@lisa from what I'd read up about, there is a big difference between babies that are small for gestational age (SGA) and babies with intrauterine growth restriction (IUGR). SGA babies are healthy but just small by nature, often due to their own or their mother's genetics. IUGR babies are small because something is wrong and they haven't reached their growth potential. So tracking consistently say on the 10th percentile isn't necessarily a problem per se.

From what I've read babies with IUGR often don't cope well with labour. If coupled with an early induction which the baby is not geared up for, I would expect the 75% chance of a vaginal birth for a FTM to drop considerably. Indeed I was induced at 40+5 with DD1 who had IUGR and ended up having an EMCS because she got distressed before the contractions had even begun. Having said that the advice of the Drs was very strongly against waiting any longer and I'm glad I at least attempted a VB rather than going straight for an ELCS.

I guess though if you've already had a VB that the chances of success of induction are higher.

Aravis I would be more worried about the likelihood of an instrumental delivery as the injuries can be lifechanging

Fair point and I'd have to say I don't know anything about the data around that. And induction was a different prospect for me as a second time mum who had a textbook first birth. A very quick search seems to find data suggesting that if anything the risk of an instrumental delivery is lower with induction at term than spontaneous labour, but as always this may not be the whole picture. Modern epidurals don't apparently increase the risk of an instrumental.

I was induced at 35 weeks as baby’s growth began to stall. Baby was always on the smaller side but at the last scan before birth the consultant was concerned about the blood flow. Again I would reiterate what previous posters have said and would advice speaking to your consultant as to what the concerns are. Normally they wouldn’t intervene unless they suspect IUGR rather then a healthy but small baby.

In terms of the induction process, my body was in no way ready for labour. So it took a long time (6 days!) for DS to arrive. So while I was induced at 35 weeks, I was 36 weeks when I gave birth. I would strongly recommend some pain relief.

Although a long labour, I was up and running afterwards and had no tears. So I’m glad i didn’t opt for a CS as I know it would haven taken a while to get back on my feet. Both interventions have there own risks. Whatever you decide to do, I hope you have a good birth and most importantly a healthy baby!

Chloe my consultant told me that IUGR was an outdated term and SGA had replaced it.....? He kept saying IUGR and then saying "of course we don't use that anymore"

But then weirdly everyone else apart from him did. Your explanation makes more sense!

OP this is totally anecdata but if it helps, when DS was born he was too weak to suck and looked like ET. You could see his ribs and chest bones. Today he is a 17wo smiler and very healthy! He has almost caught his twin sister up on growth. Your baby will get there, too.