I have just declined an induction

[crazybutkind]

Just had a growth scan due to my first baby weighing 6lbs, this baby is weighing approx 6.7lbs and they wanted to induce me to which I said no.

I am 39+3 I have had 3 growth scans now, first 2 they weren't concerned this time they said they are concerned about babies weight.

My reasons for declining are due to the fact I haven't yet reached 40 weeks so not over due, my daughter was small, lol family babies have been small, I can still feel baby moving a lot and I don't want to be in a hospital with medical help on my own for potentially 3 days.
I said I would rather wait until next Monday (when I am overdue) then if they still feel the need to I will go ahead with induction.

After speaking to family I have been made to feel stupid and they have all said I should have agreed and I am being selfish and that I am potentially threatening the life of our baby.

I asked the doctor if it was what she would strongly advise and if there is any threat to myself or baby, she said no but would offer induction to women who are over due in any circumstance.

I phoned midwife when I got home to get another perspective really and she basically said I'm fine to decline until I am overdue and if nothing has happened by next week then go ahead with induction.

Basically I want someone to either be really blunt with me.

Have I been stupid?

Now o have come away and

I'd go for the induction after your first being born on the living room floor. Both of my labours (spontaneous and induced) were painful, not much dilation so 'not in labour' followed by short official first stage (1st was 4-8 cm in about 90 minutes, mostly in the car as sent home) then 2 hrs + pushing needing a ventouse to finish.

Induction followed a very similar pattern - took 12h to start anything with the gel, then painful cramps not really making dilation happen for 4 hours, then baby out 3 hours later. The fast dilating bit is much more comfortable on a bed with access to proper pain relief than in the car...

I am going to go up to the birth centre tomorrow with my book and ask if a midwife can look at it and their recommendations. I will ring my consultant tomorrow also. I am happy to have an induction next week when I will be overdue I just want to get to my due date first and see if anything happens between now and Friday x

I would also decline induction. Our hospital will let you go to 40+14 (42 weeks) before they induce women, obviously it’s different if they think there’s a medical need but babies will come when they want :)

Unfortunately I had a similar experience to @Paperyfish in November. DD was (we found out at the post mortem) on the small side. At 41 weeks when born she was the size of a 38 week old. Just under 6 pounds. She died during labour. Her size was a factor in her passing away.

I wouldn't take the risk of going overdue again to be honest. In our case the longer she stayed in made no difference.

@LizzyAnna99 Women can decline induction at any point, not just up until 14 days

I think you've done absolutely the right thing, you know your body and your intuition and gut feeling has told you to wait.

@sheflies I am so so sorry for your loss x

I'd have the induction m. Mine took 2 hrs.

I know 3 people in different areas who have had stillborn babies. One had her baby die while she was in hospital waiting for her elective section -emergencies kept pushing her back. So I would always err on getting the baby out ASAP if they perceive there to be an issue.

Consultant pushed for me to have an induction at 40 weeks because of my age but no other risk factors. I was put under an awful lot of pressure to accept and was not (IMO) given enough information to be able to make an informed choice. There was a lot of scaremongering but none of my questions were answered particularly well. Luckily I had a fab community midwife who gave me research papers and support I needed to make an informed choice. I declined an induction and asked to be allowed to go a week over subject to daily monitoring. Two days before my due date hospital midwives were still pressurising me to have an induction. As it turned out I had my baby on my due date and all was well. I still get incredibly cross about the emotive way information was presented - the suggestion being that if I didn't agree to an induction I would be responsible for my baby dying, despite no one being able to answer my questions about risk management or contingency planning appropriately.

@crazybutkind
That growth chart shows baby's growth is slowing which is why they've suggested induction. Personally, I would accept induction if that was my growth chart. I had a IUGR at 39 weeks after her growth tailed off, they could see my placenta wasn't healthy after I gave birth.

@crazybutkind That last plot on your growth chart shows the growth is slowing, that’s what I meant about babies dropping centiles and that is an indication for indication whereas a simply small baby isn’t. You need them to fully explain this to you and the reasons why induction is offered when this happens.

Growth scans are notoriously inaccurate, though, aren't they? So how on earth can you plot 3 measurements on a graph and assume the curve is accurate when each one of those 3 measurements could be wrong? It is a very blunt tool to be using for such big decisions

It’s not a perfect tool no but it has successfully identified babies at risk of stillbirth and by delivering them the rate has been reduced since its implementation. It’s about looking at the overall trend and the trajectory of the growth. 2 plots along the same centile and a third much lower can indicate late on set growth restriction. With a full term baby the risk of induction is lower than the risk of doing nothing hence it is offered. If the baby was still pre-term it would be intensively monitor and aim for 36 weeks.

The question you need to ask is why you are producing small babies. It can’t be a known genetic / racial cause because you wouldn’t have been offered an induction. Need to remember that some minor clotting disorders (that the NHS doesn’t test for and which can be inherited) can cause microclots in the placenta that prevent growth. I would have demanded a doppler ultrasound as it can show the blood flow to various parts of the placenta / baby to see if that’s a risk - not that, that necessarily means more than a snapshot in time. My baby’s heart started to fail during my induction at 40 weeks - if I had waited even a day longer I wouldn’t have brought home my baby.

The liquor volume and dopplers should have been checked during the growth scan as it was abnormal. The OP should have hopefully been given that information but it seems she wasn’t very well informed about the reason for induction so maybe not. A genetically small baby isn’t always a problem but a baby not growing to it’s full potential indicates placental failure.

This all sounds a bit confusing - induction was recommended by one doctor but not by another? I don’t blame you for declining given the info is so inconsistent. It also makes zero sense that they have recommended induction (presumably due to concern about IUGR) but then that they are not offering any more scans when you declined. I would ask for another review with the consultant.

Couple of things to ask them to talk through:

• does it actually meet criteria for a diagnosis of growth restriction? Could it be that the abdominal measurement is underestimated? They should really be looking at the scan pictures to double check as well, given you said the measures were tricky to get.
• what are the doppler measurements? In particular, did they do the MCA doppler? And what is the CPR? (Another way of looking at dopplers and whether baby is doing fine or struggling a little).

Generally if there is growth restriction with normal doppler measurements, delivery would be recommended by around 40 weeks; in the interim doppler scans should be offered (usually once weekly depending on level of concern, as well as CTG)
If there are abnormal dopplers - either in the cord, the brain, or the CpR (which is a ratio) then delivery should be recommended now.
There’s good evidence around delivery timing esp when dopplers are abnormal.

Also to think about is why are you keen to avoid induction - are there particular things about it that are worrying you? It’s worth talking through as well. Might also be worth considering a stretch and sweep to see if that will kickstart things naturally, and also to let you know what the starting point for an induction would be (it’s a very different process if your cervix is already dilated). FWIW in my experience induction is just fine.

Bottom line with growth restriction is that it brings a higher risk of stillbirth - from small, to still-small-but-bigger. There are basically no proven medical disadvantages to induction past 39 weeks so the thinking from doctors is often “why would you wait?”. However - that discounts women’s own feelings and experiences about intervention, which IMO is equally important.

Hopefully you can get things clarified so that you are comfortable with whatever plan is made - just keep asking questions and be open minded.

Gosh I’m sorry didn’t mean to ramble on so much!!

That growth chart is perhaps the reason for their concern as it does show a noticeable dip. Is your age also a factor perhaps (for example, are you over 40?)? Was the baby conceived through IVF? Perhaps those sort of factors were also a part of the concern.

Take the medical advice. If they want an induction for a medical reason: take it. If they aren't pushing it, then don't.
My induction was 10 days after my due date. It was terrible! But I am SO happy with my baby!

Just looked at your growth chart. Personally I would agree the induction.

I waited until 40+2 to be induced. Hospital mentioned about going earlier due to ivf but I had no other risks so wanted to wait to due date. My induction was positive 17 hrs from Pessary in to baby out. In your situation I would accept the induction.

Good luck

I'd have taken it to be honest. Especially where you are in your pregnancy. My induction was absolutely fine. I don't understand the scaremongering about induction.
Anyway, I would feel like I was tempting fate for the sake of 4 days to get to due date. Youre full term anyway.

Namechange30 is right that using the charts is a blunt tool. However the research and evidence shows that for the overall population it works. When they started using them properly and inducing because of growth concerns the stillbirth rate dropped dramatically. The evidence backs them up. Yes, there is always going to be individuals where the induction was unnecessary because 1 of the growth scanS was inaccurate. But I would go with the majority and assume it’s accurate and take the induction.

Thankyou. I am going to the midwife led unit today to discuss my book and chart to try and get some better info and I will phone my consultant. I am not over 40 and baby was conceived naturally. I haven't slept much because I still have 101 questions I will keep you updated x

Crazy - I’m glad you are going to speak to someone- hope it goes well. Please ignore all the people telling you not to take the advice of your doctors, the doctors have checked you and the random internet people haven’t! I had an induction and it was fine. Wanting to get to your due date is pretty meaningless when it is so close.