To induce or not to induce

[Tiltedclone]

A recent growth scan shows that my baby’s stomach measurement has dropped and is no longer in line with the other scans I’ve had. A follow up scan showed that the cord, placenta and heartbeat were all fine but the Dr has suggested an induction due to the stomach measurement. The midwife has advised that I’d be ok to continue without the induction to see if things progress naturally. I agreed to the induction which has been booked in for this Monday (40+1), mainly so I had options.

I had a sweep on Monday which resulted in a bloody show on Wednesday and I’ve been losing my mucus plug since. I also had a second sweep on Thursday, I was having irregular cramps/pressure that evening and was sort of convinced it was early labour but woke up yesterday feeling fine lol.

During my sweep on Thursday the midwife said I was about 3cm and that my cervix was really soft but still thick and that baby’s head still had to move down, since then I’ve tried every trick in the book to try and get baby moving lol.

Now I am torn, I have experienced an induction before and so wanted a natural labour this time round. I LOVE being pregnant and I have moments where I struggle to come to terms with the fact it could soon be over, more so when an induction would mean that I’ve essentially chosen to end it sooner (if that makes sense!). But, I obviously don’t want to risk my baby’s health. However, pretty much the same exact same thing happened with my son, his stomach measurement came back smaller and I was induced the next day at 40+4, nothing ever came of it.

I guess I just need to talk it out. One minute I’m happy with having an induction and the next I just want to carry on for as long as possible just to see if baby comes on their own but I don’t want to wait it out for it to end in an induction anyway!

The best case scenario would be to go into labour this weekend lol I’ve been booked in for 3pm on Monday but it depends how busy the labour ward is as to whether I even make it up there from the antenatal clinic!

Why does the stomach measurement mean baby should be induced? I would ask for an alternative, i.e. extra monitoring (which is the NICE guideline as an alternative to induction) and wait for natural labour or reassess in a week.
Disclaimer: first pregnancy here but been reading A LOT about birth and birth choices etc and literally just read that about induction vs. monitoring today
Good.luck OP!

Thank you for replying!

I think the advice to induce comes from the fact the baby’s abdomen has measured consistently along one line and then at a recent scan had dropped down a line or two so there’s worry about fetal growth restriction.

I’ve also been reading the NICE guidelines and I think it suggests that increased monitoring is offered if induction is refused by the mother when they are 42 weeks or over. If I refused induction at 40+1 I’d just have my weekly midwife appointment as standard where they’d probably discuss induction at 42 weeks with me anyway lol

I’ve done the positive birth company hypnobirthing course this time round I feel like I might have too much information available lol last time I just followed whatever the Drs recommendations were at the time and didn’t research anything further.

I wish they could say well if you refuse the induction on Monday you’ll have the baby naturally on Thursday anyway 😂

All I would say to you ( & I have only had one induction ) my doctor - lovely woman - said to me - you have only one job & that is to get your baby out as safely & healthy as you can - so don't come come back to me whinging because you had to have an intervention . I do get what you are saying about a natural birth - I wanted one - but I had induction & then a Ceasarian - DS is healthy and happy & I regret neither. ( not sure if that helps) but I wish you all the very very best for a healthy child however it works out ( which I do think is the most important thing ) But I can't help much in the way of saying delay induction or not .

My induction was horrible (preeclampsia - I'd had high BP for a couple of weeks but every time I got checked at the hospital, it had come down again) - baby just wasn't ready and as it went on, every intervention they made meant I needed another intervention a bit further along. I narrowly avoided forceps and had a team rushing in to do it when the midwife told me to ignore them and just get my baby out. I know you've had an induction before, but after mine, I would now do everything in my power to avoid the drip (even consider a caesarean...)! Extra monitoring sounds like a much better idea, especially as baby seems fine in general and there doesn't seem to be any 'emergency' health risk to you both. Growth scans are notoriously poor. I had a scan on my due date when they said baby was looking "a bit small" which then triggered other checks, leading to induction and birth at 40+1. He was 8lb on the dot.....

This isn’t baby looking a bit small though. This is a change in established growth - these two things are entirely different.

One of my twins had IUGR which wasn’t picked up (it was clear on the scan charts that some measurements had dropped below 5th centile, I have no idea why nothing was done). I went in at 35+1 as I thought I was leaking fluid and felt unwell - he had stopped moving and I had no idea. I had an emergency caesarean right away. They never did find out why, placenta was normal. He was 25% smaller than DT1 and spent 2 months in NICU with a rare condition often linked to IUGR.

IUGR can cause so many medical issues, and increases the risk of still birth. At full term I would be wanting the baby to be born ASAP. I hope they also told you that an elective caesarean is an option if you don’t want an induction - after the recent Ockenden report, trusts should be ensuring you are aware of all your options and can give informed consent, especially around induction.

Not saying any of this to be scary, just to help you understand why this is the recommendation and what can happen. Keep a close eye on movements too, and call if you have any concerns so they can check things out.

Thank you all.

All the other measurements have been fine, if anything baby is on the ‘larger’ side but nothing to be concerned about.

I only ever spoke to a midwife who when I asked why they’d consider induction if everything else was fine she just said it’s because of the stomach and didn’t go into any detail about what a drop in measurement meant, in fact I felt like she was hinting for me to refuse the induction and carry on but I don’t think they can just come out and say that can they? I’m probably reading too much into it lol she did say that she could try and get me an appointment with a consultant but it wouldn’t have been soon as it depends how busy they are 🙄

My instinct now is telling me to go for the induction tomorrow. If I refused I’d probably only be booked in for one after next weekend anyway as I’ll be approaching 42weeks and I don’t want to go for increased monitoring after 42. I’m going to take some questions with me tomorrow and hopefully if they give me some more info and if there’s no concerns about the baby’s health they won’t get too pissed off if I change my mind at the last minute! Fingers crossed they do an examination and say I’m merely hours from giving birth naturally 😂

All that being said, I will be happy to have an induction, I sort of know what to expect and know they are more painful and can be more complicated than going into labour naturally but I’d rather baby be safe. I’m just a bit sad that this is probably going to be my last pregnancy and I haven’t experienced what it’s like to happen spontaneously.

Thank you also for the well wishes!

It’s really crap that they haven’t given you much information.

Basically, babies should continue to grow until they are born, so if your baby has been growing at a particular rate (say 50th centile for all measurements) and then one or more of those measurements drops it suggests their growth has slowed and that they are not doing as well as they should be. There may be a problem with the placenta but it’s not always possible to tell this from a scan.
If this happens earlier then it’s about assessing the risk of premature birth vs continuing with them not doing so well. Once you are full term, the risks to the baby of continuing the pregnancy are higher than the risks of them being born as soon as possible. Obviously you also need to consider risks of induction/ caesarean compared to a spontaneous vaginal birth. It’s really difficult to make these decisions when you haven’t been given the information you need.

There’s some good info here from Tommy’s

www.tommys.org/pregnancy-information/pregnancy-complications/fetal-growth-restriction-intrauterine-growth-restriction

Obviously I don’t know how much the measurement has dropped etc, but after my experience if there were any hint of growth restriction I would opt for birth ASAP. You might decide to make a different decision.

I do understand not wanting to be induced and if I were in that situation again I would request a caesarean, but we all have different feelings on this.

If I were full term or over and monitoring showed that everything was going really well then I would avoid induction / caesarean too, but in this situation I wouldn’t wait.

@Titleclone - I haven't had a natural birth and 24 years later I am just happy DC is healthy and safe and doing well. I thought baby being well and healthy was more important than my imagined perfect birth. But It is not bad to not have had the birth you wanted - but I just thought - a bit of perspective was worth it.

Again - I hope you enjoy welcoming new DC into the world as best as possible.

Thank you everyone for your advice, it’s certainly helped out everything into perspective. I’m in hospital now and they have started the induction process with a Foley Balloon, they were going to go straight in and break my waters and put me on the drip but the labour ward is very busy apparently so they thought the balloon would help make my cervix more favourable (it’s very soft and about 4cm but still thick).