Inductions- why, when, refusing etc...

[Luckyelephant1]

Hi all

I'm a FTM in 2nd trimester and recently been reading up on birth options and plans, interventions etc. Doing a hypnobirthing course at the moment. I am very much hoping for a minimal intervention birth but of course I know that can't/won't always happen.

I'm just looking for some experiences regarding induction- when to accept, when to refuse, why are they offered so readily if there's no immediate risk, etc. Of course I understand that in certain situations an induction is necessary such as pre-eclampsia, waters breaking but labour not starting itself leading to risk of infection etc. I would never decline one if there was a risk to my baby.

But I'm talking about other situations where I seem to keep reading that they are almost handed out like sweets to anyone over 40 weeks when everything is otherwise fine with the pregnancy. Why? Has anyone had experience of this and declined and if so what happened then, etc. I don't want to believe certain things I've read like along the lines of inductions being offered to just get the mother in and out, another one done etc.

Sorry pressed post too soon. Or are they not as commonplace as I think?

I’ve put in my birth plan I don’t want to be induced unless medically needed for baby or my own health.
I’ve been doing hypnobirthing as well and they go into a lot of detail about it.

I have my 34 week appointment tomorrow, so I’m going to discuss it more wirh my midwife tbough.

I would never decline one if there was a risk to my baby
This is the problem. Risk is a sliding scale, its not a case of "risk" or "no risk".
Going over 42 weeks carries an increased risk of stillbirth.
Having an induction carries an increased risk of instrumental birth and other issues.
On balance many practitioners advocate that the risk of going over 42 weeks is greater than the risk of induction, so they recommend induction.
Of course for some women it is safer to go over 42 weeks because the induction will cause other damage. But they don't know that in advance, who it will affect and how. So they just have to recommend what they believe, on a population level, to be the better choice.
You may have other opinions and that is totally valid.
A

@Luckyelephant1

Sorry pressed post too soon. Or are they not as commonplace as I think?

I think its about 30% so very high.

I also think you’ll struggle with this-

I would never decline one if there was a risk to my baby

I would decline induction if I thought thought the absolute risk to baby given my specific circumstances was lower than other risks related to induction.

That aside I see what you mean. I would agree to induction if I had GD and baby was off the scale large (would not agree to induction based on a large baby with no GD). I would agree if placenta was failing and equally would agree with pre-eclampsia.

There’s a really good chapter in the better birth hypnobirthing book about inductions. Highly recommend. They also come from a place of not being anti intervention but making sure you can be as informed as possible about where induction can lead, the different types and the things you can do if you do need one to have a better outcome.

@ChocOrange1 no I totally agree. I think if I went over 42 weeks I'd agree to one for sure. I have read it seems they are almost routinely offered to those over 40 weeks though. When in some countries eg France. the normal length of gestation is measured as 41 weeks not 40.

I'm doing the PBC hypnobirthing course and while a lot of what she says makes sense I don't want to be one of those 'cult' followers who only follows what one person says without listening to other facts or points of view if that makes sense!

I refused to be induced until they tried a stretch and sweep first, very experienced midwife did it and waters went acouple of hours later.

Remember many other countries routinely scan placentas in late pregnancy to check their function etc this isn't usual here hence they opt for induction earlier.

Remember childbirth is risky for both Mum and baby - always had been and always will be. I say this not to scaremonger but I think there is a social media portrayal that from positive pregnancy test onwards you get this happy healthy baby!

@PinkPlantCase oh I may check that book out. I guess that's what I'm trying to say, is that I either come across views that are almost totally anti-intervention or very for intervention and doing what the midwife says, there's not much in between.

The PBC course has been amazing so far don't get me wrong but one thing I have been noticing is that she's very anti-intervention. If I was a less pragmatic person who did this course and then ended up with a less than ideal birth i.e. induction etc, I'd probably feel like a failure afterwards. I don't think I'll be like that but it's good to get views on why one would go for an induction if not entirely necessary. But I get that it's a sliding scale.

Birth is chaotic and unpredictavle. Plans are just designed to make you feel more in control. I’ve had my first abs went from home birth and hypno to going over 42 weeks and having an induction and c section- the opposite of what I wanted. But I also know of people who fought for natural birth after 42 weeks and had very sick babies or no one to take home at all. I wasn’t comfortable with that risk as it had take. Is five years to have him. I feel the natural birth movement snd the medics are at polar opposites and neither tell the truth- birth cannot be planned, predicted or controlled- no amount of breathing methods will change what your body will do and first time, with complications such as weight, age and gd does not help - I had all those :)

@Luckyelephant1 sorry for typos - fat thumbs.

Thats the thing isn't it @Angliski, while this natural birth movement thing makes sense, it's only good if everything goes to plan. If it doesn't its just another thing on top of a million other things that can make some women feel like a failure if their birth isn't full of candles and music.

Sorry keep pressing post too soon! @Angliski glad you had a healthy baby in the end, that's truly all that matters in the long run 😊

I “refused” an induction at 37 weeks, nobody batted an eyelid, my consultant was happy with my choice & we went through the risks together so she knew I completely understood etc. I was induced a week later because the situation changed. My induction took 6 days in total (although only one hour of labour start to finish) followed by a 4 night stay on the PN ward, so certainly not a case of getting women in and out.

My babies all went way overdue and were induced - waited until 40+17 with my 2nd!!!

Even with my 4th the pro waiting consultant discussed the reality of stillbirth (I have several finds who have experienced this sadly) and past 42 weeks I couldn't have a home birth anyway. So again induced at 42 weeks.

So all 4 induced, 2 took 3 pessaries and ARM but the others just 1 or 2 pessaries. They were all unassisted deliveries no tears and only one tiny stitch with my 2nd who was 10lb6oz - I'm only tiny 5' and pre kids size 6-8 hips!

I think being relaxed and realistic and going with the flow really helps. By the time I had my youngest I didn't carr about the worth just wanted a baby that didn't have undiagnosed silent reflux that screamed constantly- put Labour & birth into perspective!

Personally I think it's about having the confidence to ask questions of your doctors/midwives (I believe this applies to any intervention): why do you think this is necessary? what are the risks/benefits? am I or is my baby in danger? what would happen if we didn't do it? are there any alternatives?
I also think it's worth prepping your birthing partner to ask these things on your behalf in case you aren't able to or can't concentrate on the answers etc
I went with the approach that I would try and have as little intervention as possible but would take each step as it came. In the end my waters partially broke at 37 weeks but labour didn't start so I had a stretch and sweep which triggered everything without needing further induction etc.

The most balanced review of the evidence around induction that I am aware of is a book by Sara Wickham simply called inducing labour

I had gestational diabetes and was offered an induction at 38 weeks, baby wasn't too big (6lbs11) and placenta seemed to be working fine. However, it was my first pregnancy and i was just so excited to meet my baby that when she let me choose a day/time i went the earliest i could (38 weeks 9am). Looking back I think I was quite naive and hadn't really researched/read about induction. The induction went on for 3 days and 3 pesseries and ended with forceps and pph.
I'm too early in this pregnancy to know if I have GD but will be very reluctant to accept an induction at 38 weeks again. If all was ok I would ask for extra monitoring and wait another week. If baby is large or there are any other concerns I would ask for a csec at 38 weeks x

I also think it’s worth saying that 42 weeks is full term and that staying indoors can help baby in that final month with growth etc. I absolutely didn’t want an induction before then and he was really thriving. He’s off the charts massive on head and height and I wondered if anyone else who went past 42 weeks found they had a big one year old on their hands and if these things are in any way correlated.

Almost everyone I know who had an induction ended up with instrumental delivery and/or tears. But for me, as pp said- once homebirth was out the window and still birth was a higher risk, I was done.

I hope next time I will have a different experience.

I think the view ‘as long as you and baby are healthy’ is valid but I also think mums needs and concerns after birth are a bit overlooked. When else might you have had major abdominal surgery and no check up a few weeks later? Only birth?

IOL shouldn't ever be 'routinely' offered. It has it's own risks and those must be balanced against the risk to the mum/baby of doing nothing. Fundamentally IOL is primarily there to reduce the number of stillbirths but is sometimes offered if there are risks to mum due to their own health (heart disease for example). Locally we offer IOL for low risk mums from T+7 - T+10 but they are usually closer to T+10. It was reduced from T+14 in response to a locally high stillbirth rate. You can certainly discuss the local rates of IOL, stillbirth, instrumental deliveries etc with your midwife or consultant to help you make an informed decision. If you did end up on the IOL pathway you can still use your hypnobirthing techniques very successfully. It's well worth asking about wireless monitoring, that really helps to support hypnobirthing in a 'medicalised' setting.

I admit I come at it from a different viewpoint as a delivery suite and HDU midwife. I love supporting women whatever their choices and feel very strongly part of my job is advocating for them when I've understood their birth plan. If the plan is outside guidelines I just want to be sure they fully understand all the risks/benefits but then it is part of my role to ensure the whole team listens to and respects their choices.

I personally would not go past T+14 having cared for women who have suffered devastating loss, I cant forget that trauma. That however is my professional experience which does bias my opinion. There are always stories of women who go to T+14 and beyond and all is well. Guidelines are based on large populations not individuals.

With my first baby I was induced at T+10 and delivered at T+11. It was a 22 hour labour with a PPH and blood transfusion, I also had a very big baby. I didnt find it particularly stressful because it's familiar ground...but for many that would have been very traumatic. PPH is one of the risks of IOL but it was dealt with and I recovered well. This time I want to be induced at Term because my baby was so big and this one is following the trend, I'm making a judgement about my personal risk (shoulder dystocia vs PPH etc). I will discuss it with the consultant and then make a choice. I expect my choice to be supported as you should too, whatever that choice is.

I think it's great to have a plan and idea of how you want the birth to go and you seem open minded to the fact it doesn't always go to plan, so maybe have a think about what are your hard no's?

My first birth, I'd planned to have a water birth as was low risk throughout pregnancy. At 39 weeks my blood pressure sky rocketed and I ended up being classed as high risk so water birth out the window and I was induced and it was all over in 11 hours and no pain relief.

I think it’s really wise to have a plan and a balanced view. Tbh I tried the PBC and I just found it unrealistic. I had a baby in a very very awkward position and I did Labour spontaneously after a sweep, I was overdue and I would have accepted an induction at T+12 if my sweep hadn’t worked. My Labour didn’t progress and I had some methods intervention to help it a long which I fully consented to. I declined further intervention once my Labour halted for the 3rd time and asked for a c section, the team did try and talk me round but respected my wishes. I tried and I still felt empowered knowing I had chosen to stop pushing for a normal that I wasn’t achieving. The c section was calm and positive as not a true emergency it may have been down the line if we had pushed on and in another situation I may have tried further intervention but I knew for me it was time to opt out. No candles, no whale music, lots of intervention but on the whole a truly positive experience as I remained in control. I may have progressed to a normal delivery had a accepted further intervention but I knew for me I had given all I had and I wanted out😂

I had a midwife appointment the day before my due date and was offered a stretch and sweep for a week later, she then said if that didn't work they would pre emptively want to book me in for an induction at the 42 week mark. Inductions are always voluntary though and you can always decline and request close monitoring. So it might depend on what area you are and what that trust is more likely to offer and when, some may offer them sooner than others.

I feel the same as you and wouldn't want one unless I hit 42 weeks or if there was a sudden need to get baby out. There are also different forms of induction you can look at, I really don't want the drip and said this to my midwife and she said before the drip is offered there's a catheter option where they expand it i think, also pessary and gel options too. I would like to try anything before the drip really so might be worth looking into what the standard practice is for your trust in terms of what is offered when and structure your birth plan around that, and speak to your midwife about what sort of inductions are available to you so you have a plan A, B, C and D depending on what is needed. Fingers crossed it all happens spontaneously for you though