Induction at 38 weeks

[cheesychips15]

I'm sure there's been plenty of threads about this before but just wanted to see if anyone has anything else to offer.

I'm type 1 diabetic and have known all the way through my pregnancy that I'm almost certainly going to be induced at 38 weeks. I understand the reasons why - the placenta deteriorates more quickly in people with diabetes and the risk of still birth is massively increased after that point, so there's absolutely no way I want to push back on the medical advice and let things happen naturally, it's not worth the risk.

However, now I'm 34 weeks, the reality is starting to hit home about what an induction actually involves. Part of me is swaying towards asking if it would be possible for an elective C-section, but I want to make sure I'm asking the consultant the right questions at my appointment next week to plan the birth.

My main worries are:

• I'll need to be on the antenatal ward from the time the pessary is inserted til I'm 4cm dilated. This could take around 3 days, and my husband is only allowed on the ward 8am - 8pm, meaning I might be in the early stages of labour and having contractions, but he has to leave me on my own for 12 hours with no support. He'll also need to rush back to the hospital if I go into active labour during the night.

• Increased risk of emergency C-section and/or assisted delivery. I know the risks are increased anyway for induction, but I'm also wondering whether it's even more likely being induced early as baby just isn't ready to come out yet.

• Increased likelihood of needing an epidural. I'm not opposed to having an epidural if I need it, but I'd rather go for as long as possible without so I can move around and not be confined to the bed. I've heard that being induced is more painful than natural labour, so therefore worry about needing the epidural sooner, and the risks that brings.

I've got a list of questions to ask, but just wondered if anyone has any other suggestions of things I haven't considered?

My questions to ask the consultant:

• What percentage of inductions at 38 weeks result in emergency C-section?
• What percentage of inductions at 38 weeks result in assisted delivery?
• How long does it take, on average, between the pessary being inserted and active labour beginning, at 38 weeks?
• What percentage of inductions have an epidural, and how does this compare with "natural" births?
• What monitoring is done on the antenatal ward? Why can I not go home for the first 24 hours after the pessary is inserted?
• Is there any way my husband can be with me the whole time, and not sent home for 12 hours a day?
• What are the risks of having a C-section?

Sorry this has turned out to be much longer than I thought it would be, but if anyone has any advice I'd be really grateful!

I think these are really sensible questions to be asking, especially with covid cases escalating so rapidly, visiting restrictions for partners may get even tighter after Christmas looking at the way things are going.

They all seem like good questions. Having had an induction before I would say it's likely you'll want an epidural. It was wonderful. You can still move around a bit but I was so tired I just snoozed once it went in. Induction is so variable - it works so quickly for some and is frought with issues and you can't predict which camp you'll be in I am afraid.
I am 32 weeks now and have gestational diabetes and severe polyhydraminos and my consultant advised induction of labour at 38 weeks but I've had an induction before and it was OK but I had a nasty tear and vomited for about 10 out of the 24 hours it took for her to be born so I am booked in for a C-section as want to avoid all the complications associated with polyhydraminos (cord prolapse / abnormal position). There are pros and cons for both but I need certainty after a rough pregnancy!

I was induced at 38+6 (t2 diabetic) and it took 12 hours from pessary insertion to labour, and it came on very strongly all of a sudden. They advise it usually takes a few days for a first baby, but not always as I experienced, this is why you can't go home, and they will be monitoring your blood pressure etc regularly.

I had a vaginal birth with an episiotomy as they thought they might have to use forceps but didn't in the end. I wish I had requested an epidural from the start as there was not time to do it once the contractions started and things were progressing too quickly.

I was induced with DD1 at 38+0 due to SGA baby not gaining weight.

Pessary in on Monday lunchtime. Contractions every few minutes by midnight but no change in dilation (2cm).

Was given pethidine and slept through the night. No change in dilation the next morning (Tuesday) and contractions had stopped, but they artificially broke my waters to get things going.

Epidural upon request at 4cm some time in the late afternoon.

Gave birth 6am Wednesday morning, episiotomy and forceps delivery.

I'm 34 weeks and been told today I'll be induced at 38 weeks due to bub being under the 10th percentile and low Papp-a. I could have written this thread as I have the same concerns!!! I don't want to be on a ward in early labour for days on end and I'm scared about it :( but on the other hand, I'm keen to avoid a C-section!

I’ve been induced at 36 and 38 weeks and both were positive experiences. I had an epidural both times as the pain was a lot, but both times didn’t really feel like I needed it until I was about 4cm anyway. With my first epidural I didn’t top it up so was able to move and walk around just fine. Good luck. It’s hard not to worry I know, but try and remember that the reason they still induce women rather than going straight to a C-section is because most inductions are successful.

My husband was allowed to stay with me in room, they may have bent the rules a bit. This was May though so? I think stats on induction are 75% will go on to have vaginal births. (Could be US stats however). My doctor said birth usually occurs within 24 hours, not sure how true this is. Contraction 3 min apart for two or so days but felt like a bad period, sometimes I barely felt at all. Not sure why some are hesitant on c sections. Mine was about 20 minutes. Up and about gently in about a week. Daughter was suckling before they'd finished sewing me up. The BF thing is hit or miss it seems, so i dont think moms should be torn up over it IMO.
Wasn't allowed to go home after initial induction, but the monitoring wasn't overbearing and I could watch myiPad, walk in the little garden, etc. Listened to many labors and cried with joy when it ended in a baby letting out its first wail. Some things you just gotta roll with. You and your little one will be fine and enjoying the new year soon. Xoxo

I've had 3 inductions.
One at 38 weeks which took 3 days but was in delivery room after 1st day on drip and with epidural in. It wasn't enjoyable but not too bad and like you it was all through medical reasons which I didn't want to ignore.
One at 40 weeks which actually when they went to put pessary in saw I was already 3cm so sent me to delivery room instead and they popped my waters as a method of induction and that labour was something like 8 hours from then but also had epidural.
Last one was at 36+5 weeks and from the second the pessary went in my contractions started and baby was born around 10 hours later using nothing but gas and air from 8cm onwards. It was an absolutely amazing experience that one.
I would love to go naturally this time just to experience the excitement of going into labour but if I have to be induced again then so be it. Its all just a method of ensuring baby arrives as safely as possible. Don't let any induction horror stories put you off. I'm 1 person with 3 totally different experiences so it all just depends on the baby and your body at the time. Good luck with it all 💕

I was induced with all 3, first at 40 +5, second at 41+6 and 38wks with my son. All labours were good, quick, no intervention no pain relief and pretty quick. With my first I had the pessary at 8am, waters broken by consultant at 12pm, baby here at 1424!!

Your questions sound very sensible, and I think the key is also to try and understand their overall approach (if it’s possible to ascertain such a thing!). At the hospital where I had my last two births, they were quite clearly led by maternal choice, so for instance when I asked about my husband joining me a bit later (as in, not arriving at the same time as me for the induction) they said it was totally fine and also that they wouldn’t do anything without my consent, so eg if DH was held up and I didn’t want to start the induction then they would wait. For me, that was an example (among others) of a positive culture there that focuses on the women in their care.

FWIW I have had 3 inductions, all a bit different, and all positive. I had an epidural for one as I was escalated to going on the drip, and had been recommended by others to get an epidural before placing the drip as it’s much easier to place at that point and the drip does make things much more intense. I am glad I followed that advice and it was all quite calm and collected. With my other two inductions (one with pessary, one with gel) I used gas and air and that was sufficient for me, same as with me spontaneous birth.

I hope it all goes well

I’ve had an induction during the restrictions. The worst bit was staying in hospital after the pessary but I wasn’t allowed any visitors until active labour. I honestly think I’d have been fine with those visiting hours. I slept like normal and had no pain. My partner was called before I went to get my waters broken and they waited until he arrived. I didn’t need any pain relief and only took about 6 hours of ‘active labour’. I’m sure not all inductions are straightforward but mine really wasn’t horrible.

I was induced at 38+2 with DC2. Was basically the same pattern of labour as my spontaneous first delivery.

I just had the gel which triggered natural labour. It did end up with an easy ventouse/episiotomy but so did my natural labour although I tore on that one (obviously something about my build)...

Was about 24h from gel to baby in arms, had second gel 8h later then followed my usual no dilation to all the dilation in approximately 1 hour - big plus of induction was that this wasn't in the car but bouncing on a ball in a bay in the hospital (I was an extra as reduced movements plus big baby).

Major tip is bring stuff to do, so you can flit between them. DH ended up bringing a Lego set which was great to just do to keep busy. Also phone games (bring charger, long cables and battery pack).

The questions you have asked are very good. I wish I asked those questions before I had my daughter. Although I can't give you the figures you want, I can possibly shed some light on my own experience:

I was diagnosed with gestational diabetes (GD) and was on insulin once a day, together with metformin. I was taken to the induction ward bang on 38 weeks (top tip: if being induced, take diabetic friendly food as hospital food tend to not cater for diabetics).

I was induced using the gel thing three times with very little progress. I was then advised by a consultant that they used their discretion to give me a fourth gel - again no progress and no contractions. I was in the induction ward for a total of 37 hours.

I was later taken to the delivery room where my waters were broken and placed on the hormone drip. This got the contractions started but labour progressed very slowly and I opted for an epidural. After 20 hours I was ready to push.

Almost two hours of pushing later (which honestly felt like only minutes) I was told baby wasn't coming out (head had moved slightly) and I'd have to have an emergency c-section.

23 hours after my waters were broken and more than 60 hours of being in the hospital - my daughter was born.

If I am perfectly honest, my experience left both my husband and I traumatised. We had our first child so never in our wildest dreams imagined having to go through so many emotions.

I do feel that my daughter was not ready to come out at 38 weeks, which I do believe was the reason for the C-section in the end.

But I have to stress, all experiences are different and I have heard of similar women who have been diagnosed with GD, induced and had a natural birth.

Also your point about not having an epidural as you don't want to be confined to the bed: unfortunately if you are being induced and are diabetic, you will be confined to the bed as you will have to have a hormone drip inserted. I had to stay on my hospital bed as I was connected to three dips: one in one arm and two in another.

Again - all information I wish I knew before going into labour.

@AnaBananas

Also your point about not having an epidural as you don't want to be confined to the bed: unfortunately if you are being induced and are diabetic, you will be confined to the bed as you will have to have a hormone drip inserted. I had to stay on my hospital bed as I was connected to three dips: one in one arm and two in another.

Again - all information I wish I knew before going into labour.

Sorry - meant insulin and glucose drips. I had both, together with the hormone drip

I was induced at 40 weeks and 36 weeks (twins) both times I had a quick labour. Baby/ babies were born within 6 hours of the pessary being inserted. No drip needed.

I had an epidural with dt highly recommended.

Being on a drip doesn’t necessarily mean you can’t move around, I was connected to two drips and requested to be able to move. They hooked me up to non wired monitors for me and baby and moved my hospital bed so I could still use a birthing ball while being connected to the drip. I was moving around until the last 10mins. My midwifery team were amazing so I’d definitely talk it through with them and see what they can do.

Sensible questions. The epidural is your friend.

I had an induction which began 34+4 due to severe intrahepatic cholestasis of pregnancy (I also had GD). It was June 2020 so partner not allowed to enter the hospital with me at all until active labour. That sucked. I was in for a week and saw him on 1 day, for almost all of which I was in horrendous labour.

Went in Sunday night, pessary went in early Monday morning, 2 days waiting around, not much pain at all even though there were some sort of mild contraction type feelings now and then. Wednesday middayish started me on a drip and broke my waters. I don't think I was ready but my blood test results were getting worse.

I hadn't planned to have an epidural but I absolutely needed it! I wish I had requested it sooner because the 20 minutes it took for the epidural woman to come were the longest, most torturous minutes of my life and I wanted to die. Then it didn't work on the right or central part of my body! There was no time to correct the issue by then. Terrible but my left side felt great!

My top advice would be don't be a hero and take the drugs as soon as you want them! But as I said, I think they rushed the process for me which may have made it worse. My baby had already passed meconium even though he wasn't yet 35 weeks (a consequence of my condition) so I think it was necessary. I was warned I may have to have an emergency C section, which I didn't want because a vaginal birth would likely help clear his lungs of poop!

I had an episiotomy and forceps in the end and he was born perfectly healthy at 1am, 35 weeks exactly 🥰 All worth it.

@AnaBananas

Also your point about not having an epidural as you don't want to be confined to the bed: unfortunately if you are being induced and are diabetic, you will be confined to the bed as you will have to have a hormone drip inserted. I had to stay on my hospital bed as I was connected to three dips: one in one arm and two in another.

Again - all information I wish I knew before going into labour.

I've already spoken to the midwife about being able to move around and she said the monitoring will allow me to move and I'll actually be encouraged to get out of bed to help things along.

I'll also be able to control my own diabetes until the pushing stage - this is probably a difference with type 1 and GD. I've had 25 years experience controlling my own diabetes and my control has been spot on throughout my pregnancy so there's no worries there.

Thanks everyone for sharing your experiences. It's nice to be able to read induction stories that aren't absolute horror shows which is what most of the internet seems to be filled with. Although I still can't believe how casually people have said "oh yeah I had an episiotomy and forceps, had a tear but fine after stitches" when I'm literally kept awake all night by the thought of 4th degree tears from forceps, but I guess the imagined is always likely to worse than reality for this!

Got my appointment on Thursday so will come back and update with answers if I find out anything useful!

I'm T1 Diabetic and had a baby back in April. For the same reasons as you (plus my baby was tracking large for gestational age) I opted for an elective section. It was a great experience and was lovely and calm. Being diabetic, I was first on the list so didn't have to wait for long at all. Baby was lovely and healthy, didn't need glucose after birth. She was 8lb 10 though! The section was at 38+1.

I'm now pregnant with my second which is much sooner than anticipated. I'm again going for an elective this time round, partly due to the risk of rupture but I had such a great experience last time x