Should I have an induction over 40 pregnancy!

[Mummy2B1983]

Hi all!

I wanted to get some opinions!

I am an over 40s first time mum to be, due in September.

My midwife said I'll be offered the option of an induction if baby isn't here by the due date.

I have heard good & bad things about inductions so unsure what to do! Baby may come early and in which case it wouldn't matter but I have heard a lot of people say 1st time babies are late!

Any responses would be welcome! X

Personally, I'd just wait for baby to come when they are ready, even if you do go overdue

What is your gut instinct telling you to do?

I actively chose induction, FTM also aged 40+. Was offered C-section but I wasn't keen on the potentially longer and more difficult recovery physically. I had heard horror stories about inductions and some people were very negative about my choice, but I wanted to at least choose when to start labouring. You've got to remember people are more likely to tell a horror story online than a positive one.
My induction was perfect - painful for sure, but I was well looked after, baby constantly monitored, and he was born safely after a reasonably short labour and pushing phase.
My only tips would be to remember induction is a process with different steps where you can make individual decisions that work for you, and to get the epidural before the drip (if you're going to get the drip).
Best of luck making your decision x

I would only accept it with an epidural

Ps statistically 50% babies come late and 50% come early!

everyone has a differnt pain threshold so OP might not necessarily need to have an epidural during her induction if she has to have one.. i ended up on drip eventually to get my contractions going & even at full notch i managed on just gas & air... personally if i were you op for now see how things go & if baby isnt showing any signs of coming nearer to your due date then maybe consider following their advice on an induction, hopefully you wont need to go down that route though, goodluck! x

Ask your midwife and doctor about risks and options. I had my second baby at 41.

The big risk was the increased risk of stillborn but % wise it's still a small risk but increased for us over 41.

When I mentioned to my midwife I didn't want to be induced she offered that I could come for daily monitoring at 40 weeks so there options.

For me - I didn't want to expose my baby to any additional risk. I took an induction on 39+5. During the induction there was concern for my baby and was moved quick to a c-section and I my son arrived safely and heathy.

I felt that I had really good care - once I was on labour ward - I had a lot of attention from senior staff and quick choices.

My induction was fine, pessary the night before did nothing, waters broken at 8.40am, labour started straight away, fully dilated by 10.30am, and baby born at 11.30am. But I think my body just labour's very quickly, my second wasn't induced, laboured Naturally, slight pains for a couple of hours, went to hospital as I was worried about it going very quickly again , was sent home at 7.30pm told that labour wasn't even close, I was back there at 9.30pm 5cm dilated and baby born at 11.23pm. Surprised them all that night.
Truth is you don't know how your body will react to the induction, I'd wait until I went over and hope baby comes naturally. Good luck op

Thanks for the advice everyone! 👍👍

Trigger warning

I think what a OP had said about daily monitoring is a good option. I gave birth at 37 and 39, each time I opted for an induction. The first due to reduced movements, and the second I can't even remember why now. Both times I accepted, mostly because of the knowledge of a close-friend who was 41 who had a stillborn. It had made me very frightened of going over the due date. I almost died as a baby too, because the placenta had stopped providing proper nutrients (they wouldn't believe my mum when I had been conceived and dated me wrongly).

Both my inductions were different, one was long, the other an emergency section. I'm sure waiting for the baby to be ready is a great idea but I was too anxious. I think speaking to your midwife about the risks and doing some research is a good idea, then see how you feel.

What they said^ and you want the epidural in before they hook you up to one of those bastard drips. Contractions on those are NOT like normal contractions. The difference between contractions on a drip and natural contractions are like night and day. I’ve had two babies with no pain relief whatsoever and the induction on the drip was horrendous. Much worse than my first labour

Statistically, that’s nonsense.

In your shoes I'd opt for an elective section.

I had two inductions- first time was longer and more painful as you'd expect. I'd really wanted to experience natural Labour with DD2 but doctors said they couldn't recommend it and altho I'd read everything about making decisions, I couldn't risk my baby so I took their advice and I'm not medically trained. That was the crux for me

I was 41 when DD2 was born last year, they would have left me to go to 40 weeks, but ended up starting induction at 39 weeks due to other factors on top of the age issue. It was a long process as the labour ward was short staffed, so I waited around for 6 days before my waters were broken. We had issues with her heart rate, so whilst it was frustrating had I not been in having the daily monitoring it wouldn't have been picked up. I refused the epidural, did ask for it when the drip got too much, and as they were prepping it I suddenly went from 3cm-10cm and so it was too late. It wasn't the best experience, giving that DD1 came on her own at 40+5 with no drama, but I'm 100% glad I wasn't at home not knowing there were any issues. So personally I'd just go with what they advise

Get an epidural first if you need the drip. I cannot emphasise this enough.

Hi OP, fair warning that my post is all anecdotal and not data! But - my older sister and 3 of my close friends who had inductions all ended up with emergency c-sections. 3 were due to baby's heart rate dropping dangerously low, one was mum's blood pressure was repeatedly dropping - when exhausted on day 3 of labour!

Inductions are often proposed as no big deal, but from what I've seen it's not a straightforward process and things often don't go to plan.

I haven't been induced, as said I never would go there. I had my 2 kids at 37 and 40, the first was a natural water birth and the 2nd was an elective c-sec. There won't be third (!) but if there was I'd choose ELCS every time. Having done both, I'd MUCH rather recover from a nice clean incision on my tummy than from mother nature's messy tears to my nether regions!

Plus I do believe that the risks to baby from an ELCS delivery are much less - it's so quick there's no chance to get oxygen starved or anything like that. But you could ask about data on that point?

Wish you all the best whatever you choose - and congratulations! x

Induction isn’t ideal. In fact, since the NICE guidelines changed on Induction of Labour the number of instrumental and C sections has gone up. Which are generally poorer experiences for mothers.
Outcomes for babies haven’t changed.
So think very carefully and speak to an experienced midwife.

elective C sections whilst maybe being less stressful for mothers, do prevent babies going through the birth canal which is of great benefit to their microbiome and has long term health benefits. Again speak to midwife.

I was 44 when I had DS (my only) and chose to be induced on my due date. The pessary did nothing but once the drip was in contractions went from zero to full on quite quickly - I had an epidural in the end as it was too much for me to handle.

I was not over 40 so don't have that risk factor, I was recommended to be induced as my waters broke but labour didn't start immediately and I was positive for group B strep. I was 39+5, I'd planned to personally decline induction and ask for monitoring instead of I went overdue but was still happy with babies movements, not accept induction at 40+2 like my hospital advise, I found their induction rate to be very high.

They would induce with the drip and we're very honest and said the chance of ended up in theatre with either assisted delivery or c section is high, hence why you can't eat or drink anything but water on the drip. I declined for 24 hrs since I was having antibiotics IV for the strep, but accepted after that. I did struggling being hooked up to wires and the monitor I couldn't move very far from the bed and had to use a commode. After 2 hours contractions started and we're immediately 3 every 10 mins which was a shock, I soon asked for gas and air. After 6 hours of contractions every 3-4 in 10 mins I was only 3-4cm.dilated so they recommended epidural to relax me or c section as not progressing, I wanted to avoid epidural for the risk of increased assisted delivery again but I was really struggling with the pain so agreed to it. Had it placed fine and then went from 4-10cm in less then 3 hours! I could feel a huge urge to push and found my body pushing itself, 20 mins pushing stage and baby was born very nicely! I could also move my legs even with the epidural so could move into a slightly better position than on my back.

So although I found the drip very painful ultimately it went well with epidural, babies heart rate did drop towards the end and they turned the drip down and she was fine after that.

There isn't a great deal of evidence for that; it's a bit of woo championed by "normal birth" fanatics. However, elective sections are a great way of preventing pelvic floor injuries and long-term damage, which will have a direct impact on mum's recovery and longer-term pelvic health. Plus, the risks of babies born in poor condition is much higher with drawn-out labours and emergency sections.

@MostlyBlueberryFlavoured said "However, elective sections are a great way of preventing pelvic floor injuries and long-term damage, which will have a direct impact on mum's recovery and longer-term pelvic health."

I don't mean to derail the thread but there is also little data to show that C-section reduces the risks of pelvic floor dysfunction to any statistically significant level, so this is a bit misleading.

There is a little bit of information here

"The EPINCONT study collected data from over 15000 women and it showed that regardless of mode of delivery, by the time we reach 50 years in age rates for urinary incontinence are the same for both vaginal delivery mums and c-section mums. (Rortveit G et al 2003). This was further supported by Cacciatore A et al 2010."

And then the paper here shows how contested this is - it concludes that pregnancy itself has highest impact on pelvic floor, with only minimal data to suggest vaginal birth has significant impact Here

"This review of published literature suggests that pregnancy itself is likely to lead to some degree of pelvic floor dysfunction regardless of mode of delivery although urinary and anal incontinence although may be increased following vaginal delivery." (Emphasis added)

During C-section they do move your bladder around and put all kinds of pressure on your body, it's not a non invasive procedure iykwim.

All this to say that pelvic floor health is not (and this is just my opinion by the way, so I understand if people disagree) high high up the list in terms of decision making when it comes to mode of delivery because it's just so unpredictable. I'd be thinking about risks to life of baby and the data around that (which is much stronger than the data around mode of delivery and longer term pelvic health).

It's really personal choice if someone chooses C-section or induction at this point in pregnancy, if that makes sense! I think we're all on the same page with that.

Best of luck making a decision OP I hope it goes well whatever you choose - will you update?

@Nell80 Your post is interesting to me, but I'd dispute that study based on the fact that it doesn't distinguish between emergency and elective c-sections.

I think if you have been in active labour for a long time - as is the case in many emergency c-secs - then that's when damage can be done to the PF in delivery.

Whereas if you have an elective and are literally never labouring, never dilating, never bearing down, then I believe damage would be very minimal.

I sustained 'permanent PF damage' due to a birth injury with DS1 and had a consultation with one of the senior OBs at UCLH afterwards to help process what happened and he wrote a letter for my file saying that for medical reasons any future births should be ELCS to avoid worsening the damage.

So he was pretty expert and definitely believed that delivery method would make a difference!

I haven’t read all the replies. I wouldn’t recommend an induction if the only reason for it is being overdue. I’d advise looking into the cascade of interventions. I also don’t personally believe that overdue is after 40 weeks. Term is anything from 37 to 42 weeks and due dates can be very inaccurate anyway. I stress though that this is my view from experience and I’m not quoting anything official.

A PP mentioned pain thresholds being the reason that some people need an epidural with inductions. I think this is absolute nonsense and can make women feel shit about themselves. Your body can react very badly to the synthetic hormones involved with an induction. Not everyone will react the same way, it’s nothing to do with pain threshold. I could go on but I don’t want to be too negative.

Good luck with whatever you decide.

That paper was a synthesis and review paper so it looks at multiple studies and talks about a balanced overall view - not just one study.

I'm sorry to hear about your injury, it sounds awful and I'm glad the consultant was so helpful and wrote that note for you on your file. I hope your recovery was OK and that any future births are less traumatic.