Anti interventionists; if you are overdue, at what point do you decide

[hobbgoblin]

that the baby is possibly better out than in and that one's overdueness is no longer perfectly natural and maybe there might be a problem. With my last pregnancy that went over EDD I was quite happy to wait as long as it took. With this one, I have more concerns because of earlier problems and am not as relaxed about it.

Am 40 plus 6 now.

My doctor told me. I live abroad and they monitor it as part of the ultrasound. It was the reason why I was induced, and it's very, very common post 40weeks. see here for more info

sleeplessinstretford I have experienced multiple first trimester pregnancy losses and I cannot imagine the horror of later loss. I am certainly not at all flippant about stillbirth. I cannot find anything in any of my posts to suggest that I am and I find your post arrogant and offensive. You could have simply asked for my evidence/research/reasoning.

My point remains that a statistical risk needs to be carefully weighed and women provided with all the information to make a truly informed choice for their baby.

Applying a one-size fits all approach to all "post dates pregnancies" (many of which are not overdue as EDD's are inaccurate) when the vast majority do not need it is clearly not responsible care-giving.

Further information and evidence-based, referenced research is below. I hope it helps someone.

Please consider being less inflamnatory with your next post - it really isn't necessary.
__

Abstract
Birth technology overuse is an issue of international concern for health professionals,
policy makers and families. In spite of the WHO recommendations that no country
should have an induction rate more than 10%, the rates of induction of birth have
doubled from 10% in 1989 to 20% in 2001 with very wide variations between
countries and institutions (WHO, 2001).
In order to provide baseline data about the use of birth technology and its impact on
morbidity and mortality, an exploratory descriptive study with
multi methodological triangulation was performed with a convenience sample of 200
primigravida women who gave birth in 2004. Approval to conduct the study was
given by the Human Subject?s Committee at JUST.
Data were collected using a self-assessment questionnaire, subject to pre-testing
through three pilot studies. Data were analysed using descriptive analysis, bivariate
correlations and structural equation modelling. Qualitative data were subject to
thematic analysis.
Findings
The majority of women (n=161, 81%) were induced, 27 (14%) had planned caesarean
section and 12 women (6%) gave birth spontaneously. Statistical modelling confirmed
that Induction of labour leads to significant morbidity for mother and baby (P=.068,
GFI= .925, RMSEA=.030, CI (.000-.047). Lower infant Apgar scores, admission to
ICU and readmission to hospital were significant outcomes (P

In the UK, the risk of stillbirth is about 1 per 3000 pregnancies at 39 weeks, 4 per 3000 at 42 weeks and 8 per 3000 at 43 weeks.

Also babies who go this post mature often have pre-existing issues which contribute to the mother not going into labour (which in turn contributes to the stats) So a significant number of these babies may have not survived for other reasons.

So mummysleepy - they do increase - but look how tiny a number that still is. 4 in 3000 does not relate to the 1 in 5 babies (20%) induced in this country - it does not represent enough of a risk to expose mother and baby to the risks of induction and assisted delivery.

Three extra dead babies per thousand is not nothing,having a forceps delivery is not pleasant but does not come half a percent near the utter devastation of a stillborn child. If your risk trebled/quadrupled of this happening then it's flippant to quote that more inductions are not an unassisted vaginal birth-if the baby is alive it's incomparable-and i still think the tone of my post was ok. Do you? Really?

Three extra dead babies per thousand is not nothing,having a forceps delivery is not pleasant but does not come half a percent near the utter devastation of a stillborn child. If your risk trebled/quadrupled of this happening then it's flippant to quote that more inductions are not an unassisted vaginal birth-if the baby is alive it's incomparable-and i still think the tone of my post was ok. Do you? Really?

That actually doesn't make any sense.

It seems to me that what you believe is that if all pregnancies were induced at 39 weeks that would save 3 babies per thousand. Nonsense.

It is clear to me you don't understand statistics. I urge you to read the Midwifery Today article above and grasp the relative nature of a very very small risk doubling. It is still a very small risk.

Induction is now affecting 1 in 5 babies and carries inherent risks to them, including fetal distress and neonatal death that is not included in the post term stillborn statistics.

If you take the view that any risk of any nature is too large then pregnancy, indeed life, is probably not something you want to engage in (yes, I risk being flippant there)

knowing that the risk of stillbirth increases past term was the only reason that I agreed to induction for 3 of my babies. 2 of them I waited until 14 days overdue and was induced. A 3rd I was recommended induction at 10 days overdue. I argued that I wanted to wait until 14days. The consultant said it was my choice but in his opinion the baby needed to be out. As it turned out the baby was born 5hours before I was due to be admitted. However, she was showing signs of post-maturity and had very little body fat. I believe that the consultant was correct in his assessment. I'm glad that the labour happened spontaneously but I'm equally sure that I would have been happy with the induction under the circumstances.
I wasn't willing for my baby to be one of those that make up the statistics for stillbirth if there was something that I could do about it.
14 days overdue was as much as I was willing to risk.

Thanks for recent posts.

I am in two minds about sweep tomorrow morning. The only thing stopping me is the risk I will inflict on the baby in terms of a birth that is more distressing for her when actually she may be nearly ready and come healthily and naturally in her own time.

I was prepared to go to 10 days over EDD but given early dating scans that has already passed.

I think stress may be preventing the birth. I am on my own with threat of a fast labour, and my birth partner/other help is not here with me. I doubt that is helping.

If it's any help, my second induction was no different to my spontaneous labours. According to the midwives that is quite usual for subsequent deliveries.

juuule, what method/s did you experience?

my first induction was 42weeks plus 2 days-hideous-gel,ARM etc etc.
2nd time they wanted to induce at +10days-had my sweep and booking in for the induction and i think the sweep kicked me off and then i just 'resigned myself' to it all being over and relaxed a bit and then went into labour the night before my induction was booked.
The sweep was enough to get me going as i was ready i think,i would have refused the drip as to be honest,it just is really unpleasant.
The 'best' advice I ever had was to ask questions re the interventions, ie, what happens if you do that in a day/half an hour and what happens if you don't do anything at all.
I know what 'lovebeingamummy' is on about but i don't think having an induced labour leading to potential forceps delivery can be compared to the sheer horror of what can possibly go wrong. The choice is up to you but if you know your dates then i would ask if they could 'sweep' and see if that kicks anything off. good luck.

Hobbgoblin,
1st induction was a pessary,
2nd induction was 2 lots of gel 4hours apart.

On a personal level I agreed due induction at +14 with my first (although I was confident that my dates were wrong - no early scan where I lived),

dc2 I hung out until +17 and I did start to have twinges that day but it was the middle of a huge baby boom so I was quite worried about not going in as they kept shutting hospitals and my dh doesn't drive! dd was an unexpected 10lb 6oz the cord was like rope, she had the highest grade meconium, wouldn't eat for 24 hours and they were obsessed with her blood sugars. The dr and mw were all very panicky at her birth I think the placenta was def at the end of it's operation. I was also very unwell after her birth but never was after the others don't know why though.

dc3 was induced on due date due to my chronic spd, severe antenatal depression. It was a bit of a nightmare as she clearly wasn't ready.

dc4 I agreed to induction at +14 because after 14 I couldn't have the homebirth I wanted, I think expectant management can be misleading as you know your baby is fine when you are there being monitored but 24 hours later can be too late? It was a fanastic birth still took 2 pessaries to get me going but very rapid after that.

Yes the risk of still birth is still small postdates but I didn't want end up being the 1 in 4 or 1 in 8 and end up unable to forgive myself.

I know too many people who have had still births, one of whom it was because she waited until 43 weeks as that was our hospitals policy 19/20 years ago.

Having had one child that suffered with undiagnosed silent reflux and was utterly miserable, didn't sleep and screamed for 4 months solid suddenly having a "perfect birth" just didn't matter as much, I wanted to have a happy healthy baby rather than to try and prove a point to the medics which was probably more my attitude before that experience.

I also wanted to add even with my 4th, 6 hours after the first pessary my bishops score was still only 1, I clearly don't seem to do "going into labour" then after the next pessary things did get more paiful but I went from 8cm to delivered in 3 contractions, it's quite likely I went from 2cm to delivered in less than 10 minutes! I think my body shape has something to do with they don't seem to sit on my cervix to help it dilate. Think I would have been an unassisted BBA if I'd left nature to it's own devices.

"Yes the risk of still birth is still small postdates but I didn't want end up being the 1 in 4 or 1 in 8 and end up unable to forgive myself."

That's how I felt about my inductions. Also know of someone personally who had a stillbirth past due date so obviously influenced by that.

exactly my point.thank god someone actually understands what i was attempting to say.

sleepless the other point you made about being relaxed etc I think is often a big key. It was only my 4th birth that I was relaxed about, I accepted that I wouldn't go into labour on my own before 42 weeks, accepted I wouldn't get my coveted homebirth, accepted that I'd have another big baby etc etc.

It was just a fantastic birth, yes it hurt and I was very pissed off after 6 hours of pain and my score was still 1, but I managed well on gas & air and the first thing I said was "is that it?" so yes an induction can be as straightforward and like a natural birth.

I also wonder how much of the significantly reduced mum & baby death rates is down to the increased monitoring and intervention. I'm all for getting induction and intervention down but it isn't as simple as you'll go into labour when you're ready and your baby will be fine.

hobbgoblin - how are you? Any news?

I would like to say that I do not and never did imply that risking having a stillborn child was better than having induction and possible assisted birth.

My issue is with misunderstood statistics being used to scare women.

"Yes the risk of still birth is still small postdates but I didn't want end up being the 1 in 4 or 1 in 8 and end up unable to forgive myself."

What I was trying to say that the 'risk' is vastly overstated. You are NOT 'risking being the 1in4 or 1in8.' You may potentially be one of the 4 in 3000 (if the 1958 statistics are correct).

Many MANY more babies and mothers than 4 in 3000 are harmed by the induction and what follows. So you are much MORE likely to be one of them.

I believe we need to be informed of the TRUE risk in order to make an informed decision - of being post dates AND of induction/Caesarean/assisted delivery.

Increased monitoring and intervention in labour has not significantly reduced maternal or peri/neonatal mortality (antenatal care has contributed along with better food, health and education). Continuous monitoring in labour has been shown NOT to improve outcomes. Only 8% (of or 30% national rate) of Caesareans improve outcomes. Only 10% of our 20% of inductions are deemed necessary by the WHO.

The reason this is important to me is because it is about the bigger picture - not whether one person had a good/bad/necessary induction - but what the policies are that are governing our births.

Statistics that are used to scare people who don't understand them to me is very wrong, and until we get more people able to understand that the vast majority of them would be safer NOT being induced and that you CAN still have your home birth if that is what you want - however 'overdue' you are (it is ALWAYS your choice) then NOTHING will ever change for the better for us and our babies.

Hobgoblin - I wish you the best for your baby and birth

Evening all.

I am very appreciative of the debate here because it is helping develop my understanding even if I am still deliberating over what to do!

I went for my sweep this morning but the midwife I saw was of a completely different view to the midwife who suggested a sweep in the first place and said "don't have one if you are not that keen". She was very relaxed and forthcoming and so said go and get a CTG done for reassurrance and wait a while.

So, that is what I did.

However, my CTG showed very little movement and a slow heart rate. Cue very concerned midwife who asked me to whip my trousers off immediately for an exam. Was told I'd need to have an urgent sweep if 'we can't get baby moving' and be monitored thereafter. After said removal of trousers I had a gush of fluid which disbelievingly I thought was waters but they now think was regular discharge. Speculum inserted at this point and I went on to have a huge contraction followed by reasonable movements and heart rate.

So, I've come home. With an undilated pretty un effaced cervix and the offer of a sweep and monitoring whenever I feel the need and drug induction Tuesday whatever.

I'm having sweep tomorrow morning. Still reluctant, but suitably worried - enough to feel that intervention is best at this stage.

Hi Hobbgoblin, eek sounds like a worrying appointment in that your now feeling pressurised to get induced on Tuesday and believing intervention is need due to 1 worrying trace

Ilove - sorry I used the wrong the words I meant 1 of the 4 or 1 of the 8 ending in stillbirth. Someone has to the those for or 8 Mums I didn't want it to be me. My hospital does not support HB after 42 weeks so if I rang them yes the mw would come but so would the ambulance to transfer me in, it was very clear on the consent form that would be the case. Birthing is not an exact science, it is risky and personal experiences of those close to you will always colour your judgement.

BTW I refused continuous monitoring, I refused to birth on my back perhaps I'm fortunate that my local unit is not big on c-sections and one of the consultants is very pro supporting womens choices in waiting for nature to take its course.

Hobbgoblin I look forward to a birth announcement in the near future!

Cargirl are you saying that hobbgoblin shouldn't have some concerns due to the trace? I don't think that she is being pressurised or misled to believe that intervention is needed. From their experience the medical staff sound mildly concerned and are informing hobbgoblin of that and recommending that the baby would possibly be better of born in the next few days (to be on the safe side?) It's still hobbgoblin's choice but she now has more information about how the midwives etc feel about the situation.
They have not said immediately and they are still trying for spontaneous within the next few days.

I think with reduced movements it will be silly to ignore what are becoming more worrying signs. Having said that, I was far more relaxed with my first post dates pregnancy and so didn't have any monitoring like this. For all I know, my healthy 10 days over baby would have had a similar CTG I just don't know because I didn't go for such an assessment.

Anyhow, I'm 10 days over again now and said that was as far as I was prepared to go so I am off for a bath before leaving for hospital.

Just hope the sweep does something useful before Tuesday.

Good luck, hobbgoblin.

Look forward to hearing your announcement soon! All the best. x

No I'm not saying anything of the sort, I'm saying she has had a worrying trace and understably now feels concerned that earlier intervention is necessary.

All the best hobbgoblin hope your bishops score is increasing!

Sorry cargirl. I obviously read your post the wrong way.