Correct time for induction?

Hello again,

We are now at 38 weeks and waiting for baby to arrive any time!

However, I know of a tragic case where baby was alive and kicking in the
evening, but had died before the induction next morning! The placenta had
simply become exhausted.

My question therefore is, at what stage is it advisable/appropriate to have
labour induced?

Many thanks.

best advice is around the 14 days over the due date - this gives the
best chance of spontaneous labour - which gives best chance of normal
delivery, yet delivery occurs before there is an increase in still birth
rates [at the term plus 21 mark it starts to go up - but still v low]
If a diabetic, then usually much earlier.
There are always tragic cases, but they are rare.
helen
In message , Lorenzo
writes
Hello again,

We are now at 38 weeks and waiting for baby to arrive any time!

However, I know of a tragic case where baby was alive and kicking in the
evening, but had died before the induction next morning! The placenta had
simply become exhausted.

My question therefore is, at what stage is it advisable/appropriate to have
labour induced?

Many thanks.



--
Helen Johnson
http://www.familyfrench.co.uk/nappies/index.htm
http://www.familyfrench.co.uk/elinor/pod/index.htm

"Helen Johnson" wrote in message
...

best advice is around the 14 days over the due date - this gives the best
chance of spontaneous labour - which gives best chance of normal delivery,
yet delivery occurs before there is an increase in still birth rates [at
the term plus 21 mark it starts to go up - but still v low]

Personally, I'm not really for arbitrary induction unless there is a reason
to suggest it is necessary. BUT, there is no way, NO WAY, I tell you, that
I'm having another 5 weeks of pregnancy.

Frankly, if they offered me induction now (38 weeks) I'd have a hard time
turning it down.

Nik

Well, I know of the same case, but usually the doctor would know the
answer to that question. Women who lose their baby like this are most
often high risk pregnancies or at least have had some sort of
complications. In most cases if your pregnancy is uneventful then you
should at least wait till 40 weeks.

Good Luck

Mona

Lorenzo wrote:
Hello again,

We are now at 38 weeks and waiting for baby to arrive any time!

However, I know of a tragic case where baby was alive and kicking in the
evening, but had died before the induction next morning! The placenta had
simply become exhausted.

My question therefore is, at what stage is it advisable/appropriate to have
labour induced?

Many thanks.

I am also 38 weeks at the moment, but only stopped work last friday, so
looking forward to a week or so before go into labour! Homebirth for me,
and would fight against induction except for strong medical reasons!
takes all sorts
Helen
In message ,
Nik&Andy writes

"Helen Johnson" wrote in message
...

best advice is around the 14 days over the due date - this gives the best
chance of spontaneous labour - which gives best chance of normal delivery,
yet delivery occurs before there is an increase in still birth rates [at
the term plus 21 mark it starts to go up - but still v low]

Personally, I'm not really for arbitrary induction unless there is a reason
to suggest it is necessary. BUT, there is no way, NO WAY, I tell you, that
I'm having another 5 weeks of pregnancy.

Frankly, if they offered me induction now (38 weeks) I'd have a hard time
turning it down.

Nik



--
Helen Johnson
http://www.familyfrench.co.uk/nappies/index.htm
http://www.familyfrench.co.uk/elinor/pod/index.htm

Lorenzo wrote:

Hello again,

We are now at 38 weeks and waiting for baby to arrive any time!

However, I know of a tragic case where baby was alive and kicking in the
evening, but had died before the induction next morning! The placenta had
simply become exhausted.

My question therefore is, at what stage is it advisable/appropriate to have
labour induced?

It's always a judgement call. There is no time in pregnancy
that is perfectly "safe." Pick any time, and you can find someone
who tragically lost a baby at that time with no warning. The earlier
you push induction, the fewer babies who will die in utero--but
the more babies and mothers who will suffer complications resulting
from the induction (directly or indirectly). Inductions, even at
term, are not risk-free. One must always balance the risk of the
induction against the risk of doing nothing. Fortunately, the risk
of babies dying in utero at term with no warning is blessedly tiny.

The difficult challenge with this is that a lot of research
in the area is poorly done. If you look only at the number of in
utero deaths, then virtually any study that induces earlier will show
a lower number. The question is whether the research design also
captures risks due to induction, and many do not. For this reason,
there are people who believe that inductions are a good idea even
as early as 40 weeks, and even with no other indications of trouble.
Most groups that look at evidence based medicine, however, don't find
much cause for routine induction before 42 weeks. Some care providers
will recommend tests of fetal wellbeing starting somewhere between
40 and 42 weeks. These tests are not perfect, but they do include
an assessment of placental functioning (among other things).
It is not uncommon for these tests to indicate a potential issue
when everything is fine. To cut down on these "false positives"
it can help to look for positive results from multiple tests
(multiple positives statistically cut the risk of a false positive
significantly).

As always, it's also important to rely the mother's own
sense of how things are going. If there are significant changes
or no movement for an unusually long time or a gut instinct that
something is really wrong, get it checked out. (Note, however,
that it is normal for movement to slow down a bit at the end when
the baby has so little room to move.)

Personally, I wouldn't risk induction before 42 weeks
without cause.

Best wishes,
Ericka

"Helen Johnson" wrote in message
...
I am also 38 weeks at the moment, but only stopped work last friday, so
looking forward to a week or so before go into labour! Homebirth for me,
and would fight against induction except for strong medical reasons!

Well, I'm really hoping for a home birth this time too, I'm just really,
really fed up of being pregnant. I wasn't nearly this uncomfortable last
time around. But I guess then I didn't have a 3 year old to run round
after!

DS was 16 days late. My local hospital push for induction at 40 weeks +12
on the basis that after this the still birth rates start to increase. I've
never heard of the term + 21 but to be honest if it came to it I'd probably
look into it and dig my heels in (again)!

Nik

"Ericka Kammerer" wrote in message
...


The difficult challenge with this is that a lot of research
in the area is poorly done. If you look only at the number of in
utero deaths, then virtually any study that induces earlier will show
a lower number. The question is whether the research design also
captures risks due to induction, and many do not. For this reason,
there are people who believe that inductions are a good idea even
as early as 40 weeks, and even with no other indications of trouble.
Most groups that look at evidence based medicine, however, don't find
much cause for routine induction before 42 weeks.

All what Ericka said, plus some people think (don't know about the research)
that babies who don't sent mom into labor by 42 weeks are the babies that
have problems independent of aging placenta etc. like Downs babies. It's
the same concept as that a breech baby is more likely to have some kind of
problem than a vertex baby -- but overwhelmingly, babies born spontaneously
after 42 weeks do fine, as do breech babies.

-- Dagny

Ah well. I am also fed up with being pregnant, just not sure that not
being pregnant will be better! Elinor is 3.5, so we are in a very
similar boat - lets have a race to se who's first!!
I've pretty much given up obstetrics now [except for the on call
commitment], but they were def the figures from the royal college for us
to use, and probably in the huge NICE guideline somewhere. often term
plus 12 chosen as apparently psychological more bearable! I think we
should have always thought we'd be in it for 42 weeks, just some lucky
ones come earlier, then wouldn't be so bad. My friends now all
delivered, so def feeling grumpy! elior bang on time thank goodness
Helen
In message ,
Nik&Andy writes

"Helen Johnson" wrote in message
...
I am also 38 weeks at the moment, but only stopped work last friday, so
looking forward to a week or so before go into labour! Homebirth for me,
and would fight against induction except for strong medical reasons!

Well, I'm really hoping for a home birth this time too, I'm just really,
really fed up of being pregnant. I wasn't nearly this uncomfortable last
time around. But I guess then I didn't have a 3 year old to run round
after!

DS was 16 days late. My local hospital push for induction at 40 weeks +12
on the basis that after this the still birth rates start to increase. I've
never heard of the term + 21 but to be honest if it came to it I'd probably
look into it and dig my heels in (again)!

Nik



--
Helen Johnson
http://www.familyfrench.co.uk/nappies/index.htm
http://www.familyfrench.co.uk/elinor/pod/index.htm

"Helen Johnson" wrote in message
...
Ah well. I am also fed up with being pregnant, just not sure that not
being pregnant will be better! Elinor is 3.5, so we are in a very similar
boat - lets have a race to se who's first!!
I've pretty much given up obstetrics now [except for the on call
commitment], but they were def the figures from the royal college for us
to use, and probably in the huge NICE guideline somewhere. often term plus
12 chosen as apparently psychological more bearable! I think we should
have always thought we'd be in it for 42 weeks, just some lucky ones come
earlier, then wouldn't be so bad. My friends now all delivered, so def
feeling grumpy! elior bang on time thank goodness

The trouble is you're much more able to make an informed decision than I.
My consultant last time seemed sympathetic and was initially quite
supportive of my decision when I refused an induction. He offered daily
monitoring after 40+12 which as it was my first child and I live about 1/2 a
mile from the maternity unit would have been surprisingly easy. He then
swept my membranes without seeking my consent which started off a very slow
labour that almost ended in a section. It certainly wasn't the home birth
I'd anticipated.

I was talking to a neighbour on Friday whilst some colleagues of hers
dropped by (to take her to the pub!) Apparently, they'd never seen anyone
so huge and couldn't believe I was only carrying one. My neighbour's sister
is pregnant after 5 years of trying and is terrified she's going to get as
big (which is a bit of a shame after trying for so long).

Nik