We were discussing Induction in Uni today, and wondered what the procedure is where you are? In short at 40-41 weeks we offer the client a stretch and sweep, but in the same clinic visit we ring and book them in for indiction (just incase they need it tho my mentors S&S's are legendary!). We tend to induce at term +10 or thereabouts, depending on available beds etc. If a client does not wish to be induced we require them to have daily CTGs, up until 42 weeks.

What happens where you are? and do you extend to 43 weeks? we only extend to 42 (as far as I know).

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IF they actually accept that the risks of Post dates are significant, then I would be more inclined to ask the question why do different Trusts have varying approach to IOLs with regards to at what gestation they recommend an induction. Surely, if the risks are 'real', then when it is done would not be influenced by whether they have the staff or the bed space, would it?

I agree and I was interested in what happens in other Trusts, as I only know my own.

I learnt today what happens in cases of post maturity i.e. babies lose weight, get flaky skin etc and was not aware before that they lost weight, I just naively assumed most babies thrived in utero until they decided to come join the world, unless there was a medical problem. But hey, Im still learning!

I am interested in what happens in other Trusts and what peoples views are about induction and as Lotuseater says above, if its that important why do we wait for beds?

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J
StudentMidwife.NET Founder & Director

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My first baby was 10 days over, third baby was 12 days. It depends here, some doctors like to start talking induction even as early as 38-39 weeks and won't let moms go over at all (they get itchy about big babies), but most mw's will wait it out. I feel comfortable waiting to 42 weeks myself, but if there is true postdatism, the client would have to go to a hospital if anything more than natural induction was needed, and they would only be able to have their midwife attend as a doula and not as primary. Unless they had hired a nurse midwife that had privileges.

Our trust runs much the same way as yours J ™, particularly with the bed situation!!! We do some many IOL's now as we go off the dating scan rather than the menstrual cycle EDD obviously some of these women just do not know there own bodies eh??? where did the faith go?

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Here in Va, a Labor and Delivery Nurse at a local hospital told me that 90% of the women who deliver there are induced. When I exlaimed, "Wow, that many people are post-dates?" she answered, "No, they are induced prior to their due date." I suppose it's not a coincidence that the cesarean rate at this hospital is over 40 percent. The homebirth midwives I work with here are generally comfortable waiting through the 41st week and some even through the 42nd week. If it is desired by the client, some midwives will do a stretch and sweep, others will not on principle. Only the nurse-midwives I work with, whose back-up physicians require the women to be delivered by week 42, routinely take steps to induce prior to this time...starting with the stretch and sweep, often in conjunction with having the mother drink castor oil. I have also seen the nurse midwives use a foley with balloon to assist an induction at home. I personally have had one baby who was beautiful and healthy at 42 weeks and 3 days (both my LMP and by ultrasound), with a quick labor that started spontaneously, so I have very little stomach for pushing induction before the end of the 42nd week. I think the more important question in cases where the due date comes and goes is to ask, "why?" Is the baby presenting in a less than optimal position that could be adjusted with mother's active (postural) assistance, or is there something going on with mother-to-be that is causing her to emotionally/psychologically hold the labor off? I always try to address the underlying issue first, before tinkering with mother nature. In my experience, so many induced labors are much more difficult than those which begin spontaneously, both for mother and baby. I look forward to hearing more on this topic.

Induced at 42 weeks, if everything is normal that is!

It seems they find any excuse to intervene at my trust though

I have debated this with doctors at my trust (quite carefully!)

Most of the argument seems to be for reduced placental function, I do think that IOL's are often unnessary though.

As for client wishes? Ihave yet to meet anyone whose wishes have been heard. They often recieve a consultant appointment and get talked around, I have yet to see anyone post-dates who is not being induced.

The other trust I started off with offer a stretch and sweep form 40 weeks if the woman wants it.

I am sure I read somewhere that the french believe human gestation is 42 weeks, though I cannot seem to corroberate this. They induce from 43+weeks (anyone know about this?)

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How about in everyone else's trusts?

__________________
J
StudentMidwife.NET Founder & Director

"You're braver than you believe. Stronger than you seem. And smarter than you think."
Christopher Robin in Pooh's Grand Adventure

Please help us raise funds for a bereavement room in Honey's memory by taking part in the SMNET Auction & Raffle here thanks x