Hi renee,
I've attended many homebirths and am currently a student also. I am
finding the same within the hospital where I do my clinicals - women
induced at 40+10 days give or take the weekend!!
As a birth practitioner, I am happy to take women to 43 weeks if they
are healthy normal women with well growing babies, good liquor volume
and extra surveillance - two visits/week post 42 weeks. This is actually
supported in some of the research (Enkin) which basically talks about
increased problems with postdates with IUGR babies. The other aspect of
postdates is that there is more mec stained liquor - research suggests
up to 25% past 41/42 weeks will have mec staining. If this is a big
problem for you or the hospital you work in, then it's all about (as
always) risks and benefits.
From personal observation, women do far better with normal labours, not
induced by artificial means, and I include complementary therapies in
that. Dctor John Stevenson, the homebirth doctor from Melbourne in the
80's, had over 10% of his practice go over 42 weeks, with no fetal
losses. (1146 homebirths in the data I have).
The other argument is about the original classification of dates or term
at 40 weeks - research shows that to be inaccurate and that for primips
it is more like 40 +6-8 days anyway, and multis at 40+3 days. Something
like that anyway - this is all off the top of my head tonight.
It is really difficult to address this issue - as you say, women don't
think they have a choice, but the better informed we are, the more
informed and supported the women can be...
Still births don't increase by 100% - not by 43 weeks anyway, but there
is supposedly an incremental increase. Giving continuity of care will
put you in touch with how the woman is travelling - re baby's growth and
movements and her psychological state - who knows what initiates labour
- thankfully that still remains a mystery, but what we do know is that
everything has to line up - baby's needs, mother's needs, and social,
emotional states. Women with big issues hapening will usually wait. I've
always trusted that if a baby really needs to be born it will be.
Hope all this helps,
Sue
Hi all, I'm trying to get some information, opinions re: inductions for post
term pregnancies. As a student I'm finding the majority of my birth
experiences are with women getting induced which I find a little
disheartening. Instinctively I'm of the opinion that all being well then
leave alone and I'm excluding any complications or increased risk factors
here, but the more I dig around for arguments the more it appears that
inductions after 42 weeks is best practice. I have read somewhere that true
post term pregnancies accounts for about 2%. You would think its more like
25%, but anyway...
At the hospital I'm doing clinical at, women are preemptively booked in for
induction and are 'told' at an antenatal visit that if they haven't had
there baby by a certain date then they will be going in for an induction.
There isn't an option.
Do any of IM have women that get induced? I have read the research on
cochrane and the NICE guidelines, and stats that say still births increase
by 100%, and Im aware of the complexities around accurate dates etc, but it
all just feels counter intuitive to me, but learning to base practice on
evidence means often having to re-asses my own beliefs about these things,
and not having the experience, I cant really form a judgment. Any help
opinions on the matter would be most welcome.
The rocky road to learning hey!
This might have been a discussion in previous postings, if so and anyone
remembers it could you let me know approx time.
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