IVF and labour induction?

[Liviam]

I guess they aren't really made aware of the risks.

You hit the nail on the head Schmickers. Some women just believe everything they are told by their dr because they just don't know any different. Not everyone has this wonderful source of info. But some women also don't care too.

[butterfly_warrior]

Doesn't make sense to me either *shrugs* Are they actually telling the women of the risks?

I think it is common for women who have used IVF to undergo a high rate of intervention in their births, is this because they fear their body will fail them after so much disappointment tying to fall pregnant naturally? Are they easy to convince that their bodies will harm their babies?

Absolutely! I had a very non-interventionist OB, so I didn't really have anyone out to scare me about what my body could or could not do in labour. I think it was starting as scans had my baby on the 90th percentile and I was being sent for yet another scan in order to decide whether or not I should be induced at 39 weeks. Never got there as labour started spontaneously at 36 weeks.

But... I'd been through 18 months of IVF hell. I'd been through three miscarriages. I'd seen time and time again that my body couldn't be trusted to do what it was meant to do, and it was a HUGE fear of mine that my body would once again fail at labour and then fail at breastfeeding. We got the labour part ok, but we did fail at the breastfeeding thing. When you are used to seeing your body fail to do what it's meant to, it's all too easy to fall into the belief that your body isn't going to be able to do it with labour either. I don't know that there's any way around it - it's just one of the horrible ways that infertility screws with your head.

BW

[beansbeans!]

At work there are IVF pregnancies that are induced because some OB/drs suggest it as the pregnancy is "precious" and some women want their baby. It is not standard practice though.

BUt arent all pregnancies "precious"? I mean I understand that if there is a history then they will take that into account, but seriously I consider my pregnancies to be just as precious. I suppose what I mean is does it really matter how a baby is conceived? Isnt the path of every pregnancy unknown to us, and really its all up to the baby and its relationship with its home?

It scares me to think that there are obs out there who are possibly taking advantage of how much trust people put in them. I know some women need medical intervention and that cannot be helped, but is it the women who want the csection or the obs? Especially when there has been 'intervention' (IVF etc) at the beginning? (not meaning to offend anyone, just not how to put it another way! )

[Mildez]

Working with Drs for years I have to say women who have concieved through IVF are considered more "precious" then a lady who has had a spontaneous conception. All babies are precious of course and of course the majority of care is the same (except women with IVF pregnancies usually get more options not always better options but more options and more choices and I do agree with that) The care in labour is no different except maybe the lady having the IVF gets more attention at times perhaps. But even that is rare.

To have such difficult ttc, the heart break that goes with that, cycle after cycle, year after year not getting pregnant and the disappointment, stress and grief of not been pregnant when it feels almost everyone else is, the abuse on your body emotionally and physically, the public knowledge of your sex life, your fertility problems, financially etc there is a difference no body that has not been through it themselves can really know how difficult that road is. And I do feel that its a women's right that has had such a difficult journey to get to the end of pregnancy to decide she wants the baby now over waiting even if that increases certain risks to herself and her baby. You will find alot of women who have had IVF and a difficult road to motherhood are very well researched and are aware of the risks of early induction and elective c/s. Its something they have had years to research and decide what they would wish for when they are in that position.

Inductions generally are predictable, we know the risks that it leads to a cascade of intervention including c/s, fetal distress, assisted deliveries, more pain, not as good postnatal experiences, continuous monitoring etc but then it does reduce one risk and thats presenting for an antenatal visit or in labour or to the Dr because the baby hasn't moved to find no heart beat. That is a huge fear to get to the end of the road to not get the prize at the end of it. All women have that fear regardless of how their baby was concieved but that fear is usually worse when you have lost faith in your body and you have been on the journey of parenthood for many years to finally be so close to it happening. Their is a real fear that you wont get a baby at the end of it and that it might just be to good to be true.

For a baby to die inutero close to term of course thats not common but we have all heard stories of it happening or even know someone that its happened to. Induction and elective c/s at 38-40weeks for women who are carrying a baby concieved with IVF occur when we know the baby was healthy or has all signs its healthy before the elective delivery commences. It takes away that very tiny risk of late term stillbirths (at term for no known reason) and the fear of that happening away even if its replaced with higher risks in other areas. Women put their lives and their babies into our trust to make sure they have a baby in their arms at the end of it.

As we all know after someone has lost a baby or pregnancy having another baby in the future will not take that pain away from the previous loss. In saying this and I know so many of you won't agree with me with an IVF pregnancy especially there is no guarantee that their will ever be another baby, another pregnancy. When a loss occurs at any stage your not only grieving for the baby lost but for the future of never having another child or pregnancy so to speak. When you are fertile and have proven good fertiity the grief of not getting pregnant again or not ever having another baby is nothing like the grief of knowing this baby might be the only one ever. A part of the grief of infertility is knowledge that pregnancy doesn't happen or rarely and when it finally does I can see why women do elect for a c/s or induction because its predictable. You know what to expect in comparison to the wait for sponataneous labour to occur and what that will bring.

[entreat]

Working with Drs for years I have to say women who have concieved through IVF are considered more "precious" then a lady who has had a spontaneous conception.

I agree. My OB in town had me having fornightly US, when (as I understand it) conventional pregnancies may have scans at 6/13/19 weeks, and some not even that many. I've had scans at 6/9/11/13weeks, I think because the OB likes to be more attentive to the IVF women. Knowing the journey can be very intense & fearful, I think he prefers to do more scans to put the mind of the mother at rest. I know that I was terrified until about 10 & a half weeks.

As for inducing at 38 weeks - never heard of it! my clinic bid me fairwell as soon as I was off the pessaries (not particularly necessary precaution) at 11 weeks. I think all they want is a baby photo at the other end! And my chosen OB had said nothing about induction... and I won't do it unless its needed anyway.

As for 38 week c/s... I'd rather risk an extra two weeks than major abdominal surgery unless it was really really warranted.

[onthefly]

It's a seductive thought, that we can control things. That we can guarantee outcomes. I get what you're saying Emmy83. I think there's a general misperception that with interventions the surgeon is in control, meaning risks are reduced, as opposed to letting nature take its course. But the statistics just don't support this. Yes, you may eliminate the risk of late-term loss by inducing early, but you introduce a whole hoard of other risks (which may be statistically more significant).

IVF mothers are given short shrift if OBs assume they can't make rational decisions for themselves.

[Mildez]

Marcellus I am so with you when you stated IVF mothers are given short shrift if OBs assume they can't make rational decisions for themselves. I am certainly not advocating for the routine elective induction of all IVF concieved babies but I do like the fact that women who have had such a challenging road to parenthood have a choice to deliver earlier then their baby and body decides if they choose to. Of course one would hope they are aware of the risks. Elective inductions where I work are not done before 39weeks unless its a medical reason needed and usually inductions are not offered unless the mother asks for it. Its mother that have had alot of trouble ttc or had term stillbirths that are given the highest priority for early elective inductions and very occasionally c/s.
Not that I have concieved through IVF but I think if I did and I was 39weeks (which wouldn't happen as I have a heartshaped half double uterus that can't hold a term baby) the anxiety and fear I would feel would be so great an induction would be tempting despite the risks.

[K1]

I'm currently 40 weeks preg with an IVF buba and I have never heard of induction at 38 weeks, so from where I stand what you have been told is not accurate or at the very least not commonly practiced.

[AliB]

Great thread, some really interesting comments here.

I certainly agree with lack of confidence in one's body, and agree that some OB's may 'take advantage' of that. My OB has never given me a hint that he treats my preg as anything other than 'normal'.

Possibly the only genuine concern with some IVF mums is earlier in the preg, if whatever caused the infertility or subfertility is also likely to result in higher miscarriage rates (which is true for PCOS, severe endo, and certain hormonal and bloody clotting issues). But by full term, you're surely past the high risk time?

[butterfly_warrior]

Not if it's a clotting issue, Ali. My SIL lost her first baby in labour due to a clotting problem.

BW

[AliB]

Hmmm Butterfly Warrior this is off topic, but now I'm wishing I'd been quizzing my OB about my results and whether there is anything else I could or should do in late pregnancy. I got two low positive anticardiolipin antibodies results pre-preg, and all and sundry (IVF specialist, GP and OB) said that they wouldn't do anything about a low positive result "unless I had multiple miscarriages". Given I hadn't managed to fall pregnant that outcome seemed impossible. Anyhoo maybe I should have been asking about cord blood scan or something.

[onthefly]

Yeah, obviously it depends on the circumstances. But these decisions should be made on a case-by-case basis, in full consultation with the parents.

Extreme anxiety may be a valid reason for intervention (I don't want to start listing what is and isn't, as said, it all depends), but OBs should be coming from the perspective of what is best medically,and supporting mothers, not a presumption of incompetence (whether physical or pyschological).

[spenceee]

has to be some mis-understanding there, JellyMaker and I have had no contact with the IVF Clinic after we had confirmed our stickyness.

once pregnant (assuming no other pre-existing medical conditions etc..) you are just like any other person who got there the old fashioned way.

I would bet that there is a current medical concern driving the reccomendation from the OB to induce. Encourage your friend to go and ask more questions.

hope everything works out well

[Persephone1]

At work there are IVF pregnancies that are induced because some OB/drs suggest it as the pregnancy is "precious" and some women want their baby. It is not standard practice though.

My sonographer who saw me at 12 weeks told me, with some hoity-toity self-made authority that "your Doctor will probably induce you because you're carrying such a precious bundle." I just shrugged it off as ignorance at the time, and figured she was talking out of her a****. I didn't realise other people held that view - how scary.

DH and I, and all the MWs a the Birth Centre, treat me like any other pregnant woman. I wouldn't have it any other way.

My step-mother is a former MW, and now practices as an MCHN. She announced to me when I was 6 weeks pregnant that I wouldn't be allowed to birth in the Birth Centre of my choice because my pregnancy was considered "high-risk." DH and I jumped down her throat and demanded she show us the evidence that our pregnancy is high-risk. She could only refer to the fact that we'd conceived through IVF.

There are some things that are considered "more likely" in IVF pregnancies - like spotting, which apparently can occur because the embryo implants low into the uterus compared to natural conception. Apparently low-birth weight is also more common in IVF pregnancies, but even that is a minimal increase compared to a naturally-conceived pregnancy. Neither of those things would have any statistical bearing on induction.

FWIW, I read a lot about IVF before we took the plunge. IVF babies are not statistically more at risk of anything that can't be explained (for the most part) on pre-existing issues. IVF women are statistically older than the general fertile population, and if they're being treated for infertility, there's many reasons why that might be - which may also lead them into more treatments and interventions during the pregnancy and birth.

I *think* (IMO, at least) that some things, like C-sections and inductions, might be more common in IVF pregnancies simply because some IVF women can be more anxious, and also are so used to being put through "intervention" that they don't question the treatment they are given. Medical technology put the baby in there, why not use it to get the baby out? I think it's just a mindset, not based on anything physical.

Personally, I don't think IVF pregnancies should be treated as any different from any other pregnancy. I think pregnant women should be treated as individuals, so if any treatment or intervention is given, it should be based solely on the needs of the individual woman and her baby - not simply because she conceived through IVF. That criteria alone is a load of BS.

Bring on my vee-jay-jay birth please!

[Krikkit]

Emmy83 - what you said make sense, the whole control issue. I still have a hard time beliving I am preggers or even enjoing it because there is always that *thought* that this isnt real or something bad is going to happen. I probably won't belive it till she is in my arms.

Persephone1 - My bubs is due via c-section at 38 1/2 weeks because I had a lap myomectomy during the IVF process. I am not entirely happy about it, but I guess some Drs just arent willing to risk their "profession" to deliver a baby and possilby rupture a uterus, given the fact that it was so hard for me to concieve in the first place, rupturing my uterus could leave me unable to carry a baby ever again.

[nicjay]

I had the same ob for both my pregnancies, 1st one naturally conceived and second one IVF, and it definitely wasn't standard practice for him But that's not to say that may be the case for every ob, or that elective induction wouldn't be offered.

And TBH, please don't shoot me for saying this , I can see why some IVF ladies would go for the induction. After miscarriage and IVF I felt like all the confidence had been sucked out of me. I was worried the whole pregnancy about things not ending well and despite my best efforts I could not totally shake this feeling Also, in my eyes this pregnancy was my very last chance at having my second child. I am a poor responder to the IVF meds and we only got one egg and one embryo, if I had've had to repeat the process there was no guarantee that we would have even got another embryo to put back. And with each passing month of failure, my risk of miscarriage was increasing as well - that was the way I felt anyway. When you are having feelings like this it is very easy to start thinking that induction may be the way to go, I know I did.

I had a low intervention ob, but by the time I reached 39 weeks I was feeling very anxious and totally weary of feeling this way too if that makes sense? I just wanted things to be over and to be holding my bub. So I convinced my ob to book me in for an induction at 40 weeks. But being fully aware of the risks, and having gone into labour naturally before and knowing I could cope with it, I had doubts about going ahead when it came to the crunch and I cancelled at the last minute My ob was chuffed that I did LOL and I subsequently had DD2 at 40w5d after a 1 hour drug free labour with no intervention. Actually she was born so fast that my ob didn't even get there in time LOL I'm very proud of the fact that I overcame my fears, well somewhat anyway, and held out to have DD2 naturally - I knew it was the best thing for me, my baby and my family. Also, being diabetic as well and knowing what that could have led to - well that's another story that I won't go into!

So what I guess I'm trying to say is that it is easy to believe that early induction while the bub is still well is a good thing and be talked into it, because you never know what could happen down the track a week or two. And even more so if you believe that this is your one chance to actually ever hold your own baby. And it may be uncommon to lose an IVF baby late in the pregnancy but it does happen.

Also, I do believe there is a perception in general that elective induction (and c/s too for that matter) is/are just as safe as waiting. Everyone here may realise that that is not true, but from what I know of people IRL that is not the case.

Hope I'm not opening a can of worms here, but I really just wanted to give my take on things

[barney]

oh megsmum well said hunny,great post thank you