Overdue in March

[jojozep]

Am I the first March girl to go overdue????

[Janet]

40+3 isn't overdue LOL. Term pregnancies last any time from 38-42 weeks with 70-80% of babies born between weeks 41-42. In France a term pregnancy is 41 weeks which is a little closer to reality but it's all just a guess. Babies come when they're ready and only about 5% come at 40 weeks which means you and your babe are very normal and average. And isn't that nice?!

[jojozep]

Thank goodness, cause I feel normal, or rather I dont feel overdue.
Can you tell me why they insist on inducing at 40 +10?? I am terrified of induction having had a bad experience with my first. I have been booked in for the 20th of March, and now feel like my bubby is on a time limit to come out

[Janet]

There are two main models of care in pregnancy. The obstetric model (what 99% of women get in this country which is why our outcomes are so poor) views pregnancy and birth as potentially dangerous, abnormal and requiring constant testing, management and appraisal. The midwifery model assumes pregnancy and birth to be normal states for women (obviously they are!) and watches to see if anything out of the ordinary does occur before acting on it while encouraging a proactive response to head off issues in the first place. This approach also emphasises general wellness rather than potential illness all the time. "They" in hospies who make those decisions have a few reasons "they" like to induce. One is that there is a slight rise in stillbirths AFTER 42 weeks HOWEVER dating in pregnancy is arbitrary at the best of times so an evidence based approach would OFFER you an u/s at 42 weeks (from conception, mind you, NOT LMP which is a meaningless way to date as are dating scans) and if you and the babe were clearly well, allow your baby to choose their own birthday - they always do Only 5% of babies come at around 40 weeks so the emphasis on it is utterly meaningless. Babies come when their brains and lungs have matured sufficiently, nothing to do with our bodies at all. Labour is tipped off by a chemical in the baby's brain. Further, inducing at that arbitrary "10 days" mark is essential to the running of privte obstetric practices and hospitals where women going into spontaneous labour is not convenient. Most babies in Australia are born between 9 and 5 nowadays despite what we know about how labour works and most of us would naturally go into labour at night. This is not the way that a private practice can be organised as you will have women hanging about taking up time on your books indefinitely. Midwives only take 2, or at most, 3 clients on a month so not only is the woman seeing her CP for an hour or more at each appointment but she really gets to know you and is there to support your birth when it happens not make it happen to her timetable. Hospitals need to know when you'll be off their books so despite the HUGE wealth of evidence showing how dangerous induction is and how it causes caesareans, this is a better outcome for institutions than waiting for you to labour spontaneously. Unless someone can clearly show you or your baby have a health issue, there is NEVER an excuse for induction. The greatest cause of prematurity in this country is induction because all babies cook to their own timetable. The vast number of "failed" inductions you read about are because not even the powerful and dangerous chemicals involved in an induction can make a baby come if they're not ready. And from induction comes the whole cascade of interventions which normally results in either an instrumental birth or a caesarean. To surgeons, surgery is not a bad outcome but they're not the ones trying to parent child/ren while you have a wounded body or soul. If you want the safest birth experience possibly, always say no to induction. Look up Henci Goer's article "elective induction" and Gloria Lemay's article, on biophysical profiling and what a crock it is. So for your baby to not come at 40 weeks just puts you in the majority and that has to be nice!

[jojozep]

Thanks so much Janet, sorry to keep the questions coming, but can you tell me if I have the right to refuse induction at 40 +10 days if I am going through the public hospital system??

[Janet]

Legally you have the right to refuse anything and everything from blood tests, to ultrasound to induction to caesarean, VEs, people in your room, male doctors, anything you like. YOU are the employer and without you none of them would have jobs. You're the boss! The same legal right to determine what happens to your body and to your child exists inside the hospital walls as it does outside them. The pressure brought to bear on women who refuse however is extreme and you will need support to stay strong in the face of it. Having been previously induced (on dates alone?) you are already highly motivated to avoid this dangerous and unnecessary intervention. If you don't like conflict or don't wish to be pressured, just don't turn up. No one can induce you if you're not there, right? Stay home until you're in strong labour, and if you only turn up in the hospy when you feel pushy there are fewer interventions possible at that point. For perfectly healthy women and babies, the dangers of induction outweigh anything in favour of it at all. Having a doula would help you labour at home well supported until you wish to leave. For dh, give him those articles I suggested or contact any number of the great consumer groups in Brissie who help women in the aftermath of inductions. They will have LOTS of other info to give you too. I'd list a heap but I can't give you any internet links. Sigh.
Sorry

Henci Goer's website has the best article on everything to do with induction, but there's a lot in her book, "Thinking woman's guide to a better birth" as well and it's based on 1000s of studies.

I'm happy to answer questions Keep asking whatever you need to avoid this and stay safe! =D>

[jojozep]

Wow Janet your a wealth of info, have read the articles (thank you) what do you think of Acupuncture for induction?? Would the same risks apply?? My first child was induced at 38 weeks because my due date was conflicting with the obs golfing holiday (I was 21 and had zero assertiveness) my second child was born in a birth centre with a wonderful midwife - no intervention at all. I was unable to get into the birth centre for this bub, and am very frightened about what might be in store for me with this birth. Do you think it would be to late for me to try and find a doula or student to come and attend the birth?? I've been having a look, but cant find any listed on this site, will try the maternity coalition if you think its not to late.

[BellyBelly]

Try Optimum Birth, they have Doulas in QLD

[Janet]

It's never too late to find a doula. Re: acupuncture, again unless there is a health problem, it's just not necessary. The stress you are carrying and the fear you feel could impede your capacity to labour so making sure you feel safe is VITAL. Do whatever it takes to feel safe. Stay home, lock the door, let your body and your baby perform that everyday miracle of birth. Trust your body, trust your baby and trust birth. It has kept us safe for millenia. You know in your heart what you need to birth your baby, so go create it. Love and strength to you. *hugs* Keep talking and strengthening your resolve if it helps. You can do this! Dr Sarah Buckley wrote a beautiful article called "Ecstatic birth" which explains really well how all the hormones of labour work. It will show you why you're so keen to avoid induction. You know in your bones you don't need that stuff. Look it up!

[Phteven]

Hi jojo, have you read this article on natural induction methods?
I hope bubs decided to arrive soon.

[BellyBelly]

Here's ecstatic birth for you: https://www.bellybelly.com.au/birth/...rint-for-labor

[Janet]

It's great that you feel respected in your birthing place, Kate but the reality of birth in Australia is clearly shown in our very poor outcomes. If all hospitals and surgeons behaved as per your very rare experience our outcomes would not be of concern to the World Health Organisation. Australia has the 5th highest rate of caesarean in the OECD and for some years we had the highest rate of instrumental births. It is researched fact that private hospitals and private surgeons have rates of intervention far exceeding internationally set standards of best practice. Only 5% of Australian women give birth without intervention despite WHO stating that a minimum of 80% can do so, and only 2% of Australian women gave birth with premium care last year. The rest had surgeons as primary carers either publicly or privately and concomitantly poor outcomes. Remember just because it's what you've seen or perceive doesn't make it true for the rest of the country and once you know what the actual statistics are for birth around here it's very clear that women are not respected and neither is birth. Countries where midwifery care is the norm have much better outcomes than we do. Fact, absolute fact as is my description of how the obstetric model functions. If a woman is being pressured to induce for no medical reason clearly there is no adherence to evidence based care.

[Phteven]

I'm another one who felt totally respected by my hospital - so much so that despite moving closer another hospital I prefer to travel an extra 10 minutes to get my old one.
Just a couple of weeks ago I had an experience there which really made me think a bit about women's agency in childbirth and the assumptions that many people have that birth outcomes are the fault of the hospital/model of care.

I was a bit worried because bubs had been very still so I went for some monitering (some might consider it an 'intervention' but it made me feel much happier - bless modern technology ). In the rooms at the delivery suite you can hear the conversations in the corridor outside. So..... I was lieing back listing to bub's heartbeat and I over heard this conversation between a midwife (MW) and patient (P)
MW- Are you out of the shower already - you were only in there for a second
P- I didn't want to stay in
MW- OK did I explain why I suggested a shower (midwife explains the benefits of shower for pain killing and remaining upright for speeding up labour). Would you like to get back in?
P-No I want an epidural
MW- OK I can arrange that but did you know that they can cause problems?
P- I don't care
They went back into the patient's room at this stage so I couldn't eavesdrop on the rest of the conversation but as the door shut the nurse was explaining the procedure

The thing that I was thinking after overhearing this was that despite the midwife trying to encourage this woman to have an active birth it was quite obvious by the tone in her voice that she was determined to have an epidural. In any civilised society she has every right to make that choice - as a woman she should have contol over her birthing experience and the role of the hospital is to facilitate that choice even if it may not be within thier philosophy. To deny her the choice would be a hideous infringment on her rights akin to violent abuse.
To me the important factor was that it was her choice - she didn't want to go through the pain and she chose to take the risks of an epidural instead. When we complain about the amount of intervention in Australain hospitals it seems to me that we often lay the blame on the hospital and by doing this we insult women such as this patient. She had a choice and she excercised it despite the midwife's gentle efforts to encourage her towards a non-interventional birth. She had probably heard from her friends and family how wonderful epidurals were. I know that I have been to get an epidural by a number of people. So...... I geuss the points that I am making are that
1)its too simplistic just to blame care providers for the high rates of interventions in Australia - to do so is ignoring the fact that women can and do make choices
2)that hospitals offer choices that we may not agree with but other people may wish to take these options - not to offer these choices would IMO be totalitarian and barbaric.

In terms of poor outcomes I'm not sure that I regard the fact that the majority of births in Australia result in a healthy baby and mother as a poor outcome - perhaps there less traumatic ways of achieving this outcome but just so long as the end result is healthy mums and bubs that's enough for me.

The WHO on the whole is far more concerned with the reduction of maternal and perinatal mortality and morbidity in the developing world, where 98% of these deaths occur than with rates of intervention in Australia. To do this thier goal is to ensure that every woman has access to essential obstetric care which they define as

Essential obstetric care

Essential obstetric care is the term used to describe the elements of obstetric care needed for the management of normal and complicated pregnancy, delivery and the postpartum period.

Essential Obstetric Care is defined for two different levels of the health care system:

Basic essential obstetric care services at the health centre level should include at least the following:
• parenteral antibiotics
• parenteral oxytocic drugs
• parenteral sedatives for eclampsia
• manual removal of placenta
• manual removal of retained products

Comprehensive essential obstetric care services at the district hospital level (first referral level) should include all the above plus
• surgery
• anaesthesia, and
• blood transfusion.

For the services at a facility to be considered functional, the elements of care must have been provided during the 6 months previous to data collection.

Ironically enough much of this ensures that the interventions that we in the developed world can afford to be so hoity toity about are available.

jojo, sorry to go on so much - I tend to ramble.
If you wish to avoid the induction you can request that they give you a U/S to check that bubs is OK and if there are no issues then refuse the induction.

[amber]

Kate and Dach I completely agree!

I think the most important thing in the world is the safety of the baby. I understand a birthing experience is very important as well but what use is it if you don't have a healthy baby to hold in your arms afterwards?
I am in the care of an OB who is incredible and not at all pushy and totally respects my views. I plan on having a drug free active birth and my hospital support that and have all the birthing aids to help me achieve this.
I am due today but have made a decision to be induced in a week or so if my baby hasn't arrived. No one else forced me to choose this and I'm so grateful I live in a country I can choose what I want to do.
Also, just because we have a high rate of interventions does not mean a nasty OB or bad hospital have forced them onto people. In my ante natal class a large percentage of people chose C sections for personal reasons. As they should be able to.
I have made all my decisions based on the safety of my child and to me having all the medical technology right there along with someone who has 20 odd years of experience is the best choice I could ever make.

[Debbie Lee]

When we complain about the amount of intervention in Australain hospitals it seems to me that we often lay the blame on the hospital and by doing this we insult women such as this patient.

I've often wondered the same thing, Chloe (and I only just found out that's your real name... quick on the uptake, hey?? LOL). The amount of women that I have spoken to that elected to have a caesar despite the risks is amazing (mind, I am talking about elective c/s out of choice - not for medical reasons). I even have one woman in my MG that wouldn't even entertain the idea of a natural birth!

I opted for an epidural because I was told by several friends that didn't have one to have one. I had a couple of friends who had asked for one but it was too late so they had put the fear of God into me that the same thing would happen to me. Right or wrong, that was how I felt going in. I just found that there was so much information being thrown at me (which was often contradictive) that I really had no idea what was involved with induction, epidurals and other interventions (even though I have been chatting on BB for quite some time). I often wonder what women armed with even less information would do?? We are kind of taught, rightly or wrongly, that doctors know best.
While I feel a little ripped off by my birth experience (induced early for high BP, epidural and emergency caesarian), I really didn't kick up much of a fuss. I was so scared that my baby would be still-born that I was happy to just go along with whatever. I think sometimes fear plays a major role in the amount of intervention that takes place.

I don't know. I think if you looked at births on a case by case basis, you would find that for every doctor that forced medical intervention on a patient unnessarily, there's a woman demanding it??
I agree with you, Kate. You can't tarnish all hospitals and all OB's with the same brush. Hek, in public hospitals it can be the luck of the draw if you get a doctor that is pro-natural birth as opposed to one that is induction happy.

[Janet]

Birth experiences are vital to the short term and long term health of mothers and babies. How does a mother care for her newborn effectively when she's drugged to the gills after suffering through unnecessary interventions? How does she care for that child in 6 months time when she's overwhelmed by PND and PTSD? We have ludicrously high rates of PND in this country compared with countries that are safer to birth in. Inductions, caesareans, instrumental births and the like come with significant risks up to and including death so they are supposed to be used only when this risk is lower than a normal birth continuing. Clearly using them routinely is dangerous. This is why the maternal death rate in the US is rising not falling as more caesareans are performed and fewer VBACs permitted. It's not a mattter of tarring Obs with a brush, it's factual statistical information which clearly shows surgeons are inappropriate carers for healthy pregnant women. This is why WHO recommends midwifery care and why so many countries (about 27 of them) have better outcomes than Australia.

[Debbie Lee]

Janet - I am wary of statistics though... they don't take into account the reasons why intervention was chosen. How many of those stats state whether is was the doctor that chose the intervention or the woman?

In saying that, I agree that something needs to be done. It's almost like we woman have lost faith in our own bodies. I know I didn't trust mine at all!

I'll still probably have an elective c-section next time. No amount of information on how VBACs are safer than another caesar can take away the fact that 3 consequent generations of women on my mother's side have had a still-birth (at term). So I guess I will be another statistic... with 2 healthy babies in tow....

[paradise lost]

I am really hoping for a natural labour, not because of a desire to have a totally natural birth so much that i am TERRIFIED of being induced!

I am such a chicken seriously! I am scared of how the pain relief drugs will make me feel, how the entonox will affect me (tried it at my SIL's labour, which was induced). In an induction scenario i am scared of being tied up to all the monitors and machines, and all the interventions (not the possible ones but the ones you HAVE to have, like the prostaglandin gels and syntocin).

The midwives all laugh at me because i have booked for a homebirth, and am totally unconcerned about tearing, stiches etc., but bring out the monitor for blood pressure (rather than the manual guage they use with a stethascope) and i practically panic!

I will of course be doing what is best for me and the baby at the time, but seriously - i admire those women who are brave enough to put their bodies in the hands of even the NICEsT OB, i am too chicken for that!

Hana