How often does an induction end in a caesarean?

[jasp]

Originally Posted by paradise lost

There are more stillbirths in the 43rd week (i.e 42+anything) than in the 41st and the difference is therefore factored to be in the 42nd week, so they induce you in the middle of it in some places, treating it as a window of opportunity for preventative medicine. It is NOT an evidence based practice, induction at 41+10 has not been proven to reduce stillbirth rates (i.e. the level remains the same for babies born in the 41st week whether by induction or not, and there is no way to determine how many of those babies who are induced would have been born before 42 weeks anyway) and HAS been shown to increase the c-section rate and risk of injury to both mother and babe.

And FWIW unless your ob offers foley's catheter inductions i would be surprised if they offer to induce you at all. Cytotec, prostin and pitocin have all been shown to dramatically increase the uterine rupture rate in VBAC labours.

Bx

I'm confused! If the rate of stillbirth is higher after 42+ weeks, i can understand the wish to induce prior to this. But you say this is not evidence based, induction at 41+10 has not been proven to improve stillbirth rates?
Probably just my mushy baby brain but I'm lost...

As for my induction, it was my understanding at my booking appt with the midwife that they would NOT induce due to it being a VBAC; this made sense as I was aware of the increased risk of rupture when inducing a VBAC.
I then heard from a lot of people who had been induced with VBACs. When I asked my Ob she said ARM would be the preference (if they knew that would definitely work)... gel is definitely out... it would most likely (from what I understand) involve synto, and I don't like that idea. Really I'm still undecided and hope it won't come to that anyway
PS What is Foley's catheter induction?

[paradise lost]

The point is that it's confusing! The Ob believes the baby is more likely to be stillborn if it is born in the 43rd week, yes? So he induces it the week before, because STATISTICALLY if it's born in the 42nd week its risk is lower. Of course that has nothing to do with WHY it would have been stillborn. And babies who are induced at 41+10 and stillborn aren't in the statistic, because they were born in the 42nd week - does that make sense?

Because stillbirths often have no explanation they rely on this clumsy reasoning to try to prevent it. It is like finding out that people in brown trousers are more often hit by cars and throwing your brown trousers away - you would be better using the pedestrian crossing and wearing any trousers you like. But in this case because stillbirth often has unexplained cause there is no "pedestrian crossing" option.

TBH i think everyone has their own viewpoint on this policy. I know lots of women who were terrified of losing their baby or had already been through stillbirth and they opted for induction at term because they wanted to minimise the risk and induction is the only way possible. And i know others who had such traumatic inductions they would rather "risk" stillbirth. Personally i made the decision by looking at relative risks. 2.7 babies in every 1000 are stillborn. That's 0.27%. The same Ob who wanted to induce because of that risk offered me an amniocentesis test which carried a 1.6% chance of miscarriage. He would expose my DD to the 1.6% risk of death at 16 weeks but not allow her to face less than a quarter of that risk at the end? No thanks!

Foleys catheter induction is where they insert a foley's catheter into the cervix. A foley cath. is a catheter with a balloon on it - in normal practice they insert it into the urethra and inflate the balloon inside your bladder to stop it slipping out again. In induction they insert it into your cervix and inflate the balloon and wait. The balloon mimics the baby's head on the back of your cervix which cues your body to make prostaglandins and soften your cervix, and oxytocin which start up contractions, and then as the cervix begins to dilate the balloon falls out (by which time you're in established labour). If your cervix doesn't respond the balloon can be deflated and removed and the induction can be tried again in a few days, whereas once they do an ARM you are haing your baby, one way or another, within 24 hours (normal practice) or 96 hours (if you are strepB negative and argue with them).

Bx

[jasp]

Phew... ok it is confusing it's not just me

Thanks for the info!

Now I have another question (may be hypothetical if no-one has an answer?).
Foleys catheter induction sounds like a much less invasive, more natural way of 'encouraging' labour rather than forcing it, kwim? So why would it not be the preferred option before ANYTHING else? Does NOT make sense to me

[paradise lost]

Because it's relatively little-used and not all Ob's are able to do it (i.e. have never done it) and because most hospitals have a policy of only inducing for medical need and thus the benefit of the foley induction (that it can be stopped and resumed days or even weeks later) make a mockery of the system - either it's medically necessary to get the baby out ASAP (in which case get the big guns out) or you don't need to do an induction of any kind. In addition it is not suitable where there is infection in the vagina or cervix or where strep B is suspected or known to be positive.

The exception to this is becoming (and will become more - talk to your Ob about foley induction (there's a WHO page with info about it here) in cases when a woman is aiming to VBAC and thus cannot have a chemical induction and declines ARM.

Bx

[jasp]

OH very very interesting thankyou!!!!

and after reading that I don't feel any better about oxytocin!
Here's hoping it doesn't come to that.
I have an appt at hosp next week, will mention the foley catheter then & see what they say.

Thanks again!