… says my pregnancy countdown as I’m writing this. My due date is tomorrow and we have decided to go with medical advice and accept induction at 40 weeks. Two days ago I went in for a second membrane sweep, but although it had been 12 days since the last attempt, there was no progress at all. It was impossible to do a sweep on me. My cervix is still tightly closed and the baby is not engaging at all. The doctor said they would have expected to see at least some development at this point, but since there is none it’s very unlikely to make any difference to postpone induction a few days or even their usual policy of 10 days past the due date for low risk (and non-IVF) pregnancies.
Basically there are strong indicators that I will need induction no matter what. So if there is only a very slim chance of any benefits to waiting, why take the risk and the worry. Especially since they do not actually investigate how well the placenta is working at this point. With this we feel at peace with the decision and in acceptance of intervention once again. Whatever it takes, whatever happens – it will all be worth it!!
In thinking about this over the last two weeks, I have come to realise that I’m not attached to any particular idea of a natural and idealised birth experience. I only care about the end result of holding a healthy baby in my arms, while of course hoping that the process to get to that point will go as smoothly as possible and involve as little distress as possible for both me and baby. But I would never even consider giving birth anywhere else than in a hospital and I trust the professionals there to deliver my baby safely by whatever means necessary. ‘Mother nature’ is also cruel and cannot necessarily be trusted. The millions of women and babies who have died and still die in childbirth in places and times with no access to medical help, is testament to that.
Personally all those years of infertility has taught me not to celebrate or have blind faith in ‘the natural way’ or be attached to any idea of ‘mother nature’ as a superior force. Of course I wish I could have gotten pregnant easily and naturally by making love to my husband rather than by way of doctors and IVF procedures in a hospital, but the reality turned out to be what it was. I no longer mourn that fact. It is what it is and my gratitude to modern medical science, and the intervention that got me pregnant, is limitless. The miracle of life is as amazing under these circumstances as in any other. Maybe even more so.
Tonight at 9pm I will be admitted to hospital to begin the induction process and I will stay there until the baby is out one way or another. It will be prostaglandin gel to start off with and probably a second dose later if nothing happens. Later again they might break the waters and eventually if labour is still not progressing they might put me on a syntocinon drip. They told me there is a risk that induction will fail and in that case a c-section will be considered. Thus prepared, we hope for the best while accepting to take each step as it comes and deal with whatever happens. In the end of the day no labour and birth is guaranteed to go smoothly. Anything can happen to any of us in that situation. Natural low risk labour can end up involving serious complications and drug-induced high risk labour can work out just fine. As with life in general you just never know what you’re gonna get!
Yesterday I went to the hospital for the first membrane sweep. It failed. The consultant couldn’t reach my cervix, which is still long, closed and posterior. The baby also has not fully engaged. So all in all, the conclusion is that labour looks likely to be far off. The conditions are unfavourable as the consultant put it. At 38 weeks this is not really that surprising, but it does bring the prospect of medical induction to the forefront since the general practice at the hospital is to induce IVF pregnancies early at 40 weeks, i.e. on my due date the 17th August. They will attempt a sweep again on the 14th which is just 3 days before my due date, but with the way things are looking I have my doubts whether there is any chance that it will help trigger labour naturally. Consequently I’m also starting to doubt the planned medical induction at 40 weeks. This I wonder might pose greater risks than allowing the baby to go overdue. Especially if the next sweep attempt reveal that conditions are still unfavourable.
So I have been google searching like crazy to try to find evidence for why IVF pregnancies should be induced early at no later than 40 weeks. It seems to be common practice in a lot of hospitals in the UK going by forum posts and the like. Although there are also many examples of this not being the case. The advice women, who have gone through IVF, are being given is clearly very inconsistent. And the evidence for the risk of going over the due date is sketchy at best, as far as I can find out. The reasons given are usually similar to what we have also been told – namely that the risk of still birth is higher due to the placenta not functioning as well beyond 40 weeks in IVF pregnancies.
Based on the lack of evidence there seems to be good reason to question the plan of induction at 40 weeks if the cervix is still not showing signs of being ready. We have decided to wait and see whether we should postpone the induction date. Maybe things will start happening in the mean time. Move on downwards baby boy 🙂
Last night we celebrated hitting the 37 week mark while watching the opening ceremony of the olympics. For us the countdown to the olympics has had a very special meaning because it’s taken us almost as long to get to this point as it has taken London to make the olympics possible. Now it’s all happening right around the corner from us here in East London while we are waiting in anticipation to meet our little baby boy. Everything is buzzing with a typical London combo of excitement and chaos. The chaos part is the worrying bit, because the hospital where I’m giving birth is right in the epicentre of it all. In fact it’s the officially designated hospital for the olympics. Not that the maternity unit as such will be affected by that, but the journey to the hospital will…
On Thursday 2. August we will get a taste of how difficult it is going to be to get there. I’m having a ‘membrane sweep’, which is the first step in the process of induction they have planned. We have been told that they want to ensure that I do not go over 40 weeks because it’s an IVF pregnancy. Apparently there is a higher risk of stillbirth when overdue because the placenta does not work as well anymore. Whether this has more to do with higher maternal age than IVF as such is difficult to say since the two factors often coincide. In any case, we do not see any reason to take the risk so we will go along with the plan.
A membrane sweep is viewed as the natural approach done prior to medical induction. It involves manually stretching the cervix and sweeping inside to try to encourage the release of prostaglandins, which are hormones that help trigger labour. It sounds rather unpleasant, but if it means a chance of avoiding medical induction it is worth the try. How effective it is is questionable. Presumably there should be about 50% chance that you go into labour within 48 hours. But it depends on how ready the cervix is at the time. If it doesn’t work they will do another one a week later. If nothing has happened by my due date (17. August) it will be time for medical induction. By then the olympics will be over, so it will be easier to get to the hospital. But I’m so hoping to avoid medical induction and I’m also just ready for him to come out now. So fingers crossed for an olympic baby!! 🙂