Attitudes to induction

or How Impatient are We?

In the NICE Guidelines on induction, a survey was cited which caught my attention, so I searched and read more about it.

It’s very interesting because it focuses on women’s attitudes to how their pregnancies should be managed if they go over their due date. And before reading the results, thinking about it, when it comes down to deciding whether or not to be induced, a woman’s attitude in general probably does play a substantial part (maybe even more than any healthcare professional’s advice?) in swaying her one way or the other.

The 1991 questionnaire-based UK survey asked 500 pregnant women at 37 weeks how they wanted their pregnancy to be managed if they went over their due date. All of these women were considered suitable for expectant management, in other words there wasn’t any medical reason they couldn’t wait if their due date passed. They were also told if they chose to wait they would be under careful supervision and have regular monitoring.

Although overall the results showed there was a general preference for conservative management rather than induction, only 45% of women specified they’d prefer expectant management. And this view changed as time passed. Of those who hadn’t delivered by 41 weeks, only 31% preferred to wait. Women who changed their opinion only changed it in one direction – towards induction, not towards waiting.

Some of the reasons given by the pregnant women surveyed for not wanting to wait were eye-opening to say the least. The main reason (34%) was not being able to stand the thought of still being pregnant after 42 weeks. Other main reasons were seeing no benefit in waiting (21%), worry about fetal size (20%) and the lack of availability of family members after 42 weeks (20%). These reasons leave me a little speechless.

The research recommends that the concept of an ‘estimated due date’ should be discarded because women focus too much on it and become alarmed if they go past it. It concludes that pregnant women, as well as medical professionals, prefer induction when pregnancy is prolonged, not being as in favour of expectant management as had been previously thought.

I wonder if these results are a reflection of the ‘now’ society we live in. We want something, we want it now. Information is at our fingertips, the world is ours to easily grab hold of, we have control over a lot more things in our lives. We want a baby and we already have to wait 40 weeks; we shouldn’t have to wait any more!

And this was almost twenty years ago. In that time have we learnt to be more patient? I’m afraid the answer is probably not.

Roberts LJ, Young KR. The Management of Prolonged Pregnancy – An Analysis of Women’s Attitudes Before and After Term, British Journal of Obstetrics and Gynaecology 1991. 98:(11):1102–6.

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