So...

[justbishop]

Had the induction discussion w/ my OB today. He says Tuesday will be the day if nature hasn't kicked in by then, and neither DH nor I are comfortable signing the "against medical advice" thing, so please, no responses to that effect.

My question has to do with induction protocol, and what we should insist on as far as the order of things. If you were writing a step ladder type list from most benign to most invasive induction techniques used in a hospital setting, how would it go?

I declined the cervical exam today, but will have one on Monday. If conditions aren't favorable in that department, is Cervadil a decent first stop? Are there any more natural options that we should insist on trying first (in the hospital, I mean)?

In the case of good cervical progress, I am definitely not willing to just start right off the bat with Pit. I'd like to have a good list of things we insist on trying before we resort to it, but I'm just not sure about the safest place to start (AROM, then wait how long? etc.) I mentioned niple stimulation, but our OB mentioned that that can cause hyperstimulation, and that he would insist on monitoring if that's something we'd want to do. If we DID end up at the Pit crossroads, he did agree on the lowest dose to kick start things, then turning it off, so at least that's promising...right?

[filiadeluna]

My MW said if she has to induce me (earliest would be March 21st @ 42 weeks), and all natural methods have failed thus far, she will start with either a membrane sweep, inflating a balloon in my cervix, or artificial prostiglandins. I did stress to her how much I want to avoid Pit, and she seemed to be understanding of that. I am desperately hoping she comes before that date, though.

[mom2tatum]

Oh, I so hope the best for you...its so hard being told what to do and feeling like you need to obey, especially when your vulnerable and wanting to meet your baby. But, by putting off your induction, you are not going to have to sign an against medical advice...its just, you say you'd rather wait, and then come to a more reasonable date in which you agree you'd be comfortable coming in. Research will back you up that up to 42 weeks is a normal gestation. If fluid is fine, there is no medical reason to induce. If he has a reason - FOR YOU, that is worrisome, that's different. But, research is on YOUR SIDE.

I think its hilarious that he thinks nipple stim could be hyperstimulating, yet will medically induce with drugs! Oh my. But, yeah, I guess if I felt forced to move forward in the hospital, I'd probably have him strip membranes on during your exam...then ask to wait till the end of the week, meanwhile doing everything I could think of like having sex, nipple stim, walking a ton, etc. I am not a believer in Evening Primose Oil, regardless of how its taken, but some are. If still nothing, I'd for sure take castor oil before getting AROM or PIt. Either way, you're on the clock...and membranes being ruptured without good contractions and dilation in a very short amount of time makes OB's very nervous...I wouldn't AROM unless I was really making progress otherwise...it would not be a first move for me AT ALL. But, if you don't want to do castor oil, then yes, I'd say Cervadil first. But, honestly, they are so used to this routine, it'll go cervadil, pit, more pit, epid., more pit, etc. whether or not you plan on that or not...sorry if I sound like a downer...its just I hear it all the time. My best friend is a L & D nurse and sees it all the time even though she is not an advocate of it, she tells me all the time how it happens with almost every single patient, especially first time moms.

I think you are going to go into labor before then anyway, so hopefully the cerv. exam and maybe a strip of membranes will help things along.

[nuwavemomma]

Yeah, I wouldn't go for AROM until way far into the game - you have 24 hours after that, probably less. That's the high speed train to a c/s IMO.

I guess if I'd done everything else and was truly looking at going AMA (and the PP is right here - make sure that your choices mean you would have to sign one, it's not a loose term that means just choosing a different alternative) I'd go for the balloon and cervadil if I was already dilated a bit. If I wasn't dilated at all I'm pretty sure I would choose to wait and do nothing.

Check out the link in my sig.

[Multimomma]

Originally Posted by justbishop

I declined the cervical exam today, but will have one on Monday. If conditions aren't favorable in that department, is Cervadil a decent first stop? Are there any more natural options that we should insist on trying first (in the hospital, I mean)?

In the case of good cervical progress, I am definitely not willing to just start right off the bat with Pit. I'd like to have a good list of things we insist on trying before we resort to it, but I'm just not sure about the safest place to start (AROM, then wait how long? etc.) I mentioned niple stimulation, but our OB mentioned that that can cause hyperstimulation, and that he would insist on monitoring if that's something we'd want to do. If we DID end up at the Pit crossroads, he did agree on the lowest dose to kick start things, then turning it off, so at least that's promising...right?

I have to second the pp who laughed at the idea that nipple stim would cause hyperstim, whereas pit won't...what is he thinking? Nipple stim at least only goes as far as YOUR body will go, whereas pit is a completely outside influence and doesn't take into account YOUR body. I had a pitocin induction with my first, and that's why I'm facing vbacs. My body was not ready, even starting small and working our way up on dose.

Honestly, I would spend this weekend with the nipple stim and acupressure, dh can help with both of those Here's a website with some good info on acupressure. I'd have sex, elevating hips and keeping it in as long as possible. You could even have dh do some cervical exploration...personally if I was facing chemical induction, I would have allowed the OB to check my cervix and do a sweep right then, it usually takes a day or two to kick in, and he's probably not going to do that on Tuesday.

My successful induction (my first vbac) had an overnight of cervadil, I was already dilated to a three/four and mostly effaced. I do not know how safe it is on you, or where you are at d/e wise. I would request that, then a sweep, if he'll do one in the hospital. next best bet would be an arom, and if contractions are regular in the next six to eight hours, smallest amount of pit.

Be wary of tricky times in the hospital. OBs will pressure you for a csection at dinner time and usually about 8pm, and when it's time to go home (no one wants to be on call for an unpredictable vag birth) Shift change is tricky as well, because the support staff (and yep, my mom is one of them) likes to have things tidy and finished for shift reports. If you are esp tired or things have not been going well, there will be some pressure then to either ramp things up and 'see what happens', or to end it surgically.

Of course, if there is a medical emergency, then you do what has to be done. Good luck. I was due on the 7th and I'm definitely ready to be done.

[justbishop]

Thanks ladies. I'm still feeling uber depressed about this. Couldn't sleep last night thinking of how craptastic it would be that nature might not get to choose my child's birthday and how that would completely negate all of her horoscope and astrology stuff (stupid thing to be depressed over, I know, but it's what goes through your mind @ 5 am, lol!)

And mom2tatum, this particular OB in the practice actually DID say that if we decline to schedule the induction if no labor by Monday's apppointment, that he WOULD have us signing an AMA thing He even admitted that he personally was fairly comfy going to 42 weeks with NST and such, but that b/c 41 weeks is now the ACOG (or whatever their organization is) reccomendation, he'd want a signed AMA.

So, the list rec from you guys is to:

1. do the at home stuff (sex, nipple stim., pressure points)
2. push to 42 weeks
3. internal exam @ Monday's appt.

If cervix has dialtaed at all:

1. request sweep and go home to wait
or
2. sweep and cervadil @ hospital

If no cervical dialation:

??????

[mom2tatum]

I think that sounds like a plan that suits you and your situation. If no dilation, take a deep breath and really rethink things...that would mean your BODY is REALLY not ready at all...and therefore, maybe you should really try to listen.

Again, I don't think that will be the case...yet you do have to prepare.

Good luck.

I can't believe he said that would require a signed AMA. I have never heard of such a thing...most moms will just stay home and not come in for their induction...that is a way around it, still...but wow. That sucks.

[NaturalMindedMomma]

I'm DDC crashing.

I wanted to know what is prompting him to medically advise an induction?

I guess my point is, to request you sign an AMA there has to be sound medical proof of why your Dr is advising something for you to go against? Does that make sense???

If you are not 42 weeks and there is no medical proof that something is wrong (low fluid, high blood pressure) there is no medical reason to induce therefore he cannot advise medical procedure??? That would be going against his opinion. Ask him if he has an AOO (against OB's opinion) form for you to sign.. HAHA I hope that made you laugh! I'm confused though.

I feel bad for you.

Try all the natural ways at home. Have you thought of checking your own cervix? Google it if you are comfortable trying, it can't hurt!

I would have your membranes swept on Monday.

If you are NOT dialated, your bishop score is most likely not favorable and then MEDICALLY speaking you are unfavorable for an induction.

This is poopy for you all together. Either way, I will be reading to see how it all goes. Good luck mama!

My vote is for:

Natural stuff at home (nip stim, sex, vigorous foreplay involving cervix, kissing, relaxing, caster oil, cohosh)
Membrane sweep
Foley catheter, Cervadil, pit.

I would take pit over AROM anyday. Pit can be turned off, AROM is definite delivery if you are in a hospital.

[Multimomma]

Originally Posted by justbishop

He even admitted that he personally was fairly comfy going to 42 weeks with NST and such, but that b/c 41 weeks is now the ACOG (or whatever their organization is) reccomendation, he'd want a signed AMA.

He's such a liar! ACOG says 42 weeks UNLESS there are other conditions

http://www.acog.org/publications/pat...tion/bp154.cfm

Their reasons for doing an induction are:
Your pregnancy is postterm (more than 42 weeks).
You have high blood pressure caused by your pregnancy.
You have health problems that could harm you or your baby.
You have an infection in the uterus (chorio-amnionitis).
You have abruptio placenta (the placenta has begun to separate from the inner wall of the uterus before the baby is born).
You have premature rupture of membranes (your water has broken).

[Malva]

You may also want to try acupuncture and chiropractic. Getting your spine and pelvis aligned could be all your body is waiting for. Acupuncture may be more effective than pressure points on their own.

[NaturalMindedMomma]

Originally Posted by justbishop

Thanks ladies. I'm still feeling uber depressed about this. Couldn't sleep last night thinking of how craptastic it would be that nature might not get to choose my child's birthday and how that would completely negate all of her horoscope and astrology stuff (stupid thing to be depressed over, I know, but it's what goes through your mind @ 5 am, lol!)

And mom2tatum, this particular OB in the practice actually DID say that if we decline to schedule the induction if no labor by Monday's apppointment, that he WOULD have us signing an AMA thing He even admitted that he personally was fairly comfy going to 42 weeks with NST and such, but that b/c 41 weeks is now the ACOG (or whatever their organization is) reccomendation, he'd want a signed AMA.

So, the list rec from you guys is to:

1. do the at home stuff (sex, nipple stim., pressure points)
2. push to 42 weeks
3. internal exam @ Monday's appt.

If cervix has dialtaed at all:

1. request sweep and go home to wait
or
2. sweep and cervadil @ hospital

If no cervical dialation:

??????

Ok so he is comfy with you going 42 weeks, but his office may tell him to push this "new" guideline. Signing an AMA just says that you were told that you SHOULD induce and that you will probably have no legal recourse against the DR, the office, the hospital should something go wrong.

I know you don't want to sign one, i just wanted to point that out.

I think it's so sad when a GREAT OB is comfy with 42 weeks and the fear based guidelines tie their hands. Maybe that is what is wrong with obstetrical care today. SIGHHHHHHH...

[jeliphish]

have exam on monday...discuss stripping membranes
have sex...sperm eats away at the cervix
nip stim


I wouldn't decline any more internals if the alternative is induction I think they can really speed along the process.

[filiadeluna]

I understand your frustration with the whole Astrology thing. It may seem silly, but it's really not. My Midwife said the absolute earliest she would suggest induction is 42 weeks which would land on March 21st for me, and that's the first day of Aries. Maybe that's what she is meant to be, but I really had my heart set on a Pisces. DH is a Sag, and I'm an Aquarius. We both have a lot of fire in our charts, though, so I was hoping for some sort of balance rather than more fire. Regardless, I really don't want to interfere with the possibility of her coming as naturally as possible.

Is your OB at least going to do another ultrasound and/or an NST? My Midwife scheduled an ultrasound for me tomorrow @ 40 weeks 6 days to check the placenta & amniotic fluid. If I haven't had her by Tuesday, I'll have an appointment Tuesday to do a NST. If things aren't progressing, I will definitely agree to a membrane sweep, but my MW said often those will just cause contractions that don't lead right into labor.

[koalove]

how about trying some natural induction stuff first so you dont have to do any of the invasive stuff? if that doesnt work, i would definately try to avoid pitocin because that starts a cascade of events and for sure NOT letting them break your membranes. the other stuff like the cirvadil and such, seems like no big deal.

[texanatheart]

I think you've gotten some great advice here. I know I just learned a ton! Just wanted to send you a , and you'll be in my thoughts! Hopefully, she'll show up this weekend!

[justbishop]

Originally Posted by Multimomma

He's such a liar! ACOG says 42 weeks UNLESS there are other conditions

http://www.acog.org/publications/pat...tion/bp154.cfm

Their reasons for doing an induction are:
Your pregnancy is postterm (more than 42 weeks).
You have high blood pressure caused by your pregnancy.
You have health problems that could harm you or your baby.
You have an infection in the uterus (chorio-amnionitis).
You have abruptio placenta (the placenta has begun to separate from the inner wall of the uterus before the baby is born).
You have premature rupture of membranes (your water has broken).

I was on their site last night looking for something like this, and would LOVE to print it out, but that link is requesting a username/password in order to see the article Is there any possible way for me to get that info on my own screen? It's exactly the type of thing I'd like to bring in to them on Monday!

And thanks again, ladies! This is all such wonderful advice

So, if nothing that we can do on our own works this weekend I'll be seeing a different Dr in the practice on Monday. Holding out hope that he'll have a different opinion, and maybe not even mention the AMA, but if he does, hopefully I'll have some info to show him. I do plan to request the exam and sweep (if dialated), and wish now that I'd have done it yesterday ><;;

And what you guys are saying about allowing the cervadil and eventually even pit before agreeing to AROM makes a ton of sense...idk why I hadn't thought about it that way before! Thank you!

[cyrusmama]

nak...

before going in for my last OB appt. (which we left and went straight to hospital for induction after) i tried at home EPO, tons of pineapple, eggplant parmesan, Come Out Baby hynobabies mp3. Two days before I saw the accupuncturist. Two nights before the appt I started nipple stimulation and pressure points. Two days before, I started having regular contrax, they didn't increase in intensity but were consistent. The day of induction at hosp. I did a lot of both nipple stim and pressure points while at hosp waiting to be hooked up to start the induction. I went from a big 1 to squishy 3 in a couple hours on my own while waiting. I did a pit induction, and I do think that all the stuff I had done helped.

Also, I talked to Jax a LOT letting him know we were ready to meet him.

Good luck mama, I understand what you are dealing with and it isn't easy.

[herins]

Originally Posted by justbishop

I was on their site last night looking for something like this, and would LOVE to print it out, but that link is requesting a username/password in order to see the article Is there any possible way for me to get that info on my own screen? It's exactly the type of thing I'd like to bring in to them on Monday!

I did some peeking around the site for you cuz I don't feel like going to bed! Here are a few links that might help you:
http://www.acog.org/publications/pat...tion/bp154.cfm
http://www.acog.org/publications/pat...tion/bp069.cfm
http://www.acog.org/acm/pdf/50.pdf - This is for a course in May that discusses the risks of inducing around 41 weeks, and clearly states that post-term is >42 weeks

I hope something helps! Good luck!

[happydoulamama]

Originally Posted by filiadeluna

My Midwife said the absolute earliest she would suggest induction is 42 weeks which would land on March 21st for me, and that's the first day of Aries. Maybe that's what she is meant to be, but I really had my heart set on a Pisces.

Sorry for the hijack, but I really want a Pisces too! I'm due on the 24th and measuring 4 weeks ahead still so I'm hoping that will mean an earlier birth so I can get my fishie. Our firstborn is an Aries/Taurus cusp (can you say bullheaded leader??) and our second is a Sagg. If I get another Aries, there will never be peace in our house again I'm a Virgo and hubs is a Gemini.

[justbishop]

heehee, nice to know that I'm not the only one concerned with the kid's sign!

and just a teeny update...woke up to pee @ 5:55 am and had a little gush of clear fluid (not anything my panties couldn't catch), and a bloody tinge when I wiped. been having really uncomfy ctx since then avging about 30 sec long/5 mins apart. This could be it!!!