Starting to get concerned...postdate...

[mamaw/two]

I'm at 42 weels 3 days and am starting to get concerned about baby. He has done very well up to today, he has not moved the way he normally does. He IS still moving, but only little movements and not at his usual times. Should I go in to get biophysical? If I do go in, I want to have a game plan as to what I should do if they want to induce. I just don't know what method to agree to if they want to do it. Any suggestions or advice would be greatly appreciated.

[JamieCatheryn]

Well, if you want to plan for induction you'll first need a cervical check to see how ready things are (soft, effaced, dilated, etc etc). If your bishop score is high you could go directly for Pitocin, maybe a little of that could get you on your way and it could get turned off to allow normal labor after that. If you're still closed and tight maybe cervidil (prostaglandin insert) to ripen things and start contractions, followed by Pitocin if you needed it. Cytotech is often used (against manufacturer's instructions, it's a pill for something else) instead of cervidil, since it's cheap and very effective, but can cause hyperstimulation and other complications pretty easily and can't be removed like the insert can. Sometimes they break the waters to start things, but if they do that you can't stop and go home if things don't work, and baby might get stuck in an unfavorable position without the buffer of waters to help movement. Whatever they did they'd want to monitor you closely, contractions and fetal heartrate, to make sure they aren't causing complications, which they can.

[bluewatergirl]

If you are concerned about baby's movement, I would go in to get checked - at least a doppler check or a NST for your peace of mind.
Try not to worry about induction - hopefully, it doesn't come to that.
(Maybe he's getting ready for labor right now!) (((Hugs)))

[kltroy]

personally, I would get checked (BPP or NST) - it sounds like it would be good for your own peace of mind. If everything looks good you will go home reassured. If they want to induce b/c they are concerned about the baby, well... in that case it's probably time for the baby to come out and you'll be glad you went in to check.

The good news is that this late in the game it may not take much to put you into labor. As for breaking water to induce... well if the clock is ticking b/c the kid needs to come out, I don't see much that is risked by breaking membranes. (The main argument against this is that it puts you "on the clock" to have the baby - but if the baby doesn't look good you're already on the clock).

Good luck to you.

[kcparker]

Go. Get checked out. If there's something wrong, you want to know about it, and if baby's fine, you can relax. If they don't like how baby is doing and want to induce, your choices will depend on how your cervix is looking. Hopefully at this point, it's not still high, hard, posterior. If you need a cervical ripener, they may offer you cytotec (pill form, usually given as a vag. suppository, and cervical ripening is an off-label usage for the drug - get educated about risks/benefits of it), cervidil (on a string like a tampon, can be pulled out if cxns. get going), or prepadil (gel that can be washed out if need be). If you are close anyway, sometimes cytotec kicks moms into fullblown labor, but it is harder to control dosages and can hyperstimulate the uterus too. You can suggest using acupressure and nipple stimulation to get cxns. going as a first step before you'd go to pitocin. I have seen nipple stimulation be very effective at getting a good contraction pattern going, but usually only if the mom's body is pretty ready in the first place. The nipple stim. would be a good alternative to pitocin, though it is tiresome to have to keep it up for hours on end (so make sure you have good support who doesn't mind helping you!)

Get fully informed on risks/benefits of any course of action they suggest, ask lots of questions:
- is this an emergency, do we have some time to think through options?
- why are you suggesting this procedure/drug/etc.?
- what are risks/benefits of the procedure?
- what else might need to be done as a result of choosing this procedure?
- I know this is what you normally suggest, but what are the alternatives?
- what happens if we wait (1/2 an hour, 1/2 a day, 48 hours)?
- what happens if we do nothing?
- can I have some time alone with DP to think about our options?

[XanaduMama]

I would also go get checked, if you're concerned about baby's movements. Most likely he's just running out of room!

Going that far post-dates, I'd wonder about fetal positioning: he may not be in the right position to put the necessary pressure on your cervix to get things going. Go see a chiro, one who does Webster, and also do as many pelvic tilts (cat/cow), hands and knees/crawling, and other optimal fetal positioning stuff as you can.

[mamaw/two]

Thanks for all the replies. We did go and get a nst and biophysical done today. Everything looked pretty good, except that they couldn't watch him practice breath during the ultrasound and he didn't move very much. His movement has picked up this evening, so I'm feeling much more reassured. I also talked with the midwife about induction, which will become something we may need to do if I go past 43 weeks. She feels that pit would be my best option and I guess that's probably the one I feel most comfortable with. Luckily, I have a high bishop score, so that's something. I also got my membranes stripped today, so hopefully that will just help kick things into gear.
I have been very concerned with optimal fetal positioning throughout this pregnancy and have been seeing a chiro that practices Webster since the end of my previous pregnancy (I had horrible SPD last time, and also went 18 days past my edd). The funny thing is that this morning after she adjusted me, she said that she has never seen everything so balanced on me before.

[Kidzaplenty]

Hoping you have a baby already! I am always so impatient the last couple of weeks.