updated, finally! they wanted to induce me tonight... anyone know about placenta calcifications?

[cricketsmomma]

I'll try to be brief
I'm around 40w5d, no dilation/effacement/anything like that. I have planned for an hbac but DH is starting to be not on board with that. We have a CNM with hosp privileges who has OBs backing her. I love the CNM but hate the obs, so a little while back I found our CPM who I had planned to do the hb with.
Yesterday I had an NST with the CNM and it was fine. We've been wondering about position so today I had a u/s and yes the kid is head down.
Here's the catch - got an AFI of 4.7 (5 is the low end of normal). There are some calcifications on the placenta. The back-up doc wanted to induce tonight... probably would have been around 11 p.m. The CNM said what if I did NSTs every day? Baby and mama are both fine at the moment, why rush to an induction with an unprepared cervix? Doc says there's no reason for me to stay pregnant. Well, if the baby is ok and my body isn't ready... doesn't that make 2 reasons?
Why in the world would you induce an unprepared mama this late at night? so your golf game or bbq on a holiday weekend doesn't get interrupted?
So I'm not so worried about the AFI but I wonder about calcifications. Aren't they pretty normal at the end? I know I don't want to stay pregnant forever so this show needs to get on the road soon, but is it a desperate rush? CPM doesn't seem to think it is either. I don't feel it is. CNM wants to wait too but has all of that doc pressure on her.
I wanted an hbac because I feel like that's the safest option - less intervention is best. But I'm trying to keep DH comfortable too, so I'll compromise. Our CPM will be our doula if we go to the hosp.
Comments? Suggestions? Brilliant ideas? I could use them :

[Belle]

My spidey senses are tingling.

I can't post a lot now, but it doesn't make much sense to induce an VBAC momma with an unripe cervix when both mom and baby are doing fine. It sounds like a recipe for another c/s so your OB doesn't miss his/her holiday.

[cristeen]

The fact that the OB is trying to push you for a VBAC induction is a red flag to begin with. On the Friday of a holiday weekend is an even bigger one. If the CNM and the CPM are both in agreement, then the cynic in me would chalk this up to the OB wanting to attend a holiday BBQ.

[littlebb]

I have to agree with PP. This is coming purely from gut instincts, not actual birth experience of my own yet. It sounds like you are being pressured from a purely selfish position - the doctor is either protecting him/herself from something 'going wrong' or has something more important to get to over the weekend. Something just doesn't seem right about it, especially since normal gestation is between 38 and 42 weeks. My MW mentioned in one of our appointments awhile back that calcification are normal toward the end - it's when they appear rather early on that they are a concern. The doc saying 'there's no reason for you to stay pregnant'... that just doesn't sit well with me. Best of luck to you, and if you can get them to hold off, it sounds like it would be the best. Hopefully if she has to act as doula for you, she might be able to intervene a little more?

[an_aurora]

Doctors get very nervous when they see low AFIs. Calcifications on the placenta are not a huge deal, though. I had some on mine, my friend had some on her placenta with a 38 week baby. And I wanted to add that inducing in the middle of the night is pretty common too. Some people prefer to come in, have Cervadil placed, and then sleep for the rest of the night.

[Delta]

Aren't VBAC inductions a big no-no? There are very few docs here who do VBACs and those who do refuse to induce.

[mamatolevi]

get in bed and drink a bunch of water and don't get out of bed except to pee for the next few days. I've known a handful of women w/o low fluid on Friday who just needed more water and rest for a couple of days and their "low fluid" went right back up by the following Monday. your fluid levels will likely go right back up. As long as your placenta looks fine, and I don't think you need to worry about calcifications quite just yet unless there are other risk factors going on (I could be wrong), then there's no reason to induce yet.

[Theoretica]

Originally Posted by mamatolevi

get in bed and drink a bunch of water and don't get out of bed except to pee for the next few days. I've known a handful of women w/o low fluid on Friday who just needed more water and rest for a couple of days and their "low fluid" went right back up by the following Monday. your fluid levels will likely go right back up. As long as your placenta looks fine, and I don't think you need to worry about calcifications quite just yet unless there are other risk factors going on (I could be wrong), then there's no reason to induce yet.

I'm agreeing with this.

Good luck mama, follow your instincts, do the NSTs if need be, but stick to your guns. An induced vbac is asking for trouble if it's unnecessary...

Keep us posted!

[notjustmamie]

I could be wrong, but I thought low fluid wasn't supposed to be diagnosed with just one measurement? It was my impression that if you have a low AFI, the protocol is to have you drink lots and measure again later.

Also, isn't "low fluid" becoming the new "big baby" as a reason for induction right now?

Be sure to check out you option and know the risks/benefits before you make your choice.

Good luck on a wonderful birthing experience and a healthy baby!

[MsBlack]

the calcifications are NOT an issue, IMO. This is simply not well understood at all by obstetrics, but they act/speak as if they are sure it's a problem. Why would so many women (nearly all) have at least a bit of calcification on placenta if it were a 'problem' (oh right, I forgot! Pregnancy is a DISEASE .

I would say at this stage that the 'low AFI' is also not a problem. AFI drops by some degree, by this stage of things, for most women--like calcifications, this is just not well understood. And I further would NOT believe the result of 1 u/s concerning AFI. I wouldn't go so far as to say stay in bed while drinking a lot of fluids--but give you the same suggestion that I give all women near birthing time: make sure you are getting as much rest as you actually need, which for most women includes some sort of nap/feet up in the mid day. And just drink what you need--no skimping, no putting it off because of being too busy or you just hate to be running to the bathroom so often-- but there is also no need to force fluids which will only aggravate your kidneys and could result in LESS fluid actually being absorbed (more peeing though!). Tub baths are also reported to help AFI, no experience with this myself tho.

Anyway, ITA with those who said that it's a holiday weekend...ulterior motives are so likely to be involved! The state of your cervix really doesn't have much to do with your birthing day. Sure, MOST women will start with softening/effacement and even some dilation in the weeks prior to birth. And some don't, but go into labor on their 'unripe' cervix and have fine births anyway.

If you really want an HBAC/VBAC, I'd avoid that doc for several days. Daily NSTs are just going to promote fear/distrust, IMO, with no actual benefit.

[cricketsmomma]

well I'm still pregnant...
I think I will say ok to a NST for DH's peace of mind. This whole situation sucks. I really believe that everything is fine, but with that tiny fraction of a chance that I'm wrong... oh you can just "what-if" this to death.
We'll see. I feel like the NSTs will add more drama to this but I'm trying to keep DH comfortable too. I hope this works

[an_aurora]

Sounds like a good plan to me! I did several NSTs with both girls, mainly because we were freaked out by the sudden lack of movement they both had after their EDDs.

[Sileree]

According to a nurse-midwifery text I looked at: "Amniotic fluid determinations are imprecise, practitioners overestimate low volumes by up to 89%."

The NHS of the UK's NICE guidelines: "Pregnancies with reduced amniotic fluid volume and no associated maternal or fetal conditions do not show an increased incidence of obstetric interventions or adverse perinatal outcomes."

[Asher]

AFI absolutely varies from u/s to u/s, depending on the tech, the time, babes position, etc. It's crazy. I just went through this from 34-37 weeks b/c one u/s showed a "low normal" AFI. Every single tech (I had to have u/s 1x a week and NST's 2x a week) measured the AF differently. It was crazy. And keep in mind that if there is any body part, cord, etc. in a particular quadrant, they cannot measure that fluid. So you may well have even more fluid in there, just not that they were able to measure. It's also completely common to have fluid decreasing the closer to your due date that you get.

I might also add that even though my last fluid level at 37 weeks was around 7.5cm, when my water actually broke at right around my due date, I lost copious amounts of fluid. More than I ever had with the other three, I might add. Like from the time I got from my house to the hospital, my pants were soaked down to my knees and that was with changing my pad before I left the house b/c I'd been soaked before then, too. I continued losing tons (seriously, sooo sooo much) of fluid until he was actually born. My midwife kept saying how crazy it was that they had me being tested for AFI every week when it was obvious that we had PLENTY of fluid.

Good luck, mama!!!

[Theoretica]

Keep us posted mama, I'm just popping in to see if you've got anyone popping out

[cricketsmomma]

well, today's NST was excellent. The nurse said she wouldn't worry a bit. So tomorrow I'll go for another one... it's a hassle (over an hour each way!) but it's reassuring too. Especially for DH. meanwhile... I'm going to toy with some of these natural induction ideas - but I can't bring myself to drink castor oil!

[kltroy]

Hey I just wanted to offer some encouragement to hang in there!! My VBAC was at 41+2 and they were going to induce me b/c AFI was 2. In my case I was in early labor and it all turned out perfectly. As for the calcifications, this is a sign that the placenta is getting old and may not function as well. AFI is also an indicator of this. In fact, after my placenta was delivered the doctor checked it for this (he even let my husband put on some gloves and showed him what he was looking for) - it actually feels "crunchy" if there are a lot of calcium crystals in it. Despite my low AFI, the doctor said mine wasn't in bad shape.

Anyway, I say all this only to say... good for you for doing the NSTs and sticking to your guns. As long as your baby looks good there's no reason you can't let labor start naturally. We're all cheering for your VBAC!!

[ShwarmaQueen]

Hold your ground mamma. Keep your senses and get the birth you want (and deserve).

[cricketsmomma]

no baby yet...
today's NST was great too!
They're getting antsy. The RN asked me today if I've picked a day to be induced. But today could be 40 weeks! So why why why the panic?????
:
I've tried walking, pressure points, sex, evening primrose (for weeks), visualization, nipple fun, black cohosh... because I figure these all have to be better than pitocin. Nothing made a bit of difference. I'm on my way to walk to my mom's house, it's a mile up the side of a mountain. I wish I wasn't feeling so pushed to get this kid out!
The nurse said today, "You must be so miserable." NO! I feel fine! Then she said some women just can't go into labor. Well, how many of these she's talking about were just left alone and not pestered by their care providers?
Ok, no more venting. I have a walk to take... and a lot of pineapple to eat!

[Asher]

They are so used to women coming in begging to be induced at 37 weeks (or before, but don't get me started) b/c they are just miserable and want to be done with it. *rolling eyes*

Glad babe is looking good on the nst's!