Preparing for induction

[Junegoddess]

Yes, I know it's a weird thing to do... I'll explain WHY, and try to be as brief as I can.

I am currently pregnant with my 7th, but only have two living children. My first loss was due to shoulder dystocia coupled with a prolapsed cord and an unassisted birth. I've had two miscarriages as well, and a stillbirth. After the stillbirth I tested positive for antiphospholipid antibodies, although I was not retested, which I should have been for a solid diagnosis. I am being treated as if I do have a clotting disorder, for the sake of safety. I also have really big babies who get stuck, probably due to undiagnosed gestational diabetes. I've been screened for GD twice already (only 26 weeks currently), and am fully expecting to flunk my next test.

Soooo... I am high risk, going to be birthing in an Air Force hospital, and being seen by Maternal & Fetal Medicine specialists. 'Cuz I'm cool like dat. No crunchy midwifey natural happy birth for me.

I came into this fully expecting to fight tooth and nail for as natural a hospital birth as possible. After all, my living son was born in a hospital and, other than him getting stuck, it was a decently good birth. All the complications and interventions and separations and extra crap resulting from his being stuck was no fun. My #1 goal is a living baby. My # 1 1/2 goal is getting to hold said baby immediately. I have never yet done that... hold my own newborn. The youngest baby I have ever held was a friend's, not my own.

The doctors really think the safest, smartest course of action would be a planned c-section. I see their point, but am mortally terrified of that option. Trying to get over that, in case it becomes necessary. They really do not want to let me go past my due date (yes, I know they can't induce me if I'm not present... I could protest... but every time I've forced my will on birth in the past, it has gone horribly wrong.) Not going past my due date really means I will be induced. I gestate for 41+ weeks. So... I am fully expecting to be induced, if not sectioned.

And that finally brings me to my question... what can I do, from now until the end of December, to prepare myself the best I can for an induction? I'm planning to start drinking raspberry leaf tea soon, and probably around the first of December kick it up to infusion-strength. I do not seem to have a touchy uterus, so I doubt it'll put me into labor too soon. I know Evening Primrose Oil should be helpful the last few weeks, to ripen things up. And I bought a tincture called 6 Week Formula or something like that (sorry, it's in another room and I'm pressed for typing time.) It's supposed to help ready the bod for labor. Any other ideas? I'd also welcome ideas for how to prepare for a c-section... just in case... this will absolutely be my last pregnancy, barring a miracle, so on one hand I really want to end my birthing career with my abdominal wall intact... but on the other hand, I don't need to worry about future VBACs. And I do have a few things I'd like them to do "while they're in there" LOL. I have a very bad diastasis- separation of the abdominal muscles, and if they could fix that while they've got me open, and maybe put my bladder back where it goes and tie my tubes....

[fwlady]

I am not sure what kind of advise to give you. I have done everything I can to avoid an induction in several of my births, which include UC and everything in between. I can't imagine going through what you have, and the myriad of feelings and conflict that would bring upon a person.

I don't know, I would almost say that you have a surgery that probably has to be done, and one that may be done anyway. If you end up with an emergency cesearean, they will not take care of the other things you would like to have done, so there would be two surgeries anyway. So, do you risk 2 or go ahead and consent to 1 big surgery and kill 3 birds with one stone?

It is known that any woman that usually goes weeks over her due date, will probably fail an early induction. The baby and body just aren't ready. You already have issues since you have lost so many little ones. I am so sorry for your losses. I am not sure, but I think maybe I had heard of Hunter on another board we may be on together. (CUC?) Where the EMTs gave you bad advice, and the therefore the bad outcome. I may be wrong.

I would say, if it were me, I would be as conflicted as you are. I have almost requested a Csection (and I am a HUGE VBAC advocate), for the last birth and this one, because I just don't relish the idea of all the pain (I know, I know), and my DH possibly not even being close to home when I go into labor. He was last time, but this time, he is less likely to be home. I have even thought of induction, but that is a big no-no for VBACs. Although, I know they do them everyday.

If I were you, I think I would tell them that you want the csection ONLY if they can do all those other things for you. And, that you can have your baby on the operating table if the baby is okay. You may be able to nurse with help. The drs doing the other things will just have to be quiet about what they are doing, since they aren't used to awake patients.

They would probably be more than happy to accommodate since drs hate VBACs. Otherwise, if those can't be met, then you want to try for the vaginal birth, even if it means by induction. But, the gentlest way to go is a Foley induction, is what I have heard, and it is also the safest, I believe. They didn't have that out when I was induced 14 yrs ago, that I know of, and I was also in an AF hospital.

So, I think that would be what I would do in the 10 min I have been able to put myself in your shoes and think about it. Kymberli

[elanorh]

Hopefully you'll get more responses, hopefully some from people familiar with your potential condition.

I have a friend who has a clotting disorder, she was induced and gave birth at a hospital with specialists as a result of her disorder; they did not want to c/s so I assume they did a Bishop's Score prior to the induction. I don't know if her disorder is what they assume you have....

Is there any way that they can test you to confirm whether you have this disorder, so that you all know for certain? I would imagine that would inform their advice, as well as your decision. Intuitively to my completely un-medically-educated brain, it seems that a clotting disorder combined with a c/s is probably not a good idea. But I could be very wrong.

If you've had problems with larger babies in the past, and dystocia, you may want to talk to your doctors about the Gaskin Maneuver and the fact that you'd like that to be used if such a situation appears to be happening in a vaginal birth. As long as you're not on a an epi, I think you would be able to do this. Also, if you're able to birth in a squatting or on all fours position, then your pelvis will be more open for birth, so less likelihood of problems while baby is being delivered.

Is there a possibility that they will consider doing a Bishop's Score before the induction, so that they know how likely it is that you'll be able to kick-start into labor?

I have not had a c/s. I did have guidance for that in my birth plan (I wanted dh to go with baby immediately, never separated from baby if I were having a c/s; and baby to me as soon as possible, no formula, nurse on mom ASAP etc.).

[ShwarmaQueen]

I don't know mamma, my DH has antiphospholipid syndrome (LAA) and knowing what I do know, it would be more scary for me to go straight to a c/s than an vag delivery, after induction. Reason being, you're probably going to have to stop your anticoagulants prior to either, but the risk of bleeding is exponentially higher with the c/s. So, I'd probably go for the scheduled induction at 41 weeks, if they'll let you go that long.

[Junegoddess]

Yes, I'm afraid my son Hunter is a bit famous... or infamous... I'm sure the story still circulates. At the time I was such a moron about birth that I somehow honestly did not believe he was stuck. It wasn't until my second son got stuck that I knew what "stuck" meant... and Hunter was absolutely stuck. Shoulder dystocia. The EMTs did give me horrible advice- to stop pushing- but I doubt it would have changed much. I don't know. My second son was stuck for almost two minutes, the cut-off for brain damage, I'm told. And he was more than a pound smaller. So, I imagine Hunter would have still been stuck too long, especially with no one to help.

I know what you mean about scheduling things around husbands... mine is back in college, and I'm due January 6th, and he starts his new semester on the 4th. If I could have all the drama over before he starts school again, that'd be good. I used to have strong opinions about women who induced or scheduled sections around their own needs/wants. As usual, that's coming back to bite me. I really ought to learn to never ever judge...

I really LIKE birth. My first two real labors were pretty bad... but those babies were posterior. My living son was in perfect position and I had a lovely labor. Really. It wasn't painless or orgasmic, but it was good. It never got more than I could handle. I would love to do that again... because it made me feel so good about myself. And I'd love to end my birthing days knowing all my babies were born normally. But, I question whether they should have been... I've always joked that I don't know where my hips are. I have plenty of gut, but no hips. And two out of three full-term babies were stuck. My first might have been, too... I don't think the CNM said the word, but my mom was there and remembers her "reaching in to her elbows" to get my daughter out faster. It's all a blur now, as it was almost 11 years ago.

I really am scared to push too much of my own will on this.

This might all be moot... so far my little one has been head-up in all the ultrasounds (and there will be many more... I know, I know... but...) I'm only 26 weeks, and I KNOW there's plenty of time left... but I can't help but wonder if maybe he's deciding for me. No way in hades I'd attempt (or be allowed by any of my family or doctors) to attempt a breech birth. Not after all that's happened. That would simplify things. I find myself almost hoping for that... but, no! I just want a normal birth. I want my biggest complaint to be that once again they ignored the fact that I said "no shots" and gave him the vitamin K. I want that to be the worst thing that happens.

[jess152]

Wow, I totally feel for you! What a situation to be in.

There are some other natural things that you could try before consenting to a c/s on your due date. (Here's a dumb question, but how many weeks will you be on your due date? You mentioned that you'd normally go to 41)

DTD with DH...the natural progesterone in semen is a great cervical ripener! As I read last night in my Hypnobirthing book, "What got the baby in will get the baby out!" lol

enema: sounds kinda nasty, but it stimulates the bowel which can in turn start contractions (but only if you were ready to go anyway...in any case, couldn't hurt)

nipple stimulation: also starts contractions. I'm getting them like crazy now from nursing my 2 1/2 year old. Will come in handy when I'm 42 weeks!

castor oil: probably works the same as an enema. Maybe someone with experience can chime in. I've done my research, but as you can see from my sig I've only had a c/s and no labour or TOL.

Remember too that the first baby paves the way for the rest, by clearing a birth path. The slow moulding of the baby's head changes the shape of your pelvis that makes subsequent births easier.

ETA: eating fresh pineapple...some mamas swear by it. It's so good for you, it couldn't hurt.

[Junegoddess]

Originally Posted by elanorh

Is there any way that they can test you to confirm whether you have this disorder, so that you all know for certain?

They already did, at the beginning of the pregnancy... but I had to go off the heparin for 3 days prior to the test... and then they did the wrong test. They told me about their mistake right after I'd seen the baby's heartbeat for the first time... and asked me if I wanted to try it again. No, thank you. IF I have the disorder, stopping the heparin could cause a clot that could kill the baby. Soooo... no retesting until after the baby is born.

Originally Posted by elanorh

Also, if you're able to birth in a squatting or on all fours position, then your pelvis will be more open for birth, so less likelihood of problems while baby is being delivered.

I was on all fours with my living son (and squatting with my first son). The CNM apparently didn't know that flipping me onto my back would have probably loosened things up... we all just assumed I was already in the best position.

I will ask about the Bishop's Score. I know they mentioned lots of tests they can do near the end, to guess how the baby is doing and if he's too big. Some ratio of head to tummy is supposed to be a good predictor of shoulder dystocia. I just... kinda want to be ready for anything, so I want to plan ahead. Two weeks before they decide I'll need an induction might be too late to really get my body ready for the idea.

As for risks with my clotting disorder and a c-section... I have no idea. I have never had ANY symptoms of a clot. My stillborn daughter did not actually die from a clot. It's possible my second miscarriage was due to not being given access to heparin in time... and I like to blame it on that, so that it's the military medical system's fault for not listening to me. But it was probably really due to getting pregnant immediately after having my IUD removed. I don't consider myself sick with a clotting disorder and therefore at risk of things. Maybe I'm just delusional.

[kcparker]

The other thing I'd do (PPs have lotsa good suggestions about ways to ready your body) is talk at length with your HCPs about how you'd want an induction to go - when it would happen, your desire to try to do it only with a favorable bishop score, what kind of cervical ripener you'd want, who would have control over the timing of upward titrating of a pit. drip if you need it, what time of day the ripener would be placed (hopefully night) and when the pit. would get started (early morning, hopefully after a good night of rest and some strength-imparting food), your wishes to maintain mobility, use tub/ball/gravity...I know a number of women who went into labor with just a cervical ripener, and while a pit. induction is not picnic, you CAN do it unmedicated and maintain your autonomy and mobility if you are so inclined.

Same for prepping for a c-section, get your wishes in order, then discuss them at length with the HCPs so that if it does end up seeming like the best course of action, you know that everybody is on the same page about what is going to happen.

[ShwarmaQueen]

Originally Posted by Junegoddess

As for risks with my clotting disorder and a c-section... I have no idea. I have never had ANY symptoms of a clot. My stillborn daughter did not actually die from a clot. It's possible my second miscarriage was due to not being given access to heparin in time... and I like to blame it on that, so that it's the military medical system's fault for not listening to me. But it was probably really due to getting pregnant immediately after having my IUD removed. I don't consider myself sick with a clotting disorder and therefore at risk of things. Maybe I'm just delusional.

I guess I was assuming you were on anticoagulants 24/7 now (as is my hubby). Are you? Not being on meds makes things so much simpler.

[Junegoddess]

Originally Posted by ShwarmaQueen

I guess I was assuming you were on anticoagulants 24/7 now (as is my hubby). Are you? Not being on meds makes things so much simpler.

I am on heparin... two shots a day, which means 24 hour coverage. But it's a prophylactic dose, just in case. Since I've never had a "clotting event" in the past, pregnant or non-pregnant, there's no cause for a higher dose. They didn't even bother to put me on Lovenox (the usual stuff for clotting disorders) because they apparently don't really think my clotting issue is an issue. And heparin is able to be counteracted with medication in case of an emergency.

My appointment is this afternoon... hoping I can really get good answers. Mostly hope I actually get the doctor I'm supposed to, and not an intern. I like the intern, but she is just crazy-perky and happy and thinks everything is fine and there's no point discussing big plans with her because it's not her decision.

I've been reading up more on the surgery for rejoining the stomach muscles... yikes. It's basically a tummy tuck. And while I'd certainly love to not look 5 months pregnant when not pregnant, that's a helluva thing to be recovering from with a newborn.

Oh, and someone asked what they're counting as my due date, since I gestate for 41 weeks. It's a military hospital... my reality has nothing to do with their reality. My due date is 40 weeks after my LMP, and they've even decided to change my LMP based on ultrasound results. I do not see much point arguing with them. I'm seriously surprised that they aren't pushing an earlier induction (unless something goes wrong). LOTS of docs induce at 37 weeks when there is a clotting disorder and/or history of stillbirth, under the assumption that the baby is better off out than in. But my docs don't plan to induce before 39 weeks. Which would still be two weeks early for me. Which is why I plan to prep myself with RRL infusions and EPO.

Oh... and I've never had sex or nipple stimulation help. <shrug> Castor oil seemed to have helped when I was threatened with induction with my living son... but I'd been having TONS of not-quite-labor contractions.