could use some advice. . .

[mommabear12]

I am currently 41 weeks (I know pretty exactly as I was charting). This is our first and only child. I have had no complications in my pregnancy.

My OB decided to induce me using prostaglandin gel at 39 weeks due to the baby being big (est. over 10lbs + and head size over 15in) because I wanted a vaginal birth over a c-s if at all possible. I agreed it was worth trying.

I had 4 doses of prostaglandin gel in 2 days, and I had absolutely no reaction to the gel, my cervix stayed high, hard, undilated and unchanged. She then offered to try pit drip but I declined since I was still 'early'... she also offered a schedule c-s which again I declined. We decided to 'wait and see' for another week.

Fast forward now, 2 weeks later and I am approaching 41 weeks. I am having no signs of labor starting at all, my cervix is unchanged, I am having no contractions etc. However the baby and I are healthy.

My OB is concerned the baby hasn't engaged yet and I am showing no signs of any sort of labor, my cervix is rock hard and closed apparently with fetal super glue.

She has offered to 'wait and see' if I go into labor naturally over the next few days and hope there are no complications/emergency c-s etc OR she has offered to give me a c-s scheduled at 41.5 weeks. (which I realize I can then again decline, but I am wondering what the fine line is between being unrealistic/hard headed and being realistic/educated).

I can't help but wonder, at what point does a planned c-s cause less harm/trauma (then a failed induction or failed natural labor which then becomes a emergency c-s)... ?

I am sort of at a loss as to what to do. I am looking for others who may have been in a similar situation or had to face similar decisions..

She doesn't want to try another induction since the first one failed and I had no response. She feels it will just put unnecessary drugs in my system (which I sort of agree with). However, she is also very concerned my body will not go into labor until there begins to be complications (thus meaning I would need a c-s anyway due to pre-e, failed placenta function, etc).

What would you do?

How long would you wait before scheduling a c-s if you are showing no signs of labor, the baby is big and its your first/only child?

Anyone have any sort of personal experience, good or bad?

[Gwendolyn's babies]

Oh, how frustrating for you. I don't have any real advice. I had some late babies and always before they were going to induce I would go into labor on my own.

Have you tried castor oil? Or had a sweep of the membranes? Excuse me if these are stupid questions.

by the way my last baby was a week overdue and 9 lb 6 oz. Mine steadily get bigger. My first was 8 lbs 1 oz.

I had a friend who did the low carb diet and she had a 7lb baby...this is a a woman who always had over 9 lb babies!! It's worth a shot to slow things down.

[GoBecGo]

I think i would go on indefinitely so long as baby was happy and the placenta looked fine. I would not under any circumstances have elective c-section or induce before 42 weeks. Once i passed 42 weeks i'd be fine with going to 43.5 so long as everything looked ok. On the off chance that i actually got to being 44weeks (very unlikely) i would begin to look at why babe was not coming.

I would only have a c-section if there was a medical reason to have one (and i wouldn't count the Ob's crystal ball saying "it's too big, it won't come out!" as a medical reason) and i wouldn't induce unless i was favourable. There are no 53-week pregnant women - they all come out in the end!

WHat position is bub in? Posterior babes often don't begin labour timeously because their head isn't in the best spot to get the prostaglandins going wth contact with the cervix. Walk, lunge and crawl if you can, it might help

[Contented73]

Every baby comes when it is ready.

I would not have any trust for an OB who tries to induce me at 39 weeks simply because they think my baby is going to big, and then starts offering elective cesarean "just because". I cannot emphasize enough that there is no way they can determine with any accuracy how big your baby is. I'll say it again: they really have no idea how big your baby is. Sure, they can estimate, but it is so unreliable and imprecise, that the information they come up with is worthless. By the way, how is your OB determining that the baby is big? They also have no way of determining how easily your body can accommodate a larger sized baby. Even if you are a little person, there is still a high chance that your pelvis is plenty roomy for whatever size baby you are growing.

If it were me, I would be running as fast as I can to the nearest chiropractor who deals with pregnant women. After two or three days worth of chiro treatments, to make sure the pelvis is in proper alignment to allow the baby to engage, and to help the baby line up correctly, I would start seeing an acupuncturist who is skilled with induction. If the acupuncture does not actually put you into labor, then it will work with your body to help align the baby correctly, and hopefully allow your cervix to start to ripen.

Personally, if I got to 43 weeks I would probably consent to a GENTLE medical induction - meaning that I keep getting cervidil or cytotec (yes, I might agree to cytotec) until my cervix was favorable, even if it took two days.

I would never schedule a cesarean without an urgent medical emergency, even if I was only going to have one baby. And, the failed induction at 39 weeks is pretty meaningless - obviously your body was nowhere near ready. An induction at 42 or 43 weeks may very well work.

Now, there are a few exceptions to these ideas.....if you have gestational diabetes, or if you got pregnant using a donor egg, or if you have a pelvic abnormality, or some other unusual complication. In those cases I would probably not let the pregnancy go as long, and I would not be as hopeful about having a vaginal birth given your current status.

Again, under normal circumstances, babies come when they are ready, and their mothers are able to birth them. One piece of information I would be curious about is how long other women in your family have gestated? (your mother and her sisters, in particular). Also, how big were you and your DH when you were born?

[rlmueller]

He was 17 days over

I was induced (though now I think he would've done fine comin' on his own--I'm wiser now). I take NO stock in the guess my baby's weight game. And I don't think the induction will do well if you're body is not ready for it. At 17 days over, I was finally about 3 cm dialated and contracting at night only so I think I was well ready to go anyway.

At the sono/NST you want to see a well functioning plancenta, baby still moving, good heart, and 2 cm pockets of fluid around the baby.

I charted as well, know the date that sex resulted in conception, but I have 37 day cycles. I expect to go beyond my due date just like my first one.

I wouldn't worry at all or even think about it until 42weeks. It will be out and in your arms no matter what. Of note: we are the same age.

[MsBlack]

Ultrasound size estimates can be wildly innacurate this late in the game. I have seen them be as much as 2lbs off, especially with these babies estimated so large. It is not an exact science by any means! And I seriously, extremely doubt that your baby is still growing rapidly--the 'rapid growth' phase lasts from about 32 until 38wks; growth tends to slow down some until about 40wks, then slows down even more after 40 wks. Of course, these numbers are 'averages' but in my experience babies really just don't grow that much from 39-40wks onward. Seems most care providers like to sound and seem very certain about these things--but there is really no certainty here! I would guess that your OB is just accustomed to having babies out by 39-40wks, and is going beyond her comfort zone now....this being the main reason for her suggestions at this point.

You might try using Evening Primrose Oil caps to help ripen your cervix--some women try 1000mgs orally, and 1000mgs inserted up next to the cervix (use a pin to poke holes in the gelcaps). EPO has fatty acids in it that our bodies use to create prostaglandins, naturally occurring hormones that soften the cervix. You can also have sex, go for walks, get chiro adjustment and accupuncture (I'd do both at this stage for max. impact), all known to help bring on labor when babies are ready. Relaxation, visualization of labor/birth, talking to your baby--all these things can also help.

No way I'd consent to a csec without labor first, as long as baby is fine. Remember that many normal healthy moms just take longer to cook a baby! "Oven temps vary"

[Bluegoat]

Keep in mind that 41 weeks is actually just under the average date for a first time mom to deliver, despite what your due date has said. Most deliver at 41 + 1 (Or +3 but I am pretty sure it's +1) and of course that is average so many are over that.

A cervix can go from very closed and hard to soft quite suddenly.

And there is little correlation between larger babies and c-sections, but a lot between induction and c-sections. A large baby is not normally considered a good reason for an induction.

That is assuming too that it really is a large baby, it can be difficult to tell. Estimates of size by u/s are often well off, the usual figure given is up to 2 lbs but in Ina May's Guide she reports seeing estimates off by 4 lbs.

There are a couple of studies out now that indicate as long as things are looking good, it is more dangerous to induce than to wait, statistically speaking. Here is one article on this.

Sometimes doctors will fudge the results of these things to make a perfectly fine situation sound dangerous. For example, she might say that the fluid level is low, when really it is on the low side of normal. So it can be worthwhile to find out for yourself what the parameters are and ask specifically about the results, especially if you are not sure your doctor will support you.

What I would do is this. Have some warm baths and a glass of wine or hot cider or whatever, and relax. Worry will impede the onset of labour. If you want to be more pro-active, try lots of exercise, lots of sex if you can, and maybe some nipple stimulation.

[prancie]

I would decline further cervical checks, even during labor. They mean practically nothing and only cause anxiety which will inhibit labor. Relax mentally and get some rest! You don't need to be stressed right now. You say you are having no contractions, does that include braxton-hicks contractions? Have you been having those during your pregnancy?

Besides all that I have heard far too many stories of doctors telling women their babies are huge and then they do a c-sec and it's 7 pounds or something like that. Be very skeptical about size estimates. I would rely more on family history of gestation length and baby size. I was 9 pounds at birth and I gave birth to a 8 pound 14 oz baby. My mom is petite and I am not and she had me vaginally.

[etsdtm99]

i would not induce for non-medical reasons before 42 weeks (well, again) - i know its hard to be in that position, i agreed to an induction at 41 weeks with my last pregnancy because of pressure from DH & my OB to work with their schedules.. my cervix was favorable so it was 'just' a pit induction.. and it was successful.. though my cervix had not changed on its own in the 4 weeks they had been checking it.. my baby's head was also large (15in) and he was not engaged prior to labor (about 3 hours in on the pit his head engaged)

i do have a friend who had a completely unfavorable cervix and had a successful pit induction.. (that only took 5-6 hours)

I would defiantly without a doubt try a 42+ week induction before I agreed to a c-section without even trying to labor.. just becasue the c-section rate is HIGHER for inductions with an unfavorable cervix doesn't mean that no one ever has a vaginal birth in those circumstances.. there is far more risk to having a c-section and chances are good that if you still required one it would not be an emergency

good luck, i know its hard to hang in there and not doubt your self or your decision ..

[cileag]

Just for reassurance, I'm holding my baby girl who came at 41 and 3 and I didn't have much cervical change until labor either---and labor was just about 12 hours. I second a chiropractor to help baby get into a good position, or you can go to spinningbabies.com for some self help positions to try.

As an OB nurse, I'd still try an induction btw rather than head straight to a c/s. Your body is in a totally different spot now than 2 weeks ago and I think it's pretty odd to not want to try an induction again.

[MsBlack]

Originally Posted by cileag

Just for reassurance, I'm holding my baby girl who came at 41 and 3 and I didn't have much cervical change until labor either---and labor was just about 12 hours. I second a chiropractor to help baby get into a good position, or you can go to spinningbabies.com for some self help positions to try.

As an OB nurse, I'd still try an induction btw rather than head straight to a c/s. Your body is in a totally different spot now than 2 weeks ago and I think it's pretty odd to not want to try an induction again.

Yes, yes, listen to cileag! It is really not that uncommon, first, for a cervix to not seem to be changed as birthing day approaches, *especially* for first time moms.

And second, yes with cileag, I don't know why your OB is at all concerned about a 2nd induction attempt. I would definitely go there (well, if there were CLEAR medical reasons to get baby born, and this does NOT include 'large baby') before opting for elective csec. Labor is good for babies, remember. I think your OB, again, is only talking from the standpoint of OB comfort zone, which definitely includes surgery. Csec has it's own risks for mom and baby--but nonetheless, most OBs tend to feel a lot 'safer' (that is, 'more in control of birth') with csec, but elective surgery is NOT safer for you or baby.

Gather factual info--and go with your own instincts on this. I gather that since you posted this issue here, you are not entirely comfy with your OB's thoughts/plans. I want to affirm your wariness with all of that--and urge you to keep your space from that attitude while you weigh the facts and consult your mama's intuition as the days pass. You will do the right thing!

[Poodge]

Another one here who had no cervix change until labor began. In fact on Thursday at 10:30 am 40 weeks, 1 day I was high, tight, closed. My Ob told me we needed to schedule an induction for the next week. (Oh what I have learned since then!) I went into labor that afternoon and I delivered the next day Friday morning at 9:43 am 40 weeks, 2 days.

[mommabear12]

Thank you everyone for your replies so far! Here are the answers to your questions

WHat position is bub in?

I don't know the term but he is head down with his spine facing my left side, the placenta is also on the left side

One piece of information I would be curious about is how long other women in your family have gestated? (your mother and her sisters, in particular).

My mom was induced with me at 42 weeks and also with my sister at 42 weeks. My grandmother had to be induced at 41 weeks due to leaking amnio fluids. My grandmother was 10lbs, my mom was 10, I was 10.. it runs on my moms side of the family. I was so big that my mothers OB thought she was having twins and kept waiting for the second one to come out when I was being born.

Also, how big were you and your DH when you were born?

I was about 10 lbs, born at 42 weeks. huge huge head... My DH was about 7.5 lbs and about 3-4 weeks early.. .

You might try using Evening Primrose Oil caps to help ripen your cervix--some women try 1000mgs orally, and 1000mgs inserted up next to the cervix (use a pin to poke holes in the gelcaps)

I have been doing EPO, RRL infusions, squats, exercise, acupuncture, sex regularly, the only thing I haven't tried is the nipple stimulation at this point.. .

You say you are having no contractions, does that include braxton-hicks contractions? Have you been having those during your pregnancy?

My OB did hook me up to a fetal heart rate monitor and could see I was having contractions (but I apparently don't feel them). I did have a few nights in the last week where I would have pain (not sure if it was contractions) on and off for 30 mins or so before it would go away but nothing constant. Baby is also still 'high' and hasn't dropped.

I gather that since you posted this issue here, you are not entirely comfy with your OB's thoughts/plans

Yeap. To be honest, I am second guessing her but also myself. I have had a totally complication free pregnancy (unless you count acid reflux for the last 2 weeks) and am still comfortable with no swelling etc... I feel fine waiting until 42 weeks to try another induction, and if it fails, I would be accepting of a c-section at that point... but am concerned she is so convinced it won't work that she won't even try it or the fact she seems so unwilling to wait and anxious about complications (my last appointment I got a lecture on Shoulder dystocia as a reason to induce ).. everyone is my family has been big babies, so 9lbs is on the low end of average on both my mom/dads side..

My end goal is for me and the bub to be healthy and ok in the end of this. I don't want to focus so much on the 'wedding' I forget about the actual marriage but I'm still trying to figure out where that line of stubborn vs. realistic is. . .

How long can you wait and not in turn jeopardize your body or your babies baby in the name of a natural birth?

What would you do if at 42 weeks + you show no signs of labor at all?

Is an emergency c-s safer/better/just the same/ as a scheduled c-s?

[cappuccinosmom]

Firstly, I think it's important that the decision be *yours* (not ours, not the doctors). Take the information and make the best decision you can for you and your baby. It may look different from the decisions others would make.

That said, my last two sons were born at 42 w 3 d. No induction. No complications in labor. They were both big, one just shy of 10 lb and the other 10 1/2 lob.

A bad induction and/or "failed" induction labor is a real concern with the suggestions your doctor making. A failed labor with induction is far more likely than a failed one that starts naturally. With induction you are starting off with the disadvantage of dealing with pitocin contractions, and being on a deadline. However, I would try induction as a last resort before c-section, if I believed that continuing the pregnancy any longer would endanger my baby.

One thing to remember is that the range of normal for a term birth is 37-42 weeks. You have not gone post-dates yet, and won't until you hit 42 weeks. There is some increase in risk when you go post dates but it is not as dreadful or huge as they make it out to be, and can be easily dealt with by keeping a close watch on the baby's health and being ready to induce or section if their health deteriorates.

[LilacMama]

I used castor oil with good results. Have you tried that already?

I don't agree with your doctor's reasoning about not wanting to try another induction. 2 weeks is a long time for your cervix to become more responsive to the prostaglandin gel. Inductions attempts before the due date with a first time mom are NOTORIOUS for not working. If you decide to hurry things up, I'd definitely go that route before a scheduled c/s.

[emnic77]

Being overdue is physically and emotionally draining.

What would you do if at 42 weeks + you show no signs of labor at all?

I had this question when my dd was 10 days late. And when my ds was 8 days late. A good prenatal massage, focusing on the appropriate pressure points, a good cry, and a big bowl of chili worked with my ds. Cohosh worked with my dd when nothing else did. You mentioned acupuncture, have you also seen a chiropractor?

If I were 42+ weeks, I would do BPPs and NST as frequently as would shut my provider up (well, not MINE, but in general), and as long as things looked okay, I would carry on as normal. The trick in there is having both those things done and not having to fight tooth and nail with your provider about having a section. The stress of being overdue, for me, contributed a lot to actually being overdue, so fighting with your provider certainly doesn't help.

I also agree that trying induction before your due date could be totally different than trying it now. If your body isn't ready for labor, the induction isn't going to do squat. I would absolutely insist on trying induction again before agreeing to a section.

[mommabear12]

I also agree that trying induction before your due date could be totally different than trying it now. If your body isn't ready for labor, the induction isn't going to do squat. I would absolutely insist on trying induction again before agreeing to a section.

thanks I did not realize that. I was under the assumption that if my cervix is hard and high just as badly as it was 2 weeks ago, it would not make any difference in terms of changing it again to try an induction ?

[Bmorefarmgirl]

i am sorry that you are going through this!

i just wanted to add my 2 cents: your baby is not ready to come out. your body is not ready for your baby to come out. do a non-stress test to ease your provider's and your concerns about the health of your baby. after that, just keep on waiting! like another poster said, there is no such thing as a 52 week pregnant woman. some babies take longer to get ready. sometimes a cervix can soften and dilate overnight. sometimes it takes a week or more.

be confident in your body. you know a lot more about your body and your baby than your doctor does. your body was made to give birth. it was not created as an incubator for a baby to be cut out of. it knows how to give birth, and the baby and your body work together to bring the baby into the world when they are both ready.

i wish you luck and the birth you want and a beautiful baby!!

[GoBecGo]

Is an emergency c-s safer/better/just the same/ as a scheduled c-s?

It depends on how you look at it. Babies born by emergency section often seem to do worse in studies. That is because that group includes everything from babies with impatient Obs having a failed induction to babies whose mothers have praevia and are bleeding out on the table. It's hard to adjust for every eventuality, but i'll tell you, every time i read of a baby sectioned out in a big emergency due to "distress" having apgars of 8 or 9 i shake my head! Labour is GOOD for babies. Labour tells them they are about to be born, it begins the process of squeezing all the guck out of their lungs and it stimulates their whole body to make stress hormones which are vital to aid the switch over from placental to pneumo circulation. Even women with serious medical situations (like uncontrollable GD for example) can wait for labour to begin before having their section.

A c-section can be a truly life-saving operation, and it is a FAR better option than severe oxygen deprivation or death. But as an experience how can a baby tell the difference between a c-section and a uterine rupture? The side of the uterus opens in completely NOT the direction nature is urging them and they are torn through it. The distress of a c-section (as opposed to a rupture) is obviously very short lived - the surgeon lifts them immediately to the air where they can breathe - but it is not birth as the baby is prepared for it. In your current situation, where the baby is not compromised by being in the uterus and is being carried by the AT LEAST the 3rd in a line of women who grow and can birth biggish babies, labour is the best option. IF your situation changes because the baby is suddenly severely compromised by failing placental function (just INCREDIBLY rare) or baby is very distressed due to induced/augmented/distressing labour THEN a c-section might become a better option.

Our presence on this planet would indicate that what your cervix and the baby are expecting (labour, dilation, birth) is the best plan. If, it is a big IF something ACTUALLY goes wrong with that timeless plan, you can be glad of your Ob's surgical abilities, until then try to trust. A poster above was correct - the average first time mum spontaneously labours at 41+3, it generally takes a bit longer to cook the first one - i had my DD at 41+4, one day after having a cervix so high and posterior i had to wait for the midwife with the longest hands to come off the ward to examine me!

[maotmsmi]

,.

Edited by maotmsmi - 5/21/11 at 12:59pm