Overdue - Meconium as a Reason to Induce

[skrulla]

I am 41 weeks pregnant today, and I had the "induction talk" with my midwife yesterday. She stated that she was not comfortable letting me go much past 41 weeks, because she has seen so many cases of meconium in the fluid of babies that are overdue, and in her opinion it is not worth the health risk to the baby to wait it out any longer. This took me somewhat by surprise, as I had not heard about this concern before, and my fluids and placenta looked great, as did the readings from the NST. I wanted to wait to be induced until I am 42 weeks, but I compromised, scheduling an induction for Friday, when I will be 10 days past my EDD. However, I am really second-guessing my decision, as I am weighing the risks of a medical induction against the potential for meconium aspiration. As of yesterday I was 2 cm dilated, about 70% effaced, and the baby was at -1 station. My Bishop score is 6. Also, this is my first child. Any advise about the pros and cons in this situation would be highly appreciated.

[triony]

Hi there,

I don't have any personal information, since I am a first-time momma-to-be also However, I did find this article/blog the other day which addresses "Post Dates" babies.

http://www.theunnecesarean.com/blog/...week-pregnancy

Apparently it is only recently that they consider 40+ weeks to be "overdue". I found this really interesting, and the resources are all quoted at the bottom of the article. I don't know how receptive your midwife is, but maybe you could show this to her and ask for her comments? Or, you can use this information to make up your own decision, and "miss" your appointment.

Best of luck to you!

[MegBoz]

Ay yi yi! That's a new one for me.

The rate of complications DOES go up at 41W - such as the rate of still birth. HOWEVER... the risk of still birth is still really, really small.

The rate of induction causing complications is MUCH higher!!!!! Especially in first-time Moms. The risk of you ending up with a CS due to induction are high.

I'd go to at least 42W. Personally, I went to 41W4d, had my membranes stripped, ctrx started 2 hours later, DS was born 6 hours after that.

You do know that the actual average gestation for healthy 1st time Moms is actually 41W1D? So going to 42W for a first-timer is still well within the range of normal. Simply put, I'd be wary of any MW who recommends routine induction at 41W.

Of course, as people often post, if you are the 1 in 100,000 that ends up with a still birth at 42W, it doesn't matter that the "percentage chance" of it happening was so low. But personally, birth is never risk free! And studies show it's safest for mama & baby with minimal intervention - and to me, that means not inducing before 42W at the absolutely earliest so long as NST + AFI are showing good results.

[etsdtm99]

in my experience medical induction can cause distress and lead to meconuim issues.. this happened with BOTH of my kids .. with my first my water broke at 39 weeks, everything was fine but ctx didn't start, 19 hours of pitocin later she came out covered in meconium.. with my 2nd, 41 weeks.. pit induction .. same thing.. there was no meconium when my water broke either time.. it was several hours of pit labor later that the mec. showed up.. i was told at the hospital that that happened a lot with pit. babies.. both of my kids were suctioned and were fine..

[hram]

I would go to the ICAN website and browse around and see if you can find some info or articles that will help you decide. And it can only help to get second or even third opinions since the protocals for each provider will be different. She says that she has seen worse outcomes for late term babies where as others may not. It could be in the interventions she is using. You didnt say where you were giving birth, but at home you will have the most hands off experience (usually), mw at hospitals could be more intervention happy since they have to follow the hospitals policy and dr's orders.

Persoanlly I would not be induced simply for being over due because there are several reasons for you to go past your due date, especially for being a first time mom. But you have to take responsibility for the decisions and interventions you choose, its not your midwife's call. Its your body and you baby, if you choose to be induced it should be because you feel the risks of being pregnant longer outweigh the risks of being induced. But also remember the snowball effect of being induced will likely bring. Pit, monitors, ROM for internal monitor possibly, stuck in a bed, epidural, and the increased risk of vacuum, forceps or cesarean.

I hope you find peace in your decision and have a wonderful birth.

[MegBoz]

Originally Posted by etsdtm99

in my experience medical induction can cause distress and lead to meconuim issues...

Right. If you read "The Thinking Woman's Guide to a Better Birth" and read what pit does & how it affects the uterus & therefore the baby, this makes perfect sense.

Your MW "has seen so many cases"? Well, what she has personally seen is NOT that significant! In order to make decisions on what is scientifically "effective" - we need large sample sizes! You can't have 2 people take a drug, have it work safely and say, "OK, this drug is awesome!" No! You need a large group.

Same applies to issues like induction vs. expectant management (wait) at 41W gestation. You need large sample sizes!

That is a huge pet peeve of mine when HCPs point to their own practice experience for evidence on an issue like that. That is NOT "evidence-based" practice! Sorry... getting heated here - this issue particularly ticks me off.

[cappuccinosmom]

If there was meconium in the fluid already I'd induce right away.

The possibility that there might be during labor, no. Babies at all gestations have meconium, and it's usually due to *stress* on the baby. Which induction is very good at producing.

[kltroy]

Originally Posted by cappuccinosmom

If there was meconium in the fluid already I'd induce right away.

The possibility that there might be during labor, no. Babies at all gestations have meconium, and it's usually due to *stress* on the baby. Which induction is very good at producing.

ditto that.

NSTs are predictive of fetal well-being for about 3 days, so if your MW is concerned, schedule another NST at 10 days instead of an induction. Obiously, if it's not reassuring you get the kid out.

Risks of still birth are approx 1.5 in 1000 ongoing pregnancies at 40 weeks, and around 2.5 per 1000 ongoing pregnancies at 41 weeks. While this is nearly double the risk (!!) it's still a very very small number - put into perspective, you'd have to induce 1000 women to prevent one still birth. It may make sense from an epidemiological point of view, but not from your personal point of view I think. (see Prolonged pregnancy: when should we intervene? Norwitz ER, Snegovskikh VV, Caughey AB.
Clin Obstet Gynecol. 2007 Jun;50(2):547-57.)

[Happiestever]

My dd was born with meconium in her fluid at almost 13 days past EDD. No problems with her whatsoever. I would also suggest looking at the bornfree website (although it's UC info) there are some links about meconium aspiration.

[GuavaGirl]

I'm not as far along yet, but my midwife has said the same thing. At 41.5 weeks she offers induction, due to meconium issues. I'm not sure what to think about it all either.

[Sk8ermaiden]

My water broke on the morning of 42 weeks exactly, after 9 hours of labor and was clear. She did pass meconium after about 7 hours of pushing, but had no issues/complications.

[JennTheMomma]

DS was born at 41 weeks with meconium in his fluid, he didn't have any problems and OB wasn't concerned when he saw it in my water because baby sounded just fine.

[fertilemyrtle]

Gosh, I just wanted to second what some others have said. Meconium can happen at any week, and you've already had all the best predictors that your baby is *fine.* Your week of gestation is not as important a factor as a reassuring NST. I hope you can hold out. I find it frustrating when I care provider doesn't talk about these things until you're at 41 weeks. It would have been helpful for your midwife to be more transparent and up front many months ago. Now, it seems like a pressure tactic, which is uncool.

I think acupuncture with a good practitioner familiar with pregnant women is a great way to help tip your body into a good steady labor pattern. I recommend that to my yoga students who are being pressured to induce.

[weliveintheforest]

Originally Posted by cappuccinosmom

If there was meconium in the fluid already I'd induce right away.

How would you know?

[AutumnAir]

The presence of meconium in and of itself is not necessarily a bad thing. The concern with meconium is MAS (Meconium Aspiration Syndrome) which most studies show is a prenatal event - it can even occur in C/S births. The passage of meconium *can* indicate fetal distress, but in the case of later births (40+ weeks) it often just indicates the maturity of the baby's bowels. The presence of mec alone is not worrisome. Personally if I were labouring at home, my water broke and there was mec I would not transfer unless there were clear signs of fetal distress along with the mec. Mec + fetal distress in utero may lead to MAS, though really if it comes to that there's not a lot that can be done - in fact deep suctioning (which is often used routinely in births with mec, even without any fetal distress) can often make things worse by forcing mec from the mouth/nose down into the airways.

Also, not evidence, only anecdote, but I went to 43+1 weeks with DD and despite actually being 'post-dates' and having a very difficult labour she did not pass any mec. So, it doesn't always happen even if you are *really* late!

It's a difficult position to be in. I remember how hard it was to hold out against all the pressure and scare tactics to do what I believed to be the best thing based on the evidence and information I had. But ultimately I think that's the best thing to do - do your own research, think long and hard about it and make your own decisions. Try not to allow yourself to be pressured into something against your better judgement.

[Belle]

Originally Posted by MegBoz

Your MW "has seen so many cases"? Well, what she has personally seen is NOT that significant! In order to make decisions on what is scientifically "effective" - we need large sample sizes! You can't have 2 people take a drug, have it work safely and say, "OK, this drug is awesome!" No! You need a large group.

I feel this is an important point. Induction is more likely to stress your baby. If your mw routinely induces at 41 weeks she is more likely to see meconium babies after 41 weeks. Likely she is the cause and not because they are "overdue".

[skrulla]

Thanks, everyone for your input. You are all pretty much saying the same thing that my instinct is telling me, so I went ahead and canceled the induction that was scheduled for tomorrow. Instead I'm going in for another NST. However, I had my "bloody show" this morning, so I'm hoping that the NST will not be necessary either

[kltroy]

This doesn't change your decision any, but I thought I'd share that the AHRQ actually has a pretty good write-up on this topic, which is pretty objective IMHO. It's located here:
http://www.ncbi.nlm.nih.gov/bookshel...ta&part=A80788

Here's a quote from their conclusion:
Induction of labor at 41 weeks or beyond results in fewer perinatal deaths compared with antepartum testing, but at least 500 inductions are necessary to prevent one death. There is insufficient evidence to recommend any specific induction agent in this setting. Additional high-quality research is needed.

[AlexisT]

Originally Posted by weliveintheforest

How would you know?

Water ruptures but you don't go into labor?