If they have to induce...

[Dov'sMom]

I'm 4 days past my EDD, and my doc will insist on inducing by next Thursday. They've told me that if I need pitocin, I have to be continuously monitored.

Because of my weight, the external monitors only work if I'm lying nearly completely prone, which is a very hard position for me to labor in.

My two prior (natural) labors were very long -- 50+ hours and 24 hours. I only got to the hospital for the last few hours of both of them. With #1, I had excruciating back labor and I absolutely could not lie down for even intermittent monitoring, and since my water had broken (more than 48 hours into labor), they placed an internal monitor. With #2, it wasn't back labor so I managed for the 15 minutes they needed of initial monitoring, and then the baby was born within the hour so I didn't need any more monitoring. My water didn't break until sometime in the last 25 minutes of labor (not sure when -- I THINK it happened when I was in the shower, but I came out pushing and baby was born 5-10 minutes later).

If this baby is induced, I anticipate a long, unpleasant labor experience, especially since most of my pain relief during the first two labors came from hot showers, which wouldn't be possible. If I have to lie prone for the whole thing, I have no doubt I will need an epidural.

Am I crazy to think it might be better to let them break my water instead of pitocin? I +think+ I wouldn't need the continuous monitoring then, which significantly improves the likelihood that I'll make it through this labor without other issues. What about if they start with pitocin and I can't deal with lying down the whole time -- what do you think about asking for an internal monitor at that point? The downside to waiting until I am having trouble from the pitocin is that I still won't be able to use the shower -- the hospital doesn't have the remote internal monitoring capacity.

Advice?

[engineer_mom]

Why won't he wait till you are officially 2 wks over? Thursday cuts out a couple of extra days.

Maybe next Tuesday/Wednesday you could actively try to get things rolling at home (acupressure, castor oil, ...).

[MegBoz]

Originally Posted by Dov'sMom

and my doc will insist on inducing by next Thursday.

Sorry, just REALLY ticks me off when docs say stuff like that.

YOU HAVE A RIGHT TO REFUSE ANY AND ALL MEDICAL TREATMENT! Period. He can't "insist" that you submit to anything - whether it be induction, episiotomy, continual fetal monitoring, an IV, etc. He MUST FIRST OBTAIN YOUR CONSENT before moving forward with anything.

I would absolutely, positively, not induce until closer to 43 weeks. Get twice-weekly NST + AFIs. Make sure you drink plenty of water to keep up the amniotic fluid. If all results are good, I'd wait until absolutely at least 42 weeks before considering induction.

I went to 41W 4D, but then having my membranes stripped kicked it off. My hospital policy was to 'routinely induce' at 42W 0D, but my midwives knew I was the type of gal to know the facts and was likely to refuse. Thankfully, at least one of them was totally cool with that. She said, "So are you going to let us induce you on Monday?" (notice, she asked "LET US," not "So we're gonna have to induce you on Monday."

Before I could even reply, she said, "Well, I went to 43W with one of mine & it was fine." Love her!

To answer your Q, no, I wouldn't induce labor with AROM.

1. If baby's in a bad position, he can get stuck that way (which can be really detrimental to progression of labor & even totally prevent the possibility of vaginal birth)
2. Cord prolapse can occur, necessitating immediate CS
3. Makes labor more painful for you
4. makes labor harder on baby (no 'cushion' of water) - which may lead to fetal distress
5. Puts you on the clock. Many hospitals insist on birth within 24 hours of ROM, sometimes even less! & obviously you don't have the option of lying to them about when ROM occurred! Again, you could refuse the CS, but you'd be dealing with another battle & they'd be sure to "drop the 'dead baby' card." With your history of longer labors, this is a real concern.
6. Finally, it's proven to speed up 1st stage labor by a whopping 20 minutes! So I don't know how well it would kick things off if you weren't in labor at all.

I'd only consent to AROM to speed things up if you were already in a well established labor pattern, near 6 cm or more, with baby well-engaged.

There have been some other threads with more info on making the most of induction, so you may want to check them out.

[Megan73]

Yup. I would not induce with AROM for all the reasons MegBoz mentioned.
If I were you, I'd look into cervix-ripening with cervidil or a Foley catheter before starting the pit.
Have you read Henci Goer's fact sheet on making the best of induction?
http://www.hencigoer.com/articles/el...duction/#risks

[mntnmom]

With AROM, they *will* most likely need continuous monitoring. They won't let you get up because of the risk of cord prolapse, plus everything Meg said.
I say, do everything you can on your own to encourage labor. If the baby is in good shape, there is no medical reason to induce. There are some good resources at the top of the forum about "fetal macrosomia", the so -called "big baby", that very rarely really happens.
I have also heard good things about cervix ripening beforehand even if you do go with an induction. Talk to your OB about using low doses of pitocin to start with. But just remember, he can schedule whatever he wants, he can't do it if you're not there.

[2sweetboysmom]

I don't think it's a crazy idea at all.
IME They can pump my veins full of pit for 2 days and I will STILL fail to get into an active labor pattern. (3rd birth, fantastic Bishops score, induction at 39+w for an iugr babe with non reassuring heart beat variations on NST, turns out he had a really short cord with a true knot) However turn off the pit for an hour , give me a snack, break my water, and I'll give you a babe very quickly (2.5hrs) In fact all of my labors have been putt-sy at best untill my water was broken then I labored very well and rather quickly.
If it were me, I would work on optimal positioning exercisies until my induction date (whatever day that may be ) and then ask to start my labor with AROM.
Good luck. I hope&pray you will go into labor on your own and either way that you will have a wonderful birth.


ETA: In all three cases, I was required to stay on the bed on monitors (external) for 1hour as the baby moved lower into my pelvis, and the fluid continued to drain. In my first labor (posterior presentation turned in transition) I wound up needing to be in the bed for the duration of labor on my right side due to fetal distress on the heart rate. My other two labors I was on my feet, on the ball, on the rocker, on the bed, wherever I wanted to be for the duration of labor

[GOPLawyer]

Completely ditto MegBoz. Your doc can insist 'till he's blue in the face. He can throw temper tantrums and dead baby stories and non-evidence based BS too. However, he CANNOT make you have an induction. It absolutely requires your consent.

If you don't want the induction...say, "NO". Simple as that. Don't debate it...just keep saying no. Over and over. No, no, no. Debating a doctor on their turf is hard...saying NO is easy.

If you are ok w/ the induction, I would definitely go a route other than AROM for the reasons previously listed.

[cappuccinosmom]

I think your doctor is feeding you some lines.

First of all, you can say no to induction.

Second, I know it's impolite to ask about weight, but the external monitor thing bugged me. I was very close to 300 lb when my last son was born and the external moniters worked just fine. MW just held it up under my belly while I labored and pushed on hands and knees and it was fine.

I would go for an epidural too if I had to lie down through labor, especially pit labor. Insane. I hope this will all be moot and you'll be able to have your baby naturally.

[Dov'sMom]

Thank you all for your responses. I especially appreciated the specific risks of inducing labor by AROM, and you've made me comfortable that that is not a real option.

1. Not going to 42 weeks because that's a Sunday, and hospital won't allow inductions on Sat-Sun. They'd let me go to Friday, but I know I have long, slow labors, and that the hospital is chronically understaffed weekends, and would rather not be having trouble late Friday night.

2. I know I can say no. I also know that I have long, slow labors, and I want my birth attendant to be on my side when I insist on them tolerating and waiting out what they'll undoubtedly call a "stalled" labor. If I force them to attend a natural birth outside their comfort zone, they're going to be faster to call for a c-section.

3. External monitor: I am about 320 lbs now, and 5'10". What I'm saying about the monitors is from my own personal experience -- maybe it's just how I'm built, but with my first labor they absolutely could not get a reading unless I was lying down and I absolutely could not lie down. Placing the monitor internally wasn't as big a deal as I didn't go to the hospital until after my water broke. With my second, they tried when I was sitting for a few minutes and couldn't get a consistent reading. I didn't have any real trouble lying down, though, and I wanted to be done with the monitoring ASAP so I could get in the shower as I was going through transition when I got to the hospital, so we just did it that way. It's possible that won't happen this time, but I'm not optimistic.


In any case, I think I'm in early labor now. As I said, my labors tend to be long and slow, so I'm not expecting a baby for at least 20-24 hours; maybe more like 48, but I am expecting this baby before next week. So hopefully this will all be moot.

[Turquesa]

Good luck, mama! I hope this is labor

[Dov'sMom]

I think it is, because I am dilating (ever so slowly) and I have to breathe through the contractions.

But this is my most frustrating labor so far because the contractions are still only 8 or 9 minutes apart -- even though it's been going on for 24 hours already. I wish I could check my dilation effectively, but maybe it's my size? I don't know why I really can't seem to do it. I know I am dilating because of the discharge and because of the general feeling of "openness" that wasn't there before, but I don't know if I've been sitting at the same place all night or if I am progressing.

[emnic77]

For what it's worth, my contractions with both my kids were NEVER regular. I was dilated to 5 cm with my son before I even realized I was actually in labor because my contractions would be 10 minutes apart, then 6, then 8, then 5, then 15...there was just never any discernible pattern whatsoever. If I hadn't checked myself and felt a bag of water I never would've known and probably would've had the baby on my bathroom floor because I'd have been pushing before I figured out it was "the real thing."
(In hindsight, I kinda wish I had just had the baby on the bathroom floor )

Good luck to you, I hope you have a smooth easy labor

[triscuitsmom]

I see it's been more than 24 hours since your last MDC post. I hope that you're holding a new squishy baby by now. I'm sending tons of good thoughts for whatever is happening right now.