Avoiding Induction @ 42 weeks?

[TifosiGirl]

Hi Ladies!

I'm 41w2d today and have had an incredibly healthy pregnancy. I'm starting to feel like I'm playing a game of "beat the clock", trying to avoid induction with my OB. I'm really getting nervous that I won't go into labor naturally in time...

As of 08/14 I was 1.5cm dilated with a VERY soft cervix (I've taken lots of Evening Primrose Oil, at the advice of my labor doula) but the baby is at a -3 station. Baby is in the perfect position (Left Occiput Anterior) for delivery. My OB did a quick ultrasound and found PLENTY of amniotic fluid and she was amazed that my placenta is showing little to no signs of calcification/degrading. We also did a NST and it was completely normal. I'm going for another one in just a few minutes.

I REALLY want to let this happen on its own; I've been walking a lot to help bring the baby down, having sex, doing acupuncture and trying my best to stay relaxed.

I certainly don't want to put my baby at risk if the placenta starts to degrade or my fluid gets low but inducing when those aren't issues makes no sense to me... Any thoughts? Has anyone been in this situation? I'd love to hear your thoughts and stories, ladies...

Thank You!!

[MegBoz]

Well, kudos to you for sounding so calm about the whole thing. I went to 41W4D with my DS & I was a MESS! A complete mess! I never even had any BH contractions & was starting to worry that my uterus didn't even work! I was terrified at the thought of being induced & freaking out. I actually stopped working at 40W1D because if one more co-worker said to me, "You're still here?!" "No baby yet?!" I was going to really lose my mind.

My hospital-based CNMs recommended AFIs + NST twice weekly starting at 41W. I still didn't have a vaginal exam until 41W4D when I called the office & asked them to squeeze me in to strip my membranes.

Turns out I was already 3cm, went to 4 as she did the stripping, and "A really perfect cervix! I think this is going to do the trick!" I had asked her about coming back in the evening to have it done again & she didn't think that would be necessary.

Turns out she was right! Regular ctrx started 2 hours later, DS was born about 6 hours after that!

It seems the research on membrane stripping is mixed, but I personally figured it's so low risk, it doesn't hurt to try. It was slighly uncomfortable, but definitely not 'painful' as I've heard others describe it. & it took like 2 seconds.

In any case, just try to bear in mind that 41W1D is AVERAGE for first-time moms! It's so stupid that they set "due dates" at 40W! Sooo stupid! They should set it at the "average" which, again, is 41W1D for first-time moms who are white (other ethnic groups were slightly shorter, but still over 40W.) This is according to a meta-analysis done by Mittendorf in the 1990s on the "length of uncomplicated human gestation."

The 40W0D due date is based on "Nagel's rule" - by a German OB in the 1800s who observed that pregnancy lasts about 10 moons = 40W. NOT EVIDENCE-BASED!

So really, I wouldn't worry too much about placenta degrading. Sure, it can happen, but you're not that far along yet. You can just keep an eye on your 'kick count' & if you're doing twice-weekly NST + AFI, that is a good reassurance. & of course drink lots of water to keep the AF up.

Does your OB have a 'hard' date in mind where s/he thinks induction is absolutely necessary? (Despite positive results from NST, AFI, kick-counts, blood pressure, etc.) If so, you can either take an assertive stance & simply state that, again, in the absence of any negative test results, you're willing to go beyond that (I personally was & would again.)

Oooor - be a bit passive aggressive to keep the peace. Say, "Oh, let me call my DH, he has to double check his work schedule & then we'll schedule the induction." Then schedule it for 42W1D. 2 days before that, call & say your DH has a conflict & can we move it back again? The person on the phone making appointments won't necessarily give you a lecture about pushing it out 2 more days. And if she does? So what?! The person answering the phone isn't someone you need to 'keep the peace with' so you can just say, "I'm healthy & fine, 2 more days isn't going to matter. Just tell me what time on Thursday works."
(hopefully you & your OB see eye-to-eye on most other things!! Cuz if you don't then I wouldn't advise this tactic - start standing up for yourself now if the OB will try to push crap like "nothing by mouth" & cEFM.)

For me, it was my hospital's policy to induce routinely at 42W0D & I knew that. I also knew that policy be damned - I didn't have to do anything I didn't want to. One of my fav MWs, at my NST+AFI on 41W3D said to me, and I quote:
"So are you going to let us induce you on Monday?" (When I'd be 42W0D).

Note she says "let."

Before I could even reply, she says, "I went to 43W with one of mine & it was fine."
In this, "Eeeh, it's no big deal!" tone of voice.


LOVE HER! So in 2 brief sentences, she confirmed:
1. Although it may be "policy" she knows that I know I have a choice & don't have to go along with it. (& she's not trying to coerce me.)
2. She personally doesn't agree with that policy.

Sending labor vibes your way!!

[TifosiGirl]

Thank you so much for sharing!!

Their policy is not to let anyone go past 42 weeks, which would be this Saturday for me. I have an appointment with one of the OBs on Thursday and if I can milk another few days with an ultrasound to have them look at AF and the placenta, I WILL! Even if I can get them to schedule me for Monday vs. this Friday!!

Thanks again!

[BlackSheepPDX]

Great advice given by PP.

Just to reiterate, the average natural gestation is 41w1d. It's kind of scary to me that your OB was "amazed" that your placenta wasn't degrading. Lay low and be patient. I had a BPP at about 41w1 I think, which I was happy to do for everyone's peace of mind. DD was born at 41w5. I'm 40w5 right now with my second, and will probably schedule a BPP for later this week if nothing happens tomorrow. (BTW, 40w4d is average for second timers)

Sounds like you're doing all the right things! Good luck!

[cappuccinosmom]

42 w 2 days here, twice!

You do not have to submit to induction at 42 weeks. If you want to make yourself feel more comfortable about it, do the NST/ultrasound thing. I dragged myself to the hosp 2x a week for two weeks in order to keep the doctors off my back and assure myself they were using scare tactics rather than facts. Both my "late" babies were perfectly happy and healthy in the womb.

And when labor finally started, it *started*. 4 hours with both of them. They were healthy, had no blood sugar issues (in spite of being very large), and were still absolutely covered in vernix. No meconium in the waters either.

[honeybee]

So, take a deep breath. And then repeat after me: "My body, my baby, my decision." It does not matter what their "policy" is... you can refuse induction at any time, even after 42 weeks. If you don't want to argue, you can schedule the induction and then just "forget" to show up.

I was in a similar situation with my first. Thankfully, I had a wonderful family doctor that does not do high-pressure or scare tactics. She respectfully shared her concerns about going past 42 weeks with me, but did not put on the pressure. 42 weeks was a Sunday, and we had a NST and u/s scheduled for Monday morning. I was fully prepared to refuse the induction on Monday provided everything looked good on the NST and u/s. I gave birth at 11:30 pm Saturday night. I was not even 1 cm dilated or effaced much at my last exam... Thurs or Friday. Dilation prior to labor means nothing. Cervical checks are pointless! I never felt much in the way of Braxton-Hicks contractions, either. But my entire labor, including pre-labor, was only about 6 hours. I went to the hospital before I was even sure I was in labor and he was born 2 hours later.

Doing the research on 42 weeks gave me that confidence to say no to induction. I strongly recommend reading the chapter in Henci Goer's The Thinking Woman's Guide to a Better Birth about the research surrounding post-dates inductions. You could sit in a bookstore for an hour and read the relevant chapter as well as the research summary in the appendix without even buying the book. Bring a notepad and take notes. It explains why it is policy, what the research says, and why you might want to rethink automatic inductions after 42 weeks. She also has good tips about how to make sure the NST and amniotic fluid checks are as accurate as possible.

It's not an easy decision to make, as there are arguments on both sides. Like anything else, it is a risk assessment each woman needs to make for herself. But you should really look at the research yourself. Your doc's viewpoint of the risk assessment may not be the same as yours. Docs are trained to "do something" and intervene. They are not trained to be patient and wait it out.

I really think your own intuition and sense of how your baby is faring should also play a large role. It also might make a difference on how your edd was determined. If you are going by LMP (as I was with my first), and you have very irregular or longer cycles, then your date may not even be accurate. the same is true with a later u/s. My first came right around the time I estimated my due date to be... not the date the doc gave me.

[honeybee]

I would put your question on the Lamaze International forum. Or you could try a search and see what comes up. There is a really good thread on there right now about inducing at 41w, 1 day... it doesn't specifically address the 42 week cut-off, but it is good info about induction of a first-time mom in general. I'm sure there's more good info there, as well. Good luck.

http://www.lamaze.org/Default.aspx?T...icsview&aff=11

[TifosiGirl]

Thank you, thank you, thank you ladies!! Your comments and stories make me feel incredibly empowered. I'm at a point where I'm feeling REALLY emotional and pretty exhausted... your words help more than I can say!

[St. Margaret]

Everything honeybee said!!! Hang in there

[Tigerle]

Wow, what interesting information about gestational dating, Meg! I was actually wondering recently whether there was any evidence-based information on this, as obviously anything that relies on the mythical LMP calculation could not be very correct. Thank you for posting this. I have mentally updated my due date for my second birth now by 4 days, which gives me peace of mind as there are reasons for me to have my baby come later rather than sooner (not that I don't really really want to meet her...). Do you have a link?

[TifosiGirl]

Tigerle, I actually fought my OBs recently to update my due date based on my 8 and 12 week ultrasounds and my ovulation chart, as they all showed a due date of 08/07, NOT 08/04. I bought myself 3 days which didn't seem like a big deal a while back but now might make a big difference in how the next week will play out!

[WifeofAnt]

Originally Posted by MegBoz

The 40W0D due date is based on "Nagel's rule" - by a German OB in the 1800s who observed that pregnancy lasts about 10 moons = 40W.

The problem with 40 weeks being 10 moons is that 10 moons is 295 days, which is actually a little over 42 weeks!

[donutmolly]

Hey there! My 2009 August baby was a stubborn one too! Boy, was I surprised since she was my 3rd and I had gone into labor near my EDD for my first 2 births. I had a planned HB, but also felt the pressure to induce (not because of my mw, just the general cuture of "you're still pregnant?!", which I'm sure you know all too well by now.)

I did end up using castor oil to move things along (with my mw's consent/direction) at 41+6... I was sure of my dates, and had already done one hospital NST/amniotic fluid check, and I really, really, really, didn't want to have to go in again.

Definitely keep on waiting, I'm sure baby is fine and will come on his/her own timetable! But, if the pressure is on to induce, I'd do just about anything to avoid a pitocin induction... even though I was opposed to the more "natural" induction methods, they seemed preferrable to the other option.

Oh, and my DD3 is the sweetest, most easy-going baby -- so hopefully that laid-back, "oh, you want me to come out?!" attitude will transfer to a laid-back babe for you!

[TifosiGirl]

Hi There!

Originally Posted by donutmolly

I did end up using castor oil to move things along (with my mw's consent/direction)

I hear you about even the natural interventions; I have just been having sex and taking evening primrose oil for the past few weeks. Tonight I tried some nipple stimulation with my pump. I did talk with my doula monitrice tonight about castor oil and she gave me her recommended protocol... if nothing has happened by Friday morning (41w6d) I think I'm going to give it a shot.

[MegBoz]

Originally Posted by Tigerle

Do you have a link?

Here:

Obstet Gynecol. 1990 Jun;75(6):929-32.
The length of uncomplicated human gestation.

Mittendorf R, Williams MA, Berkey CS, Cotter PF.

Abstract
By retrospective exclusion of gestations with known obstetric complications, maternal diseases, or unreliable menstrual histories, we found that uncomplicated, spontaneous-labor pregnancy in private-care white mothers is longer than Naegele's rule predicts. For primiparas, the median duration of gestation from assumed ovulation to delivery was 274 days, significantly longer than the predicted 266 days (P = .0003). For multiparas, the median duration of pregnancy was 269 days, also significantly longer than the prediction (P = .019).

Henci Goer also addressed it here.

[alegna]

My ds was 43 weeks 5 days and did not look even a tiny bit overdue. Was covered in THICK vernix.

And yeah, I'm sure of my dates.

-Angela

[phathui5]

At the first birth I attended as a doula, the mama was 42w5d along. Her doctors were not happy that she had decided to induce, but there was nothing they could do about it; it was her choice. She did go into labor on her own and had a beautiful, healthy baby.

Here's me rambling about due dates:

http://naturalparentingsupport.blogs...-or-other.html

[TifosiGirl]

Originally Posted by phathui5

At the first birth I attended as a doula, the mama was 42w5d along. Her doctors were not happy that she had decided to induce, but there was nothing they could do about it; it was her choice. She did go into labor on her own and had a beautiful, healthy baby.

I'm hoping to buy a little more time at my appointment tomorrow with another BPP - at least through the weekend (I had another WONDERFUL NST today). I'm lucky to have a super-supportive husband and REALLY supportive and experienced doula monitrice in my corner!!

[AutumnAir]

My DD was born at 43+1 weeks, and I'm 42 weeks today with number 2, who seems just as reluctant to come out. I really hate confrontation, but keep reminding myself that there is *no one* who wants this baby to come out safe and healthy more than I do - so I get to make the decisions that I feel (based on *a lot* of research) will most likely lead to that outcome. I am not only advocating for myself but for my baby too - and that gives me the strength to stand up to bullying and scare tactics.

[TifosiGirl]

AutumnAir - that's fantastic to hear!! Are you with a MW or an OB? Have they started to put pressure on you to induce? If you're comfortable sharing, I would love to hear your thoughts!