Induction *on* the due date?!?!

[laurac5]

My friend is delivering at a hospital with an OB, but she really wants an unmedicated birth. She just found out that they will induce her on her due date if her cervix is still closed. Any ideas for advice I can give her to stand up to the OB, or to encourage dilation, so she can still get her natural birth?

[WifeofAnt]

That just seems like really backwards logic to me. If the cervix isn't ready... force it open? That's just ASKING for a c-section.

One piece of advice I've heard is that its an estimated due date, not a 'due by' date. Babies don't have calendars and most first babies come a week or more late anyway.

[LionessMom]

tell her to not let them induce her. induction can be really hard on a baby. the best way to have a med free birth is to not allow meds for an induction then labor at home for as long as possible. more than half of babies (i believe) go past 41 weeks. some even go to 43 weeks i have heard. she can refuse induction. the doctor worksd for her. the doctor is the employee. it is her body.

[ckberkey]

I hope she goes into labor on her own before her due date. Is this a blanket policy or are they telling her that her baby will be "too big"... any health issues?

[jeminijad]

Can she at least negotiate waiting till 41 weeks? That way she won't seem like the crazy, uncooperate patient who wants to go to 42+ weeks

She'll have a decent chance of going into labor herself by then... possibly a better shot at successful induction, if not.

[MiaMama]

The OB will code that an "elective induction." If it is elective, she can choose to not "elect" it. LOL

There is no medical reason to induce just because it is the ESTIMATED due date. Even the conservative official guidelines don't start recommending extra testing and possible induction until 41 weeks in an otherwise healthy pregnancy.*

For reference, I went in to an OB when I was 38 weeks because I had a possible issue. After the NST and Ultrasound which showed an absolutely perfect thriving baby, he offered me an induction right then and there. LOL I was there only to rule out the problem so I could birth with midwives. OBs LIKE inductions. That baby went to 40w5d and had NO syptoms of being even a little "late."

Also, to avoid the "if your cervix is still closed" problem, she can refuse internal checks. Seriously, there is no evidence that full term cervical checks have any benefit whatsoever, and they are downright useless for predicting spontaneous labor.

In fact, a closed cervix is one of the biggest risk factors for a FAILED induction.

[Halfasianmomma]

She could...bring a friend or a doula to the appointment to help reinforce the fact that she doesn't want an induction.... or, just not show up to any appointments.

Heck, even my super natural-birth friendly family doctor and her intern started discussing when it would be "good" for them to have me induced at my 39 week appointment because I was "so big". I was livid. They were talking about me right in front of me, as if I didn't even have anything to say about the decision.

Half-crying, half-raging, I said "why don't we ask the patient IF she even WANTS an induction right now". That put a stop to everything. It's not like they were going to strap me down and do it right then and there. I asked that we kindly wait AFTER 41 weeks, and that if I HAD to be induced, it would be as "natural as possible".

I gave into their request that I show up every 2 days for NST, but every time, I repeated that I wasn't having an induction just yet.

Finally, at 42 wks + 1, still having not a single contraction in sight (BUT being 50% effaced and 3 cm dialated), I chose to have AROM. Even that didn't work and we had to do pitocin for 3 hrs (which I had turned OFF after) to get things going.

So, inductions aren't always ALL bad, and it is possible to retain some control over the situation. You just need to be obnoxious and stubborn.

[MegBoz]

Does she have any medical concerns like high blood pressure?

If not, don't induce. Period. MAYBE consider it at like 42 Weeks... maybe.


The risk of induction leading to CS, especially in a first time mom, is absurdly high - I've heard about 50%.

I hate to say it, but if she's even considering consenting to proposed purely elective induction ON her due date (which is 8 days earlier than average since due dates are set at 40W 0D and first timers go to 41W 1D on average), then clearly she is very uneducated about birth.

& a severe lack of education combined with, what at least based on the original post, appears to be a standard American OB (aka - intervention happy), odds are absurdly slim that she'll have a happy, low-intervention (well, non-unnecessary-intervention), natural birth. If she gets induced on her due date, odds are slim she'll even achieve vaginal birth, let alone no-epidural.

If she's serious about wanting a natural, or at least vaginal birth, I'd urge her to contact a local child birth educator & ask for a crash-course. I think the Bradley method would help her learn facts & help her & DH advocate for their birth. Bradley is supposed to be a 12-week course, but I'm sure an instructor would make an exception for a personal, crash-course session.

Natural birth, especially in an American hospital with an OB, doesn't happen without a good bit of work & preparation. A shame she seems to not know this & may be running out of time.

Originally Posted by MiaMama

Seriously, there is no evidence that full term cervical checks have any benefit whatsoever, and they are downright useless for predicting spontaneous labor.

In fact, a closed cervix is one of the biggest risk factors for a FAILED induction.

Ask her to look into the term "Bishop's Score" & she'll see that a low bishop's score (& a closed cervix would get a lower score) indicates induction is less likely to succeed.

I wonder what this OB's CS rate is - especially if s/he typically induces first-timers, at due date, with closed cervixes... (All 3 of which are bad ideas, again, in absence of medical need). I'm guessing his/her rate is well over the already excessive national average of 33%.

[MegBoz]

Originally Posted by Halfasianmomma

So, inductions aren't always ALL bad, and it is possible to retain some control over the situation. You just need to be obnoxious and stubborn.

Agreed.
But, inductions shouldn't be done without reason. Period.

Being "post-dates" IS a legit reason, since the rate of stillbirth does go up at 42W (the diagnosis of "post-dates" is 42W, NOT 41W!) The rate of stillbirth is still very low, but it does go up at 42W.

But, again, inducing at 40W, especially in a first-timer, without any medical justification is wrong.

[laurac5]

Thanks for your input, everyone. I needed some perspective because I have only experienced birth with a midwife who let me go to 42 weeks with dd. I know I can't expect my friend's OB to be that hands-off, but 40 weeks seems way to early for anyone with a decent understanding of human gestation to be getting impatient!

I feel just AWFUL because way back in May I was planning on lending my friend "The Thinking Woman's Guide to a Better Birth" ... and I kept forgetting it and forgetting it and then before I could get it to her, our apartment had a serious fire, and the book became smoke damaged and had to be cleaned. It still hasn't been unpacked. *sigh*

[GOPLawyer]

No negotiations. No discussing options. She is on their turf and most doctors are *very* good at these discussions and getting their way.

Say no. Don't show up.

If there is no legitimate medical reason, inducing under such circumstances is begging for a c/s.

The power to decide is hers and not her doctor's. Period.

[Comtessa]

One more vote for "DO NOT SHOW UP to any appointment on your due date." Just tell her to skip the appointment. Don't go. That way, they can't do anything to her. If she doesn't feel educated enough about birth (or strong enough) to stand up to an induction-happy OB, she shouldn't put herself in the position of having to do so. Unless there's some other medical reason to induce her at 40 weeks, there's no reason to show up and let them do anything.

[MyFullHouse]

I *did* go in for an induction on my EDD with my first baby. My OB recommended it, I was young, eager, and trusting, and I jumped at the chance. But I also had no plans for any sort of natural birth. I got my first dose of cervadil at 8 or 9am and he was born at 6:16pm... the following day!

While I didn't wind up with a c-section and my ds was perfectly healthy, I would never in a million years recommend it to another person. ESPECIALLY if they're hoping for an otherwise drug-free birth. I had an epidural through the entire second day.

NEVER AGAIN!

[cappuccinosmom]

Has she asked *why*? "They will induce her..." makes it sound like they just announced it as a given. If that's the case, she needs to have a serious discussion with her doctor. Why induce? Why on that date? What are the specific, emergent medical issues that would require induction right on that day?

With my first, I was too young and unaware to know any better, and the doctor scheduled my induction for my EDD. She told me there wasn't a good medical reason, but the baby was "huge" and my amniotic fluid was "low" and wouldn't it be nice to have the baby and how cool that my parents anniversary was on that date. All the usual garbage.

Fortunately for me he came a few days early and I missed out on the all-wonderful Pit. He was also under 7 lb, so clearly not "huge".

[MegBoz]

Originally Posted by laurac5

I feel just AWFUL because way back in May I was planning on lending my friend "The Thinking Woman's Guide to a Better Birth"

Don't feel bad. If she couldn't be bothered with getting her hands on a copy of that book some other way (or reading other books, watching movies like BoBB, etc.) then I'm somewhat doubtful she would have even bothered to read it anyway.

Point being, if she wanted to educate herself, she could have, and would have. If she had the motivation & desire to learn, she would have made it happen. And she didn't. Don't blame yourself for that! You already helped her out by simply telling her about the existence of that fantastic book & providing a different perspective than the mainstream view of birth.