Seriously considering <gulp> induction (long)

[MyFullHouse]

It's been a crazy 36 hours since finding out that my mws will stop delivering in my hospital right when I'm due. (Most calculators say 12/20, but my mws say 12/22. They're delivering up to 12/20)

My options for alternate "acceptable" care providers are extremely limited *IF* any of them even have any openings for a holiday-time delivery at this point. Being the weekend, I haven't been able to find out yet.

I have major trust issues when it comes to pregnancy and delivery. After being with my mws for nearly 8 years, 2 babies, and various other issues, I can't imagine trusting anyone but these women.

FWIW, I have ruled out a planned homebirth due to our location, not desire.

I emailed one of the mws this morning, asking for advice. She responded, asking if I was open to induction before they leave.

Generally speaking, I'm opposed to non-medically-necessary inductions, period. The idea of an early induction obviously goes against that. However, birthing with a stranger is something that terrifies me.

Medically speaking, I don't believe that induction poses as high a risk for me as it may for others. My first two babies were induced with OBs (40w- born 40w1d, and 41w) and went well, as far as inductions go. My 3rd was completely natural at 40w1d with these mws. With my 4th, I pushed for an induction at 42w on a gut instinct. While they did do it, my mws worked really hard to talk me out of it, so it's very strange to hear it suggested, particularly pre-dates.

Half of me is screaming to accept the induction. I've experienced it before, I've vaginally delivered all 4 babies, I'd have providers I believe in and trust with my life and my babies' lives, and (less importantly, but still) I'd avoid weather and holiday complications, as well as being able to make solid childcare plans for the other kids, and even plans for my pets.

The other half of me knows there are still risks. None of my kids has been born before their EDD. My induction with #4 was scary, and we'll never TRULY know if the induction contributed to that, or if it was just his cord issues. And I'll almost definitely be hooked up to an IV pole at the very least (though they'd still allow me to have a water birth if all else goes well.)

Unless I'm faced with an emergency, there is no other hospital that I'm willing to deliver in. If I can find an available provider, I'll have less than 11 weeks to form a relationship with them, and dh and I are both worried that I still won't have complete confidence in them at delivery. He's especially worried that I'll flip out and demand he hunt down my midwives to catch our baby in the parking lot. While that made me laugh, I can imagine it happening!

I'm just absolutely sick over this whole situation, and I can't seem to think straight!

Any GENTLE thoughts?

[loveneverfails]

I'd do it, but I'd try to throw yourself into labor before hitting the pit. Like, go for the vigorous membrane sweep 2 days before you'd go for the pit maybe?

I think mom's comfort level and being able to trust her providers counts for a whole heck of a lot. At 37 weeks, not a good choice, but when you're talking about just a couple days before your due date? I think it's legitimate to choose to induce labor to ensure that you're with a care provider whose judgment you trust. As long as you're really certain on your dates, I think you're fine. In a vacuum without these issues, you'd be waiting it out, but when your choices are a gentle induction with midwives you trust versus waiting it out and going with a provider whom you don't have a rapport with, I'd choose your peace of mind. To me, that is absolutely a valid indication for a post 39 weeks induction in a mom with a good number of kids.

And another thing to consider is that if membranes aren't ruptured, you can always *stop* an induction that isn't taking. You could give it a shot, decline AROM, and if it doesn't work it doesn't work. Maybe that would be a more "middle of the road" option for you to feel like you're willing to nudge things but not to take a sledgehammer to it?

Good luck, Mom! Whatever you choose, I hope you have a beautiful and wonderful birth.

[jcregan]

Perhaps consider looking around for a provider and see if you find one in the next few weeks that you feel comfortable with, then if not, revisit the induction decision? You probably don't need to decide on that for sure right now right?

I could see keeping induction an open possibility in a situation where no matter what you do ends up a less then ideal decision you have to make. Fear and anxiety are defiantly not conducive to a good birth experience so perhaps an induction for you is most likely to end up the most gentle and with less other interventions.

[kltroy]

Yes - what the PP said. Look around and try your best to identify an acceptable alternative. (Seriously, couldn't your current mWs have told you a bit earlier about this? I had to switch my care at 30 weeks with my last pregnancy, but my MWs gave me a heads up around 18 weeks and told me to identify a backup (and gave me a list of recommendations) in case I ended up having to switch).

Anyway, if you can't find someone you're comfortable with, and you don't feel that taking the on-call person is a reasonable choice, go for the induction. I would check not only MWs but also get some recs on some family practice doctors that do obstetrics. They tend to have a similar philosophy as MWs, since they, too, are not surgeons and specialize in normal healthy pregnancies.

I will say that my last (really lovely VBAC) birth was with family practice, and my doctor ended up being out of town for the birth so I ended up with the on-call doctor. Not only was the birth great, but I have switched my entire family over to this doctor I liked him so much.

Anyway, best of luck with your search. You don't need to make any decisions yet, and you may go into labor early (esp. if you have your mws try a few tricks like a membrane sweep each week starting around 37 weeks, sex, etc)

[homemademom]

Originally Posted by loveneverfails

I'd do it, but I'd try to throw yourself into labor before hitting the pit. Like, go for the vigorous membrane sweep 2 days before you'd go for the pit maybe?

I think mom's comfort level and being able to trust her providers counts for a whole heck of a lot. At 37 weeks, not a good choice, but when you're talking about just a couple days before your due date? I think it's legitimate to choose to induce labor to ensure that you're with a care provider whose judgment you trust. As long as you're really certain on your dates, I think you're fine. In a vacuum without these issues, you'd be waiting it out, but when your choices are a gentle induction with midwives you trust versus waiting it out and going with a provider whom you don't have a rapport with, I'd choose your peace of mind. To me, that is absolutely a valid indication for a post 39 weeks induction in a mom with a good number of kids.

And another thing to consider is that if membranes aren't ruptured, you can always *stop* an induction that isn't taking. You could give it a shot, decline AROM, and if it doesn't work it doesn't work. Maybe that would be a more "middle of the road" option for you to feel like you're willing to nudge things but not to take a sledgehammer to it?

Good luck, Mom! Whatever you choose, I hope you have a beautiful and wonderful birth.

I agree with this.

[smeep]

There are many questions you need to ask of them and yourself. I'm completely against non-medically necessary inductions, but if I were in your shoes I think I might also consider it.

First, I would continue to look around and talk to other HCPs and drill them and try to find out how supportive they are and find mums who have birthed with them before. Exhaust your options, just so you can be sure this is your best shot.

Now, questions for the induction.

If baby needs to go to the NICU for some reason, are they breastfeeding friendly? Will they try to push bottles and/or formula on you? Do they have LCs there and are they actually supportive and knowledgeable LCs? Do they allow kangaroo care? Chances are if it's close enough to your EDD (I assume it would be around 39 weeks?) baby won't need any assistance or it will be minor temporary assistance, but you still need to check out these options so, at the very least, you know what you may have to fight against.

What type of induction would your midwives do? Will they be willing to try an induction with a foley catheter first? Are you planning on using EPO to possibly help ripen your cervix and other methods of "natural" inductions first? If at some point they decide to use pitocin, are they willing to slow it down or stop it altogether if contractions are going well? Are they okay with no AROM (unless it sincerely looks like it's a last shot chance)? Will they be okay with moving the IV pole and wires and everything around to help you move into more effective positions? Do they (or the OBs above them or the hospital) have a "time limit" on total labour or post-ROM labour? If so, would they be willing to "forget" about the clock so long as there's no signs of infections? What about EFM?

There are so many questions to ask. I would agree that your chances of a successful induction are higher than many women simply because you have a history of successful inductions, but that doesn't mean you shouldn't be cautious and shouldn't review all your options and possible courses of action.

Good luck, mama!

[CookAMH]

Because I think you would have success with an induction because of this being #5, and it is so close to your due date, I would strongly lean that way if I were in your shoes. You may only need cervidil to get going on your own after that. I would, however, do like the pps recommended and madly search out options the next couple of weeks. Just wondering, where in PA are you? Have you posted on your local tribe? Where are the midwives referring their other clients?

[MyFullHouse]

I cannot even begin to express what a relief it is to hear that I'm not *completely* insane! I thank you all so much for that!

I do plan to make many phone calls today so I can better know what my other options are. My expectations in that area are rather low, having searched for a new practice for more than 4 years now. We live an hour from the current practice and hospital, so I was really trying to find something closer when I was pg with #4. And the fact that my EDD is so close to the holidays concerns me, but I won't know for certain until I try!

My mws are also holding a meeting on Wed. that I'm trying to make child care arrangements for so I can learn more. They're not "closing" so much as their shifting focus, and have switched to a new hospital for VBAC-friendliness, which is fabulous, but another 30-45 minutes from my home. They're also focusing on homebirths.

The only input from my Tribe has been on homebirths, which would definitely be one of my ideals, but dh and I finally decided we're not comfortable with our distance from (crummy) transfer hospitals, particularly when snow/ice could be a real issue. We do agree that, if we win the lottery before then, lol, we'll be buying a house close to my favorite hospital and homebirthing there!

I really appreciate the specific questions raised. Some of them I already know the answers to, but others bring up some good points for me to think on and ask about.

This 5th baby has been my biggest "wild card" by far. While he definitely seems to be in perfect health, so many things have come up in the past 6 months to make me question everything I know. It's reassuring to be reminded by others, particularly on this board, that ideals are important, but not ALWAYS realistic. I just hope to make the best decisions possible.

[GoBecGo]

I want to second a PP - ask about a foley cath induction. It is reversible and you could ask them to try it at 39weeks, then if it didn't work, again a few days later. In between you can get up and go home if it doesn't start things up.

I get that ideals have to be considered. My DH laughs at me because when i let mine slide he quizzes me and i say "Hey, i'm a Purist, but i don't let it interfere with my life!"

You're definitely NOT crazy to want to have the careproviders you love and trust, even if it means doing things a little differently. Best of luck.

[honeybee]

I totally understand not wanting to have a stranger caring for you during your birth. Even if you find another HCP, it is likely to be in a practice where you get whomever is on call anyways. Have you considered looking for a family practice doctor? In our town, the fps who do births are much more ncb friendly. Plus, my own family doctor came to births even when she was not "on-call." She was not on call the day ds1 was born, but she was there to catch him.

But, there are potential complications from inductions, too, so I can see your dilemma.

I can think of a couple of alternatives.

#1-- You could always "try" an induction, but then stop it if things are not progressing... just don't let them break your water. You could map out what induction methods you're willing to use, and for how long. You might want to figure out your Bishop's score just before, and use that info as part of your decision-making at the time.

#2--have a backup, non-induction plan. Look for a careprovider now, but also consider hiring a doula (really, couldn't your mw act as a doula? It just seems insane that they are making this change while they still have clients due at the hospital... I mean unless the hospital is somehow revoking their privileges??) that you have a great rapport with, and consider her your labor support at the hospital. A doula could provide a buffer between less-known providers. Most hospital-based care providers don't show up for much of the labor, anyways. Or perhaps bring a hb or nb knowledgable friend who can be your advocate.

[rhiOrion]

I'm not sure I'd accept a pit induction in these circumstances (but, another pit induction honestly scares me more than unknown drs... so my view point is different than yours).

But, how about several membrane sweeps, maybe castor oil, maybe a foley bulb or cervadil?

[phathui5]

How far from you will their new hospital be?

[TiredX2]

If your concern with a homebirth is location, not being out of the hospital--- how about a different location for a "home" birth? Friends house? Family? Hotel?

Good luck!

[MyFullHouse]

Originally Posted by phathui5

How far from you will their new hospital be?

It's about an an hour and 45m from here - If the roads are clear and dry, if it's not during commuter time, and if it's not during holiday traveler time.

Originally Posted by TiredX2

If your concern with a homebirth is location, not being out of the hospital--- how about a different location for a "home" birth? Friends house? Family? Hotel?

I have been giving the hotel option some thought. The only pro-hb friend I have lives here, lol, and my family would FLIP! I don't particularly like the hotel idea, but I am mulling it over!

[lovebeingamomma]

My midwife left the practice when I was 33 weeks pregnant, didn't even tell anyone! I ended up with a random OB I had never met, and you know what, he was WONDERFUL. So my only suggestion is, don't assume you won't be comfortable with anyone else. I would definitely interview other providers that deliver at your hospital (or ask the midwives for a doctor who they know who give similar care.) And consider hiring a birth doula.

[smeep]

Originally Posted by MyFullHouse

I have been giving the hotel option some thought. The only pro-hb friend I have lives here, lol, and my family would FLIP! I don't particularly like the hotel idea, but I am mulling it over!

IMO, I would gladly birth in a hotel before a hospital (barring need for medical intervention in a hospital, of course). Sure, it's not the ideal choice, but hospitals aren't exactly "comfy and homey" either. Obviously it's up to you, but I think it would be a very good idea to think it through thoroughly.

As for your family...just don't tell them! They don't have to know. You can tell them after the fact if you like, but you certainly don't have to bother telling them before hand. They already know you're seeing midwives in a hospital, so you could just omit that it's no longer going to be in a hospital. It's none of their business, really.