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Induction

post #1 of 74
Thread Starter 
I was just curious... I've read a lot of posts recently where women say, "They are going to induce me if I go past ten days...." or, "If I don't go into labor by such-and-such, they're going to induce..."
I was wondering, why don't you question the need for induction? Or simply refuse it altogether? Postmaturity is extremely rare, and there are tests available to insure that the placenta is functioning and the baby is still thriving. Inducing once a woman is a certain number of days past her due date is usually not in the mother and baby's best interest; it's simply the hospital/doctor's policy to help cover their butts from lawsuits. I, for one, would rather do what's in the best interest of my child rather than what's in the best interest of the hospital's routines and procedures.... I'm not saying that induction is NEVER appropriate, and I do not want to offend those of you who will have it or have had it done in the past, I just wanted to know why, in the absence of clear medical reasoning, women will allow themselves to be induced simply for going a certain number of days over their due date.
post #2 of 74
i always said that if my midwives wanted to induce, they would have to come and get me and drag me to the hospital. it never came to that, but seriously, unless there was something wrong, i would probably let them think they were inducing and then not show up. the passive-aggressive approach to medical management.
post #3 of 74
Well, my doc had given me a date he didn't want me to go past, claiming he was concerned about the amount of amniotic fluid being adequate. Luckily ds decided to come before then, or we woulda had a battle on our hands. And I had red hair and hormones on my side!

A friend was recently induced with her second because she's very small and her first baby was large and suffered a dislocated shoulder and had some other problems as she was trying to come out. The second baby was looking pretty big too, so they induced shortly after the due date. Who knows, though, she may have been just fine. I was surprised by how casually she accepted their recommendation to induce. I woulda asked WAY more questions.
post #4 of 74
TMI

17 days was enough for me, my baby and my very conservative team of osteopathic docs.

Sarah
post #5 of 74
Sarah, were there other signs that your baby was postmature? I'm just curious, because induction in itself can cause distress (which may have been the reason that he passed meconium so soon.)
post #6 of 74
The concern with meconium is whether or not babe's aspirate it. They are not getting it into their lungs in utero. If they are bulbed or suctioned on the perineum and come out pink, active, good hr and resps, then there is no concern. Meconium is a fairly common thing. And while it can definitely be a signal for a distressed baby, that is not always the case. Inducing a stressed and pooping babe can only make the problem worse.
post #7 of 74
I am really concerned about how eager some docs are to induce... some midwives too, I guess. I could swear I read somewhere recently (maybe in Mothering?) that the leading cause of underweight babies is induction, and that it is either the leading cause or second leading cause of sections. That ain't good my friends. I'm with you shoshanna's mom! If they want to induce me the pregnancy police are gonna have to come to my house and chase me around with the drugs! There is one doc in my area who is doing 100% inductions, and using cytotec for most of them. Scary.
post #8 of 74
I was induced two weeks past my due date when my waters broke and I had no contractions for 24 hours. Even after my water's broke I had plenty of fluid, but dd's heartrate dropped on the monitor, scaring everyone around. Do you think I jumped the gun? Could I have waited and let her come out when she wanted to? I wish I knew more...
post #9 of 74
Hi! I must say that after a personal round with pitocin, I can understand how the baby might get stressed- I sure was...

The practice of induction is associated with increased incidence of meconium, largely due to the prolonged and intense nature of induced contractions. If you also rupture the membranes you remove the in-built "shock absorber" for the baby, and then the baby's presenting part receives much more of the contraction pressure and strength. This stresses the baby out more, and can tire the baby sooner... leading to meconium release...

I would definitely opt to do fetal kick counts, etc. before rushing the baby.

If it became a real issue, I would try more natural methods first. If the baby and your body are ready, labor will respond to natural methods. I have had good success with nipple stimulation after sex- both nipples for a bit over an hour... but it worked... Sex for the prostaglandins in semen, and nipple stimulation for the oxytocin- oh yeah, orgasm releases oxytocin as well... If that doesn't do it I know many a castor oil baby... if it isn't time for labor it won't force it, but if it is boy you'd better do it after a full nights sleep and a good meal... (and do your midwife a favor, warn her the day before, and do it in the morning... :P) More is not better with castor oil, do enough to get it rolling and not enough to keep you on the toilet for 16 hours... One source recommends 1tbsp in orange juice (or whatever you can mask it in, one lady I know of fried some eggs in it...) and then another an hour later... followed by one more an hour later... (Personally, I would hold off on the 3rd one if it looked like labor was kicking in, since castor oil births have a reputation for being fast and a bit hard... ) You can discuss Labor "Prep" herbal formulas with your midwife, usually they contain blue cohosh, sometimes evening primrose oil, black cohosh,... and various other ingredients- she probably has a few favorites...

These methods are gentler on the baby, and the mom... and they will not bring a baby out before its time.

If it is a large baby you are concerned about, remember position is everything- that is in two respects... the baby's position... and your pushing position... once it is time to push, there is not much YOU can do about baby's position- but you have total control over your pushing position, you are less likely to have "stuck shoulders" or shoulder dystocia in a Squat position than in the lying flat on the back position with legs in the air... your pushing will be more effective, and the birth canal is shorter and wider... (YAY!!) also you can drop into hands and knees if a dystocia actually were to occur while squatting, and the change in position would likely resolve the problem...

Well, I could go on and on... but this post is long enough...

The Lord bless you all!
Zoie
http://groups.yahoo.com/group/Godsbabycatchers
post #10 of 74
I didn't notice that anyone talked about the membrane. My midwife told me that she would do something (I can't remember the exact word because I am so deliriously tired right now) to the membrane and then apply primrose oil on it. I know this is still considered inducing but isn't it a little more natural than the drugs?
post #11 of 74

ugh. primrose oil on cervix

This topic has been on my mind a lot lately, as we're constantly talking about when and how to have the next little bugger. Midwife told us she would induce b/c we were two weeks overdue, so we tried castor oil --nothing-- and then primrose oil on the cervix, which resulted in ruptured membrane. Sooooo, contractions were very slow to come on and labor was 14 hours, roughly, b/f MW counciled that pitocin would be the next step. Tried that for a few and labor definately sped up, but after 36 hours, I was only c. 3cm !!! Finally tried an epidural b/c my mom (after months of telling how easy her labors were) said her babies came always within an hour after the epi. Sure enough, baby was out in 2 hours. Cord was ragged and wrapped around her neck, which meant a week in NICU and various complications after. Of course, she's lovely and fine now. I just WONDER -- was she TOO overdue? Was it the primrose oil that doomed us (the clock seemed to start ticking at the point of rupture, with lots of pressure to get her out b/f infection set in)? Was it the hospital birth and the midwife who was basically a doc in MW clothing? How to decide what's best for the next time around??
post #12 of 74
We've always used EPO on stubborn cervices and have never noticed a correlation with ruptured membranes. In fact, all of our first time mamas have used it internally and orally without any trouble. In fact, we've had fantastic success with it helping those cervices quickly move out of the way. I would say with great confidence that a single application of EPO to your cervix before active labor began and before you were significantly dilated would not result in all the things that happened to you. Possibly your midwife poking around in your cervix caused your membranes to rupture? Perhaps they were just going to rupture anyway?

PAFlower, your midwife probably said "strip your membranes," which basically means a nice and long internal where she runs her finger in and around the os of your cervix.

If you are worried about external application of EPO, just take it orally. But, if your options are EPO or Pit, I would suggest EPO all the way. Start oral EPO at 35 weeks for a first baby and you can also insert a capsule vaginally at night. Good luck to you both.
post #13 of 74
dddD, I don't think anyone her wants to make you feel bad about how your birth went. There is a great deal of pressure to deliver after the bag of waters breaks. There is a lot of concern about infection. The unfortunate thing is that the primary cause of infection is vaginal exams, but that doesn't stop most docs from wanting plenty of them done. You might have had a gentler and less stressful birth if you hsadn't been induced, but you had a healthy birth and a healthy baby.
post #14 of 74
I have had experiences with induction and for myself would never let them do anything of the sort again. Too many problems because of their interventions and I will never agree again.
post #15 of 74
Hi! The membrane procedure you were referring to is "stripping the membranes" which involves pressing upward on the presenting amnion at the cervix and loosening its adherence to the chorion... I'm not a huge fan of this because if it doesn't work, it puts undue strain on the ligaments of the uterus and lower spine, and can be uncomfortable or painful to mom... but a friend of mine had it done with both her babies and it evidently worked for her... I would personally wonder if there weren't an increased risk for infection if labor didn't happen to kick in... (another thing some will try is cervix "stretching" manually during the last weeks of your pregnancy, that'll wake you and send you flying off the table... not advisable for comfort or the health of your cervix...)

Lilzmama, I've honestly never encountered any other incidences of Evening Primrose oil causing ruptured membranes... sometimes it just happens with no apparent cause... I've seen ladies take rather huge quantities of it orally and vaginally in hope of results and get nothing... fortunately it has nutritional value...

Just reading what you have written, first thing that I would wonder about would be the position of the baby in utero. This is something seldom mentioned other than head down or bottom down, and sometimes anterior or posterior. Most doctors don't palpate further than just the head down or bottom down issue. The truth is, position of the baby can be wonderfuly "anterior" and head well tucked (flexed), or any other variation which changes speed of the labor and decent of the baby... So in your case I would want to know the postion of the baby and then what position changes you could make to help your uterus move the baby into a more optimal one (hands and knees is a good one, and the boyancy of a bath can help as well...)... the uterus will try to move the baby, and if after many hours it can't turn the baby, it will pick up strength and begin to mold the baby's head to fit through anyway. This process takes much longer than if the uterus didn't have all the extra details to smooth out.

The next, although less likely, detail would be, how wrapped was the cord, and how long was the rest of the cord? A considerably shortened cord can slow things down since the presenting part can't press on the cervix firmly to help dilation. (In fact there was a lady who labored naturally for 3 full days between hospital and home, and nothing happened, Csection delivered a baby wrapped 4 times around neck and body, so the baby couldn't decend... this is hugely rare...)

As for the age, the baby's outward appearance is the real indicator to postdates baby or not. Contrary to popular belief, larger size is not always the deciding factor since it is such a variable. At birth you would see some peeling skin, no vernix/lanugo, rather long finger nails, a "wizened" appearance (older,, a head with less molding (harder skull bones), and deep creases in the soles of the feet. All of these are characteristics of a baby who has developed postdates. The harder skull bones actually take a bit longer to mold down and fit through, so it helps to be patient if you suspect a late baby...

There are alternative monitoring techniques and options if you are working against the clock because of early rupture of mebranes. They can monitor your temp. and prescribe antibiotics... like they do for severly preterm rupture of membrane moms to help entend the pregnancy to safer dates... This has proven to be a safe alternative...

The Lord bless you,
Zoie
http://groups.yahoo.com/group/Godsbabycatchers
post #16 of 74
i held my doctor off of induction for 3 weeks by agreeing to the tests (non-stress and biophysical profile) the non stress was performed 5 times and the bpp once which i would have been due for a2nd had i not agreed to the induction. all those tests are ultrasound exposure which i weighed against the dangers/concerns of induction. when i did consent to induction i made it very clear i was not participating in one method or another until the baby is born. i tried one method, slept, tried another and checked out of the hospital, the following night i went in for a successful induction and had an experience similar (im sure) to natural chilbirth with no meds or iv. for me the tests were more stressful than the induction.
post #17 of 74
My opinion of induction is VERY low, but that of course is due to the fact that I had such a bad experience with it.

I definitely think my induction was a classic case of hospital staff thinking 'gee, she's here...we might as well induce'~I showed up at the hospital, two DAYS after my due date, with regular, medium strength contractions, and dilated to 2. I wasn't feeling too awful yet, but I definitely knew something was going on, so I went in to see what was up. My daughter was in good shape-no signs of fetal distress whatsoever, and I was also physically fit with no signs of problems. However, instead of sending me home, or just monitoring me, they admitted me and immediately started me on a Pitocin drip 'to help things along'.

After 10 hours, I was finally completely dilated and effaced, yet I had absolutely no urge to push at all. I went ahead and did so, though, and SIX hours later, my daughter was not yet even halfway down and showing signs of distress. The decision to do a C-section was made, I was prepped, and as they were wheeling me down the hall to surgery, I finally felt the urge to push~almost SEVEN hours after my body was supposedly ready to give birth.

At the time, my experience was chalked up to cephalopelvic disproportion. However, I've recently read (in Mothering, of course) that the use of Pitocin can completely stall labor & cause all sorts of complications. Upon reading that, my anger and frustration with the medical staff that put me through what they did was enormous-I just can't believe that they rushed me through my labor simply because they could.

Luckily I don't have to worry about Pitocin this time around~My Dr. & M/W have already told me they will not under any circumstances induce me for fear of uterine rupture. I've also been forwarned that if there are any signs of fetal distress, or if I go too far past my due date, a repeat C-section will be performed. However, they are both incredibly supportive of my desire to perform a V-BAC if at all possible, and realize that another C-section really will be an emergency or last resort proposition only.

Basically I've come to the conclusion through my own experience and through reading that induction really is way over used in this country. In my opinion, it should be used only when absolutely necessary-ie there is fetal distress, the mother has a medical problem, or the baby is seriously overdue. I think the discontinuation of induction merely for conveinience sake would save a lot of mothers a lot of heartache that comes from labor complications.
post #18 of 74
That reminds me of a conversation I overheard between two nurses while I was waiting to see my gyn... First nurse, "Why is Mrs Smith going in Thursday to be induced?" Second nurse, "Social"!! The hell?
post #19 of 74
I would never let them induce me. Some people don't understand that just because the doc says it has to be done doesn't mean it really has to be done!

Also, the "due date" is not an exact science anyway. Even ultrasound is not 100% accurate. Some women claim that although the ultrasound showed the baby was postmature, according to the last date of their period, the baby still had a few weeks to go, so the doc induced them only to deliver a premature baby.

I personally would not let the size of the baby bother me either. Babies are made to fit their mothers. A woman can vaginally deliver as much as 12 lbs (perhaps more?) and docs can't always guess the size anyway. I was told mine would be 4 lbs and she was 7.5 (and 2 weeks early!)

Of course, someone else may have a valid reason for induction, but not me.
post #20 of 74
Hi! I have actually read of ladies who after transition, did not get an urge to push, and with all vitals for mom and baby being fine, they took a nap- only to wake and find that they were ready to push!! Both mom and baby were fine!

Sometimes the body just takes a break, and as long as mom and baby are okay, then there is not reason to worry. Baby's head may need a little more moulding, and moms uterus may need a little break.

It is when mom is pushing, and baby is making zero progress, not a budge, and baby begins to show signs of not liking the way things are going... heart rates, etc... mom needs to change position and try again, midwife needs to check baby's position and look for hands at face/neck... things like that. If it doesn't resolve with simple changes then it may truely be time for more assertive action...

It is not that the pushing urge is late, it is that adults are impatient... If a small test push doesn't jumpstart the urge, and applying a bit of downward pressure to the inside of the vaginal canal doesn't do it either, mom just needs a rest, a popscicle, and a pep rally...

The Lord bless you,
Zoie
http://groups.yahoo.com/group/Godsbabycatchers
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