Would you induce?

[kblackstone444]

Situation...

39 weeks this coming Friday.

Last checkup (every Thursday now), was about 30% effaced and 2 centimeters.

Braxton-Hicks, but nothing productive.

Lost mucus plug almost 2 weeks ago.

Baby is healthy and strong, very active.

Mother is physically miserable, but okay.

Baby is head down, dropping, however, not engaged yet.

Hospital is a 26 minute ride, with no traffic- we've gotten alot of snow this winter, and the Mother's ride works 15 minutes in the other direction, with no traffic, and unless it's an emergency, probably can't just drop everything and leave immediately, so at the onset of labor, it's not impossible to say that it could take a couple hours to get to the hospital.

Mother cannot take maternity leave until after the baby is born, due to financial reasons.

Mother keeps getting sick (pregnancy related) and missing a day here, a day there, from work- down to less than three weeks PAID maternity and NO savings left in the bank.

Mother cannot apply for childcare assistance until the baby is born, and the funds are only open for a short amount of time.

Mother is not eligible for Food Stamps or Medicaid for herself, her older child, or the baby until after the baby is born.  (Family is currently on work insurance, which is an arm and a leg.)

Mother is GBS+, would like to make sure that whatever the situation, there is time for 8 hours of antibiotics during labor, so as not to be required to spend 48 hours after bith in the hospital.

Father was... not very nice... and Mother cannot have him near her or either child.  The closer it gets to the due date, the more chance of him showing up at the hospital, either during delivery, or after birth, starting drama.  Mother would like to be home and recovered before all that gets started- in her own time, in her own territory, with friends and family there for backup.

Mother had a previous induction (15 year old son, water broke, labor did not start), so she's aware that it will be a harder labor with an induction.

Doctor's appointment is tomorrow evening.  Given these circumstances, would you try to talk your doctor into inducing you when you go in to your appointment tomorrow?  Given these circumstances, do you think a doctor (she's a bit crunchy) would agree to it?  Thoughts?

[cileag]

Wow mama, sounds like you have a lot on your plate! I can certainly see why induction is appealing at this point.

Two things to consider:

1. If it's been 15 years since your last vaginal birth, I often see those labors taking longer than typical 2nd time labors, which translates into an induction having a higher change of failing and sending you into a cesarean birth.  I'm betting that would be an even more challenging situation for you, so I would want to keep my chances at a normal, vaginal delivery as high as possible and inductions do have a higher rate of c/s.

2. Are you sure about your dates? Inductions right around that 39 week mark are cutting it close to my comfort zone.  If you're a little unsure, then you really could be inducing a 37 or 38 week baby and mostly those babes are fine, but sometimes they have minor breathing or nursing issues that take some time to resolve.

Also, why do you have to have 8 hours of antibiotics in?  I'm an L and D nurse and we operate under the premise that we need the 1st does completed i.e. 4 hours, and hopefully the second dose in and/or started, but not necessarily completed.  I've never heard of them making you have to have 8 hours before delivery.

good luck and hang in there!

[Nicoleandco]

Gosh that's tough.  Normally, I would say no way to induction, but sometimes there are other factors that have to come into play. 

About the father- the nurses have seen this before and can (and will) keep him out of the room.  I wouldn't let that be a deciding factor.  Talk to your delivery doctor about this too and make it known before hand that you don't want the father in the room.  

Before going the medical route of induction, I would try forms of natural induction. 

Good luck!  I hope you find a comfortable solution.  

[kblackstone444]

A C-section would be incredibly challenging to me, especially given the circumstances, but if my water breaks and the baby's not out within 24 hours, it's very likely there will be a c-section anyways.  I'll be in the hospital, with no support- just me, the doc and the nurses, and I'm not sure how much of a state I'll be in to advocate for myself in any situation.  Either way, it's a gamble.

 

I'm absolutely positive about my dates.  There were only two dates available to pick from, two days apart, and this date was the later one.

 

If I don't get 8 hours of antibiotics during labor, I'm told, with GBS+, they will likely not release the baby until he's 48 hours old.  Especially since I don't have a pediatrician for him (or more accurately, I have one, but no coverage until that Medicaid comes through- he'll be covered on my insurance, which the pedi doesn't take, until then), they won't want to release him.  I need to be in and out of the hospital in the quickest time possible.

 

I'm sure the nurses can keep him out of the room, but I don't want to have to worry about all the other deciding factors.  Long story short, he was abusive and threatened to take the baby.  Could he in the hospital?  Probably not, but I don't want him there pushing to get the DNA test done in the hospital or being on the birth certificate, etc- I need to buy time until I can bring it all to court with me getting full custody, etc.  I don't want him to have any legal rights until if can be done in court- his name on the birth certificate would give him legal rights from day one where I am, a DNA test immeditately after birth would also speed up the process on his end.  The last thing I need to be worrying about during labor is my baby's safety once he's born.

 

I've tried every form of natural induction (except sex- I'm single) that I can think of.  I've walked so much, I probably have thighs of steel.

[PoppyMama]

Given your circumstances i might very well opt for an induction and an epidural once labor was established if I felt I needed it.  If you were a first time mom I would say no but with a favorable cervix and if you refuse AROM until close to the end it doesn't equal csection.  I would also talk to your OB about laboring down to reduce the tearing that seems to happen with highly managed births.  I know you need to recover as quickly as possible.  Take the time you have really easy.  Do you even know of a daycare that will take an infant that young?

[elisheva]

Hugs to you, mama. Difficult decisions. Just wanted to say that, if it looks like the inductions isn't working and they haven't broken your water, you can request to stop and try again in a few days. Better a few tries than a c/s from a failed induction, right? Hope all goes smoothly for you. Can you look into a free doula-in-training so you have someone with you at the hospital who is only there for your emotional support?

[ElliesMomma]

have you tried climbing stairs? walking is so low impact, i don't have a lot of faith in it starting labor. my doula said "curb walking" would do it. have somebody (your 15 yo?) with you (to hold your hand) and walk with one foot on the curb and the other on the ground. personally i believe i started my labor a little early by doing some jogging. i ran the bases at a minor league baseball game with my daughter after the game. this turned out to be about two days before delivery. the day before delivery, i also jogged next to a little car/train ride at a picnic -- slow jogging on uneven ground. no necessarily recommending that per se, just to say that i did those things and delivered about two weeks early. but it was more than walking -- more "impact". i felt something shift after the picnic "jogging".

sounds like you want to induce. go for it.

[kblackstone444]

My browser's not letting me multiquote.  I'll have to figure out why later.

 

The Child Care Council won't tell me if there's funding until after the baby's born, and daycares won't put the baby on the list until I can afford to pay for his care.  There are some daycares in the area that take 6 week olds, but he's not on the list and I'm not sure if I'd be able to get him on any lists with such short notice.  That being said, I do have a former coworker who's home with her grandson, who's willing to take care of my son, providing the Child Care Council helps me pay for it.  I'm not sure what I'm gonna be able to do if there are no funds available yet.

 

I like the idea of stopping and induction and trying again in a couple days if it's not working.

 

I had a free doula-in-training that was gonna help me, but she lost interest.  I haven't found anyone else yet and it doesn't look like I'm gonna.

 

Yup, walking stairs I've done as well.  I live on the first floor of a 6 story apartment building.  Curb walking (the equivilant- low balance beam at work) and chasing the kids at work also- my coworkers are starting to think I'm crazy.  Marching worked really good for contractions, but I haven't been able to keep it up long enough yet, only 45 minutes or an hour at a time, and then I'm too tired to continue and the contractions go away.

[Italiamom]

Have you tried posting in your tribal area about a support mama?  Someone to come and be with you during L&D?  Even if she's not a doula, most of the mamas here are far more educated about birthing options.  It breaks my heart to think of any mom alone :(

[MegBoz]

I worry about BFing troubles the most. My DS didn't arrive until 41W4D - if I'd kicked him out at 39W, I imagine he would not have had the strength he did to BF, and therefore I might have had supply troubles. (I know lots of Moms of premies have a lot of trouble.)

Sure, 39W is absolutely not premature, but it's nearly 3 weeks earlier than my DS did arrive, therefore I have to think that particular baby might not have done so well a full 3 weeks earlier. 3 Weeks is pretty substantial.

Again, sure, babies very rarely have breathing difficulties at 39W, but I know BFing problems are just so, so common. Of course, I don't know if BFing problems are relatively more common to babies born before 40W, but I'm just paranoid enough about it that I'd let my baby pick his own birthday unless I thought baby or I were physically in danger.

Hard data would be nice to have here- but I don't know if anyone has studied prevalence of BFing troubles in full term babies who were induced vs. not. At least as far as the US is concerned, it seems the majority of American mamas give up so easily anyway, so I wouldn't put too much stock in any data on American BFing success or failure.

[kblackstone444]

Originally Posted by MegBoz 

I worry about BFing troubles the most. My DS didn't arrive until 41W4D - if I'd kicked him out at 39W, I imagine he would not have had the strength he did to BF, and therefore I might have had supply troubles. (I know lots of Moms of premies have a lot of trouble.)

Sure, 39W is absolutely not premature, but it's nearly 3 weeks earlier than my DS did arrive, therefore I have to think that particular baby might not have done so well a full 3 weeks earlier. 3 Weeks is pretty substantial.

Again, sure, babies very rarely have breathing difficulties at 39W, but I know BFing problems are just so, so common. Of course, I don't know if BFing problems are relatively more common to babies born before 40W, but I'm just paranoid enough about it that I'd let my baby pick his own birthday unless I thought baby or I were physically in danger.

Hard data would be nice to have here- but I don't know if anyone has studied prevalence of BFing troubles in full term babies who were induced vs. not. At least as far as the US is concerned, it seems the majority of American mamas give up so easily anyway, so I wouldn't put too much stock in any data on American BFing success or failure.

I'm not too worried about breastfeeding this little one- my first was 2 weeks early, induced, and took to breastfeeding like a pro.  I also had an overabundant milk supply.  His only problem was jaundice for the first 4-5 days.  This little one is now 5 days away from 40 weeks, and every single ultrasound we've done, all he does is suck on his hands- the doctor even commented on how he'll have no problem with sucking, this one, so I'm not worried about that.  I know every baby is different, but I can't see any medical or feeding reason to hold off.  My doctor has agreed to discuss induction at my next appointment, right before 40 weeks.  I'm not crazy about being induced, but it might be the lesser of two evils, given the circumstances.  My doc and I will go over all the pros and cons and hopefully make the right decision soon.  In the meantime, please keep your fingers and toes crossed that I go into labor before my appointment.  I hear a full moon is soon...

[BunnySlippers]

If induction is what my instinct was telling me to do, I would do it if that option was the safer one.

[AtYourCervices]

I would not induce.

1. Apply for assistance as soon as you can, after the baby's born. In fact, pick up the paperwork right now and fill out what you can, so you can just drop it off when you leave the hospital.

2. Instead of antibiotics during labor you can try Hibiclens.

3. Notify the hospital of a potential security problem and they will handle the father if he shows up.

4. Typically labor takes quite a while and you'll have plenty of time to get to the hospital before the baby's born, even if your ride does take a couple hours. Just be sure to call your ride when you begin to even consider "This may be it."