Legit concerns or scare tactics?

[Narleegates]

OK, so I went in for my 34 week appointment today, and as we were finishing up the doc asked me about induction, I told him I wanted to avoid an induction if at all possible and he was totally fine with it, very understanding, he said the only reason he brought it up was because slots fill up fast and if I don't schedule one and then decide at 38 weeks- "OK induce me!" and they don't have any open slots, then they can't bump anyone until I'm 10 days overdue.  Then we get into the "what if I go overdue" waters, I've been going to the OB since 6 weeks, so my due date is pretty firm and accurate-as far as due dates can be.  He said that if I was to go 10-14 days overdue it would very probably result in a C-section due to me being pretty small, he said we would go with whatever I wanted to do, but that it was just some food for thought.

I know I've read in the birthing books that doctors will try to use scare tactics to get you to do an induction or C-section, but I really didn't get that vibe so much, but then again, I'm a little worried now.  I mean, I was a 9.5 pounder, so the likelihood of this being a decent sized baby is very real, and I know it wouldn't be an issue with my cervix not being dilated enough, but rather my hip bones being wide enough...and I've read birth stories from both sides where in some cases doc says "baby won't fit" and baby fits fine, and other cases where baby gets stuck at the shoulders ya know? 

but back to my appointment, Doc says next appt in 2 weeks we'll start doing cervix checks, and that will tell us a bit about where we stand on whether or not I'd be more likely to go over and we can talk about it more then.  I'm thinking I might meet half way here and schedule an induction a week-ish after my due date and just hope I pop early, but an induction has it's conveniences too, especially with DH being overseas, it gives him an exact date to give his officers rather than being all up in the air and not knowing what's going on...

...I have a lot to think about I guess, advice is welcome, as well as positive stories...I've already heard one story this week about a friend of a friend who tore to the rectum when baby got stuck...

[4 in 2005]

Cervical checks really tell you nothing in terms of if you will go over or not.  YIKES.  You can be 0cms 0% effaced etc and go into labor that day or you can be like me and walk around 4cms, 85% effaced and not go into labor.  

UGH... now they can tell you how likely an induction is to be effective, or can be a tool to tell if you are in active labor but that is about it.

[melinstar]

Many docs will find various reasons to induce you once you're past your due date, that may or may not be legitimate.  One example, that happened to me 5 days post-due date, was the "low fluid" reason.  So, if you were to book an induction slot (the OB means pitocin, right?) a week past due date, that might even be past when he would order an indiction for whatever reason he finds at the time.  In that case, it wouldn't hurt to do it that way, since it could avoid a c-section, and also allow your husband to be there.  HOpefully, though, before any medical intervention, you go into labor on your own (and your hubby can be there).

[guatemama1]

I'm a newbie but I wanted to chime in because your post scared me!

One thing I remember reading from Ina May books and others is that, pending any health issues, we women generally grow babies we can push out ourselves. I have a lot of faith in that fact and it's why I'm more scared of childbirth going the hospital/OB route, because it seems to me that all those interventions n' stuff pushed onto regular, healthy women make it seen like we "can't" do it on our own. For me to do this, I gotta know & believe my body was made for regular childbirth!

Of course I'm no doctor, and I don't know your health background, but if I were you I, too, would be wondering if I was being scared into potential interventions just for the sake of whatever the doctor or hospital is comfortable with.

I wish you good luck & hope your upcoming appointments give you peace and not fear :(

[~Katie~]

It sounds like your doctor is used to doing convenience inductions and has a lot of patients who are more than willing to do them, so he offered it to you. Often times planting the seed is enough to allow them more management and control over the situation for convenience. You obviously have the additional benefit of knowing that a convenience induction is more likely to land you in a c-section. If for any valid medical reason you need an induction, you will not be denied one. He's simply offering you the opportunity to schedule a convenience induction and I personally see no reason why you should do that. Going over your due date alone is not a valid reason.
 

I would be wary of any doctor who claims that cervical checks are an accurate determinant of when labor will start, and any doctor who claims that a baby who goes over their due date is too big to be born vaginally. That would mean that the majority of first time mothers are unable to birth vaginally, since the average first time pregnancy lasts just over 41 weeks. The only accurate determinant of whether a baby can be born vaginally is a trial of labor and you can increase your chances of doing so successfully by laboring and birthing upright to work with gravity and to encourage optimal fetal positioning, and by being unhindered by unnecessary interventions. That means not laboring and pushing on your back. The nice thing about the pelvis and baby skulls is that they flex to allow them to fit with the help of relaxin and fontanels. They aren't solid, unbending objects. Trust that your body can do this. Again, a doctor who doesn't understand the physiological process of how birth works would make me wary. I would consider it a gift if I were left alone until I was 10 days overdue.

FWIW, with my first I wasn't dilated at all until I went into labor on my due date after absolutely no signs of impending labor. With my second I walked around from 37-39 weeks at 5cm dilated before finally giving birth. As previously said, the only time a cervical check is warranted is when you need to consider a medically necessary induction and need to know your bishop score to determine how likely it'll be successful.

I've been there as far as the overseas business goes but my advice would be to let yourself go into labor naturally, ignore the negative birth stories, and create the most optimal setting for you to birth vaginally. My DH deployed 2 weeks before my last birth and was finally able to meet her when she was 4 months old so I understand the temptation of scheduling things, but if your desire is to reduce your chances of a c-section or other interventions that you'd rather avoid you can increase your chances by allowing your baby to come when they're ready.

You also don't know what factors played into other people's births, each birth is individual to that person and you shouldn't use it as a comparison to your own.

Edited by ~Katie~ - 6/14/11 at 2:09pm

[APToddlerMama]

DDCC.  I would try to keep an open mind and not worry so much about planning ahead. There are an infinite number of things you could plan for, most of which won't happen.  I would never schedule an induction unless there was a good reason to do so.  I really believe babies cook as long as they need to for the most part, and unless I was faced with a specific reason to do an induction, I wouldn't plan one.  I am sure if your doctor has a legitimate concern whether you are three days before your due date or four days after that he will suggest an induction then.  I can't imagine a doctor saying "well...yeah you know you need an induction because otherwise you and baby will be in danger, but unfortunately, you didn't schedule one, so now you're going to have to wait another week for it."  If that is the kind of person you're working with, you better run now regardless. 

Also, things like tearing and baby size are notoriously hard to predict.  I am one of those unlucky women who tore through their rectum...with a less than 7 pound baby who was supposedly a less than 5 pound baby (he was preterm).  Guessing size is just that...a guessing game.  As for tearing, I have numerous friends who delivered huge babies without a scratch and other friends who delivered tiny babies with major tears.  You're going to drive yourself crazy planning for all the possible things that could go wrong.  FWIW...I'd rather tear through my rectum again than have a c-section.  And I am not a super crunchy mom.  Both take a long time to heal, but at least with the vaginal birth and tear, I could choose not to have medication (which would have undoubtedly made me puke as I'm very sensitive to that stuff), and there were all sorts of other risks I was able to avoid.  Take it a day at a time...  Wishing you a peaceful rest of your pregnancy and a birth that meets your expectations. 

[Narleegates]

Originally Posted by 4 in 2005 

Cervical checks really tell you nothing in terms of if you will go over or not.  YIKES.  You can be 0cms 0% effaced etc and go into labor that day or you can be like me and walk around 4cms, 85% effaced and not go into labor.  

UGH... now they can tell you how likely an induction is to be effective, or can be a tool to tell if you are in active labor but that is about it.

maybe that's what he meant...he just said it would give us a better idea

Originally Posted by melinstar  In that case, it wouldn't hurt to do it that way, since it could avoid a c-section, and also allow your husband to be there.  HOpefully, though, before any medical intervention, you go into labor on your own (and your hubby can be there).

no, sorry for the misunderstanding, hubby won't be here regardless, but he might be able to Skype or Facetime during the birth if he's not in the air or office when it happens

for the record I really really really like my doc, he seems like he genuinely has the best intentions and that's why I'm left wandering a little bit.  I know his usual patients ARE the birth-scheduling type, they like to know exactly when it'll happen and know that he'll be the one attending, whereas I don't really care too much about when where and who so much as how! haha
 

[SuburbanHippie]

I was tiny when I had my first.  Size 2 with the most slender hips ever.  My 8 lb 15 oz baby came out just fine.  No tearing, no cutting, nada.  I really don't believe in the whole "hips too slender to give birth vaginally" thing.  The percentage of women that affects has got to be incredibly small.  So when doctors throw out the excuse, it makes me really question their motives. 

If you really feel pressured, I would schedule an induction date for a week to ten days after your due date and just hope you go before that.  Get yourself ready with any sort of way (EPO, pineapple, eggplant parmesan, long walks, bouncing on an exercise ball, orgasms, anything) and hope for the best.

Inductions aren't really the end of the world.  I've had 3 and am facing my 4th.  My only non-induction birth I induced myself with castor oil, but I don't count it as a "real" induction because I wasn't hooked up to pitocin.

[melinstar]

So sorry your husband will be missing the birth.  I can only imagine how difficult it is for everyone who has to experience that.

I agree with the PPs about letting your body direct what's to come, and also that of course your doc would give you an induction when it's medically necessary even if you didn't schedule it.  I guess if it were me, I'd want to not only avoid a pre-40 week, non-medical reason induction, but also a c-section (10 days post due date or otherwise).  That's why a 41 week scheduled induction might allay your doc, appease your concerns, prevent a c-section, and allow your husband to Skype in.  Of course, anything can happen at any time, but booking it, and actually going through with it 7 weeks from now, are two different things. 

I do have to say, the doc being so comfortable with scheduling inductions for everyone's convenience is disturbing, but if you otherwise have always had, and still do have, confidence in him, then trust those instincts and, combined with your gut, and what happens with your body naturally, proceed from there.  That's what I think we all have to do.   

[Narleegates]

and I remembered late last night, when he first started talking about induction, the first thing he brought up was breaking the waters, so I'm thinking I can maybe finagle a semi-natural induction.  I would definitely still try to wait until at least 41 weeks though

[HidaShara]

Originally Posted by SuburbanHippie 

I was tiny when I had my first.  Size 2 with the most slender hips ever.  My 8 lb 15 oz baby came out just fine.  No tearing, no cutting, nada.  I really don't believe in the whole "hips too slender to give birth vaginally" thing.  The percentage of women that affects has got to be incredibly small.  So when doctors throw out the excuse, it makes me really question their motives. 

Add a "me too" from me.  I'm a size 0 when not preggers, very slight.  But man, your joints turn to rubber!  Your pelvis loosens out and a well-positioned baby "fits" just fine, even if (s)he's a big one.  

From what I've heard, induction can be really painful and so often leads to c-sections.... all this because a doctor doesn't like the look of your body?  Seems silly to me.
 

[staryla]

After re-reading what your doc said, I think he probably brought up the induction initially because so many of his patients want and expect to know their exact due date.  He's probably had a lot of patients get impatient once they reach 'full-term' and just want to get things over with, then they can't schedule an induction because all the slots are full.  The fact that he is so willing to schedule convenience inductions is disheartening, but finding obstetricians in the American system who actively try to dissuade their patients from such things is very rare. 

I am curious about why he thinks you being overdue would result in a c-section.  I hope that he would let you labor before automatically jumping into a c-section 'because you are pretty small' (totally bogus!).  No one knows the future, but even if you go overdue you should be able to birth your baby.

As someone else said, there are infinite variations of 'what-ifs'.  I wouldn't worry about it.

[Naturallove]

Yeah, I agree with PPs that he probably did bring it up because he is used to the request. I think it gets a little fishy when he mentions that you may need a c-section if you are over due... Barring a health issue you haven't mentioned that just isn't true. Your body in a natural healthy state will not grow a baby too large for you to birth vaginally. I think doctors do run into this problem occasionally because of the  hospital-standard-on-your-back birth position decreases the room in your pelvis by about 30%. The biggest reason for this is your tail bone is not able to bend back and move out of the way for the baby to go through when you are sitting/laying on it. So, even if you do end up with an epidural you can at least turn and lay on your side instead of your back to optimize your pelvic space.

I would also be very very weary of ANYONE who wanted to induce you by breaking your water. That is one of the worst methods of induction because the second that water breaks your labor clock starts and if you don't get that baby out before your time runs up (which is usually 24 hrs), you get a c-section. There is no turning back. Where as if you are in there and get Cervadil or pit or something along those lines and your labor isn't kicking in on it's own, you can turn around and walk out of that hospital and come back when your body is more ready. 

[Greenlea]

Originally Posted by Narleegates 

and I remembered late last night, when he first started talking about induction, the first thing he brought up was breaking the waters, so I'm thinking I can maybe finagle a semi-natural induction.  I would definitely still try to wait until at least 41 weeks though

However, if he breaks your waters when your body is not ready to go into labor, you'll only have 24 hours to birth that baby before you will have to get a c-section.  I would really recommend trying to let you body go into labor naturally.  Don't even think about induction at this time.  Obviously if you go far enough over, you may have to be induced, but just don't worry about that now.  Also, personally I wouldn't be having him do so many cervical checks.  It can cause an infection and frankly will just make you worry more.  Like a PP said, you can be 0 cm and go into labor that day, or be 3 cm and still be weeks off.

As far as size, I birthed a 9lb 2oz baby without tearing.

[SuburbanHippie]

Originally Posted by Naturallove 

I would also be very very weary of ANYONE who wanted to induce you by breaking your water. That is one of the worst methods of induction because the second that water breaks your labor clock starts and if you don't get that baby out before your time runs up (which is usually 24 hrs), you get a c-section. There is no turning back. Where as if you are in there and get Cervadil or pit or something along those lines and your labor isn't kicking in on it's own, you can turn around and walk out of that hospital and come back when your body is more ready. 

Agreed!  That is one of the worst ways to start labor.  You're on a time schedule that is set up against you and will likely end up with a c/s.  I think that Cervadil to ripen the cervix overnight and then pitocin in the morning is a much safer alternative.  If you're not ready and your body doesn't take to the induction, there's no damage there to have to "undo" unlike if they break your water.
 

[~Katie~]

Originally Posted by Greenlea 

However, if he breaks your waters when your body is not ready to go into labor, you'll only have 24 hours to birth that baby before you will have to get a c-section.  I would really recommend trying to let you body go into labor naturally.  Don't even think about induction at this time.  Obviously if you go far enough over, you may have to be induced, but just don't worry about that now.  Also, personally I wouldn't be having him do so many cervical checks.  It can cause an infection and frankly will just make you worry more.  Like a PP said, you can be 0 cm and go into labor that day, or be 3 cm and still be weeks off.

As far as size, I birthed a 9lb 2oz baby without tearing.

There's no guarantee that breaking your water alone will start labor, so it could likely lead to a cascade of interventions anyway. I had AROM with my first baby after labor was already established and I would never, ever, ever want to start labor that way. My contractions went from fairly calm, almost zen-like to being hit by a freight train because the waters cushioned his head, not to mention he was in a poor position and once that bag broke he was locked into it. My current midwife is under strict orders to leave my bag of waters alone and let it break naturally.

[Naturallove]

Oh and I forgot to add earlier that my SIL was dilated to 4 cm for 3 weeks before she went into labor with my nephew. It wasn't her first baby, granted but more it goes to show that cervical checks are not a reliable way to predict when labor will begin.

[Gismobabe]

I believe the convenience for induction and/or c-section is on the side of the doctor, not the patient (my doctor gets 1000 Euros for any kind of birth - whether she sits there holding your hand in the middle of the night or does a 50 minute c-section!). I am from Europe and live in Austria (married to an American) and here inductions are only done if the patient is 10 days overdue or there is some worries about the baby.

These tactics make me so mad because after pitocin twice for membrane rupture without contractions and one natural labor I know: induction hurts and prolongs labor (27 and 12 hours for me, my second took 4 hours with no pain meds!).

The babies that are big are mostly fat and long but their head is not wider, so how should the baby not fit? Your outer hips have nothing to do with your inner hip measurements. My babies had head circumfences of 37-38 cm and I never even tore, not even during a delivery with a suction cup (maybe because I did the perennial massage or maybe because I slide my babies down ignoring the "push, push" from the crew).

Are you sure of your due date? Do you know when you ovulated and did you calculate that way instead of your last period? If you do I would schedule an induction ten days after the correct due date, if at all.

With this baby I calculated with my ovulation date of day 25 and corrected the due date by pretending that my period had started 11 days after it did. Imagine I would go by my correct date of last period. I would be 10 days overdue even before I reached my due date!

And always remember: YOU are the patient and THEY are your service provider (nothing more!). Customer comes first! In no other situation would we allow a person providing services to tell us what to do!

[greenmama66]

Originally Posted by ~Katie~ 

There's no guarantee that breaking your water alone will start labor, so it could likely lead to a cascade of interventions anyway. I had AROM with my first baby after labor was already established and I would never, ever, ever want to start labor that way. My contractions went from fairly calm, almost zen-like to being hit by a freight train because the waters cushioned his head, not to mention he was in a poor position and once that bag broke he was locked into it. My current midwife is under strict orders to leave my bag of waters alone and let it break naturally.

AROM is so downright dangerous, I'd RUN as fast as I could if I had a provider mention that. I did have it with my first birth but that was over 20 years ago and I'm way more informed/educated now (twins because I was 10 days late and swelling and we tried all other methods so my midwife used an amnihook and broke my water BUT my first heads twin was so far down there was little risk of cord prolapse and first twin was born 4.5 hours later at home as planned). I didn't perceive labor as too bad but it was my frist time and I just had back labor (first twin born posterior) but compared to my second labor where the water broke as son's head emerged, that was painless so I can say now there was a difference.

My midwife prefers to let babies who are going to be born in the caul just be born that way . No need to break water ever in her opinion.

I am sorry you have to deal with scare tactics, wow I think regular OB care needs to radically revolutionized.

[APToddlerMama]

Originally Posted by greenmama66 

AROM is so downright dangerous, I'd RUN as fast as I could if I had a provider mention that.

I don't want to thread-jack but can you point me to more info about this or tell me what the risks are?  I had AROM with my first when I was 8 or 9 cm dilated and I am really curious because I am using the same provider.