SIL is 44 weeks overdue... induce?

[baschabad]

My sister in law is/was planning a homebirth but she is almost 44 weeks! They want to induce tomorrow evening if she doesn't go into labor spontaneously before then.

She is also overweight although I don't know if that's a factor.

Does anyone have any experience with this? I don't want her to undergo an induction or hospital birth if she doesn't need one, but it might be the best choice now...

(She is foreign and needs me as a translator and wanted me to be with her for her birth which is why I am involved.)

[greencarnation]

That's a tough one.  44 weeks is rather late, but induction has it's risks.  Has she taken NST and that sort of thing?  Is the baby showing any signs of distress?

[baschabad]

She has been going to bi-weekly monitoring/ultrasound and it has been so far, so good, but the midwife is recommending induction by tomorrow evening. I hope she is not being unnecessarily pressured into an induction and likely c-section...

[nanasmom]

Hi Bas Chabad 

I am not going to be of much help here but I would not be comfortable going past 44 weeks but that is just me.  Instead of doing a "full on" induction, maybe she can try some natural methods that might give her body the push it needs to get kick-started?

[thencamehenry]

Well all inductions, even with pitocin in the hospital, are not the same.  A friend was induced a few months ago and her doctor allowed her to have a very slow and gentle labor, very different from experiences I've heard from another hospital in town.  She was not "on the clock" with unreasonable 1 cm per hour expectations. A good doctor who has witnessed normal births should know that labor can have many variations within the range of normal.  I hope the midwife has a good backup doctor who understands that it's beneficial for birth to be as natural as possible even when an induction is necessary.

If I were in her place (and I am currently pregnant, so I've thought about this) I would ask for the lowest possible dose of pitocin and give that ample time to work.  If more is necessary increase in the smallest increments possible while allowing mom to move around as much as possible to get labor going.  My old OB does inductions with a balloon in the cervix that is slowly inflated instead of using a cervical ripening agent like Cytotec, which can cause overstimulation of the uterus just like too much pitocin.  That's the main thing to avoid in an induction, since contractions coming too hard and fast can cause distress in the baby and therefore an emergency c-section.  Maybe ask the OB how long they expect it to take, and what their thoughts are on it taking longer to open the discussion.  This is not medical advice, but based on my personal knowledge about birth it would be my course of action.  Basically, how can the induction most closely mimic the natural course of labor?
 

It might just be one of those things, but there could also be a reason baby hasn't come yet.  How accurate are dates? Is baby engaged in the pelvis? I recently read a birth story where the baby couldn't descend because the cord was around the shoulder. There are rare occasions when a c-section is a good and necessary thing.

Good luck to you and your SIL!

[mmaramba]

No.  Once you get to 90 weeks, you get a baby, a Christmas ham, a big screen TV, an assortment of fine collectibles and a cash prize of over $35,000.  She's only got 6 weeks to go-- I say she holds out.

Sorry, couldn't resist!

[baschabad]

Thank you for your encouraging replies everyone! (The $35,000 cash reward was especially encouraging! ;) )

Just wanted to update this with the great news that my SIL had her healthy baby girl at home last night!

It was a long labor; she began labor early morning and the baby was born at 10:04 PM.

It was the first birth that I ever attended, other than my own and thank G-d it was amazing! Despite the many odds; weight, being "overdue", meconium in the water and being justifiably tired, she did it! Of course, this means that she JUST NARROWLY avoided an induction!

And while I didn't stay until they weighed the baby, she looked pretty small to me, and the placenta only had just begun calcifying, (Not that I could tell that, but the midwife did!)

So I offer my encouragement to anyone in such a situation!

[MarineWife]

Wonderful news about your SIL! So glad she was able to avoid the induction and have her baby without medical intervention.

I know I'm very late to this now but I wanted to add something for anyone else who might be in a similar situation in the future. The first thing I would wonder with someone being 44w is whether or not the dates are correct. It is very possible to ovulate very late and, therefore, seem to be much further along than you actually are. Women who are overweight are more likely to have longer and more irregular cycles and more likely to have this issue. It's not really a problem from a pg standpoint except that the medical establishment insists on starting with the false assumption that every woman has a 28 day cycle and ovulates on day 14.

With my 2nd child, the medical establishment considered me 4w pg 2 days before I had even conceived since I didn't ovulate until day 30 of my cycle. Because of that, they would have had me at 44w when my baby's gestational age would have been only 39w5d, making me really only 41w5d (if I did my math correctly), so not really overdue yet considering the average normal, healthy pg that is allowed to progress without any interventions lasts 41w and 1-3 days.

Based on that, I would probably not agree to an induction unless there were signs of distress specific to my baby.