Refusing an induction?

[mamaecho]

This is just kind of for future reference..

I'm with a midwife group that I really love, but I'm nervous about their rule for how far you can go. One of the midwives said that they would prefer to let moms go to 42 weeks, but the hospitals/doctors said 40 weeks, so they conceeded to 41 and 4. I didn't press the issue then (although I wish I would have), but what can legally/insurance wise/etc happen if I go to 41 and 4 and refuse to be induced? I'm hoping this won't be an issue, I'm going to start all the herbs and such at 36 weeks, but what if? Anyone refuse it before??

Thanks!

[jksmith]

I didn't go into labour until 42 weeks after trying everything (seriously, I did castor oil TWICE!) fortunately my midwives stick to 42 week rule. But even if I'd gone another day I would have refused an oxytocin induction and made them try breaking my waters first. We had even found an OB that might have broke my water and sent me home for homebirth. If you push the issue, you midwives might be able to find solutions, if you say nothing then they might just think you are fine with it. But in the end it's your right to refuse. I must admit however, that I don't know much about how it works in the states.   

If you are getting close and are a little dilated try the breast pump method, it seemed to be the only thing that really got my contractions going: an electric pump works best, pump left side for one minute then get up and walk for two minutes, pump right side for one minute, walk for two minutes, repeat for an hour, but stop if contractions start coming back to back. You can combine this method with homeopathics, herbals, castor oil, etc.

Good luck!

[LiLStar]

They can't legally do a thing. To drop you from care, they must legally provide you with 30 days emergency care. If you're 41+4 and refusing induction, you'll go into labor long before those 30 days are up! Insurance shouldn't come into it at all. If the date comes around you can either refuse to schedule, schedule, then call the hospital the night before and cancel, or just not show up. When you do go into labor they can't turn you away. the only thing I'd wonder about is if they'd refuse to allow the midwives to attend past that date and make you stuck with the OBs? 

[womenswisdom]

In some states, midwives practice under an agreement with a physician, which outlines what their scope of practice is. If you go over 42 weeks, depending on the state, your care may be transferred to the backup OB practice. This is not abandonment of care, because you will have a care provider, just not the one you'd prefer. But again, it depends on the state laws about how CNMs can practice.

[cappuccinosmom]

Our midwives last time were bound by hospital policy too. :(

I refused induction.  The docs were unhappy, but nothing they could do about it.  I got tired of the harassment from the doctor with my third, so I told her "Listen, I am more than happy to come in and make sure the baby is happy in there.  If you're worried about him being too big, bring me whatever papers you need to release you from liability and I'll sign them."  I have no idea if anything I'd signed would have released her from liability in court, but it worked.  It might just have been my confidence and obvious difficulty to manipulate with scare tactics.

[dot1]

Couldn't help but jump in here for any lurkers who are reading.  I hope this is not hijacking the original intent.  

I was afraid of being induced with dd1...just as some OB's are afraid of NOT inducing.  A blanket policy of 40 weeks is not evidence-based (unless there is medical complications) and sounds like a policy of convenience (given that early ultrasounds for dating can still be off by 5 days +/- and late ultrasounds more inaccurate), but I would say 41 + 4 (or 42) is evidence-based...if you are very SURE of the due date.  Unfortunately, the baby's chance of tolerating labour well does decrease past 42 weeks...so if you're going to 42 weeks, then you NEED to know exactly when you conceived, lest you risk the baby actually being closer to 43 weeks along.

I want to offer some reassurance for anyone who may be alarmed at the idea of inductions (like I was with my first).  I was induced with my first at 40 + 3.  I really wanted to put it off but my blood pressure was very high and fluid very low (less than 2.5% percentile).  My due date was pretty accurate (early ultrasound) and cervix was ripe (the KEY to successful induction with pitocen).  I was able to get a saline lock IV that could be unhooked as needed...and was able to move around lots, despite being strapped to a monitor, which we unhooked occasionally to walk with the IV pole.  Sat up on the birthing ball all afternoon, got into shower on a birthing stool which dilated me FAST (docs by then agreed to take continuous monitor off as the oxytocin drip was stopped and labour well established).  No one broke my water, didn't get many dilation checks.  My experience was about as natural as you can get.  Didn't need pain medication.  Delayed cord clamping.  Baby nursed well and often.  Had a doula (no midwifery care available at the time), music, etc.  

It took a while for me to come to terms with not going into labour "naturally"...but reflecting on it, it was the best thing that could have happened being induced.  A friend of mine had waited too long and her fluid got too low, causing cord compression/fetal distress and necessitated an emergency c-section.  

Inductions can be positive and save lives when used appropriately.  The most important thing is to be VERY sure of your due date.  Almost everyone I know who was induced had a successful vaginal birth...the only ones I personally know who ended up with a c-section went in for an induction on their due date or just before (40 weeks) as they were eager to get things going, and so were their OB's...but no other valid reason given.  It can go the other way where you're actually further along than you think....

Very important to also do your research in order to be able to have informed conversations with your midwives.  When you are BOTH operating from a place of evidence and hard facts (as opposed to fears, e.g. litigation, fear of intervention, etc.) then you can make decisions that are more objective....and be respected more in your choices.  Be prepared with articles/abstracts from PubMED and the COCHRANE database of systematic reviews.  Be sure to point out to them that you don't listen to Dr. Google.  Obviously inductions due to medical reasons are different than simply dates alone...but if refusing inductions you yourself need to be very confident about your date of conception, and very confident your fluid levels are okay (ultrasounds are good at detecting normal levels...can be some inaccuracy with low level detection), and most importantly, be very clear on the actual risks to continuing the pregnancy versus risks of inducing.  

I'm at the point where an induction will be suggested.  Tomorrow it's the lemon verbina herbal induction...and if it doesn't work, then it's the medical one early next week.  I'm not going to refuse as I couldn't live with myself if I waited too long and my baby died in utero...but I can accept the much smaller risks to me with inductions and/or possible emergency c-section.  However, everyone has a different level of risk tolerance - as long as you are fully informed with the facts and prepared to deal with all the possible outcomes, then your decision will be the right one for you.

[Shami]

Great post dot1.  If one is going to refuse induction, one must have all the facts in order to make an informed, balanced decision.  Thanks for pointing out all of those things to consider.  I have high blood pressure and it's scary.  As much as I don't want to be induced...it's not worth my health or the baby's health.

I have a friend who is a NICU nurse. She said there are so many babies that have to spend time in the NICU because they were left in too long.  What a sad unnecessary thing to happen.   Honestly not trying to scare anyone here.   In the past I was so 'gung ho' on everything natural, and suspicious of the medical society in general that I swore I would not do 'this' and never do 'that', but actually all of these medical interventions have a great possibility to save lives.  Are the interventions over used?  Yes, but to me it's a small price to pay to end up with a healthy baby.  Everyone weighs the risk verses benefits in their own way.   Just adding my 2 cents and hopefully haven't offended anyone here.

[AlexisT]

One thing I will add: I do know several failed inductions at 40-41 weeks. Several involved the use of magnesium sulfate. Now, if you need mag you needed that induction (evidence is pretty firmly on the side of inducing for hypertension after 37 weeks, even if it's not full fledged preeclampsia), but it IS a tocolytic, it's a known factor for failed induction, and if someone tells you about a failed induction they had for high BP, you should be aware of that. It's not about the induction being unnecessary or the woman not being ready to go.

[Just1More]

Yes.  Great post dot.

I agree that sometimes we put "natural birth" out there as THE thing to do.  All other things are substandard, and unacceptable.  If we fall in the group of women that those things happen to, then we have to feel guilty and try to overcome it, or justify it.  v

In reality, however, we want a natural birth for a REASON.  And sometimes, those reasons can't be had with a natural birth...sometimes we can get far closer to meeting the things we were trying to accomplish with the help of medicine.  So, I believe it is very important to look at all the information and decide what you want to happen in various situations to meet the things that are important to you.  Not just "try" for a "natural birth" because people say it's "better."

Speaking as a mom who would have let her baby go a little longer, but acupuntured her out at 41+5.

[mamaecho]

My perspective is this: I was induced twice on my due date for no medical reasoning. My second son suffered the most and I don't wish to go through that again unless actually medically necessary. If I hit 42 weeks, then ok, but I don't see the point of inducing at 41 and 4 just because. I also know the actual date I conceived so I know I wouldn't be further along.