I think it's almost time! - Page 3 « Back to Group Discussions

[MrsKatie]

Originally Posted by jbk21 

This totally makes sense.  Hopefully once you discuss your fears with your MW she can reassure you about how she might go about protecting your birth plans, even in the hospital.  I'm sure the 41- week deadline is imposed by the hospital since the BC is affiliated.  I think the OR laws would only apply to free-standing birth centers who are autonomous.  Maybe you'll just have a super fast labor and pop that baby out at home in the tub with grandma upstairs pacing the floors.  (You're supposed to laugh at that, not get more stressed out )  Then you can be like LOOK granny, I know what I'm doing after all   LOL.  All kidding aside, another thing I thought of is planning dates and outings for the next few weeks.  It will help get your mind off of things.  DH and I just sat around at home waiting on DS1 and I think that was what did us in.  A watched pot never boils, you know 

Thanks, that DID give me a good laugh.  I'm gonna go call my friend who had her baby back in July and schedule a lunch date.  I'm feeling pretty good and energized these days, I should take a little advantage of it.  And make plans that don't involve lying around and obsessing over every little labor sign.

I will discuss my fears with the midwife, and luckily my husband is an amazing advocate and a pro at keeping a level head when everything around him is chaotic (a quality we do NOT share), so between them I've got a pretty solid support system.  There are 5 midwives in the practice, and we get the one who's on call when we go into labor.  I trust all of them to look out for me.  There is one of them I don't like much, but I still believe she would make sure my wishes were carried out were I to deliver in the hospital.  Plus, there's a 4 out of 5 chance I won't end up with her, anyway.

[jbk21]

Good for you, keep your chin up   It's all going to work out just perfectly.  You've still got lots of time!  

And hey, even if you have to cancel a date with your friend at least you'll be in labor   Fill that schedule up!
 

Originally Posted by MrsKatie 

Thanks, that DID give me a good laugh.  I'm gonna go call my friend who had her baby back in July and schedule a lunch date.  I'm feeling pretty good and energized these days, I should take a little advantage of it.  And make plans that don't involve lying around and obsessing over every little labor sign.

I will discuss my fears with the midwife, and luckily my husband is an amazing advocate and a pro at keeping a level head when everything around him is chaotic (a quality we do NOT share), so between them I've got a pretty solid support system.  There are 5 midwives in the practice, and we get the one who's on call when we go into labor.  I trust all of them to look out for me.  There is one of them I don't like much, but I still believe she would make sure my wishes were carried out were I to deliver in the hospital.  Plus, there's a 4 out of 5 chance I won't end up with her, anyway.

[IwannaBanRN]

Originally Posted by jbk21 

This totally makes sense.  Hopefully once you discuss your fears with your MW she can reassure you about how she might go about protecting your birth plans, even in the hospital.  I'm sure the 41- week deadline is imposed by the hospital since the BC is affiliated.  I think the OR laws would only apply to free-standing birth centers who are autonomous.  Maybe you'll just have a super fast labor and pop that baby out at home in the tub with grandma upstairs pacing the floors.  (You're supposed to laugh at that, not get more stressed out )  Then you can be like LOOK granny, I know what I'm doing after all   LOL.  All kidding aside, another thing I thought of is planning dates and outings for the next few weeks.  It will help get your mind off of things.  DH and I just sat around at home waiting on DS1 and I think that was what did us in.  A watched pot never boils, you know 

hahaha "Look, Granny! No hands!"
 

[meb2]

Still no babe. Hahaha.... I'm giving up. He's gonna come at 41 6 because that will be the last day that he will be allowed to be born at the birth center I'm planning to deliver at. I have an appointment today at 2:30... I'm 39 weeks exactly today. I think I'm going to ask them to check me to see what my progression is- if anything? My sister in Boston has doulaed a few births and I REALLY want her to be here for this little guy's arrival so I would like to know that what I'm feeling is real and it's getting me somewhere and I'm not having her make plans around me for nothing  Annnd I'm really curious as well.

[IwannaBanRN]

Could you have your midwife strip your membranes when she checks you? With my DD it got contractions going for me at 39 weeks 6 days and I was in labor the next day.

[TalkToMeNow]

Originally Posted by IwannaBanRN 

Could you have your midwife strip your membranes when she checks you? With my DD it got contractions going for me at 39 weeks 6 days and I was in labor the next day.

Doesn't stripping the membranes increase the chances of them breaking? I thought that was the case.... Not sure, though. I had that done with dd2 at 40 weeks, 4 days, I think. When I went into labor, my water broke immediately. It was so much more painful than laboring with the water intact, like I did with dd1. This time, I do not want that. I would much rather go very late than deal with that type of labor again.

But, of course, I am no expert! And there is always a chance your water will break on it's own in early labor, anyway. That's just my experience and what I've discussed with my midwives this time. 

[Jaimee]

Originally Posted by TalkToMeNow 

Doesn't stripping the membranes increase the chances of them breaking? I thought that was the case....

It strips the bag of waters from the uterine lining around the cervix, which releases prostaglandins to soften the cerivx and possibly cause contractions, but doesn't actually break either bag of water.  But, any messing around in there I imagine could increase the chances of your water breaking earlier on.  But, I had mine stripped at 39w3d and my water didn't break until I was in transition 2 days later.  My water also didn't break with dd until they broke it for me when I was in transition (birth center forced intervention... sigh) so I may have particularly strong bags of water, who knows.  I've also heard sometimes even the amniohook can't break the bag, so I think that women really differ when it comes to the strength of their bags of water.
 

ETA: an article from the American College of Nurse Midwives says:

Are There Risks to Having Membranes Stripped?

•  The cramping that may occur in the 24 hours after your membranes are stripped can make it hard to rest or

sleep; this means that you might lose some sleep before actually going into labor.

• Some people worry that membrane stripping may cause the bag of water to break or cause mothers or

babies to become sick. Studies have found that membrane stripping does not make them more likely.

[Jaimee]

Okay, I might have a slight addiction to journal searches... 

The role of membrane stripping in prevention of post-term pregnancy: A randomised clinical trial in Ile-Ife, Nigeria

Dare, F.O., Oboro, V.O.

Department of Obstetrics, Faculty of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

Abstract

This study was carried out to evaluate the efficacy and safety of membrane stripping at term in reducing the incidence of post-term (41 weeks or greater) pregnancies. One hundred and thirty-seven pregnant women at 38 weeks gestation were randomised to receive either membrane stripping (69) or gentle cervical examination (68). Women who received stripping had earlier delivery (4.8 vs. 12.1 days; P<0.001) and less incidence of delivery at 41 weeks or greater (3% vs. 16%; P=0.009). No statistically significant difference was noted in incidence of premature rupture of membranes, clinical evidence of chorioamnionitis, intrapartum characteristics and perinatal outcome. We conclude that membrane stripping is a safe method to reduce the incidence of post-term pregnancy.

Membrane sweeping to induce labor in low-risk patients at term pregnancy: A randomised controlled trial

Yildirim, G.^a, Güngördük, K.^ab, Karadaǧ, O.I.^a, Aslan, H.^a, Turhan, E.^a, Ceylan, Y.^a

^a  Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Women and Children Hospital, Istanbul, Turkey
^b  Erzincan Military Hospital, Erzincan, Turkey

Abstract

Objective.To evaluate the efficacy of membrane sweeping at initiation of labor induction in low-risk patients at term pregnancy (3840 gestational weeks). Methods.This prospective study included 351 antenatal women who were randomly assigned to one of two groups: a sweeping of the membranes group (n181) and a no sweeping control group (n170). The primary outcome measure was the proportion of women who entered spontaneous labor within 1 week of entry into the study. Secondary outcome measures included mode of delivery and maternal and fetal complications. Results.Five patients (two in the sweeping group and three in the no sweeping group) were excluded from the study because of breech presentation at labor. There were no statistically significant differences between the two groups regarding maternal age, parity or Bishop score. The proportion of subjects who entered spontaneous labor before 41 weeks of gestation was significantly different between the two groups (p<0.0001). The mode of delivery did not differ significantly between the groups and there was no statistically significant difference in maternal or fetal complications. Conclusions.Sweeping of membranes is a safe method to reduce the length of term in pregnancy and the incidence of prolonged gestation in a low-risk population. There is no evidence that sweeping the membranes increases the risk of maternal or neonatal adverse outcomes. © 2010 Informa UK Ltd.

A comparative study of membrane stripping and nonstripping for induction of labor in uncomplicated term pregnancy

Tannirandorn, Y., Jumrustanasan, T.

Dept. of Obtetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand

Abstract

A prospective, randomized controlled trial was undertaken at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn Hospital to determine whether stripping of the fetal membranes is a safe and effective method for induction of labor in uncomplicated term pregnancy. Ninety-six women were included in this study; 16 were excluded; 41 were randomized to a study group and 39 to a control group. Both groups had pelvic examination performed under sterile technique and a Bishop score was assessed. In the study group, membrane stripping was performed. Gentle pelvic examination for Bishop scoring was continued weekly in both groups. Thirty five of 41 women (85.4%) in the study group delivered within 7 days as compared to 22 of 39 women (56.4%) in the control group, a statistically significant difference (P = 0.004). A statistically significant difference was also observed with respect to the mean number of days to delivery (5.3 ± 4.9 versus 9.5 ± 5.9 days, respectively; P = 0.002). No statistically significant differences were observed in both maternal and fetal complications. In conclusion, membrane stripping is a safe and effective method for induction of labor in uncomplicated term pregnancy.

Stripping membranes at term: Can it safely reduce the incidence of post-term pregnancies?

McColgin, S.W., Hampton, H.L., McCaul, J.F., Howard, P.R., Andrew, M.E., Morrison, J.C.

Dept. of Obstetrics/Gynecology, University of Colorado, Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262, United States

Abstract

Membrane stripping has been used clinically for many years but has not been well studied. An investigation was undertaken to determine whether weekly membrane stripping beginning at 38 weeks could safely reduce post-term pregnancies. One hundred eighty patients with firm gestational dates were randomized to either a treatment or control group. Control subjects received a gentle cervicovaginal examination each week to assess Bishop scores, whereas the treatment group also underwent weekly stripping of membranes. Women who received treatment had earlier delivery (mean ± SEM 8.60 ± 0.74 versus 15.14 ± 0.83 days; P < .0001) and fewer post-term deliveries than those in the control group (three versus 14; P < .004). The reduction of post-term pregnancies was most notable in nulliparous women with unfavorable Bishop scores. Complications were similar in both groups. Membrane stripping was safe and was associated with earlier delivery and a decreased incidence of post-term gestation.

In regards to ruptured membranes...  I can't get it to paste b/c it's an image of an article... annoying.  I'll type the important parts...

The stripped subjects delivered about 7 days earlier than the controls...97% of patients delivered by 41 weeks, compared with 68% of the controls.  Mode of delivery was similar, as was incidence of rupture of membranes or amnionitis in labor.

[TalkToMeNow]

Interesting, Jaimee. So my water probably just broke randomly. Dang... That means I have just as much of a chance of it breaking this time even if I don't have my membranes stripped. I attributed it to that as my water didn't break with dd1 until my midwife broke it when I was fully dilated.

[KayPea]

Neat, thanks for posting the studies Jaimee.

Originally Posted by TalkToMeNow 

Doesn't stripping the membranes increase the chances of them breaking? I thought that was the case.... Not sure, though. I had that done with dd2 at 40 weeks, 4 days, I think. When I went into labor, my water broke immediately. It was so much more painful than laboring with the water intact, like I did with dd1. This time, I do not want that. I would much rather go very late than deal with that type of labor again.

But, of course, I am no expert! And there is always a chance your water will break on it's own in early labor, anyway. That's just my experience and what I've discussed with my midwives this time. 

I wonder if it was your water breaking early or something else (or  combo) that made for a tough labour? My water broke 7 hours before my first contraction (anecdotally, I had 2 stretch'n'sweeps before, and intercourse the night before) but I don't feel like I had a particularly difficult labour. My strongest negative thought about the labour was while I was in transition, and I remember thinking "I don't know if I can keep doing this for another few hours." So I've never even thought about the connection between broken bag of waters and a more intense labour, until now. So maybe you can hope that even if your waters break early, it won't be the same kind of tough labour as with your second? 

[meb2]

During my birth class that I took the doula that was teaching it said that there was a link between the amount a vitamin C that the mama to be takes in and the strength of the bag :) Not sure on where she got that information, but I thought that was VERY interesting. 

GOOD NEWS FROM TODAY'S APPOINTMENT!!!! I'm already 4 cm dilated, 80 percent effaced and at 0 station! :) :) WOO-HOO! No need to strip my membranes ;) :) Yay! And she said that she could feel the huge sac of water :) Yay!

[Jaimee]

Wow!  4cm already and not yet in active labor!  That's unusual for a FTM! 

And yes, there is a link between vitamin C and strength of membranes- I've read that several places and heard/seen it recommended to those that had previous PROM.  But too much in the first tri has also been linked to m/c.

Here I go again...  

Vitamin C supplementation to prevent premature rupture of the chorioamniotic membranes: A randomized trial

Casanueva, E.^ad, Ripoll, C.^a, Tolentino, M.^a, Morales, R.M.^a, Pfeffer, F.^a, Vilchis, P.^b, Vadillo-Ortega, F.^c

^a  Public Health Research Branch, National Institute of Perinatology, Mexico City, Mexico
^b  Department of Obstetrics, National Institute of Perinatology, Mexico City, Mexico
^c  Direction of Research, National Institute of Perinatology, Mexico City, Mexico
^d  Public Health Research Branch, Instituto Nacional de Perinatologia, Torre de Investigacion, Montes Urales 800, Lomas de Virreyes, DF 11000, Mexico

Abstract

Background: Vitamin C is involved in the synthesis and degradation of collagen and is important for maintenance of the chorioamniotic membranes. Inadequate availability of ascorbic acid during pregnancy has been proposed as a risk factor for premature rupture of the chorioamniotic membranes (PROM). Objective: The objective of the study was to evaluate the effectiveness of 100 mg vitamin C/d in preventing PROM. Design: A controlled double-blind trial was performed. Pregnant women (n = 126) in their 20th wk of gestation were invited; 120 accepted and were randomly assigned to 2 groups (100 mg vitamin C/d or placebo). Every 4 wk, plasma and leukocyte vitamin C concentrations were measured, and each subject was evaluated for cervicovaginal infection. The incidence of PROM was recorded for each group as an indicator of the protective effect of vitamin C supplementation. Results: One hundred nine patients finished the study. Mean plasma vitamin C concentrations decreased significantly throughout the pregnancy in both groups (P = 0.001), and there were no significant differences between groups. Between weeks 20 and 36, mean leukocyte vitamin C concentrations decreased from 17.5 to 15.23 μg/10⁸ cells in the placebo group and increased from 17.26 to 22.17 μg/10⁸ cells in the supplemented group (within- and between-group differences: P = 0.001). The incidence of PROM was 14 per 57 pregnancies (24.5%) in the placebo group and 4 per 52 pregnancies (7.69%) in the supplemented group (relative risk: 0.26; 95% CI: 0.078, 0.837). Conclusion: Daily supplementation with 100 mg vitamin C after 20 wk of gestation effectively lessens the incidence of PROM. © 2005 American Society for Clinical Nutrition.

[jbk21]

Originally Posted by meb2 

During my birth class that I took the doula that was teaching it said that there was a link between the amount a vitamin C that the mama to be takes in and the strength of the bag :) Not sure on where she got that information, but I thought that was VERY interesting. 

GOOD NEWS FROM TODAY'S APPOINTMENT!!!! I'm already 4 cm dilated, 80 percent effaced and at 0 station! :) :) WOO-HOO! No need to strip my membranes ;) :) Yay! And she said that she could feel the huge sac of water :) Yay!

HOLY CRAP!  It took me 12 hours to get to 4cm during labor, lol!  I guess those ctx the other day were really working!  WOOHOOOO!!!!!

[mommy2sage]

4 cm already!  That is awesome...I wish for that kind of progress.

[TalkToMeNow]

Originally Posted by KayPea 

Neat, thanks for posting the studies Jaimee.

I wonder if it was your water breaking early or something else (or  combo) that made for a tough labour? My water broke 7 hours before my first contraction (anecdotally, I had 2 stretch'n'sweeps before, and intercourse the night before) but I don't feel like I had a particularly difficult labour. My strongest negative thought about the labour was while I was in transition, and I remember thinking "I don't know if I can keep doing this for another few hours." So I've never even thought about the connection between broken bag of waters and a more intense labour, until now. So maybe you can hope that even if your waters break early, it won't be the same kind of tough labour as with your second? 

Hmm... maybe. I'm really not sure. I figured it was the water being broken because with dd1, I felt fine through my entire labor until my water was broken. It was much more intense after that. Dd2's labor (where my water broke at the beginning) was so intense the entire time. Also, my two best friend both said labor was much worse once their waters broke. But again, that is three people! Not really data! :) I just made some assumptions based on antecdata. 

[TalkToMeNow]

Originally Posted by meb2 

During my birth class that I took the doula that was teaching it said that there was a link between the amount a vitamin C that the mama to be takes in and the strength of the bag :) Not sure on where she got that information, but I thought that was VERY interesting. 

GOOD NEWS FROM TODAY'S APPOINTMENT!!!! I'm already 4 cm dilated, 80 percent effaced and at 0 station! :) :) WOO-HOO! No need to strip my membranes ;) :) Yay! And she said that she could feel the huge sac of water :) Yay!

Awesome!  So exciting!

[MrsKatie]

Meb - I'm so excited for you and also SO jealous! Go have that baby now!!!  I'll be sending you good vibes, girl!

[meb2]

I was SHOCKED when my midwife told me that... I expected to have a low station and maybe be like, 1 cm dilated or something... but 4!?!? WOO-HOO!!! :) 

[Abraisme]

Yup, me too.  I tend to start at NEGATIVE zero though.  Ha ha.
 

Originally Posted by jbk21 

HOLY CRAP!  It took me 12 hours to get to 4cm during labor, lol!  I guess those ctx the other day were really working!  WOOHOOOO!!!!!

[Jaimee]

Originally Posted by TalkToMeNow 

I figured it was the water being broken because with dd1, I felt fine through my entire labor until my water was broken. It was much more intense after that. Dd2's labor (where my water broke at the beginning) was so intense the entire time.

This was totally me as well.  I think that as soon as the bag of waters ruptures, the head sinks onto the cervix even harder and contractions become more intense.  I was totally in the hypnozone at 8cm with my first and then the mw at the birth center broke my water and BOOM!  I completely lost focus and the next 2cm were extremely difficult for me.  With my second my water broke on its own while I was in the tub and the contractions definitely got more intense after that as well, but I think I was probably 9cm or so at that point b/c baby came about 30-45 minutes later.