Originally Posted by ifnotnowwhen
I feel like I may have to have a convirsation with my doctor because at my last appointment she mentioned possible induction between 37 and 38 weeks (due to the possibility of placental insufficiency?). I was not prepared for that conversation at the last visit and I'd really like to avoid induction if at all possible. Does anybody have any good arguments / rationale that I could use to justify my position?
here is the general stance i took on this and many other things. any time doctors wanted to do something that was not the "wait and let things unfold by themselves" category, i politely put it on them to explain and show me in some medical studies why they felt that route was warranted. the default is to do nothing, there might be very good reasons depending on the situation to go down a different path, once explained and backed up with actually properly done medical studies, you can make a truly informed choice.
the result of this position of mine when both ways, at times the would give me a link or print me out a study that they had read and we talk about it and did the extra thing.
other times, they got to reflect and admit that they do it because it just made THEM feel better, but they guess it was my choice. they got more and more willing to admit this as we went along and say that i appreciated this honestly and did not think less of them for admitting it.
i did not find any well done large scale studies that support the broadly applied induction for placental insufficiency in di/di pregnancies. and i also learned that small calcium deposits that folks see in late u/s are not by themselves cause for concern usually. i fond it even more suspect what a doctor tells me 10 weeks early that i'm going to have xyz problem later on.
i personally had Cholestasis a horrifically annoying liver bile condition that freaks the crap out of doctors and moms to be. it is super understudied and not well understood, but is believed to cause sudden fetal demise and apparently that risk increases a lot past 37 weeks. So the completely standard thing is to induse at 37w or even 36w in some practices.
no one could really find me a study that looked at if mild or super well controlled cases where the same as uncontrolled or even undiagnosed ones, if secondary problems that were common could be accounted for in the studies and what testing was warranted. it was maddening. i finally told the ob on my team i liked the most that it was his job to show me factually why i should induce, he went to go find it and then came back with, "you know what, i see most twins come just when they need to, most come before the kind of induction dates i would give, so lets wait and see and watch very closely. as long as you understand the information and what we know of the risks, i'll walk this path with you."
my twins came from spontaneous labor that started at 35w5d and were finally born just into the morning of 36w0d they were small but not to small 5-3 and 5-10, needed no NICU and were strong from day one, i do feel like they came when they needed to. and that was their decision. i also personally think that the fact that they were gaining weight faster than i was, causing my body to be stripped of fat, muscle, energy and probably even bone mass was more the cause of labor than anything else.
i think it is this last point that Dr Luke is talking about, yeah her book is overwhelming, and i took her with a grain of salt because the best rest and early labor stuff did not pass my bull meter. but i made it my full time job to feed myself.(im the kind of person that often gives that a low priority and snacks a lot) i was slightly overweight ( BMI of 27.6) at the start.
what i read it is 1 pound a week for those in my category. at 18 weeks i was at 18 pounds and feeling great, did a bunch of moving and traveling at by 26 weeks(next time i had a scale around) i was just 23 pounds up, that started my falling behind. it was harder and harder to keep up as they grew faster and faster, there were weeks that they gained 1.5 pound together and i only gained maybe 1/2 pound, in the end 36w i had only gained 31 pounds and by day 6 i was back to my pre pregnancy weight. my arms and legs were actually gaunt, i was down 25 more pounds in the next few months, from rushing around and breastfeeding. only about a year later did i really feel like my bodies fuel system was in good shape again. I'm still 15 pound under my pre-pregnacy weight and now i feel good.
i took eating high nutrient high protein foods very seriously, if i did it all over again i would have taken even more seriously.