In what circumstance would you butt in on someone's birth plans?

[nilatti]

So, this is something that I experience a couple times each year, and I never know what to do...

I should start by saying that I had both of my babies at home, with a midwife, and in the process became really well-educated on the subject. Whenever I hear some one saying something that I know is against evidence, but is recommended by the dr, I don't know how far to go.

Here is an example. My friend's daughter (whom I barely know) was past due with her first baby. My friend texted me to tell me that they were planning an induction at 41 + 3 because the dr was concerned that the baby would be too big for her to deliver.

The first thoughts that ran through my head were the following: 

1) Inductions have a higher rate of c-section and forceps use.

2) The average length of a first pregnancy is 41 + 3!! (I looked up the study where I read this to confirm that I remembered correctly.)

3) Estimated weight at the end of pregnancy has a TWO POUND margin of error (and, seriously, how much bigger could the baby get in another week?)

Then I thought...what do I tell my friend? I thought about this for days....and ended up just texting her back to say that I was praying for a peaceful delivery. I really don't know the daughter, and didn't know all the details, probably.

Well, they did the induction.

The baby was only 8.5 lbs. I personally know four women who had eleven-pound babies without needing stitches (and the mom and the grandma both keep talking about how big he is...)

The mom avoided a c-section, but had a deep episiotomy and hemmorhoids from pushing. I really believe that if her doctor had just waited for her body to be ready, she would have avoided these injuries. I feel really guilty now for not saying anything, but I also didn't want to invade her privacy.

Where do you draw the line? If the mom in this situation was your best friend, would you have offered unsolicited advice? What if she was a stranger you overheard at a coffee shop?

[WildKingdom]

There is no circumstance at all where I would Monday-morning quarterback someone's birth experience. There is one acceptable thing to say to your friend, and that is, "congratulations on your beautiful baby."

[nilatti]

Sorry, I should have been clearer--not Monday morning quarterbacking, but saying something beforehand. In this case, maybe I could have replied to my friend (three days before the induction) with the statistic bout first pregnancies, on average, being 41 weeks, 3 days, and inductions being risky for interventions.

Of course, after the fact, "Congratulations" is the only thing one should say.

[WildKingdom]

I wouldn't say anything before, either.

[oliversmommy329]

Please do not take this the wrong way, because I truly believe you have the best intentions, but their birth is NOT YOUR BIRTH. Not everyone has the desire for a home birth. Not everyone has the desire to have an unmedicated birth. Not everyone has the desire to go to 42 weeks. Some people want epidurals, they want to be induced, they want to do whatever the heck their doctor says. It's what they know and it's what they're comfortable with. Could she have possibly avoided an episiotomy? Maybe. You will never know.

I had a completely unmedicated birth and was not induced and ended up with a tear all the way from my cervix to my anus. They were stitching me up for an hour and a half after the birth. I'm still healing 8 months later. I also had hemorrhoids. My baby was only 7lbs 1 oz...I can't even imagine what an 8.5 lb baby would have done to my poor lady parts! My sister also had a completely unmedicated birth and she had an episiotomy because she was starting to "starburst" tear. Her midwife had only ever done two episiotomies before hers so she was definitely not episiotomy-happy. She also had hemorrhoids following the birth. Everyone's birth experience is different and there is no way for you to say that your friend's induction caused those problems.

With all of that being said, I think inductions happen way too often for "big babies". I have known people to give birth to ten pound babies vaginally with no problems. I personally would refuse an induction for a "big baby" because I am educated on the subject and know the risks of an induction. So I really do understand why you feel the way you do and why you would be concerned for your friend. But the bottom line is she is not you and she deserves to make the decisions that she feels is best for herself and for her baby. The ONLY people I would offer unsolicited advice to are my best friend who is more like a sister to me or my actual sisters, but only because we are all very close and share the same views about birth. Anyone other than that...a friend, a family member, a stranger...it is absolutely none of my business.

[studentDr]

the safety of the mother and the baby should always be number one.

post date pregnancies can run into complications because this is when placental insufficiency can start to happen. supply of nutrients and oxygen delivered to the baby is reduced and keeps reducing.

this is the main concern and if this happens then it is not giod for the babys brain ie well being , so if a mother doesn't go into labour then it's off to theatre for a c section. so induction of labour at least provides for a chance at vaginal delivery. but yes induction has risks.
Edited by studentDr - 12/8/12 at 11:37am

[Jennyanydots]

I can relate, OP. In fact, i just spoke with my aunt last week on my cousin's due date, and she told me that my cousin would be induced this week, at 41 weeks. It's her first baby, and I felt like I had to force myself to hold back any questions I had about why they were making the choice to induce... But I didn't say anything. I think so near to a woman's due date, she has probably made up her mind and unless she asks for your opinion, you should probably keep advice/opinions to yourself. If you feel strongly that you have good advice to share about this stuff, and have a close enough relationship with her, there's plenty of time for those discussions earlier in the pregnancy, before the pressure's on. Near the finish line, it's got to be support only. Just my two cents. I think you handled it well.

[starrlamia]

i dont think it is wrong to supply information, just be non-judgemental and not pushy.

[JamieCatheryn]

If she was interested in discussing it, I'd warn her gently that induced labors hurt more and they don't always go as smoothly as spontaneous ones especially in first time moms, and try to give her the idea it is really up to her whether to do it or not.

[studentDr]

I think I came across something somewhere that some people have more stretchy connective tissue,(skin) these are the people who are less likely to get the painful lacerations, and they are also less likely to get the striae gravidum (stretch marks)

did I get it the right way around ?

[cileag]

Honestly, waiting until 41 and 3 is pretty generous by hospital standards. I only offer information if it asked of me, and I would be hesitant to to give lots of advice to someone I knew so peripherally. Now with my sister or cousins or very close friends, I specifically remind them that I love to talk birth and am willing to pretty much at any point, but otherwise I stay out of it. I have a list of websites that I send people too, since I find that seems be received better as well. It's tough sometimes to watch, but no one really likes an evangelist.

[Hoopin' Mama]

You should say nothing unless asked for your advice. It's not your baby, your body or your birth. It is simply not your business to inform others what they should be doing.  

[Dakotacakes]

I wouldn't provide information or opinion unles asked. if you flipped the circumstances I would not like that either. Being informed is not always unilateal. Informed could lead someone to believe that 41 +3 is dangerous. Or that homebirth is risky. I f I were planning a homebirth I would not want someone "informing" me on why I shouldn't be going forward with it. Similarly if I was being induced I wouldn't want someone telling me why I shouldn't Everyone is different.

I personally had more than one person try to educate me on how most caesareans were unnecessarians after I had my child via c-section. In my case it absolutely was not (I have a structural abnormality confirmed via x-ray after my birth to try to pinpoint why delivery didn't go as planned). It drives me crazy and makes me consider becoming combative. And I generally agree, there are likely more c-sections performed that are necessary but that doesn't mean that individuals should be informed of this after the case.

As for the question the only circumstances I would butt into someones birth plan would be if it was truly dangerous. For example, if I knew someone was planning an unassisted at home planned c-section with no medical personnel or pain medicaation, I might butt in on that. But anything that is just a different value system I would keep it o myself

[nilatti]

Thanks for your input everyone. As I said, I kept out of it, but was having a moment of "what if" and second-guessing my decision.

Oliversmommy, I am cringing reading about your birth injury. I hope you heal fully and soon!

[firespiritmelody]

If this was a very close friend of mine, I wouldn't hesitate to offer information or sources for information (like: "there's a great book by xyz called abc that has some really good information pertaining to inductions) and if the friend seemed interested I'd take it as far they wanted, and if not, I'd it go. I wouldn't be pushy or nosy and I wouldn't say anything about pain - not everyone who gets pit experiences contractions that are more painful then without. Saying something like, "I did some research when preparing for my own births about induction that I found interesting. Did you know that the average pregnancy is actually over 41 weeks and only about 15% of babies are born on or before their due-date?" If the conversation takes off, great! If not, drop it.

[buko]

Originally Posted by firespiritmelody 

only about 15% of babies are born on or before their due-date?

Do you have a citation for this?  I thought it was 15% of spontaneous births ON the due date, not on or before?

[1babysmom]

I can relate.  I have a REALLY hard time hearing stuff like that, too.  I've never said anything though, despite WANTING to and wishing I knew a way to get through to someone. (wait, I think one time I might have asked my cousin if she had considered another option, but I can't recall the specifics of the conversation)  BUT....the thing that always makes me feel better is that sometimes people have to experience things on their own to come to a place of wanting to change/educate themselves/etc, whatever it might be. (not that all those people are necessarily "wrong" in the first place, but that just experiencing something firsthand is obviously different from hearing it from someone else, especially with a subject as touchy as birth, where another persons thoughts might be a turn-off instead of a motivator.)  Hopefully their births go well and everything works out fine, but maybe it will be a learning experience all the same.  I know I was that way...I was "fairly" natural minded with #1, but it wasn't until after I had experienced an induced, medicated hospital birth (a very positive experience with zero complications, overall) that I realized I simply wanted something different. (and then I became a full-on UC'er! LOL)  And so began my journey to becoming passionate about pregnancy and birth!

[firespiritmelody]

Originally Posted by buko 

Do you have a citation for this?  I thought it was 15% of spontaneous births ON the due date, not on or before?

I don't anymore, but I can see if I can find it. My CBE/doula mentor uses that statistic in her workshops regularly. I think it might be 15% before, 5% on and 80% after.

[1babysmom]

I've always heard 5% on the date, too.  It sticks in my head because my brother and I were both born on our dates- spontaneously.

[Quinalla]

If the person is looking for advice or information, I'll offer it gently and carefully, but when their mind is made up, I just say "Good luck!" or whatever. Unsolicited advice is annoying any time, but worse during pregnancy IMO and even if someone makes different choices than I would, I firmly support their right to make their own choices.

The only time I could maybe think about saying something without advice is if I was really close to the person and they were talking to me directly, like maybe with my sister, can't see with anyone else. Then I might ask a couple gently probing questions just to make sure she was fully informed by her OB/midwife. But with people I'm close to, I usually share resources I liked as soon as I find out they are pregnant and offer to listen to gripes, give advice only when asked and otherwise to shutup and wish them well. I figure they can read or not, ask or not, but I've given them open access to my information and it is up to them to make the call. And I leave myself as a safe person they can talk to who has BTDT which is so important for any pregnant woman!