Your input please! Potential induction... UPDATED

[mamabutterfly]

Despite all her best intentions, my friend is facing a hospital induction tomorrow, and is trying to decide whether to try either castor oil or black cohosh tonight. Also when the morning comes, whether to begin w/Pitocin or with amniotomy (in the second case she would have some time of being mobile, could take a walk, shower - not with the Pit running).

Ideally, she wanted an *all natural no intervention birth*, like she had w/ her first. So what happened?

Well, so my friend is pregnant with twins, and has had an amazing pregnancy. Great diet, exercise, positive outlook, self-education, rest. Her concern was premature twins, so she chose a highrisk practice w/good NICU ... and now here she is at 39.5 weeks! The babies are doing great by all measures.

So.... she kind of wishes now she'd found a midwife for a homebirth, BUT she feels stuck where she is. She chose an OB practice at a fancy hospital which another mom of twins recommended, and one doc in particular was said to be very open to natural birth. Turns out, he is -- just that his two collegues are kinds of jerks!

Anyway, we'll call the laid back guy Doc #1. Two weeks ago Doc #2 does an ultrasound, pronounces the 37 week babies to be 7.5 pounds each. (Notoriously inaccurate of course, but let's just say they're big for twins).
Good news is she's 50% effaced, 3-4 cms, and both babes are head down.
He schedules an induction for 38 weeks, scares her w/talk of stillbirth, failed placentas... again.

She went in last week, hooked up to pitocin, nothin happened. Refused AROM, went home.
She was 4 cms and 80% now, baby A at -1 station.

Now nearly 40 weeks, even Doc #1 wants to get babies out. He scheduled her for another try tomorrow if labor hadn't started by then. So... all week she's tried: nipple stimulation, long walks, sex/orgasm, spicy food, several visits to accupuncture. Nada.

Questions:

Maybe uterus is too distended to contract? Has anyone heard of this?
Maybe babies aren't ready. Do you know of twin moms going past 40 weeks?
Maybe membrane rupture wouldn't be worst thing in the world in this situation? (recall she is 80%, 4 cms, first baby is low) Should induction fail tomorrow they will do a cesarean anyway. Maybe nothing to lose?
Would you use castor oil or black cohosh or anything the night before this in the hopes of starting on your own?

Sorry so long! Thanks for your wisdom, mamas.

mb

[kimberlylibby]

Sounds like there is NO reason for induction at ALL!

Good grief, yes a mama can go "overdue" with twins!

She's doing awesome and will have nice porky babies!

The docs just need to get their hands off of her and let her body do it's thang.

That makes me so mad!!! Inductions for medical reasons are one thing, inductions just for the sake of "inducing" are vomitous! And all their scare tactics are pure junk!!

IF she decides to go through with it (and she DOES NOT have to, it is HER body!!!) she should probably go ahead with some cohosh... but I really think she should tell them that it is HER body and she is not inducing because she has confidence that her body will labor on its own.

JM(humble??)O

Kimberly

[Greaseball]

Maybe babies aren't ready. Do you know of twin moms going past 40 weeks?

Yes. There are some on this board.

They should be congratulating her for growing big babies who stayed in for 40 weeks! Too many twins are born small and early.

The best thing she could do is not show up until labor begins - they can't induce her if she isn't there!

[neveryoumindthere]

or is it possible her dates were a bit off and she really *isnt* 40 weeks..

ugh, doctors, they wanted to induce with me at 29 weeks : cuz the baby was too small...: soooo inducing would help with that : i ended up with an induction at 38 weeks with a perfectly healthy (but tiny) little girl, i shudder to think what would have happened with an induction at 29 weeks...

at any rate, unless there is something 'wrong' there is no reason for her to go in. she can just skip the appointment, they're not gonna hunt her down

[cottonwood]

Have they not even offered a non-stress test or ultrasound? I mean, if they are honestly concerned about the health of the babies and placenta... it seems like that would be the first step, before starting in with the drugs and surgery. Just to assume that 40 weeks is too long for twins, and to make medical decisions based on that assumption is very, very, very bad science.

I haven't heard of any twins going past 40 weeks, but then are they ever allowed to? We just can't know how common it would be normally. I personally wouldn't take the castor oil or cohoshes, just because they can put the babies into distress. It just doesn't make sense to me to take one risk in order to avoid another. But that's just me. Anyway, if she does decide to let them induce she should remember that if they do AROM she's on the clock! (She probably already knows that...)

[BusyMommy]

Well, I know nothing about twins. But, if she feels confident, she can refuse. W/my first, my dr warned my I MUST induce so I scheduled and then just called in sick. I mean, what are they gonna do? And, I ended up having a lovely home birth on day 14. Thankfully, labor started at 10pm b/c my rescheduled induction was at 6am.

[mamabutterfly]

Originally Posted by blueviolet

Have they not even offered a non-stress test or ultrasound? I mean, if they are honestly concerned about the health of the babies and placenta... it seems like that would be the first step, before starting in with the drugs and surgery. Just to assume that 40 weeks is too long for twins, and to make medical decisions based on that assumption is very, very, very bad science.

I haven't heard of any twins going past 40 weeks, but then are they ever allowed to? We just can't know how common it would be normally. I personally wouldn't take the castor oil or cohoshes, just because they can put the babies into distress. It just doesn't make sense to me to take one risk in order to avoid another. But that's just me. Anyway, if she does decide to let them induce she should remember that if they do AROM she's on the clock! (She probably already knows that...)

They have done both ultrasound & NST... and both babies look beautifully fine. My friend, though humongous, is fine. It's really all about the dates, that's it.

Believe me, she's a wreck about it. This is where it gets so insidious. I don't know if others have encountered this, but I've seen this a few times now as a doula:
A mom will be faced with a strong recommendation from a care provider - one that might go against her instinct, but then a mind game begins that goes like this -
If I go with my decision, and G*d forbid anything goes wrong, it's on me.
If I go with the Dr recommendation, I could forgive myself more easily for a bad outcome.

In a vulnerable emotional moment like late pregnancy can be, I've seen women more afraid of 'going against dr's orders' and developing complications.

I just wish all care providers would know the research & the real risks onf intervention, and *trust* the process of birth. So mamas wouldn't constantly find themselves in these combative positions.
They are really implying she is inviting stillbirth if she waits another week. Now, while she is clear on all the risks of induction - What a horrible position to be put in! Ugh.

Thanks for all your thoughts. Any others?

[Greaseball]

I would blame myself if I went against my instincts, listened to a doctor and something bad happened to my baby.

She may not go much beyond 40 weeks anyway. I think hotmamacita is the member who had her twins at home past 40 weeks.

I thought even doctors agreed that the risk of stillbirth doesn't rise until after 42 weeks (which we know is crap).

[Kiki Runs]

Originally Posted by mamabutterfly

Believe me, she's a wreck about it. This is where it gets so insidious. I don't know if others have encountered this, but I've seen this a few times now as a doula:
A mom will be faced with a strong recommendation from a care provider - one that might go against her instinct, but then a mind game begins that goes like this -
If I go with my decision, and G*d forbid anything goes wrong, it's on me.
If I go with the Dr recommendation, I could forgive myself more easily for a bad outcome.

In a vulnerable emotional moment like late pregnancy can be, I've seen women more afraid of 'going against dr's orders' and developing complications.

I just wish all care providers would know the research & the real risks onf intervention, and *trust* the process of birth. So mamas wouldn't constantly find themselves in these combative positions.
They are really implying she is inviting stillbirth if she waits another week. Now, while she is clear on all the risks of induction - What a horrible position to be put in! Ugh.

Thanks for all your thoughts. Any others?

I wanted to speak to this: "If I go with the Dr recommendation, I could forgive myself more easily for a bad outcome". Ummm.....not necessarily. I know it sounds like it's true, and *I* thought this, too, somewhat. Now I'm finding that it's just not true. (Or if it is, good grief, I 'd hate to see myself had I gone more against the doc) I'm still blaming myself very strongly, a year later.

Just reading your post made me cringe. WTH is wrong w/those docs? They should be celebrating the fact that she's kept those babes inside for so long, not trying to scare her into getting them out.

And I totally agree w/who ever said the dates could be wrong. Does your friend know EXACTLY when she conceived? I did, and I still had to argue w/my docs. Hello? Not all women are mindless robots who ovulate on the 14th day of our cycles. GRRR.


Please, please help your friend be strong. Sounds like SHE has done everything right, and maybe now she just needs a little support to stick it out.

Remind her they can't induce her if she's sitting at home in her living room. And I've never heard of a doc driving to a mom's house to drag her butt to the hospital, have you? Maybe if she can bail on even just this first induction appt, that'll be enough time for her babes to come on their own.

I've not been induced, but I have had both pit and AROM. While it does sound like AROM would be an easier way to go (given that she can walk around afterward w/no IV), I have to say that I would not choose it. After my AROM, my contractions got 100% harder and sooo painful, and my labor turned to back labor. While I was "allowed" to walk around, I physically could not. My contractions got closer together and like I said, so very painful. It was all I could do to turn myself onto hands and knees.

I can't say much about the pit b/c by the time I had it, I also had an epidural. But we all know what it CAN do to contractions, and that it's an IV, so mobility is restricted.

Please help your friend to stay strong and resist the induction unless there is a MEDICAL reason (and NOT "oh, the U/S shows your babes are big" crap). Remind her of the increased possibility for c/s w/an induction. Heck, just remind her of the increased interventions/restrictions!

Good luck to you and your friend. I hope she's able to resist the docs and have her babies naturally, when THEY are ready!

Kinsey

[mamabutterfly]

Originally Posted by kinsey43

I wanted to speak to this: "If I go with the Dr recommendation, I could forgive myself more easily for a bad outcome". Ummm.....not necessarily. I know it sounds like it's true, and *I* thought this, too, somewhat. Now I'm finding that it's just not true. (Or if it is, good grief, I 'd hate to see myself had I gone more against the doc) I'm still blaming myself very strongly, a year later.


Please, please help your friend be strong. Sounds like SHE has done everything right, and maybe now she just needs a little support to stick it out.

Remind her they can't induce her if she's sitting at home in her living room. And I've never heard of a doc driving to a mom's house to drag her butt to the hospital, have you? Maybe if she can bail on even just this first induction appt, that'll be enough time for her babes to come on their own.

I've not been induced, but I have had both pit and AROM. While it does sound like AROM would be an easier way to go (given that she can walk around afterward w/no IV), I have to say that I would not choose it. After my AROM, my contractions got 100% harder and sooo painful, and my labor turned to back labor. While I was "allowed" to walk around, I physically could not. My contractions got closer together and like I said, so very painful. It was all I could do to turn myself onto hands and knees.

I can't say much about the pit b/c by the time I had it, I also had an epidural. But we all know what it CAN do to contractions, and that it's an IV, so mobility is restricted.


Kinsey

Thanks, Kinsey, for sharing your experience. I think that's a good point - and I didn't mean that I was saying I thought every woman would feel good afterwards about going against her instincts! Of course that isn't the case! Didn't mean it to come across like that.

I was just saying that I more understanding now of why sometimes women feel so trapped in these moments than I used to be when reading books and thinking "Who would ever agree to an induction?" I still feel too strongly myself to think I'd ever consent to one, for almost any reason. But I have a different perspective on the emotional effects of hospital pressure. (Still makes me angry at hospitals, but I see now how it happens, if that makes sense...).

Greaseball - thanks, I was thinking of pm'ing hotmamacita.

[msrog]

I read positive, successful homebirth stories of moms going past 42 weeks with twins!!!! PLEASE assure that mama that she and her babies will be fine. If she was wishing she could have switched to a homebirth anyway, she should not have a problem with skipping her appointment and staying home until labor begins. Did she go over with her first? My first came at 41 wks 1 day, and I'm praying my twins will cook in there until 40+ also.

[gotmilkmama]

That is awesome she is keeping them in that long! Gosh I hate that docs just can't let nature take it's course. : I went 41w1d with ds and had to fight w/doc to not get induced because there was NO WAY I was going to let that happen. I just compromised with coming in everyday for NST and/or US to make sure baby was okay. And since those all were fine I just said NO...I want to wait some more. And he thought baby was about 7-7 1/2 lbs...turned out being 8lbs 12oz!

Anyway I have a new doc now but she isn't keen on letting me go past 38 weeks or so with my twins. I just say we'll talk about that when I get there...knowing that as long as babies are okay then I'm not budging.

You said "They are really implying she is inviting stillbirth if she waits another week." I am curious if the NST and US show babies being fine then why do they think waiting will cause stillbirth? What are the reasons? Are there any stats or info showing that twins going to 40w or pass with good NST and US are at risk for still birth?

If I tell my doc I have other info than he/she does they always ask 'well i'd like to see that reference'. And I provide it. Just the same if they are giving us info...that we are paying them for...then can they provide the reference? Preferably something more recent than 1940!

Good luck to her!

Carmella
34w3d - so far 4lbs2oz and 4lbs8oz
MZ sweet baby girls : edd 7-4-04 (40w)
Dominic (The Dom) :binky 12-29-02 (41w1d)

[mamabutterfly]

[QUOTE=gotmilkmama]

You said "They are really implying she is inviting stillbirth if she waits another week." I am curious if the NST and US show babies being fine then why do they think waiting will cause stillbirth? What are the reasons? Are there any stats or info showing that twins going to 40w or pass with good NST and US are at risk for still birth?

QUOTE]

That's the thing - they aren't offering *anything* to back up that vague fear. I don't think it is supported by evidence.
Carmella - I'm sure you are going to have a wonderful rest of pg & good birth!

I just actually spoke to my friend & she was having some ctx last night & other labor-ish signs today! So here's hoping it will all be moot!

[shelbean91]

My sister's friend had twins around 40 weeks, perfectly healthy, each over 7 lbs, completely natural birth. I'm not sure exactly how long she went, but I know I was impressed b/c you always hear about twins coming early.

A woman I used to work with was pg w/twins, wanted to induce, dr's wouldn't (this was on a reservation, not sure if that made a difference or not). She ended up having them at 43 weeks with very bad results- one was stillborn, one died a few days later. I don't know if the length of pg was the cause of that outcome or if it would have ended up that way anyway- this particular woman had previously lost twins at 5 mos pg and had at least one other m/c.

Good luck to your friend- I'm sure all will be great with her. I don't know why docs are SOOOO impatient.

[Tigerchild]

Hmmmm...

I could understand the docs' worry if there was some evidence of TTTS or other problems, but it doesn't sound like that's the case.

It IS, however, standard practice for twins to be considered term at 37 weeks. (Why this is, I have no clue), so in their minds she is 3 weeks 'overdue' if she's at 40 weeks.

If I were in that position, I think I would want NSTs every other day (hopefully no flames for that) but no matter what do movement counts a couple of times each day. But other than that modest intervention I would not want them to induce unless something was found to be wrong.

The difference in uterus extention between 37 weeks and beyond shouldn't be a factor. I mean, if there's going to be a problem at 40 weeks, then there would've been one earlier too, unless the babies gain 10 pounds in a week. So if they're saying that's a concern...I would call bullshit on it.

Multiple mamas have to be ESPECIALLY careful of the intervention cascade. So I'd try to avoid induction, almost at all costs. Just as long as she's keeping close tabs on things like movement and heartbeat, hopefully that will allow her to catch (probably before any doctor would) anything suspicious.

[lorijds]

Like all the other mamas;

I agree that she should simly avoid induction by not showing up. She sounds very strong; just have her call and schedule an appointment for an NST in a day or two with the office.

Never consent to AROM purely for induction; it puts you at risk for infection, and it puts you on a time schedule; which often leads to augmentation and/or section.

However, if she is going to try something at home---I highly recommend castor oil. one ounce at 8 am, and again at noon. Take in 4 ounces of oj with some baking soda for fiz. This is what we do to our moms who are way over and are looking at transporting because they are beyond 42 weeks (not our rule, but one we have to abide by *if* we have sure dates...wind wink, nudge nudge, know what I mean, know what I mean).

If you are ready to go, this often tips mamas over the edge into a good, strong labor. Not the kind that peters out after several hours. This is my experience, anyhow. We have not seen a higher rate of meconium or of any other type of complication in the labor of moms who have used castor oil; granted, it is less than 5% of our moms who do this, so it's not like we have a huge sample!

But, it is her body. She should do what her heart is telling her. DOes she have a doula? Are you her doula? Help her keep strong!

ANd, wow, good for her for going term with twins! The docs should be celebrating her, not threatening her with induction!

Lori

[Greaseball]

Or, she could tell the doctor she will agree to the induction if it can be at 3 a.m. on a Saturday. Maybe sometime on Memorial Day weekend, when he would rather be out doing something fun...maybe that's why he was trying to get her to hurry and deliver!

[sahm23boys2003]

2 of my friends in my twins group went 41 and 42 weeks!! NOthing wrong with that at all unless like people have said there is something wrong with the babies or with Mamma! I went 38 weeks with an induction for medical reasons due to MY health. I would let them cook as long as they need to!

[mamabutterfly]

Originally Posted by Tigerchild

Multiple mamas have to be ESPECIALLY careful of the intervention cascade.

Yep.

Well, I thought I should update: The induction went forward, and the twins are here. Both are big! Thanks for everyone's thoughts on the situation.

They did do AROM (in addition to pit) and mom was complete within 1.5 hours, all drug free, relaxed, and upright thru much of it.

Then -- hospital's standard procedures for twins went into effect. [I considered not sharing this wondering if it violates my friend's privacy but I think not since I am not sharing details, and I just want to share it to offer as information to others who might be in a similar situation.]
It was so wild. She reached 10 cms, and the following happened:
Epidural placed 'in case of an emergency while pushing'
Pitocin continued to counter epi
Mom wheeled to operating room.
Mom placed on OR table on back, legs in stirrups, told when to push.

First baby delivered. Second turned sideways, Doc couldn't turn him back headdown or grab his legs. Heartrate dropped. Didn't come back up. Mom was unable to change positions so response to dropping heartrate was cesarean.

I do believe he was at risk when they operated, and they revived him and now he's fine. Who's to say whether he would have been in distress had those various procedures not taken place? You can never live the same experience twince, of course. But I do know that Baby B had no heart deceleration all day and the first time he experienced distress was while mom was on her back for over half an hour.
I'm not questioning any twin mom who had to make hard decisions about interventions. It's such a vulnerable position to be in. We all do what we think is best in the moment.

I don't know. My friend was amazing throughout it. She thought thru her decisions but ultimately felt compelled to cooperate with the procedures of the hospital where she was birthing. I believe she feels at peace with how it happened, and I would never suggest to the parents that I feel anything could have gone differently than how it did. They are just overjoyed to have their babies here, and so I am thrilled along with them.

Each birth I witness is such a learning experience.

thanks again for your thoughts.

mb

[Greaseball]

Who's to say whether he would have been in distress had those various procedures not taken place?

I'll say he wouldn't have! Stupid policy...is it also against policy for them to help the mom get into a better position if she can't do it herself? I've heard that a lot - "I knew I'd have a better chance of delivering if I could get off my back, but I couldn't move and the nurses refused to help me."