what's with this trend of starting labor < 40 weeks? - Page 2

[Ravin]

I was put in the position of having to let them induce at 41 wks 6 days or leave the hospital AMA and be stuck w/ the bill I couldn't pay. DD was 7 lbs. 13 oz. It ended in a C-section because DD didn't respond well to the induced contrax. My gut told me she just wasn't quite ready.

In a similar situation in future, I will tell them to shove their pitocin and RUN AWAY. Money notwithstanding. Not every baby takes the same exact amount of time to gestate, just lik they don't all gain weight exactlly the same once they're born or learn to roll over on the same day, etc.

[party_of_seven]

Originally Posted by Malama

I saw Penny Simkin give a wonderful talk on this, called "The Seduction of Induction". She painted OBs as people who prey on the fragile emotions of very pregnant moms. See, they see them all pregnancy long, always hoping for some kind of connection (all women want that, right?). Then, towards the end, kind Doc, who has never given the woman more than 8 minutes of his time says,
"Geez, I really want to be at your birth! I'm going to be off call/ on vacation soon and I just don't wanna miss it. If we induce next week, then I can be there and you'll have the birth you want."

Now, if you've ever been pregnant, you know how vulnerable you can be at the end. And, of course all of the horrors of the "big" baby, etc.... are there too. UGH!

You can check out the power point presentation of this talk at her website
www.pennysimkin.com- interesting stuff.

Thank goodness there are enough women who have the sense to say no.... but I do shudder when I think about all of the women in my community who are succumbing to the OBs desire to put predictability in birth.

I agree 100%. I think its also a matter of fragile exhausted emotional moms just wanting to see their long-awaited babies. If a doc offers you the option to pick a day- and you will have your baby- I know of very few women who would pass up that chance. Besides, they figure that the doc wouldn't offer to do anything that was unsafe.

I just wish that more women would chose to research this crap instead of investing all of their energy in picking out crib sheets and layettes!

Its not like there is no one who has written a freakin book about it! Sorry, but, WTEWYE is not the pregnancy/childbirth bible...kay?!?

This stuff makes me mad. I know that a good portion of the blame lies with the doctors, but if women were more educated it would be a heck of a lot harder for the doctors to victimize them!

[Greaseball]

There is a very good reason why we have never discovered the fossilized remains of a woman pregnant with a 3-year-old child.

It's because even before pitocin and hospital births, no pregnancy EVER went on forever! That's why I don't understand women who say "I am not capable of going into labor on my own; I needed pit with all of my children." How can someone know they'll never go into labor? Have they tried waiting 40 weeks? What about 42 weeks? Maybe try waiting 48 weeks and see what happens.

[CryPixie83]

Originally Posted by klothos

my own OB told me he prefers to deliver babies at 36 or 37 weeks because then they aren't "too big" ~ because according to him, any babies closer to 40 weeks come out and are like "shoving a huge table through a small doorway."

i was just reading through another forum for pregnant mamas (one that's a bit more mainstream) and nearly everyone there are talking about how their doctors are pushing them to have the babies, and they're all around 37 weeks! a few are actually scheduled for induction at 38 weeks, simply because "it's time." one woman's doctor told her that if she went to 40 weeks, she'll "need" a c-section, because "that's just too long to keep a baby in there."

is this some new obstetrical trend?

I guess it must be because on my mainstream birth board there were tons of women at 36-38 weeks getting induced for BS reasons (doctor fears baby getting "too big", tired of being pregnant, family coming in town, etc) and I simply don't understand it. One woman was *considering* an induction and asked why so many were being induced so I posted a list of the possible dangers or induction and got blasted for it... : Apparently it's rude to try to educate people (yes, I was actually told that in so many words)

I understand being anxious to hold your baby, or being tired of being pregnant, but I've seen so many women inducing for what, IMO, seem like really selfish, stupid reasons and it just makes me really sad. And shame on the doctors who push to induce routinely... baby getting too big my arse, as you said, it've very uncommon for the body to grow something it can't birth. But most doctors (and women unfortunately) have no faith in the human body...


Maybe someone else knows why docs like to induce so early... but gosh 36 weeks isn't even full term...

[MamaChel]

My OB's with my son started pushing induction at 37 weeks. I was told that my son was going to be "at least 10 pounds!" I allowed an induction attempt at 41 weeks- it didn't take. Luckily my OB did it and he sent me home agianst hospital policy to aviod a c/section. We planned another induction attempt at 5am Tuesday (1st was at 5 am Sunday) my son was born at 1:11am Tuesday.

I avoided many of the things they wanted to do to me- have the staff dr break my water at 5 cm, epidural (they offerred this several times AFTER being told very firmly by myself, my OB, and everyone else involved with me to lay off.) I did end up with about 1/3 the recommended dose of Stadol- I started about 4 hours before my son was born, by that time I had been having pitocen contractions for close to 2 days and I was tired. My OB broke my water at 9cm and I pushed my son out shortly thereafter. I am so grateful that we both came through that with minimal trauma- I think it was horrible btu it could have been worse. My son was a whopping 7lb 6oz at birth- so much for "too big"

This time (I'm 34 weeks pg now) I went with a midwife. The whole experience has been more relaxing. I will not be on a time clock during my labor - her philosophy is that the baby will come when the baby is ready, not before. I wish I had stuck up for myself last time- I allowed my family to pressure me into doing what they were comfortable with.

[starrynight]

This whole topic is scary and infuriating at the same time. I feel SO grateful to have access to awesome midwifery care, so I don't have to worry about some doctor telling me my baby has to be born early.

I have a friend who used an OB for both of her births and was told both times that her babies were getting "too big". The first one weighed 7lbs even (so huge!) the second weighed 7lbs 6 oz. He actually told her that her body was not capable of birthing anything larger and that an 8lb baby would require a c/s. He determined this by just looking at her, nothing scientific whatsoever. And she believes him completely! She thinks without him, she'd have been in big trouble. And this is an intelligent educated woman we are talking about here. So sad.... it's like some doctor's want their patients to literally believe they can't give birth without them. Is this an ego trip? I can't help but think this is some form of deep rooted misogyny. As in women are too defective to birth babies without the help of modern medicine. Yes, modern medicine is awesome when there is an emergency and truly needed, but this is the exception and not the rule!

[obnurse]

This is despicable. I thought our "post dates" inductions (40weeks and 1day) [tongue in cheek] were pretty bad, but I can't believe that they are inducing earlier!!! I don't care if the baby is 12 pounds at 36-37 weeks...he/she is still not ready to come out! In this malpractice happy society, you would think that OB's would be scared to induce early for fear of being sued over a preterm baby! I have heard some of our more liberal providers say that truely there is no scientific evidence that inducing early will make the baby fit threw the pelvis..if its gonna fit, its gonna fit when its good and ready (and it usually does) In fact, probably the WORST shoulder dystocia I ever saw was born to a mom who was induced at 38 weeks for gestational diabetes. She had a wonderful anesthesia free labor, but those shoulders wouldn't budge for anything.

[BoobyJuice]

Wow - I hadn't even heard about this one. That's absurd - 36 weeks isn't even full term; their lungs might not even be developed yet. I do know of a few women who have been told they had to have inductions because the baby was "too big" - and they had 7 lb babies. Now personally I wouldn't want to be delivering an 11 or 12 lber, but that really doesn't happen very often (especially now that they can look for gestational diabetes). It's very much like taking the average timea woman was in labor and making it the maximum time they would allow a woman to labor (can't remember all the books I've read that one in) - in all their time in med school did they not learn about averages? Evidently they're taking the same path for size - 7 lbs is average so anything over that is just too big. Why, oh, why are we stuck with this medical system?

[doctorjen]

I know many OB providers are truly awful when it comes to pushing inductions, but believe me, there are plenty of pregnant mamas pushing, too (no pun intended.) It's to the point that I almost dread doing prenatal visits for some of my patients in the last month. I've heard every reason under the sun for why someone just has to be induced. Most recently, a woman pregnant with her 3rd child asked me to induce her at 36 weeks so she and her family could go to Disney World when she should be 38 weeks. I kid you not. I sat there with my mouth hanging open so long, she thought I was actually considering it.
I had one dad call me day and night, and eventually park himself and his wife in the hospital and refuse to leave. They needed the baby out NOW because he's a truck driver. ( )
I spend many of these last month visits warning about the dangers of induction, talking up how wonderful it is that baby is still cooking (at like the ripe old gestation of 37 weeks) and talking about how much easier natual labor is. I tell moms how induction with an unripe cervix means at least a 50% chance of cesarean. And moms still drive me nuts begging for induction. I must say "but you aren't even due for a week yet" several times a month!
I'm thinking about telling everybody they're due 2 weeks later than they actually are. I actually do suggest to moms that they tell their families that their "due date" is 2 weeks later than it actually is.
When I was pregnant with #3 my family doc explained apologetically when I was 41 weeks that due to hospital policy, he couldn't schedule an induction unless something was wrong until 42 weeks. I was thrilled not to have to argue about it. I had a beautiful delivery at 41 wks 2 days, with a lovely slow, gentle labor.

[CryPixie83]

Originally Posted by doctorjen

Most recently, a woman pregnant with her 3rd child asked me to induce her at 36 weeks so she and her family could go to Disney World when she should be 38 weeks. I kid you not. I sat there with my mouth hanging open so long, she thought I was actually considering it.
I had one dad call me day and night, and eventually park himself and his wife in the hospital and refuse to leave. They needed the baby out NOW because he's a truck driver. ( )

What is it with these selfish people? I read things like this on mainstream boards ALL THE TIME and it truly sickens me. It's bad enough that women just take whatever their doctors tell them for the indisputable truth and do absolutely no research (that's the doctor's job and the doctor would never do anything to harm them or their babies...) but to put their baby's (and their own) LIFE at risk for something so trivial is just mind boggling. I just don't get it. They're completely detatched from their bodies... pregnancy isn't something they experience, it's something that happens to them, they let other people let them know what's going on with their bodies when if they would just educate themselves they would know on their own!

I am reminded daily that we (MDC mamas) are the exception and not the rule, and it really saddens me. How can people be so out of touch and ignorant and selfish?

BTW, DrJen... it really is great to see a doctor who urges her patients to actually experience their bodies and take responsiblity for what happens to them throughout their care. Where can we find more docs like you?

[mehndi mama]

From what I've heard from just about every pregnant woman I've run into lately, this seems to be the *thing* for all the OB's here, too. I swear, it's always the same - ask someone who looks like she's about ready when she's due, and she'll say "My due-date is 3 weeks from now, but the doctor wants to induce early because the baby is getting so big." And then you look in the newspaper, and not a single baby announcement has a weight over 8.5 lbs. Oh yeah, that's gigantic. Tell that to my friend who had her 13lb. baby at home without even tearing! :LOL A lot of doctors around here seem to be really quick to slap a "gestational diabetes" label on a mom, too. I know some mamas really do get GD, but can it really be as many as it seems? I know the glucose tolerance test can often be a load of crap.....but then, with OB's telling moms that soda & junk foods are A-ok (the oB I had when I was a teenager actually said that I could have a diet soda per day. A DIET aspartame-laden tooth-dissolving soda! PER DAY!), I guess that could be expected, eh?

I love it when people ask me if I had big babies, and I can say "Oh, not all that big - 9 1/2 lbs was my biggest." Their eyes bug out at the thought of a 9+ baby being "not that big". But the truth is, it's not. 12-13 lbs, maybe

[crazy_eights]

OB's tell me about the pressure that they are under to induce pts. all the time. But I think it is a vicious cycle - when OB's by and large have convinced women that inductions are 'just another way to have a baby', it's no surprise that they turn around and say "well, if it's just another way to have a baby, then I want my baby NOW." Back before the advent of cervidil and other prostaglandin ripening agents, OB's took induction much more seriously. Now they feel that can bring just about anyone in and it has a reasonable chance of success. And once that is the case, the 'indication' for induction can be 'baby too big', 'baby too small', 'maternal discomfort', 'impending post-dates' [that one kills me - she isn't past her due date yet, but if we don't induce her, she MIGHT go past her due date], 'impending macrosomia' [again - not big yet, but it might get bigger], hell - "BABY IN UTERO", that is sufficient. And with it, the window for an 'acceptable' time to have a baby has gotten ridiculously small - the two weeks before your due date and that's about it.

[Aura_Kitten]

the comments about gestational diabetes reminded me of the conversation i had w/ my doctor about that too ~ it astounds me that a doctor can act like such an expert on nutrition + diabetes when it's not even their specialty, kwim?

i refused the "standard" gd screening, opting instead to monitor my blood glucose levels w/ a glucometer + test strips... every single result was great and consistent over a 4-week period, except one: i had drank a glass of green tea during my yoga practice one morning, and ended up with sky-high blood sugar (185 mg/dL). so i did a little research and found out it was because of the caffeine. well i mentioned it to my OB and he insisted it absolutely was not the caffeine, but the 1/2 C of rice krispies i had for breakfast that morning... even though i had been eating rice krispies for breakfast *every* morning for weeks at that point and had not had one single result like the one i had after drinking the tea (normally 2 hr. after eating breakfast my blood sugar was 98-105 mg/dL). :LOL so i shrugged it off... although i am slightly curious if he made any notes in my chart about it.

i do wish more mamas out there would question their doctors. i totally agree with whoever said that this is just giving society more women who say "i couldn't have had a homebirth or i would DIED..." :

[obnurse]

Doctorjen, I agree. Many of my colleague's complain mostly of patients demanding inductions at early times. I must say that most of the BS inductions are PATIENT presurred, and the OB's just can't stand listening to them anymore. I think that they go against their better judgement because they weigh their options, think the baby is close enough to term, and they can end their own misery. UNFORTUNATELY... if this practice was not allowed, then women would not even ask for it, because they wouldn't even know it was possible. I can't even tell you how many times I have had an induction like that, and then as soon as those aweful pit contractions hit, the moma is saying"oh get me outta here, I don't want to do this anymore'.. I keep my sweet consoling voice on, but gently say.. 'honey, YOU asked for this" and "you can't have your epidural 'till your 5cm!" (just kidding)

About OB's not being experts on GDM (gestational diabetes)... doctors (at least most) are not stupid. They all have very well rounded educations including diabetes. They don't just go to obstetrics school and skip everything else. Unfortunately, what your are describing is the doctor lacking one basic function....listening. You obviously know what YOU are talking about, and he was not taking the time to listen to you. True, they don't deal with diabetics everyday, but they do know what they are talking about. However, diabetes not being their specialty... here all GDM moms are referred immediately to a Diabetic clinic, that involves glucose monitoring, nutrition, exercize. They are followed by a VERY awesome woman doctor, that KNOWS what she is talking about! I wish you all had the same system.

[stayinghome]

Why are you with a practice that says that if you don't agree with it? Are they your only option? I'm not trying to stir up anything, but aren't you worried that he'll do the same to you?

I live in a small town where there is one hospital and two ob practices to choose from. They are the same way- wanting to induce at 39-39 weeks. And i've seen it end in failed inductions ending in c-sections several times. The last one i saw the reason of big baby was given- the baby's weight 7 lbs 1 ounce.

[mamabutterfly]

Originally Posted by Mom2six

And once that is the case, the 'indication' for induction can be 'baby too big', 'baby too small', 'maternal discomfort', 'impending post-dates' [that one kills me - she isn't past her due date yet, but if we don't induce her, she MIGHT go past her due date], 'impending macrosomia' [again - not big yet, but it might get bigger], hell - "BABY IN UTERO", that is sufficient.

:LOL "baby in utero" as indication for induction. love it!

[Teresa]

There seems to be a huge 'big baby' trend here, too.
I know someone who had an elective surgical delivery because her OB told her the baby could be as big as 11+ pounds.
A day or two before the surgery they tried induction and. . . she slept through some of it.
Obviously not time, right, but no. . . took the baby a few days later!
And she was allegedly 9 lbs. some ozs., but it took her more than a month to regain her 'birth' weight and they 'had to' supplement with formula.
I suspect that the birth weight was exaggerated and didn't say so but suggested instead that they use the baby's first pediatrician's-office weight instead.

'Big Babies' is the most common reason I hear lately for going the surgical route. When I say, ''Oh! What was his head circumference?" I get a strange look, but all my doula/homebirth/midwife friends say the same thing--it's the 'big-head' babies that are hardest to push. Two friends have said that their heaviest babies--both 10 1/2 lbs.--were the easiest labors!

[crazy_eights]

Originally Posted by obnurse

Doctorjen, I agree. Many of my colleague's complain mostly of patients demanding inductions at early times. I must say that most of the BS inductions are PATIENT presurred, and the OB's just can't stand listening to them anymore. I think that they go against their better judgement because they weigh their options, think the baby is close enough to term, and they can end their own misery.

I'm a hospital based RN in L&D (and we have close to 200 OB's on staff) and while I agree that there is pressure from pts. to induce, most of the OB"s themself believe that it is better to have a baby earlier rather than later. Hardly any are comfortable with going more than a few days past a due date and CERTAINLY not until 42 weeks. Which is STILL how ACOG defines 'post-dates' to this day. Considering the fact that the average length of pregnancy for a first time mom is 8 days past her due date, it's not hard to figure out that you are going to have induce a lot of women if you only 'let' them go a a day or two past their due date. Add to that the incredible fear of most OB's of a 'big baby with stuck shoulder' and that the 'baby will get too bit and you'll wind up with a c/sec'. I am not buying it that it is just pts. *demanding* to be induced. Like you said - if OB's would refuse (which until not so many years ago they did) this would not be an option.

Just as an aside - an OB heard me talking the other day about the fact that I had gone to 41 and 42 weeks with most of my pregnancies and he said "why did you do that?!?!?! You are an OB nurse. You should have known better! You should have gone in at 38 weeks for your induction!" Right.

[doctorjen]

I did not mean to imply that women demanding induction is the whole problem. I think it is definitely a symptom of how we view childbirth in the US. As a pp mentioned, if docs push that induction as just another way to have a baby, women say "Then I want my baby now." We have a responsibility as providers to give out good information. I find most women change their minds about induction when I explain that with an unripe cervix they are looking at a 50% chance of c-section, or 24-48 hours of attempting induction. I explain that chances that we are wrong about their due dates and that baby could have difficulty breathing, and that even very healthy 38 week babies often have trouble learning to eat.
Unfortunately, it's kind of like breastfeeding in the US. (Well, I was formula fed and I'm just fine kind of thing.) Moms are always telling me about their first baby that was induced at 38 weeks and was just fine, or their sister's kid who would have died if it went to term, yadda, yadda, yadda.
I start at the very first prenatal visit by telling moms not to think of having a due date, but a due half-a-month, and that first time moms should just plan on having their babies about a week late.
I'm not unsympathetic, really. I've experienced that this-pregnancy-will-go-on-forever feeling myself, but I try to encourage moms to think that their natural labor will be so much easier than if we try to force the babe out before both mom and babe are ready.
It's much harder to argue with the moms who are already asking at the first prenatal when they can have their epidural!
Anyway, I don't think the poor docs are just unfortune victims here. I think the responsibility absolutely lies with modern medicine, just the whole thing frustrates the heck out of me, often!

[CryPixie83]

Originally Posted by Mom2six

Just as an aside - an OB heard me talking the other day about the fact that I had gone to 41 and 42 weeks with most of my pregnancies and he said "why did you do that?!?!?! You are an OB nurse. You should have known better! You should have gone in at 38 weeks for your induction!" Right.

What exactly do doctors with this mindset think women did before induction was a medical normality? How do they justify the risks of induction versus the "risks" of going past 38 weeks (gee, darn better not let that baby get to term... rawr)?