need compelling evidence AGAINST induction at 42 weeks

[mamas2atti]

My deadline is Monday. Midwives say I have to be induced at 42 weeks. I received a few messages on MDC saying I can deny treatment, etc. But I don't know if I can...

Everything I have read from scholarly medical journals says the risk to the baby increases drastically for a lot of different things after 42 weeks or 294 days. I am absolutely positive of the date of my last period, date of ovulation, and date of conception. I have always had 28 day cycles that started within the same hour of the day (14 years of them-except during first pregnancy and three months after birth).

I have also read that inducing with pit, which is what I will have to do, puts women at a high risk for c-sections if they don't have any labor going. I am absolutely terrifeid of c-sections.

If you have any evidence that it is better to go on, please share.

Thanks.

[Godiva]

I'm living proof right here, I was due on the 11th and she's still in there happy as can be, fetal tones are strong, lots of movement. Definatly NOT a baby in any sort of trouble. My mom carried both me and my sister to 43-44 weeks and we were both born very healthy as well. So that's my personal proof, now to look up some medical proof for ya....
"While there are risks associated with post-term pregnancy that may require your baby to get special care after birth, most post-term babies are born healthy without any complications. The monitoring and tests that are currently available for post-term pregnancies has helped to increase the likelihood of good outcomes."

Basically the risks are not enough blood supply to the baby due to placenta deterioration, or a big baby at birth. As long as all tests indicate that the placenta is functioning normally (baby active, gaining weight..) then there is no need to induce at any time. The only time there would be a need to induce would be if the baby showed signs of distress from not getting proper oxygen/nutrition. At 42 weeks a placenta will not just shut down, yes there is a higher risk of it not being as productive, but fetal monitoring can rule out any complications of that happening.

[alegna]

Not in your group... but... I don't understand why you think you can't refuse induction. What are they going to do? Kidnap you and haul you to the hospital? Normal gestation is 37-42 weeks. Normal. Average is usually said to be around 41 weeks. Babies don't have a pop out timer and explode at 42 weeks. That's just not the way it works. They come out when they're ready.

you're right- you have a good chance of ending up with a section if you agree to an induction.



-Angela

[celrae]

No medical evidence here, just personal experience. I was 40 weeks preg with twins when I was induced due to my doctors recommendation and I was tired of being preg. I labored fine with no complications and vaginally gave birth to 2 healthy 8# girls. The current standard is to induce at 38 weeks for twin preg and I am very glad my doctor was willing to let me go longer.

[Aka mommy]

Thought you could use a laugh but how about telling your midwives that you forgot to have your hubby impregnant you with a calendar so that your dear child could be sure to arrive before the 294 day deadline???

But on a more serious note there is plenty of info you can research online about inductions. Cytotec for one (if they use it) isnt even approved by the FDA for use on pregnant women and has a high risk of causing damage to the baby and possibly even death during the labor ( http://www.rxlist.com/cgi/generic/misopro.htm. ) You have a high risk of c section with pit and it doesnt always get labor going. My personal experience. I was induced at 41 weeks with my first dd and i relate her baby problems to the pit. We went through RSV, asthma, a blood disorder that causes her to have a crappy immune system, and those are just to name a few.

[BetsyPage]

I'm not in your "due date" club, but I just wanted to say that I was induced with Cytotec at 42 weeks and I DO NOT recommend it... I argued with my dr on two issues, the "induction" issue and the method of induction... they "scared" me into doing it there way with both. (naive first-time mom without good support). I went from not really being in labor to hard, active labor within an hour or so. (After 4 doses of Cytotec, the maximum allowed.) The rationale for Cytotec was basically that it would get me into labor faster, since I was not dilated, not effaced at all, etc., they weren't sure if Pitocin would *do* anything, and would be *more* likely to lead to a c-section.

Here is the interesting thing... I had 3 fetal non-stress tests in the week before... dd looked GREAT in all of them. After the birth, they were examining my placenta and one of the doctors commented that it looked like a "39 week placenta". So really, I guess I was just a long gestator! I estimate I would have gone 43 weeks probably, or more. She didn't look like a "post-date" baby, though, just a normal, full-term baby. My dd was big though, 9 lbs 5 oz, and 21 1/4 inches long... she probably would have been over 10 lbs if I hadn't been induced, but honestly, I think my body could have handled it, I only pushed for 1 hour with her, it was no problem getting her out.

I did want to mention that I did NOTHING really to try to bring labor on... no herbs, etc., basically I just tried to walk a lot. But I'm not sure if those things would have done any good if she wasn't ready to come out anyway! But maybe you are doing more things that I did, which I would probably recommend if it doesn't stress you out.

I do know some women who have gone 43 weeks... I know one woman who is a Midwife who went 43 weeks with one of her dc, if you would like to talk to her let me know I can get you her contact info.

Also, I just want to send good baby vibes your way- I really remember my anxiety about it all! I would say trust your body and your intuition.

Oh, also, have you seen this link? I saw it posted here recently...
http://www.birthlove.com/free/ten_month_mama.html

[allgirls]

All of the "risks" are based on statistic...what are the medical reasons to induce you for this particular baby. For me to be induced they would have to give me a compelling reason...this particular baby is in trouble not "statistically the risks of such and such increase"

And what will they do if you don't get induced?

[freestyler]

Hmmm, sounds more like a medwife than a midwife! Hugs to you for having to deal with this person. If I were you, I'd stand my ground and refuse to let them do anything to you without proof that it's necessary. Remember, scare tactics are NOT proof---they are only scare tactics! You sound a bit concerned about going over 42 weeks, yourself, and to alleviate your concern I might recommend having a non-stress test done to be sure baby is fine in there. Heck, have one done every two days if it makes you feel better and keeps the medwife at bay.

Three out of my four kids were born at 42 weeks, that's just how long they took! And yes, a normal pregnancy is 38-42 weeks, so being "postdue" really doesn't start until AFTER 42 weeks, a fact which care providers routinely overlook.

Hugs to you. Your baby will grow until ready to come out! Babies generally spend the time they need to inside, for reasons which grown-ups cannot see! (I like the "impregnate you with a calendar" comment! Hahahahaha!) Trust your baby and your body. You'll do fine.

[mamas2atti]

Originally Posted by alegna

I don't understand why you think you can't refuse induction. What are they going to do?

It's not that I can't refuse it. I know that I can. The only problems are: 1) my midwife works out of a birth center and her hands are tied after 42 weeks and 2) I fear that if I don't show up and then go to the hospital later I might be treated by some insensitive doctor and have an awful experience.

I spent the first 26 weeks of pregnancy trying to find a midwife I loved for a homebirth. After several local midwives stood me up, didn't return my calls, etc. I met my midwife at the birth center and fell in love. I really respect her and the training she went through to become who she is. So that's why it is such a hard decision for me...

Thanks for all that you all have shared. I am thinking, thinking, thinking...and hoping he just makes his appearance tomorrow!

[alegna]

Would they attempt the induction at the birth center or would it be at the hospital anyway? If you're stuck in the hospital anyway, you gain nothing by inducing. I'm sorry you couldn't find a hombirth midwife that you clicked with. That's rough. It does sound like the midwife you have is more medwife.

good luck!

-Angela

[mamas2atti]

My midwife is a medwife. She is at the only free standing birth center in Arizona, and unfortunately they have to do a lot to cover their asses with liability insurance problems liek there are today.

If she is able to break my water and it kicks things into gear I will be at the birth center tomorrow. Otherwise, it's to the hospital for me. As far as hospitals go, this one is pretty cool because they are used to the midwives being there. They will even let you labor in their gigantic tubs if all is well--they just pull you out before you deliver.

[mamaroling]

You may not want to hear this...

Hi
I felt very much like you...no induction only natural with a mid wife. I was 10 days over when labour started. 12 hours later I needed an emergency c-section due to no heartbeat. Our son had swallowed meconium which resulted in a collasped lung and 3 weeks in ICU at our province's childern's hospital.

While we were there a nurse made this comment
"We get preterm and post-term babies, we never see babies in here who were induced."

I find I don't grieve over having a c-section, what I grieve is not having that first 3 weeks with him and the stress of visiting the hospital.I recovered from the c-section quickly, even with a infection. He was my priority. Now he is 7 months and is happy and healthy, no long term effects due to the trauma.

Good Luck with wharever you choose

[freestyler]

Having your water broken to start things that are not already started is a BAD IDEA. It will generally lead to lots and lots of interventions if the baby is not ready to come out. It can also cause cord prolapse, and I for one would avoid it like the plague. If your baby is not ready, and you attempt to force things, your chances of ending up with a bad experience are greater than if you just leave things alone and then insist on an intervention-free birth at the hospital, a few days later.

Yes, you could end up with an insensitive doctor. Hell, you could get in a car accident this morning and end up with one anyway---we all could, it's just a risk of living. AND it is a risk of birthing. You could also end up with a superb, very able and nice doctor. Remember that. Also remember that your chances of ending up in a very stressful situation, and being ultimately sent to the hospital, are much greater if you try to use the water breaking as a method of induction. What I mean is: Personally, I would be totally stressed out if my medwife did an intervention that didn't work and I ended up in the hospital AND with the pressure of if-you-don't-deliver-within-24-hours-after-water-breaking-we-cut-you type of thing. Under those circumstances, any doctor that walked into the room would stress me out and so would everything else. BUT if I ended up in the hospital at 43 weeks, having gone peacefully into labor on my own, on my baby's timeframe, I'd be less stressed to begin with, and in a better frame of mind to handle whatever the heck got thrown my way. I would also NOT have the pressure of them watching the clock because of AROM (artificial rupture of membranes.) I would also sleep easier afterwards, because no matter what happened during the labor, even unlikely emergency stuff, I would know that I at least did not let anyone do things to me that caused the problems. Anything that happened would be an act of nature and not because of interventions. Does that make sense? There is nothing worse than feeling remorse after a birth, like "if only I hadn't done XYZ maybe things would have happened differently." I speak from experience on that one!

If it were me, I would totally trust my baby. I would believe that he/she has a good reason to be born at whatever date, and I would also believe that babies choose whom they want at their births. I also believe, I really do, that if a baby does not feel safe with a certain care provider or place, they wait until they do feel safe. Such was the case with my second. I had medwives, and my son would NOT let me go into labor until 42 weeks, after I switched to good care providers a couple of days before. Maybe your baby has a good reason to seek a hospital setting. Maybe he/she knows that some assistance will be required or just wants to play it safe! Not that they understand it in a conscious way, but I truly believe that babies understand what to do on an unconscious level.

Sorry for the novel. Just my two cents. Good luck and please trust your baby above all else. Certainly have more faith in the little one, and in your body, than in artificial means to start labor.

[homemademomma]

Originally Posted by alegna

Would they attempt the induction at the birth center or would it be at the hospital anyway? If you're stuck in the hospital anyway, you gain nothing by inducing. I'm sorry you couldn't find a hombirth midwife that you clicked with. That's rough. It does sound like the midwife you have is more medwife.

good luck!

-Angela

i just have to stick up for this mw a little bit. when a mw gets licensed, she gains a lot of priviledges, such as (depending on the state) insurance reimbursement, collaborative care with doctors, easier time with transfers, easier time getting rx drugs (like pitocin), and better "standing" in the medical community, which means a lot in cases of complications. BUT, if a mw gets licensed, especially if she works out of a birth center, she is held to certain laws and community standards of practice. she could lose her license if she took care of you in labor past 42 weeks. that doesnt make her a medwife. that makes her someone who had a hard decision to make (do i get licensed or not??), and who has to work within certain constraints. it totally sucks, but that doesnt mean it is her fault. at the BC i am a student at, we cannot help women deliver before 37 weeks or after 42 weeks, or someone who has had ROM for more than 24 hours, or a VBAC, or a million other things. the mw i work with is wonderful and hands off and respectful of women, but she still has to transfer someone at 42 weeks, unless our back up dr gives us the ok to keep her (not likely!)

licensed hb midwives have more wiggle room since they dont work in collaboration with an OB, but they still are bound by laws and standards of practice. you gain some advantage by being licensed, but you lose a lot too. it doesnt make her a bad mw.


anyway, sorry that was totally OT. it is a hard decision to make. you want to avoid induction, but you dont want to lose your MW (who im sure would go to the hospital with you if you were to be induced).

i would definitely refuse induction at all costs (unless your baby is in distress). you can still stay with your mw most likely, and also see the OB, until you go into labor naturally. then you can stay home until you feel like pushing, and then go to the hospital (or just stay home!). your mw will come with you, and if you talk to the OB about your wishes, and wait until the last minute to go to the hospital, and maybe have a doula, and make sure your partner knows your wishes (no epis, no IV, baby born to you, all newborn procedures done on your belly, no separation, etc etc etc), you stand a pretty good chance for a normal devliery.


sorry mama. i would UC if i were you , but many people jsut arent okay with doing that.

[mamabeth]

Hi mama--
I hope that you have gone into labor by now, but...just wanted to share my experience. I went to 43 weeks with my ds (3 weeks old today) and researched on PubMed and all kinds of places, and the statistic I found was that the risks go up significantly at 43 weeks, not at 42. I can find the study if you want, but basically we stuck to our guns and did not schedule a c-section (which was my option since I was planning a VBAC) until 43 weeks. The docs and midwives were squirming, but we basically just told them it was our baby and that we wanted to wait. They cannot drop you from care without 30 days notice, it's illegal.

I'm so glad I did wait...my baby was very healthy and only 9 lbs (my dd was 10lbs 9oz at 42 weeks). He looked a bit post-term but not much, just peely skin.

Anyway, good luck whatever you decide. I know it's hard to be up against all that but just know that you are in charge...it's your baby and your body.

[freestyler]

I like your point, homemademamma, about the midwife having a hard decision to make, and that it's not really her fault. Thanks for broadening my thinking.

I also liked the reply from mamabeth--very lucid and well put, and I hope it gets read in time!

[mamas2atti]

I am still thinking of not doing it tomorrow. My husband is about to go insane from my roller coaster of emotions.

As an aside, my midwife personally didn't deliver her son until 43 weeks, so I don't think it's a question of not trusting mamas/babies. She is bound by constrictions outside of even her belief system. Also, my husband was 3 weeks late and his sister was 16 days late. Both perfectly healthy babies. I read somewhere recently that it might be father's genes responsible for postdate babies.

[eclipse]

Susan, I had the same problem in the other direction - I delivered at 36w5days, and because of that was unable to deliver at our birth center. it was disappointing, buti don't blame the midwives at all. as was pointed out, they are constricted by rules that they have to follow in order to keep practicing. i'm sorry you have to make the choice.

[Godiva]

hey, I was just wondering if you decided to go for the induction or are you still waiting? I guess I'll know my answer if you take a few days to respond

[crazy_eights]

Originally Posted by mamaroling

While we were there a nurse made this comment
"We get preterm and post-term babies, we never see babies in here who were induced."

I'm sorry for what happend to your baby. But all due respect, that nurse is full of it. I've worked 5 years L&D and all types of babies go to the NICU - preterm, full-term, induced, not induced. In this area of the country NOT getting induced is a rarity, and plenty of inductions wind up with infections (from repeated internal exams & early amniotomy), maternal fevers (often from hours and hours of epidurals which increase the incidence of febrile moms) requiring a septic work-up and antibiotics for baby, or are they just born with problems that earn them a trip to the NICU. Not to mention that 'post-term' (I assume she meant 'post-dates') is not until after 42 completed weeks of pregnancy - so your baby's admission would prove her wrong right there. Sorry for the OT rant, but comments like this from my nursing collegues really get my panties in a wad.

Oh, and just to throw out to the OP, meconium does increase the longer the pregnancy continues, but meconium aspiration does not - it remains at a constant rate across the spectrum from 38 - 43 weeks of pregnancy.