Antibiotics vs. induction: WWYD?

[Smithie]

I am potentially facing a hard decision, and I need advice.

I am prone to UTIs and even more so during pregnancy, and have had three courses of antibiotics during this pg. I just finished the last course yesterday, and am exactly 36 weeks today.

With my ds (born May '04), I was totally commited to carrying him 40 weeks and wound up taking abx the whole month prior to his birth. In retrospect, I'm not sure I did either of us any favors by killing off all our natural flora at a time when we were both so vulnerable (him=newly born, me=postpartum).

So... if I get another infection, I can treat with abx again and keep the pregnancy going, or I can be induced (getting the baby off my bladder will resolve the issue). I am currently using probiotics, cranberry, nettle tea and chiropractic to try and prevent more UTIs, but once I get one I need to take abx or I wind up in the hospital with a kidney infection.

I saw my midwife today, who says that Sarah (my baby) is very healthy and well positioned for birth but only weighs about six pounds right now. Next week, at 37 weeks exactly, I have an ultrasound to get more information about how well developed Sarah is. At that point, I should know whether or not another UTI is happening.

What would you do in my shoes? What do you think is best for Sarah? Both decisions solve my problem, but I truly can't decide if she's better off coming a bit early with all her flora intact or at 40 weeks with all her flora killed off by abx.

[nurnur]

I would take the abx and try to keep my baby in longer. Just my personal opinion. The baby who is not ready can have such an uphill battle nursing, digesting and just overall with all those little systems running smoothly can be compormised as well. Sounds like you are doing everything you can and I feel your dilema, my twins were taken from me via - planned c-sec at 39 weeks (their dates) and they just were not ready, they were 6.3 & 6.15 so very good weights for twins I am told, but it was not their time and we just had a hell of a time with EVERYTHING. Are the options you are facing taking the abx or induction?

Carrie, mama to 4 :

[Smithie]

Thanks for responding, Carrie! Yes, as far as I can tell my only options if I get another UTI are abx or induction, because if I just leave the infection untreated it will become systemic and kick off labor anyhow. This almost happened to me with my son, I was in the hospital at 36w5d with a fever and contractions. They pumped me full of abx and the contractions abated. But I'm sure you can imagine how much that experience sucked.

What do you think should be the biggest factor in weighing my options - size or gestational age? My ds was 7lbs6oz, I thought that was a good size. My midwife believes that this baby is simply a smaller person and will not weigh that much even if she goes to 40 weeks. I am sorry, but not surprised, to hear that your twins and you had a hard time at the beginning. I know the 6 lb. range is not generally considered dangerous, but it seems quite tiny to me...

[maybebaby]

Wow, totally crossing fingers another uti stays away for you!

I'd have to agree I'd try more abx before inducing. My first two were inductions and I really hated the Pit.

Good luck and keep us posted!!

[NYCVeg]

This is only my opinion--I am NOT a birth professional--but I think gestational age is more important than size. Size varies so much depending on genetics and other factors--dh, for instance, was born full term at 6 pounds, 1 oz., and did great. I was born at 41+ weeks at 6 pounds, 11 oz. and also did great. Our families just consistently have smaller babies. OTOH, one could have a 7-pound baby born due to complications at 36 weeks--and because that baby was "SUPPOSED" be 10 pounds, her lungs might not be fully developed, etc. In other words, higher weight is better for a premature babe, but I think it's no guarantee that their lungs or other systems are where they should be.

The other thing that would worry me is that estimates of weight, particularly so late in pregnancy, are notoriously unreliable. They can be off by as much as +/- 2-3 pounds. I can't tell you how many stories I've heard about babies that were induced at 37 or 38 weeks because they were "already so big" and "mom wouldn't even be able to birth them if they got any bigger" or people who had scheduled c/s because doc told them "baby was too big to birth"...and then the mama had an underweight or under-developed baby who ended up in the NICU.

I am NOT saying this would happen to you if you were induced. But I also would take the abx over an early induction--and I have horrible, horrible reactions to abx, so that's saying a lot.

[Marylizah]

I agree with the other posters so far-- I'd rather a full-term baby with abx than an induction without.... And, by the way, to you, UTIs are soooo the pits (I also have lots of experience with them).

Good luck making your decision, it's so hard to know what to choose!

[liseux]

Smithie, I`m lurking from Sept, but I have one more thing for you to try & prevent UTI`s.

2000 mg of vitamin C every day, 1000 in am & 1000 in pm. Take more if you want, but this is the minimum that will keep your urine too acidic for bacteria. Cranberry works too, but the vit C regimen is stronger & quicker & you just excrete the excess. My South African mw in my 1st pregnancy recommended this to me as I used to get a UTI EVERY month & now I haven`t had one in 7 years but I do this every single day. Good luck!

[Peppamint]

I've been induced so I wouldn't want to go through that again- yet, I always have horrid side effects from anbx. In your case though, I would take the anbx again, if necessary, while boosting your good bacteria with lots of good probiotics via pills, kefir etc.

My induced 38 weeker was not ready to be born, she did fine overall but was way too sleepy and hard to nurse... now if this baby were to come on his/her own at 38 weeks fine, but I wouldn't induce.

Best wishes!

[KatSG]

I agree with all the pps. If those were my only choices, I'd choose antibiotics over induction, for the same reasons said above. I'd rather have a baby ready for the world. Also inductions are more likely to result in more interventions, esp c-section, if your body isn't ready.

I also agree about the Vit C. I had a tail-end of a UTI that my MWs found in a routine test. I didn't have any symptoms, though. I'm now taking 2000 mg Vit C/day and adding UNSWEETENED Cranberry juice to my water (make sure yours is unsweetened) and all seems well right now.

Good luck!!

[Snowdrift]

Originally Posted by NYCVeg

This is only my opinion--I am NOT a birth professional--but I think gestational age is more important than size. Size varies so much depending on genetics and other factors--dh, for instance, was born full term at 6 pounds, 1 oz., and did great. I was born at 41+ weeks at 6 pounds, 11 oz. and also did great. Our families just consistently have smaller babies. OTOH, one could have a 7-pound baby born due to complications at 36 weeks--and because that baby was "SUPPOSED" be 10 pounds, her lungs might not be fully developed, etc. In other words, higher weight is better for a premature babe, but I think it's no guarantee that their lungs or other systems are where they should be.

ITA. My brother was a NICU baby for a couple of weeks. He was born at 7.5 pounds at 35-1/2 weeks. His lungs were not mature enough, and he's had more health problems his whole life than the rest of us sibs put together--allergies, asthma, speech delay, all sorts of things. Not necessarily related to his prematurity but certainly could be a factor. Size doesn't mean all that much.

I'd do the abx/probiotics combo rather than induce.

[Smithie]

Can you believe I have no Vitamin C in the house?!? Better put that on the grocery list...

48 hrs off abx and no UTI symptoms yet! :

[Throkmorton]

I would definitely opt for the ABX. Just make sure to be generous with the probiotics, the vitamin c and everything else.

Induction is a miserable road. Really.

[nurnur]

I would have to say gestational age is the bigger factor. There of course are NO garuntees in birth as with life, but that is the factor I would want to lean more heavily with, beit a small baby or not. Maturity can make a HUGE difference. to you as you journey thru this.

~Carrie, mama to 4: :

[Smithie]

OK, 10 days off the abx and I heard from my NP on Saturday that the course of Keflex did NOT cure the UTI. The urine sample I gave right after finishing the prescription still showed bacteria and white blood cells. I don't FEEL sick, so I'm not treating it. But I am soooooo disappointed.

38 weeks on Wednesday...

[Marylizah]

Oooh, so disappointing!! I'm so sorry to hear that, those are some tough guys you've got there.

[flowmom]

What a dilemma. I would definitely opt for abx over an induction. The risks of inducing are much higher than abx because inductions increase your risks of birth problems including c-sections. Plus you want your baby to be "fully cooked". I don't think that their assessments of that are particularly accurate - your body's natural progress is the best measure of your baby's readiness to be born. That's great that you're doing everything you can to prevent UTIs. Here's hoping you won't have to do either!

[provocativa]

My two cents on top of the vitamin C- which is a brilliant reminder. It sounds like your probiotics might be wimpy. When I switched from decent, regular probiotics to kefir and yogurt, with expensive probiotics, and then on to homemade yogurt and homemade kefir, I ousted some thrush yeasties I'd been fighting for almost 3 years. All the anti stuff didn't work- it only helped me temporarily (natural antifungals of verious sorts, and of course stupid nystatin). I needed more powerful bugs to win the war. You may be in labor now, and it's not the time to start culturing your own stuff (babymoon), but in some places it's still common to take a yogurt cure- eat health food store yogurt and kefir, both plain, constantly. All day all night. Buy those and the probiotic pills based on the variety of organisms contained therein. Then 2 months from now, go to the nutrition forum and learn how to make your own, which are infinitely more powerful.

[Smithie]

Thanks for the advice! My naturopath prescribed my probiotics and I trust her, but really, NOTHING in capsule form can be as effective as a whole-food-based cure IME. That is probably something I should look into as a long-term solution for my UTIs.

I have great news, though: I had my 38-week appt. yesterday. 3 cm dilated, mostly effaced, I think I'm going to make it!

I gave another urine sample, we'll see how the bacterial load is, but I think I've been keeping the UTI at bay. I'm still asymptomatic. Come on, baby, come on...