Talked to a woman who induced at 38 weeks due to husbands work schedule.

[Emilie]

We were at dinner tonight with dh's coworkers. This woman( and I get the stress from their job- her dh is normally about an hour from her and possibly hard to get a hold of without a pager)

But.... she asked the doctor to induce her at 38 weeks to insure that he would be there. Hmm... I just don't know. She did have a history( prior birth 4 hours) of short labors- and she did birth after 4 hours. She did get the epidural and regrets it because it took the lady 8 tries to get it in right!:

She tried to BF for a week then her milk dried up.

What do you say>? I smiled and nodded sympathetically.

They are not having other children.

[wifeandmom]

Her body, her baby, her choice. That's what I think.

Of course, to determine whether or not it made sense from a MEDICAL standpoint, I'd want to know more about the condition of her cervix when they induced her. A favorable cervix in a woman with a prior history of laboring and delivering in 4 hours who also has a husband who can be up to an hour away and/or difficult to reach...I can see where she was coming from I guess. A NON-favorable cervix is a whole different ball game.

I'd also want to know at what gestation she delivered her previous baby and whether or not she was showing other signs of readiness beyond a favorable cervix (assuming of course that her cervix WAS favorable).

Lastly, at 38 weeks, I'd have personally requested an amnio, *especially* if the baby in question was male or unknown, to insure lung maturity. If she was carrying a girl, I'd be ok without an amnio at 38 weeks. I'd personally have to be closer to 39 weeks if it were a male baby we were talking about inducing, but that's my own comfort level speaking.

And of course, the risks vs. benefits of such a decision should have been THOROUGHLY discussed with her physician. That should happen anyway though.

I wouldn't go so far as to say she was 'lucky' that it worked out well (short labor and vaginal delivery) even with interventions, but it certainly opened the door to the potential for complications. Of course, the door was closed to the potential of her having to give birth without her DH present with the induction, so perhaps the trade off was worth it in her mind.

[wifeandmom]

I'll also add that while I am not *usually* a fan of inducing for reasons such as this, being a military wife has opened my eyes to very real situations that I myself would likely choose to induce for other than medical reasons.

A couple we knew of was due 3 days after her DH was scheduled to go to Iraq. For a year.

They induced her after an amnio indicated lung maturity at just a bit over 38 weeks. This was her third baby, previous two both born without induction at all prior to 40 weeks gestation. It was also a girl, which is better in terms of lung maturity issues. Her DH was able to be there for the birth and spend those first few precious days getting to know his new daughter.

He came home in a body bag less than 6 months later. Those first days were all he ever had, but there will always be pictures and video of him with his baby girl, something that very well might not exist should they have made a different choice.

[MamaTaraX]

I have only attended one planned (and sadly failed) induction that I ever stood behind. It was so that the husbnad could be there too. but this one was because the husband was overseas (in the middle east) and it was literally the only time he could come home. While the induction failed and ended in a c/s, the experience was very positive for them. (that was over a year ago, I guess now she could be looking back negatively on it but last time I talked to her they were really happy about it all)

Namaste, Tara

[Ambrose]

Originally Posted by wifeandmom

Lastly, at 38 weeks, I'd have personally requested an amnio, *especially* if the baby in question was male or unknown, to insure lung maturity. If she was carrying a girl, I'd be ok without an amnio at 38 weeks. I'd personally have to be closer to 39 weeks if it were a male baby we were talking about inducing, but that's my own comfort level speaking.

Why the concern with wanting an amnio and waiting to closer to 39 weeks if it's a boy? -Just curious, as I'm having a boy and inducing at 37wks

tia

[egoldber]

Why the concern with wanting an amnio and waiting to closer to 39 weeks if it's a boy?

Generally, premature boy babies tend to have more problems than premature girl babies. There are always exceptions to this rule of course, so nothing is certain.

We are delivering this baby between 36 and 37 weeks, and my OB and perinatologist plan to do an amnio prior to delivery to check lung maturity. Its pretty standard in most places to do an amnio for deliveries planned before 38 weeks. Its a fine line between balancing the risks to the baby by going longer in the pregnancy vs being born with lung immaturity and the possible long term complications that can involve.

[Emilie]

why are you inducing at 37 weeks? not flaming- just curious

[Ambrose]

Well it's actually a scheduled csection rather than induce and try labor. DS has hydrocephalus (fluid build up on his brain that isn't draining causing his head to become grosly enlarged) and he also has a cyst that is 3cm large (this was 4 weeks ago, so it's likely bigger now) per the MRI we had done of his brain. Because of the cyst, he developed hydrocephalus. The cyst blocks the pathway that the cerebrospinal fluid drains. The cyst has also has gotten so big that it's prevented his cerebellum from continuing development adn the cerebellum is actually atrophying. Unfortunately, the cyst also prevented the back left portion of his brain from ever developing too.... So he's got a lot of medical concerns that the doctors said they couldn't do anything about it while he was in utero but that they didn't feel comfortable taking him out sooner than 37 weeks because the damage that's been done is so great, they truly do not think taking him out sooner to perform the shunt placement surgery and/or the cyst drainage surgery would increase positive chances of development.


Weirdly though... they haven't given me any steroid shot yet to help his lungs out.... (I was wondering why my neightbor kept asking me if the docs had plans for giving me that- it never occured to me that she knew about males and lung development and just assumed I did too..) Do you think on Monday I should call and ask them if it's possible to get one?

[lolar2]

Why not, the worst they'll say is no.

[wifeandmom]

Boys tend to develop a bit slower than girls, on average of course, when it comes to lung maturity.

39 weeks is the research backed point at which amnio is no longer medically indicated for elective induction or section for no medical reason, although some docs are ok with doing so at some point after 38 weeks. Around here, 10 days prior to due date, which would put you at 38w4d is about as early as any doc is going to do any type of elective induction or section without medical reason. Some docs want you closer to the 39 week point with male babies, some don't make a distinction between the two.

As for steroid shots to mature the baby's lungs, I saw four peris with my twin pg. None of them would do steroid shots after 34 weeks, and although I do not remember the reasoning behind this, I do remember looking into it at the time and it was the prevailing practice at the time (this was 5+ years ago).

Sometimes, delivery needs to happen regardless of lung maturity, at which point you want to be sure you're in a hospital with a great NICU.

[carmel23]

Originally Posted by wifeandmom

He came home in a body bag less than 6 months later. Those first days were all he ever had, but there will always be pictures and video of him with his baby girl, something that very well might not exist should they have made a different choice.

: : :

This is so sweetly sad--to think of a man going into such a terrible situation with the image of his new baby girl makes me cry.

[egoldber]

Originally Posted by Ambrose

Weirdly though... they haven't given me any steroid shot yet to help his lungs out....

There is generally no added benefit to steroid shots after 34/35 weeks. There are some potential side effects to the steroids as well, so 34/35 weeks is used as a guideline for when to give the shots vs not.

[Mama Poot]

:Puke

That's what I think about it.

[DocsNemesis]

Originally Posted by Ambrose

Well it's actually a scheduled csection rather than induce and try labor. DS has hydrocephalus (fluid build up on his brain that isn't draining causing his head to become grosly enlarged) and he also has a cyst that is 3cm large (this was 4 weeks ago, so it's likely bigger now) per the MRI we had done of his brain. Because of the cyst, he developed hydrocephalus. The cyst blocks the pathway that the cerebrospinal fluid drains. The cyst has also has gotten so big that it's prevented his cerebellum from continuing development adn the cerebellum is actually atrophying.

Poor guy! I find this somewhat interesting though. I have an arachnoid cyst and excess spinal cord fluid around my brain too (its called pseudo tumor cerebri in my case), but none of the neurologists think that the cyst has anything to do with my excess fluid, even though they magically occured at the same time....grrrr. Anyway, I hope everything goes well for you and your little guy!

[Ruthla]

Ambrose It must be so stressful to be worried about your baby like that.

I wish doctors would save the interventions for cases like yours where they're really necessary.