Degrees of induction?

[Sanguine]

Hi, all,
I am asking this with some trepidation, since I know it's a very charged subject... heck, it's pretty charged for *me*... but I'm going in for my next checkup tomorrow afternoon and I feel like I need to do a lot of thinking beforehand. Sunday will be 42 weeks... which I realize is not extreme at all, since Teddy seems fine, I am physically fine, etc. However, I know we will be discussing "options" tomorrow.

The factors here that make me feel like considering doing anything but just plain waiting:
1) I am fairly certain that the two most wonderful nurses, who I've already met, befriended, bonded with, been cared for by, will be on call starting today and tomorrow. (when I was in over the weekend for the second time in 2 days to be checked, flipping out because I was exhausted and worried, and said 'I must be the most high maintenance pregnant lady ever, you must think I'm nuts' they said, 'no, actually we hope you'll hold on until we're working again, and if anything we're going to fight over who gets to labor with you.')

2) my mom is taking next week off from work (not to pressure me.. but because she needs a mental health week or she's going to quit her job in frustration)

I just talked with a friend who was induced, once at 10 days, once at 12, by having her water broken... and was in labor within hours both times. We had a serious discussion about what a difficult decision it was for her... that required a lot of deep searching and painful questioning... but that ultimately she felt she'd made the right choice for her.

So... for anyone who's willing to even contemplate this question... any thoughts? Or ideas about different things to consider? for instance, I wonder if they would go along with me trying Cervidil and NOT planning to have my water broken if that isn't enough on its own? The wild card here, which I still wonder about, is the possibility of old scarring from laser surgery making my cervix unable to dilate on its own. I'm not trying to psyche myself out, but it is a possibility.

I haven't decided I'm willing to/ interested in being induced at all. I just don't make any decisions--including decisions NOT to do something--without thinking over all sides.

[gulatigirl]

I'm starting to think about all this too. I'm 41 weeks tomorrow and I do NOT want to be induced but I've started to talk about options with the midwives. I'm planning a home birth and really hope the baby will be ready to come soon so I don't have to have an induction and a hospital birth - I just don't think it is in the best interest of me or our baby.

On Friday, 41+1, I'll be having an ultrasound to check on the amount of fluid etc. They've also got one scheduled for Monday 41+4. These I'm fine with.

But I'm also booked for an induction with an OB and transfer of care for labour and birth in hospital with midwives on Tuesday 41+5 because if I wait until 42, the OB won't transfer care back to midwives. I'm freaked about inducing at 41+5 but I figure if I have to have a hospital birth (which I'd have to do by 42 weeks in any case according to the rules), I want to be cared for by midwives I've been dealing with all along.

Knowing that baby will only come naturally when baby is ready, I've started taking EPO orally and vaginally, going for walks, having sex, sitting / bounce on my ball to help the baby put pressure on the cervix. I'm having BH contractions almost constantly, but not like the 1 min short labour contractions that have been told "count". I found out on Tuesday that I haven't dialated at all yet. My midwives did an exam and attempted to lightly stimulate the cervix manually but they could hardly reach it because it was so high. They are really supportive and want me to have the home birth too and will try again to stimulate the cervix tomorrow morning. I just wish we didn't have to follow these rules of induction by 42 weeks or in the case of keeping midwifery care, starting induction by 41+5 so that there's time for the induction to work and the doctor to transfer care back!!

[crazyeight]

since you have questions as to whether your scares will/might/are preventing you from dialating i wouldn't want to have your water broken and then really HAVE to get 'more' induced so you wouldn't get infected. of course if you've dialated any at this point you at least know it works and breaking your water might move things along.

of course u want to be as gentle as possible so i would find out about the natural stuff before the cervidol (?).

not really educated but just what i would do.
nak

[maciascl]

I am sure you know this but my concern with breaking your water would be that it starts clock watching. Most OBs will only give you so much time to deliver after your water has been broken before that want to do a c-sect to avoid infections.

Other than that I don't know much about induction methods. But I did want to say good luck no matter what you choose

[mojumi]

Accupuncture! Accupuncture! Gooooooooo Accupuncture!

Can't say enough about it. I saw an accupuncturist (formerly a pediatric RN) at 41 wk 5 days with #1 and was in labor 12 hours labor. I've also heard great things about chiropractic adjustments. Neither thing will make you go into labor if you are not ready anyway, but can 'clear the path' so to speak. Neither is invasive or puts you on a count-down clock. And even if neither thing 'works' you'll still have a nice, relaxing experience before whatever happens next.

[blairinargentina]

Ditto on the accupuncture! It has worked for many of my friends. I tried it myself for my little one (now three weeks old : ) because I knew I would be induced the following day. It defiantely got things moving, though things were super slow and other complications arose that led to pitocin. Uh. avoid that stuff like the plague!!!

IMO you can't go wrong with a visit to an accupuncturist.

[clovergirl]

i think something important to ask your doc is if you do go along with the induction, is it final? as in, let's say they start you off with cervadil and *nothing* happens. will they let you go home and rest for a day or two or continue on with pitocin? same goes for the pitocin, if you don't make any progress with it, will they want to break your bag of waters or will they back off for a while?
inductions can and do work, but sometimes when the baby and your body just aren't ready it's worthless... and that's wehn you wind up with a c-section. the problem is, there's no way to tell beforehand if it's a good time to induce or not.
it's a tough decision, for sure. are you 100% sure on your dates?

[noteworthy]

Originally Posted by mojumi

Accupuncture! Accupuncture! Gooooooooo Accupuncture!

hmmm, not knowing too much about this subject. Where did they focus on? Can accupressure spots work too? and if so, where are they?
I also heard something about reflexology can be used to induce. Wonder what part of the foot it is... time to Google.

[blairinargentina]

My accupuncturist did a variety of things... as far as the needles go she used 6 (maybe 8?) points that would normally be contraindicated for pregnancy (they would cause miscarriage early in preg). which she called a "strong treatment". she also burned a chinese herb stick called moxa near a pt on my little toe... too small for needles so heat works best there. this treatment is used in hospitals in china because it is so useful for turning posterior, and sometimes breech babies, which was present in my case. also, she gave me black cohosh to get contractions going (i never actually took these cause contractions started with the other treatments) and motherwort to keep the contractions coming regularly.
so, that's what mine entailed, if that gives you some indication as to what to expect.

[Sanguine]

Thanks for the input, everybody... I'm sure there is no way I want my water broken, unless there is some real medical reason this baby needs to be out NOW to be safe (which I totally do not expect... he is squirming vigorously and ringing the ol' cervix doorbell... really, I'm having this odd buzzing sensation!). Especially being group b strep positive, I know that would mean I was going to be in the hospital to stay. And I'm not in a rush... the more I talk and think about it, the more I think that the only reason I would try ANYTHING to move things along is the fatigue factor. Even if I totally hang out and rest, there's the question of how much rest can I get at this point, when sometimes sleep is hard even if I *WANT* to do nothing but rest.

I will ask about whether they would let me try just cervidil, and whether or not I need to be observed, & for how long, if they tried it. I'm not going to do ANYTHING tomorrow (unless it's a medical emergency)... I would at least sleep on it... and cervidil (or however it's spelled) is the most I would even consider. The acupuncture is a good idea though... my husband is a massage therapist & can give me a good workout on those pressure points and see what happens. I'm pretty well burnt out on the more strenuous ways to try to bring on labor (walking, bouncing, dancing, you name it, I've done it, and chewing is about all I'm up for right now!)

Thanks for helping me talk/think it over... basically I feel more and more comfortable letting my body do its thing on its own schedule (until the end of next week, when I think they are going to start agitating for induction no matter what. Up until then, my practice really doesn't want to mess with the process unless you're really asking for it, which is why I like them so much). Again, the only question is fatigue.. 5 hours of sleep last night, and my body is less and less able to be comfortable. I don't want to go into the marathon with no reserves left. We'll see if I can get better rest tonight.

Thanks again!

[gwinith]

sleeping and chewing

eat what you enjoy and keep trying to sleep... sounds like a good plan while you wait to see. stay positive

best wishes to you sistah!

[Sanguine]

Update... (longish)

So... after another rough night (my new late-pregnancy feature seems to be hour-long runs of irregular heartbeats... extra beats, racing pulse, etc... pretty darn hard to sleep through : ), I woke up, promptly felt really rotten, got violently ill, started having shaking chills and panting. Fun!! I scared the (*^& out of my husband (and, frankly, myself). I didn't think I was in labor, but I did think somebody should check me out, so since I was due to show up for my checkup in the afternoon anyway, I went down to the hospital. By the time I got there, I felt better, but hung out on the monitor for a while anyway and chatted with my terrific nurse.

So, after meeting with my doula, I saw the OB (midwife still on vacation til tomorrow). The long & short is... I am getting very exhausted. I have been having contractions, sometimes organizing into a pattern (like every 3 minutes for an hour or two!), sometimes not, but never stopping, for a solid week now. I am still only 1.5 cm--no change since Sunday. I am really, really effaced, & have a nice soft cervix. Without prompting, or looking at my history, the OB said 'by any chance have you had any procedures on your cervix?' I told him about my laser vaporization, & he said, 'well, hmm, you've been having lots of contractions for a long time now... and you're hanging out at the same dilation'. He is thinking that I have some scarring that needs some help to get out of the way.

My midwife is back tomorrow night, and will be back in the office monday. We decided to schedule an induction for Monday, if nothing has happened spontaneously by then. Looking back at our conception date, we realized my due date was actually a few days off--and I am 42 weeks today, with a solid conception date. So by monday, we'll be solidly on the way to 43 weeks. Baby is doing fine, but I am wearing out, and even with biophysical profiles, this practice gives a pretty solid outside limit of 43 weeks. Since I know there's no chance he's actually premature, and we have reason to believe I have a mechanical block to progress, I feel like this is a circumstance where induction is reasonable. As I understand, once we break through the scarring--with cervidil or if necessary pitocin to get things started--there is no reason to believe I won't finish dilating on my own.

I would NOT want to be induced by the OB, who told me, 'yup, I'd go straight to pitocin, why mess around.' I know my midwife takes a much slower approach: try cervidil, if that doesn't work on its own overnight, take the next step (not sure in my case if we are looking at rupturing membranes or pitocin--you better believe I will find out and know the plan before we get started). This is a woman who let a friend of mine have a basically unassisted birth at the hospital--staying nearby if needed. She is not going to come at me with musts and thou shalt nots--but I do trust her judgement to work with me to find a safe way for all of us to have a good birth for Teddy.

So... I am going to rest up for the next few days, prepare myself physically and emotionally, and if he decides he's ready before Monday, way to go.. and if not, I feel good about the backup plan. Yes, scarring sucks, no, I did not want to be induced, but I know I can still have a good birth. And scarring still beats cervical cancer with a stick! He may need a little help opening the door, but in the end, I'm going to have an amazing little person.

[nichole]

good luck! sounds like you have a supportive team

[Piper's mama]

I'm right there with you Sanguine...Monday will be my 42 weeks mark. Our plan is: Today (Friday) my MW is coming to do a non-stress-test and sweep my membranes. In the afternoon I am having the Bio-Profile. I am hoping to schedule in some accupuncture as well (thanks ladies). I have been taking a mixture of Red Raspberry and the cohoshes since 36 weeks (up to 12 tabs a day) and also EPO orally and vag. We've been doing nipple stim, squatting, sitting on my ball. I did castor oil Tuesday and yesterday. DH and I had sex Wednesday night that brought on very light contractions, so I got up immediatley and started Cohosh tinctures every 30 minutes. Same thing yesterday, very light contractions, never leading into anything. If I am still pregnant Monday, and since we will have tried everything we possibly can by then, my MW's would like to break my water so we can still try for a homebirth. The idea of it makes me want to , but I absolutley do not want to go to the hospital.

On the cervadil front...I was induced with DD 10 days after my EDD with Cervadil. My MW started off with the lowest dose possible, her goal was to gently coax my cervix. Nothing happened with the first dose at 2pm, so we went back to the hospital at 7pm for another round. I went in at 3cm, and by 4am I was at 4cm, so my MW said "you can either go home, or I can break your water". We decided to break my water, and DD was born at 11:44, after crazy intense unmedicated (pain wise) labor and 45 minutes of pushing. We were extremely lucky. I don't want to push my luck again ...But I thought I would give you my experience. For an induction it was a great experience, and very close to the birth I wanted to have. I will think of you Monday... maybe we can hold hands thru cyberspace and go into the hospital together if it comes down to that .

[Sanguine]

Hey, Piper's mama,
wow... sorry we're in the same boat, but if we're in the damn boat anyway, we might as well be there together!

One question...

Originally Posted by Piper's mama

We were extremely lucky. I don't want to push my luck again ...

Wasn't quite sure what you meant--was it about the short pushing stage or staying unmedicated or..? (I'm getting more and more dense as I get ever more tired and pregnant!)

So... speaking of getting tired... GOOD LUCK with everything you're trying, and make sure you're getting rest! I tell you, after hula hooping on that ball for 20 solid minutes and getting up and doing the twist, I was so wiped I would have been ups**t creek if I actually went into labor!

Do you have a doula or additional support to bring to the hospital if it comes to that? I hope it doesn't & you get to have your homebirth, but if it does, well, we'll link virtual arms and stride into the maternity ward together.

I'll be thinking every good thought for your membrane sweep & acupuncture, etc. Let's both just remember that if all the stuff we've been trying doesn't work, we're still strong & autonomous mamas and the most important part of our births is going to be how we work with our babies as they come on out--no matter where it happens or what gets the process going.