Point me to induction information?

[skueppers]

I'm at 40 weeks, 4 days today, and am still totally confident that I'm going to go into labor on my own sometime in the next few days. My first baby was born at 41 weeks; I went into labor spontaneously at 40 weeks, 6 days. In both cases, I'm sure about the date of conception. I'm almost 37, the pregnancy has been completely normal, and today's biophysical profile showed no problems.

My OB talked with me about induction today, so we'd have a "backup plan" in place if I don't go into labor on my own. I should note that he and I are basically on the same page about the desirability of avoiding induction -- we both think it's a lot better for a woman to go into labor on her own. Anyway, he thought it would be best to schedule an induction for next Wednesday or Thursday, when I would be 9 or 10 days overdue. I held out for Friday, 11 days, and I know I could talk him into letting things go 14 days with another biophysical profile late next week, but it clearly made him nervous. When we talked about why, he said that the rate of stillbirth, while remaining rare, increases as you get closer to 42 weeks. I scheduled an appointment for next Wednesday, so I'd have a chance to revisit the induction issue if I hadn't gone into labor by then.

Anyway, I understand the downsides of induction. My question is, does anyone have any information about the risks to the baby as the pregnancy continues? How much more likely is a spontaneous stillbirth, cord accident, or other complication? Pointers to any studies you know of on the subject would be most helpful.

[wombatclay]

Heyla mama!

So...technically, a pregnancy isn't even "post term" until 42 weeks. So the overdue clock really shouldn't be running till you hit 42 weeks.

The post-term risks generally looked at by the medical world are:

--increased babe size (due to a longer time "growing") can lead to a longer labor and an increased chance of a medical delivery (forcep, vacuum, c/s).

--possible decrease in the ability of the placenta to provide adequate blood flow and oxygen to the babe, possibly leading to fetal distress during labor and delivery.

--the babe has a higher chance of releasing meconium into the waters, and as a result there is a greater risk of their aspirating that meconium and having either breathing difficulties or needing intensive suctioning at birth.

This page : http://patients.uptodate.com/topic.a...e=pregnan/5708
provides some statistical information (and a bibliography to research each topic further).

According to them (and the studies they site all seem to be from larger, peer reviewed, medical journals so they're probably pretty good):

The incidence of stillbirth or infant death is increased in pregnancies that continue beyond 42 weeks. However, the risk is relatively small, with only 4 to 7 deaths per 1000 deliveries. By comparison, the risk of stillbirth or infant death in pregnancies between 37 and 42 weeks is 2 to 3 per 1000 deliveries.

They also mention large infant size (and possible complications as a result), possible reduced blood/oxygen to the fetus, and meconium aspiration as the main problems, but there are no studies citing specific numbers for these.

Obviously induction carries it's own risks...and it sounds like your doctor is aware of that! Perhaps ask about your Bishop's score to see how effective an induction attempt might be? And avoid cytotec at all costs (assuming your hospital, birth center, or care provider still use it)...cytotec has an "off lable" use as an induction tool (off lable meaning it's not an approved use for the medication and has not been tested by the FDA...in fact, their package insert says specifically NOT to use it with pregnant women!) and it has been linked to uterine damage and even rupture in women with no other risk factor for UR.

Good luck mama and happy birthing!

[alegna]

Originally Posted by skueppers

When we talked about why, he said that the rate of stillbirth, while remaining rare, increases as you get closer to 42 weeks.

I don't have a link (sorry!) but what I read was that the chance of stillbirth does not go up until PAST 42 weeks.

good luck!

-Angela

[skueppers]

Thanks for your responses! I found an interesting article which indicated that the risks of stillbirth and infant mortality do start to go up before 42 weeks. Apparently, there are some differences in the way earlier studies performed their statistical analysis which made the risks appear lower than they actually are. ("Post-term induction of labor revisited," Rand, Robinson, et al., Obstetrics and Gynecology, Volume 96, Issue 5, Part 1, November 2000, pages 779-783) I'm going to keep looking to see what else I can find.

As I said originally, I feel really confident that I'll go into labor before induction becomes a reality, and I'm also quite certain that if I were induced, it would be successful -- my cervix is favorable now, so that will only improve over the next week. As for cervical ripening agents, my doctor wouldn't recommend them in this situation; I have no idea what he might say in some other situation, since it's never come up between us.

[momuveight2B]

I agreed to an induction at 42 weeks, no softening of the cervix, no signs of labor but my blood pressure was going up and I felt terrible.

Just want to mention that the pains are not natural however I was still able to have a natural birth. My doula and OB both said I would need an epidural because the pains would be unbearable. It was difficult but I am really glad I proved them wrong.

[wombatclay]

("Post-term induction of labor revisited," Rand, Robinson, et al., Obstetrics and Gynecology, Volume 96, Issue 5, Part 1, November 2000, pages 779-783)

Thats actually one of the papers they used on the website I posted above.

[skueppers]

Originally Posted by wombatclay

So...technically, a pregnancy isn't even "post term" until 42 weeks. So the overdue clock really shouldn't be running till you hit 42 weeks.

One of the things I wonder about is whether this is a figure that's been revisited since more accurate dating of conception has become commonplace. Since the "average" length of pregnancy is usually given as 40 weeks from the start of the last menstrual period, obviously there's going to be a fair amount of variation in the "normal" length of pregnancy simply because women don't all actually conceive their children on day 14 of their menstrual cycle. I wonder what the curve looks like when based on the actual date of conception rather than on last menstrual period? Is it possible that the true range of gestation leading to the best outcomes is actually shorter than 4 weeks, but that's been obscured by variation in when women actually beocme pregnant?

I know that at least one study showed that the actual median length of normal pregnancies is 274 days from the date of conception for first-time moms (that is, 40w8d), and 269 days (40w3d) for second and later pregnancies. ("The length of human gestation," Mittendorf, Williams, et al, Obstetrics & Gynecology, October 1990.) What I don't know is what the variation looked like.

[DahliaRW]

Have you looked into more "natural" methods to try to bring on labor? I know a lot of people have had good luck with accupuncture and pressure point massage. Just a thought to help you "go on your own" rather than have to be induced with pitocin.

[skueppers]

Originally Posted by DahliaRW

Have you looked into more "natural" methods to try to bring on labor? I know a lot of people have had good luck with accupuncture and pressure point massage. Just a thought to help you "go on your own" rather than have to be induced with pitocin.

I'm familiar with them, but I don't currently have any plans to use them -- I may change my mind late next week. I'm still convinced that I'll go into labor on my own (my body is showing plenty of preparatory signs), and I tend to view any method of inducing labor, no matter how "natural," as being an undesirable intervention in the birth process.

[DucetteMama21842]

Wishing labor upon you mama!! If you need any of the natural induction techniques.. feel free to pm me!