How can I convince OB to NOT induce?

[taralv]

I'm 20 weeks in my third pregnancy and I've been told that I will have to be induced (again). My first was induced at 41 weeks because they said that my amniotic fluid was too low. My second was induced on my due date because dd1 had her shoulder stuck during birth and her right clavicle was broken as a result. Ds(second birth) did not get stuck, but the OB said that he would have if she had not anticipated it and turned him accordingly. Now, the OB wants to induce me this time at 39 weeks to avoid another baby getting stuck. I understand the seriousness of that situation, but I believe that if the OB allows me to go into labor naturally, the chances of this happening would be the same anyway. FYI, my daughter was 7lbs3oz at 41weeks and my son was 7lbs9oz on his due date. So, is it safe to go into labor naturally? I don't want to be induced again because I do labor naturally and the pain with induction is almost unbearable. I would really like to have a better birth experience this time. Sorry this turned into a medical journal article - too much detail. Any feedback would be appreciated.

[luckymamato2]

The easiest way is to not show up for your induction. Avoid their phone calls when they call looking for you.

OR

Show him/her that you've done your homework and believe that the situation will not happen again. Complain about the painful inductions you've had. You can also prepare your mind/body for labor by doing yoga or perineal massage, hypnobirthing, etc.

[Rachael Cail]

Just say no

Hey, it's so hard reading stories like this. Tara, this is YOUR birth. You can decline an induction, which given your situation is entirely reasonable. Frankly, sounds like you have an induction-happy o.b. I know it can be very hard to stand your ground with doctors - do you have, or have you considered having a doula? Also, know that it is never too late to change care providers if you do not trust the one you're with. I'm in Georgia too, actually - if you need ANY help with resources, info., etc., please let me know; I'm a doula and know lots of CB educators and other birth professionals.

[Romana]

Well, you have a couple of options. One is to switch healthcare providers, either to a different OB, to a family practitioner (usually, but not always, more naturally-minded), or to a midwife. Another option is simply to remember that no doctor can force you to have an induction. You can be discharged from care earlier in the pregnancy, but if you get to the end of the pregnancy with an OB and you refuse or don't show up for your induction, he or she can't drop you from care at that point.

I think the best option is to find a new doctor or other HCP. Someone who will support your desire for a natural birth.

In terms of how safe it is for you to labor naturally or deliver vaginally, that's something that requires a little more research. Women who've experienced a prior shoulder dystocia are more likely to see it again. However, you said your births were induced. That makes me wonder if you gave birth in an upright position or not. Birthing upright opens the pelvic outlet and can reduce the chances of a stuck baby. Also, your doctor may not use the gaskin maneuver, which is basically just having a mama with a stuck baby flip over in order to free the baby. In most cases, this is all that's necessary, but many OBs are unaware of the techniqure or are unwilling to try it (or it's impossible because the mama has had an epidural). I think ultimately only you can decide which risks you're more comfortable with, but if you decide you'd rather labor naturally and avoid the induction, find a HCP who will be supportive of that decision.

Also, someone correct me if I'm wrong, but can't induction actually lead to stuck babies because they're more likely to end up malpositioned during an induction? Not sure about that one or if it applies to a shoulder dystocia situation.

[Rachael Cail]

oops

Oh, you're not in Georgia

[alegna]

Just say no. Were you pushing on your back when the baby got "stuck"?

-Angela

[DoomaYula]

An Ob who has induced you twice and is already talking about it at only 20w, doesn't sound like a good provider to me. Also, first time was 41w, then 40w, now he wants to do it at 39w? Jeez, will he suggest your next baby be induced at 35w???? :

Personally, I'd find a new provider.

Or

Get some EVIDENCED-based info on induction, sticky shoulders, and present it to your Ob. And then be prepared for him telling you that you're going to kill your baby and all kinds of other nonsense.

[sweeetpea]

I agree with the pp's - You appear to have a very-medically minded CYA OB. You might be much better off with another provider who actually practices evidence based care.

Where in VA are you? I might be able to point you to some resources. PM me if you prefer.

sweetpea

[katheek77]

Well, honestly, while a broken clavicle doesn't sound like fun, it also isn't life-threatening.

I know that sounds harsh, but, what I mean is, the risks of induction are more than I'd be willing to risk to avoid a possibly broken clavicle. I would think that once labor is progressing, they will be able to tell if the baby is "stuck" or not, and, if intervention *is* necessary, do it then (I don't think intervention is necessary, but, worst case scenario)...why induce? That's what's getting me...how will inducing prevent the baby not being turned correctly? Your OB has even said that your son avoided it because he "turned him correctly"...well, just tell him to turn this next baby correctly.

I had early dilation and bleeding (no cause determined), and the ob was pushing at 37 weeks (!!!!) for an induction. I just kept saying that when they could show me that the baby was in obvious fetal distress they were welcome to slice me open in the office, but, until then, I'd wait to go into labor naturally. I gave birth (no induction) at 41 w 1 d.

FWIW, my mom had a broken clavicle at birth (natural) and she was under six pounds (but late!). She has never had problems from it.

[mommyminer]

Sounds to me like you had a true should dystocia during your first birth - which does statistically increase your chance of having another baby with a shoulder dystocia. Although a broken clavicle may not be life threatening - the situation from which it arose (sd) is life threatening.

You can do a lot to avoid a shoulder dystocia though - such as avoiding an epidural and listening to your body during labor and birth. During an induced labor, this is much more difficult to do since you are continously monitored which restricts mobility.

I would focus on educating myself about shoulder dystocia and natural birth. I also would find a different OB. Yes you can not show up for an induction - and you do have patient rights, but fighting for what you want during labor releases stress hormones which counteract your birthing ability. Why not find a supportive HCP?

[alegna]

Originally Posted by mommyminer

Sounds to me like you had a true should dystocia during your first birth - which does statistically increase your chance of having another baby with a shoulder dystocia.

IMO it's not dystocia if mom was on her back and no position change was tried.

-Angela

[pamamidwife]

Wow, an extra two or three weeks isn't going to reduce the risk of shoulder dystocia. In fact, half of all shoulder dystocias are babies under 8lbs.

I don't think you should assume it's your responsibility to convince your doctor of anything. In fact, the fact that you had a hospital birth and was likely on your back played into the shoulder dystocia issue.

Induction increases your risk of cesarean section. I'm surprised your doc isn't talking about doing that instead of inducing.

My advice? Get thee to a homebirth midwife - or at least a family practice doc or nurse-midwife. You need some better, more research-based care!

[pamamidwife]

Originally Posted by alegna

IMO it's not dystocia if mom was on her back and no position change was tried.

-Angela

Actually, I think most dystocias are caused by mom being on her tailbone - it decreases the pelvic outlet greatly and doesn't foster baby's natural ability to rotate down through the pelvis.

And most women in hospitals cannot change position because 1) they have epidurals; 2) they are on the most ridiculous narrow beds; 3) their providers don't understand the mechanics of shoulder dystocia and would rather cut an episiotomy and have the vagina right in front of them upright than to have the woman move into another position, precariously so with a baby's head out of her.

We cannot say for sure if it was a true shoulder dystocia based on the fact that we weren't there, but with a broken clavicle, it sounds likely.

[LoveChild421]

yep, I'd fire them, find a midwife (homebirth or hospital based, your choice) instead. OBs just don't understand birth. They understand how to scare you into doing things that are convenient for them but are not in your best interest.

Always remember one thing, they work for you- you pay their salary. They have no business telling you what they will "allow you" to do, a quality birth attendant will empower you to make your own choices and always remind you that they are indeed YOUR choices to make.

I would think that inducing would cause a baby to be more likely to get stuck or malpositioned- those last few weeks it seems like the baby always gets into a better position for birth and with a natural labor if the baby isn't in a favorable position, contractions won't be as productive until you move around and the baby wiggles into a better position. And definately, as pp have said, giving birth on your back is the worst of all positions when it comes to babies getting stuck.

[yarngoddess]

I would schedule a Meeting with your doctor, not an OB visit with the peeing and weight, but a sit in you office and talk meeting. I would tell Doc your concerns, and tell Him/er that you are not comfortable with this plan, and that you have no intention to be at a scheduled induction. I would have some documentiation handy, and stick to your guns. Contact Doula's in your area, and see if you can afford one- if not still contact them and tell them that you really need help and that you can only pay X ammount.

How is your OB going to understand you if you don't talk to Him/er. They need to know why you are unhappy, and if things don't work out then they will know the reason. Don't let the medical community become your decision makers. Make your own decision that is right for your family, and stick to your guns.

Keep us posted also!!

*Blessings*

[hipmummy]

Just say NO!

[applejuice]

Originally Posted by pamamidwife

My advice? Get thee to a homebirth midwife - or at least a family practice doc or nurse-midwife. You need some better, more research-based care!

Precisely. Forget what your insurance pays for and get a decent hcp if you do not want another induction.

[pampered_mom]

Originally Posted by taralv

Now, the OB wants to induce me this time at 39 weeks to avoid another baby getting stuck. I understand the seriousness of that situation, but I believe that if the OB allows me to go into labor naturally, the chances of this happening would be the same anyway.

First off, the OB doesn't "allow" you to do anything. It's your body, your baby, and you are the one who does the allowing.

Secondly, I wouldn't even try to convince an OB not to do anything. I just wouldn't agree to the induction and if for whatever reason they ended up scheduling it, I wouldn't show up (just like I would do in the case of a schedule c/s).

Third, are they that sure of your dates that they know if they induce at 39 weeks that there's *no* chance that your baby will be premature?

Above all, I agree with the pps - it's time to find a different CP. There are other options out there and you're early enough in your pregnancy that you've got some time to start looking.

[SublimeBirthGirl]

Find an OB or midwife who recognizes the fact that you're an adult capable of making your own health care decisions. Is he the one pushing a baby out of his vagina? If not, whether to induce or not is not his choice. Do what you want to do.

[huggerwocky]

Say no and don't go for the appointment.