Inducing Multiples ~38 weeks? - Page 2

[rmzbm]

Originally Posted by alegna

Twins or singleton- I would never induce without medical reason. Period.

Dates are not a medical reason.

-Angela

Yup. I'd also be less liekly to induce with twins, I'd want to keep them in there as long as I could...

[wifeandmom]

Originally Posted by mom2seven

I'm really curious if you have actually taken a look at any of the studies or are basing your conclusions on what someone else told you (not to mention that there are now more recent studies contradicting this info).

I had my twins 6 years ago. A lot can happen research wise in that time frame, so I probably should do some more reading before assuming that current research agrees with what was out several years ago.

What you've posted seems to indicate that perhaps the window has been pushed closer to 40 weeks for twins, instead of the previous studies that indicated 37-39 weeks were associated with better outcomes.

Of course newer studies aren't always better than older ones based solely on WHEN they were done, so I'd really have to do more reading to assess the overall impact of more current research.

I suppose I should also add that my thoughts on the matter are very much clouded by a dear friend of ours that lost full term twins while doing the whole 'expectant management' thing. She begged them to induce her (Bishop score was already more than favorable and had been for weeks). Her doctor kept pushing and pushing, basically bragging that "his" twin moms went as far as possible.

Her girls were both stillborn at just under 40 weeks.

Had he induced her any of the numerous times she'd begged him to, she'd have twin girls that would be 5 years old now.

It really only takes a case or two like that to understand why 'expectant management' isn't always all it's cracked up to be. And there's a lot of research to support that thought too.

[wifeandmom]

Originally Posted by rmzbm

Yup. I'd also be less liekly to induce with twins, I'd want to keep them in there as long as I could...

Yeah. Get back to me on that one after you've carried 14 pounds of baby for a while.

My 8lb 10oz baby was *nothing* compared to the end of pg with my twins. I hardly felt pg at all in terms of how big my belly was with him.

But by the time my girls got to about a combined weight of 13 pounds, I was in horrid pain all the time. It wears on you, and staying pg 'as long as possible' just isn't as appealing when you're in agony all day every day.

Or maybe I'm just a wimp.

[rmzbm]

Originally Posted by wifeandmom

Yeah. Get back to me on that one after you've carried 14 pounds of baby for a while.

My 8lb 10oz baby was *nothing* compared to the end of pg with my twins. I hardly felt pg at all in terms of how big my belly was with him.

But by the time my girls got to about a combined weight of 13 pounds, I was in horrid pain all the time. It wears on you, and staying pg 'as long as possible' just isn't as appealing when you're in agony all day every day.

Or maybe I'm just a wimp.

I'm sure it's not fun. But their well being would be paramount to me. And, IMO, inducing ANY pregnancy at 38 wks. - without valid medical reason - is a bad idea.

[HerthElde]

Perhaps the bigger issue is that doctors need to pay more attention to the woman's intuition. Of course, women need to pay more attention to their own too.

[LemonPie]

My intent was not to start a debate about this. I was genuinely curious about what the reasoning was behind this practice. Thanks momofseven for posting that article.
Jen

[crazy_eights]

Originally Posted by wifeandmom

What you've posted seems to indicate that perhaps the window has been pushed closer to 40 weeks for twins, instead of the previous studies that indicated 37-39 weeks were associated with better outcomes.

The study that I quoted above actually found worse outcomes at 37 weeks than at 40.

It really only takes a case or two like that to understand why 'expectant management' isn't always all it's cracked up to be. And there's a lot of research to support that thought too.

Yes, while I'm sorry for your friend, a few cases we call "anecdote" and don't a study make

[alegna]

Originally Posted by wifeandmom

Her girls were both stillborn at just under 40 weeks.

Had he induced her any of the numerous times she'd begged him to, she'd have twin girls that would be 5 years old now.

I'm terribly sorry for your friend. But of course there is no guarantee that if she'd been induced that they would be fine. They might have been. Or might not. There are no guarantees.

-Angela

[crazy_eights]

I was re-reading my post and I think it maybe sounds cold and cruel. But do you know how many times I've heard people say, "if he had just done x, y or z..." when it is not research supported? It's a pet peeve of mine (I work L&D so I get to hear a lot of it). You know, if we induced everyone (not just twins) at 38 weeks, we would have no 39, 40 or 41 week demises. But the question is, "at what cost?".

[Romana]

Originally Posted by HerthElde

Perhaps the bigger issue is that doctors need to pay more attention to the woman's intuition. Of course, women need to pay more attention to their own too.

I think this is so important. The mother's intuition should not be discounted. An informed mother who willingly chooses induction at 38 weeks should get one. Except in emergencies, doctors are not there to make the decision for the woman - they are there as a consultant and practitioner, to advise the patient, provide information, support the mother's informed decision, and carry out the treatment. Not override her judgment. If a woman seems to be making an irrational decision (in the practitioner's opinion), it is that practitioner's duty to inform her of the risks and benefits of her decision, and then follow her direction. I can see extreme cases where a doctor would feel he or she could not carry out the mother's directive, but in the vast majority of cases it should not be an issue.

[mothragirl]

my sister and i were born at 41 weeks, we were both under 5 lbs. i'm so glad we were undiagnosed and my mom had a normal vaginal birth with no one worrying.

[wannabe]

Originally Posted by SublimeBirthGirl

I'd have to look at the studies pretty carefully. I'm no scientist, and what I'm finding is that a lot of studies are done by doctors with no scientific background. They're not any more valid than they would be if I did them.

It's not the background of the person, it's the science in the study. Most medical research is really really badly done, but when reading a paper and assessing it, you look at the science, not the person.

You could do an excellent study, or you could do a crap one, it would depend on your design.

[veganf]

Originally Posted by wifeandmom

If staying pg past 39 weeks awaiting spontaneous labor was BETTER for the babies, it would have shown up in the outcomes of at least some of the studies available to date. But it hasn't. The opposite has been shown to be true. Waiting for labor past 39 weeks with twins is associated with increased risk to babies overall complication rate.

Maybe because ALL of the studies of twins were followed by an OB and born in a hospital .

[Sileree]

Originally Posted by wifeandmom

So is there *ever* a point where induction strictly because of gestation length would be appropriate or do you think *all* women should simply be monitored (how exactly?) until they finally do go into labor on their own?

Yes, I believe induction should be used only if there is a medical indication. A due date is not one. Due dates are 95% of the time wrong.

[Sileree]

Originally Posted by wifeandmom

What I'm saying is that YES, there are risks to induction. BUT those risks seem to be LESS than the risks of staying pg after a certain gestation length (this applies to singletons as well as multiples, though the actual length is different).

Are you referring to that old study from the 1950s that shows that the risk of stillbirth is double at 42 weeks and triple at 43?

[Sileree]

Originally Posted by veganf

Maybe because ALL of the studies of twins were followed by an OB and born in a hospital .

That may be true. Complications caused by nervous OBs does not reflect upon what is physiologically safe.

[Sileree]

Originally Posted by wifeandmom

I suppose I should also add that my thoughts on the matter are very much clouded by a dear friend of ours that lost full term twins while doing the whole 'expectant management' thing. She begged them to induce her (Bishop score was already more than favorable and had been for weeks). Her doctor kept pushing and pushing, basically bragging that "his" twin moms went as far as possible.

Her girls were both stillborn at just under 40 weeks.

Had he induced her any of the numerous times she'd begged him to, she'd have twin girls that would be 5 years old now.

It really only takes a case or two like that to understand why 'expectant management' isn't always all it's cracked up to be. And there's a lot of research to support that thought too.

I am really sorry that happened. There is some research that shows that induction is best (such as from Hannah et al), but having read through them and browsing critiques of these studies, I do not agree they were well-conducted. Induction isn't all its cracked up to be either. Our bodies do not have a "best-before" date. Its not the amount of weeks that have passed that matter, its how the baby is doing inside. Doctors take an oath to first do no harm. If the baby is doing well, how can we advocate undergoing a risky procedure? I just don't believe its right.

[rmzbm]

Originally Posted by veganf

Maybe because ALL of the studies of twins were followed by an OB and born in a hospital .

[Novella]

So many good points have been made. . .

I just wanted to underscore the importance of reading the details of any study that will influence one's decision-making. A couple of flags to this came up during my own twin pregnancy:

1) An international, randomized trial is currently being done (out of Toronto) to determine if twins are best birthed vaginally or by c-section. When I found out we were having twins, I was excited to contribute to twin research. When I read the study brochure, I was appalled - there was no way I could take part. In an effort to control for the slight rise of still-birth at-/near-term, the authors of the study will induce every woman in the vaginal-birth group at 38 (or was it 39?) weeks if she hasn't birthed by then. When this study is published, thousands of women will be told it's results speak to "c-section versus vaginal birth" but what they really will show is "c-section versus highly-managed vaginal birth no later than 38 weeks". That's not to mention that this study will only record the results of pregnancies of those mothers who are 100% OK with having major surgery simply because their names were randomly selected. We know in so many ways of the significant mind-body connections. It seems reasonable that there might be a factor there that is overlooked in the zeal to control for the stillbirth risk.

2) We were also looking for research about vaginal births of breech second twins. It was quite arrogant to see that more than one study failed to mention spontaneous vaginal birth as even a possibility. Our doctor kept saying "See. . . breech extraction is better than a c-section". Yes. . . so what. . . that's not the question we were asking.

You just about can't be careful enough when drawing conclusions from medical studies.