What is with all this induction talk?

[*MamaJen*]

I just don't get it. What is with all this early induction by midwives? Mine has never even mentioned induction, and the way I understand it, 42 or even 43 weeks is still completely within the normal bell curve. Why would midwives pressure you to induce at 41.5? I mean, OBs it wouldn't surprise me. But midwives? Half of us haven't even hit our due dates yet and it seems like every damn thread in the last two weeks has been obsessing over induction. And why is everyone freaking out about not being in labor when they're not even 40 weeks? I thought the whole point of natural pregnancy and delivery was letting nature take its course.
I mean, if you're at 42 weeks and seeing signs of fetal distress, sure, thank goodness for pitocin. But otherwise? Can't we just relax?

[Elsaraw]

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[DucetteMama21842]

I agree and I think it has to do completely with politics. That being said... I know in some states there are some rules midwives have to follow.... and I have to respect that of my midwife if that occurs... I just would probably be going AMA at that point cuz no one is coming near me with pitocin... EVER.

[starry_mama]

Yes. The induction talk is getting tiring.

[MCKH]

In many areas midwives are not allowed, legally, to attend home births after 42 weeks.

Also, when I was using an OB in my previous pregnancy, she told me (I am not sure how true this is - I'm just repeating what she said) that placental funciton begins to decline at around 40/41 weeks and that by 42 weeks the risk of stillbirth and fetal distress is increased to the point where an induction should be considered. Again, I'm not saying I agree or that this is even true, but just sharing what the mentality behind the inductions might be.

And of course, some moms are just really uncomfortable and miserable and want their pregnancies over with.

Lets just hope all of our babies are quite on-time so we don't even have to think about this! And yeah, I can't for the life of me understand why anyone would choose a "conveneince" induction prior to 40 weeks.. I have a friend who just did this at 37 and is encountering a lot of problems that near-term infants have (poor nursing, sleepy, weak suck, etc.)

[transformed]

I think it has to do with liability.

I am convinced EVERYTHING has to do with liability in Florida.

[Frenchie2]

I agree. I think the induction talk with my mw has to do with the fairly conservative area that I live in. My aunt works at a hospital in my state and says that almost all of their births are inductions and they rarely ever see babies that are over 8 lbs and most are all born around 38 weeks.

My mw said they wont let me go 10 days past my due date, which I dont know if that is office policy, hospital policy or some other policy that I am not aware of. My delivery will be at the hospital, so maybe that makes a difference too versus a home birth or birthing center.

It is nice to have a place to complain about being pregnant though even though we may not be 40 weeks but are just uncomfortable and tired. I would never want my baby to be in danger and I would stay pregnant for 50 weeks if I had to but when it gets near the end and my body doesnt feel like my own and I just cant wait to see what my baby looks like it is nice to be able to whine a little with women who know what it feels like.

[kittywitty]

Originally Posted by MCKH

In many areas midwives are not allowed, legally, to attend home births after 42 weeks.

Also, when I was using an OB in my previous pregnancy, she told me (I am not sure how true this is - I'm just repeating what she said) that placental funciton begins to decline at around 40/41 weeks and that by 42 weeks the risk of stillbirth and fetal distress is increased to the point where an induction should be considered. Again, I'm not saying I agree or that this is even true, but just sharing what the mentality behind the inductions might be.

I think that myth was put to rest in Pushed or one of those books... basically that's not true.

[Synchro246]

I'm not in your ddc. It came up in new posts.


Actually the risk of stillbirth does gradually increase the longer the pregnancy continues. It's well accepted. HOWEVER the risk is still very very smal and the risks of induction exist too. It should be up to the woman solely & the risks of stillbirth shouldn't be made out to be larger than the risks of induction.
Here is a cochrane review about induction at or post term http://www.cochrane.org/reviews/en/ab004945.html
The difference was small, but there.

Inductions still should only be done with medical indications as there is no reliable test for placental function & the body should be trusted to do it's work. We, as a species, didn't survive this long without developing some internal mechanics for deciding when and being able to start labor naturally.


ETA-- not that it applies to this conversation completely, but here's the cochrane review of induction for suspected fetal macrosomia http://www.cochrane.org/reviews/en/ab000938.html

[*MamaJen*]

Well, I just realized, reading over my original post, that I sound quite petulant and cranky. I think I went about 45 minutes too long without eating.
I don't mean to trash mamas who are having a difficult end of the pregnancy--it's great to have a safe space where we can vent a little. I mean, jeez, when Mrs. head-over-heels-in-lurve mushy pants Zjande actually started griping about her husband, I figured that was a clear sign she'd be snuggling her baby within three days, tops.
But I think what disturbs me about the induction talk is I'm not hearing mamas say, "I hate being 38 weeks pregnant and I want to induce." I'm hearing mamas say, "My midwife is threatening to induce me and I really don't want that but it's the rules."
Studies show that the average first pregnancy lasts a few days longer than 40 weeks, and I find it surprising that midwives--not OBs, but midwives--would pressure clients to induce so early. I guess there is legislation in some states or policies in some hospitals, but being 41.5 weeks is not an immediate cause for concern, as far as I can tell. I was doing some research about post-term pregnancies, and it looks like they haven't even proven that up to 43 weeks is automatically dangerous. I personally might consider going in for an ultrasound at 42 weeks to check fluid levels, but I wouldn't jump to induction.

[ivymae]

I think this is where a discussion of what a "midwife" really is, and all the levels of midwifery is needed.

Ideally, every women would have the option to interview multiple midwives in her area, get to know their birth philosophies, and their policies, and would be able to hire the person she felt most comfortable with. But with the state-to-state confusion on who can practice midwifery, how they can legally respond to women, the fact that insurance will not cover many midwives, etc, women are often ushered into a practice that they took to be one thing, but ends up being not so dissimilar to the situation they were trying to avoid.

A title does not define a person's philosophies. Personally, our first birth was with a very clinical midwife, who was very pro-birth, but worked strictly on a medical level with her clients. Our current midwife is almost her exact opposite, and is a much better fit for us. They are both midwives, but have completely different takes on their role in birth. Heck, my sister's births were with a midwife in a hospital, who induced her, gave her episiotomies and discouraged rooming-in/breastfeeding.

I feel lucky that we found our current midwife (who never brought up induction to a friend of mine who went 45 weeks!) but I know that she is not the norm. I think our first midwife (Medwife?) is much more common, and I would guess that the mama's who are being pushed towards induction bought the "midwife" ticket without reading the small print...

(nursing, eating dinner and typing - forgive my rambling)

[squeakermansmom]

my awesome midwife has suggested stripping my membranes prior to 40 weeks but that is b/c my last baby was 10 lbs and did have shoulder dystocia. She wants to try to lower the odds of that happening again, esp. since this baby seems to be following on the same path of weight gain.

[zjande]

Originally Posted by *MamaJen*

I don't mean to trash mamas who are having a difficult end of the pregnancy--it's great to have a safe space where we can vent a little. I mean, jeez, when Mrs. head-over-heels-in-lurve mushy pants Zjande actually started griping about her husband, I figured that was a clear sign she'd be snuggling her baby within three days, tops.
.

I have nothing intelligent to add to this conversation, I just wanted to share how much coming across this made me laugh out loud & I read it to my husband.

[guest9921]

Weight isn't necessarily a factor in shoulder dystocia.
Can happen with 6lb babies as well.

[SheBear]

I'm just glad that my midwife is being a very calm port in my own personal storm....i just posted in the daily thread about my own EDD confusion, and she called me tonight to check on me, and it was actually she who suggested I take a look at whether my dates were totally accurate, or if we could jiggle with them a bit so I could relax.

And even though I'm still confused, it actually worked--I can feel my mindset shifting gears just enough that I am less cranky and more wait-and-see about it. So, that being the case, it'll prolly happen tonight, LOL!

But seriously, I'm so glad she's not adding to my stress at this point. She's totally cool with going as long as the baby goes! Actually, knowing how contrary I like to be, maybe if she HAD said something about induction I'd have been that much quicker to say "Don't you dare! This baby just isn't ready yet!" But that's just because I happen to be.....ornery! : Betcha wouldn't have guessed that!

[Quindin]

One of my midwives said I should be going into the hospital today to pencil in an induction date at 41.5 weeks (December 28th) just in case I go that far. Because "no woman here is allowed to go past 42 weeks" :

I am obviously NOT going and I don't care what their "rules" are -- this baby is coming when it is ready AT HOME!

[mama2rey]

Originally Posted by Quindin

One of my midwives said I should be going into the hospital today to pencil in an induction date at 41.5 weeks (December 28th) just in case I go that far. Because "no woman here is allowed to go past 42 weeks" :

I am obviously NOT going and I don't care what their "rules" are -- this baby is coming when it is ready AT HOME!

I thought this was just a U.S. thing because medical professionals here are such triggers for being sued. I was actually about to post about this-then I saw your post. I am so sorry that they are treating you like this!

[Quindin]

The good thing here though is, because they are state funded, all they can do is to scare women into doing what they want.

By law, they MUST attend my birth at my home, or wherever I please even if I go to 44 weeks : And they cannot force me to do anything by threatening to withdraw care

See, my American midwife was private so she could just say "sorry, I am not going to let you give birth at the center after 42 weeks" but here they can't!

Unfortunately, most women here just believe these lies and scaremongering They do try to talk women into inducing to make it easier for themselves, but there are great organizations here created to help women know their rights

[mama2rey]

That's good!!! I feel lucky that my MW's will let me do what I want and just tell me options. Yesterday when I was exhausted and talking about wanting to be induced-my MW just said to me-go to sleep-we'll talk when you can make the best decision for you. She just keeps telling me to tell her what I want-her job is to make it safe. She even told me I could refuse antibiotics at the hospital even though I am GBS positive-and then told me under what circumstances she would worry, and when she wouldn't! However, I know that I found a gem of a MW-and many people are not so lucky. I don't know what they would do if I were to go past 42 weeks-but from my own experience with them-I think they would just tell me what they have to say to do the CYA thing-but then let me make my choices-at worst they would make me sign something. I do know that I would not be able to use the hospital birthing center though-I would have to be in a regular hospital room.

I am glad that your MW's have to attend your birth-and that you know your rights. So many women don't know their rights and are bullied by HCPs everywhere in the world!

[crsta33]

My midwives cannot attend my birth if it happens past 42 weeks. It has to do with state regulations, licensing, and retaining their backup providers. If I go to 42 weeks, I have to transfer to the care of a physician and birth in the hospital or go unassisted (which I'm not comfortable doing).

So, I am very nervous. And I don't know exactly how the midwives handle "post dates" and at what point they start suggesting and/or pressuring natural induction methods (most of which I'm not comfortable doing...esp castor oil which I am adamantly against b/c of my history of irritable bowel syndrome).

I want to mostly leave things alone until I hit 41 weeks (b/c I think something like 80% of babies are born by then) but I'm already worrying *now*. I don't want a hospital birth, by induction or natural, and I'm under a timeline to get this baby out or that's what I'm facing.

Christa