Appt. this morning - induction questions (Update)

[operamommy]

Let me preface this by saying:
1) I think it's best for mama and baby when baby comes on his own schedule
2) Just b/c I have an OB does NOT mean that she's an intervention-happy idiot; she's very supportive of our wishes for a natural birth - this is our 2nd birth with her

I'll be 37 weeks this Sunday. My OB is concerned that if this babe is as big or bigger than my last that I could end up with a c-section (which neither of us want!). To be very fair, she made NO guess on babe's size; she was just voicing a concern. My last babe (ds2) was 8 lb. 4 oz., so not a huge baby. But...he got stuck after he crowned and we ended up needing the vacuum extractor. With this pregnancy so far I'm 10 pounds above my weight last pregnancy and I have 3 1/2 weeks to go - but who knows how that correlates to babe's size.

She said that if I've dilated by week 39 that she'd like to have me deliver then. Her plan would be to cervical massage, which she said with a 4th baby and dilation should be enough to throw me into active labor. No pit, no nothing except for cervical massage.

Pros: I have *fast* labors, and virtually NO signs of early labor at all. I've labored and delivered my last two babes in less than 4 hours from start to finish. Dd was born 45 minutes after I got to the hospital; ds2 was born 3 hours after I got there only because we were already on our way b/c we knew that I would be going into labor that evening based on a cervical check earlier that day. I live 30 minutes away from the hospital - my dr. lives closer to 45 minutes away. We have 3 other children to make arrangements for, so "knowing" when babe #4 is coming would sure help. Also, my dh works almost an hour away; if I go into labor while he's gone at work then 1 of my friends will need to come get me - the closest is 30 minutes away and has small kids of her own. There's a good chance of having to face transition in the car...eeek! And of course, I'd hate for this babe to get stuck like my last and I end up needing a section.



Any thoughts, mamas? Thanks!

[the elyse]

if it were me, i'd ask if she would be willing to let you push in a different position other that laying on your back. i had horrific back labor with my daughter, and plan on being upright on my knees with this one. that's all i got! this is what i'm picturing... very doable in a hospital. well, not the first picture... but the story following it.

[operamommy]

Oh, she's very willing to have me push/birth in any position that I choose. I had back labor with ds2, and believe it or not, being *on* my back was most comfy - I tried to get up on my hands/knees and it just increased the pain.

[lincap]

Tricky situation. I *think* if it were me, I would ask for maybe an ultrasound weight estimate. Maybe. I don't think a mama's weight has anything to do with baby weight, but it might... Some obs/mw can palpate and are very good guessers on weight.. some are not.. so it is tricky.

Since you labor fast... something I would consider is schedule the induction, then the day of or before go to the acupuncturist to get induced more naturally and get the ball rolling.

I think you woudl have some peace of mind knowing your family is taken care of if you knew the date of "induction" (to me cervical massage doesn't seem like a traditional induction).

I agree with the elyse about different positions for pushing taht will help open your pelvis more to help birth a big baby (or even a small one! some positions are just better for birth!)

So I *think* if I were in your position, I would be open to the cervical massage, but know that pitocin could be needed have your bags packed with natural indcution methods before going pitocin route.

Your history of fast labor would really lean me in that direction.

[lincap]

Tricky situation. I *think* if it were me, I would ask for maybe an ultrasound weight estimate. Maybe. I don't think a mama's weight has anything to do with baby weight, but it might... Some obs/mw can palpate and are very good guessers on weight.. some are not.. so it is tricky.

Since you labor fast... something I would consider is schedule the induction, then the day of or before go to the acupuncturist to get induced more naturally and get the ball rolling.

I think you woudl have some peace of mind knowing your family is taken care of if you knew the date of "induction" (to me cervical massage doesn't seem like a traditional induction).

I agree with the elyse about different positions for pushing taht will help open your pelvis more to help birth a big baby (or even a small one! some positions are just better for birth!)

So I *think* if I were in your position, I would be open to the cervical massage, but know that pitocin could be needed have your bags packed with natural indcution methods before going pitocin route.

Your history of fast labor would really lean me in that direction.

[lilyblossom]

operamommy - it is a difficult situation, I agree. *Personally*, if the baby is full term and I didn't have any bad intuition against it, I would try natural methods of induction. If you have a bad feeling about it, don't do it! Only you really know what is best for your baby.

I find having a doc that I trust is huge. My naturopath is my primary resource and she even suggested natural methods if my OB/GYN is pressuring me to get induced. We all think I'm going late and so we're talking about how to cut them off at the pass, ya' know .

[LawrenceDoula]

Your pelvis HAS birthed a big head so why worry that it can't this time? Your position and the baby's position are the biggest factors in how it fits through your pelvis. You never know what position will feel good to you this time around. Would you rather feel more pain in an upright position and avoid the vacuum or a c-section?

I would try to not worry until you really have a reason to. I doubt cervical massage would hurt anything (well, it could be painful) but I think you'll do fine on your own. Why not try sex instead?

[flapjack]

My overwhelming thought is to think that "lightning doesn't strike in the same place twice." Yes, we all know it does, but the majority of problems with so-called big babies don't recur in a subsequent pregnancy: using shoulder dystocia as a more clearly identifiable condition than CPD, 50% of babies affected had risk factors including a sibling who had SD, induction or macrosomia. The rest were just sheer bad luck- and I think the same thing happened to you. IF you have a head circumference measurement from your 20 week scan, there could be a benefit to a late scan to try and compare the growth curve, but I really think you're going to be fine. You listened to your body, birthed in a position where your pelvis was as open as it possibly could be, the chances are that if baby's head had been aligned differently by a millimetre or two then he'd have flown out.
I think my big query is: IS your OB actually offering you a relatively gentle route of going into labour at a planned place and time because she knows how concerned you are about the logistics of birth and she wants to spare you the stress? I'm kind of assuming that she's talking about the foley catheter here, and I hear some good things about them here on MDC. At the same time, it's a pretty invasive way of labouring, are you SURE this is how you want your baby brought into the world? Just a thought...

[LoveChild421]

I wouldn't worry too much about the big baby/positioning issue. Given that you had back labor last time, chances are the baby just wasn't in the best position birthing- which has nothing to due with size- yours or baby's- its just one of those fluke things. Unless you have another posterior baby (persistently posterior), I wouldn't worry about that too much.

But, I understand your worry about having to face transition in the car and shuttle the kids around and try to stay focused during all the turmoil.
I don't think that a very gentle membrane sweep at 39 weeks is necessarily a bad thing given your circumstances.
If it sends you into labor great, if not fine. Sweeping the membranes is a lot different than an all out induction complete with breaking your water and starting you on pit. If I were you I would try to have a chiro adjustment a day or so prior to the membrane sweep so that the baby has a chance of getting into a more optimal position for birth this time. And lots of sex prior to the appt as LawrenceDoula suggested to increase the changes of it being a success!

[operamommy]

Thanks for the insights, mamas. Dh and I talked earlier, and came to the conclusion that we don't have a conclusion yet. He brought up that he doesn't feel that cervical massage is an any more of a "medical" induction than having lots of sex, etc. I tend to agree with him. (flapjack - no catheter will be used - this is my doc's hands only)

I will admit that I've been having a lot of stress over the logistics of the birth. I'm probably the only woman in the world who wishes she had longer labors! As some of you have said, it's a very tricky situation - there are so many factors at play. I *do* trust my dr. She's incredibly supportive and respectful of my wishes both this time and the last - she had her own babe years ago with a midwife.

I know I'm going to do a lot of thinking and talking with dh this week and next. As LoveChild pointed out, what my dr. is proposing is a far different thing than breaking waters and pit; I wouldn't even consider that.

[Mama2-4]

Have you been using evening primrose oil? I would start using that orally and vaginally. This along with the cervical massage the MD is proposing should get you going. I think what I would do is take the EPO and when you are 39 weeks have the MD work her magic in the office, then go home, walk, dtd, rest and see what happens!

[flapjack]

Erm. OK. There is a body of evidence to show that repeated stretch-and-sweeps will prevent a pregnancy from going post-dates (42 weeks or beyond) if done twice weekly from 38 weeks onwards, and a smaller, slighter body of evidence that suggests that done once will result in spontaneous labour within 3 days in something like 60% of women- that's done once at 41 weeks, though, when your odds of labouring spontaneously within the next 3 days are around 30-40% anyhow. I've never come across anything that would suggest it would get you the kind of punctuality you need.

This is probably going to sound insane and for the sake of my blushes, please don't respond to this. Skye was induced by us at 42 weeks with a day in bed, spent making love, with DH manipulating and massaging my cervixm etc, etc. The loving energy that got her in there really did come into play in getting her out, and I'm wondering if your OB would be up for coaching your DH on finding your cervix with a view to him doing it instead as part of your normal lives together. Or, alternatively, if you would. I can't really see an advantage to having your ob do it

[applecore]

I understand your not wanting to have a vacuum extraction again- that must be awful! Here's my question: When you (or doc/midwife) say "stuck" what does that mean? I just saw a baby that was on the perineum for what seemed like forever. It sure looked stuck, but in actuality, it was moving out very slowly. The scalp color was good, and we just waited it out, and even though mom was dealing with the ring of fire for way longer than she wanted, baby was born, and mom had no tears. I think the relationship between what bodies need, and how labor responds can be very strong. In this case, mom had a perineum that really needed that extra time to stretch properly. I'm not trying to make any judgement here, just wondering if that may have been the case for you, as I know many hospitals are not comfortable with the waiting game.

[NamastePlatypus]

Originally Posted by lincap

Tricky situation. I *think* if it were me, I would ask for maybe an ultrasound weight estimate. Maybe. I don't think a mama's weight has anything to do with baby weight, but it might... Some obs/mw can palpate and are very good guessers on weight.. some are not.. so it is tricky.
I have little faith in that, they did one when I was in labor and said that e was MAYBE 8, he was almost ten. A girl I know through DH's work had a c sec at 37 weeks because the doc said the baby was too big:like 10 lbs, so she had the section, it was 6.8. You can't go by they at all.
Since you labor fast... something I would consider is schedule the induction, then the day of or before go to the acupuncturist to get induced more naturally and get the ball rolling.

I think you woudl have some peace of mind knowing your family is taken care of if you knew the date of "induction" (to me cervical massage doesn't seem like a traditional induction).

I agree with the elyse about different positions for pushing taht will help open your pelvis more to help birth a big baby (or even a small one! some positions are just better for birth!)

So I *think* if I were in your position, I would be open to the cervical massage, but know that pitocin could be needed have your bags packed with natural indcution methods before going pitocin route.

Your history of fast labor would really lean me in that direction.

I would let things go as they go, if the placenta is good and baby is good, let it happen. I am a small girl when not preg, and I had an almost 10 lb baby first time no prob. You have done it before, trust your body, it was meant to do this.

[PlayaMama]

i would second the acupuncture recommendation. i had acupunture when my first was just about hitting 42 weeks and he came the next day. i actually started having contractions when she put the needles in.

[zulupetalz]

Fetal macrosomia is not a great reason to induce. Your more likely to have a better outcome and easier labor if you just let nature take its course. Food for thought: Pitocin is forcing your body to have stronger contractions that might force a "too large" baby further down the birth canal than he/she would ordinarilly get. I think you're more likely to have an obstructed labor that way, then if you just let things go. Also, it isn't the size of the baby, it is the size of your pelvis. I'm sort of against induction, in general, but that is just me.

[operamommy]

Originally Posted by zulupetalz

Fetal macrosomia is not a great reason to induce. Your more likely to have a better outcome and easier labor if you just let nature take its course. Food for thought: Pitocin is forcing your body to have stronger contractions that might force a "too large" baby further down the birth canal than he/she would ordinarilly get. I think you're more likely to have an obstructed labor that way, then if you just let things go. Also, it isn't the size of the baby, it is the size of your pelvis. I'm sort of against induction, in general, but that is just me.

I'm not considering pitocin; the dr. is discussing cervical massage. Just wanted to make certain that was clear!

At this point I think the only reason I'm leaning towards the cervical massage is my history of fast labor/births and our distance from the hospital, etc. The dr. did NOT say I was carrying a baby that is too big; her concern was more about *my* size, since ds2 got stuck before.

We're not making a decision at this point. I'm going to talk with her next week and ask some more questions.

[kathywiehl]

I can totally understand the worry you are having regarding the logistics of the birth. My last birth was 2 hrs start to finish and the one before that was 45 minutes from the time I felt the first painful contraction to the time my dd was born. (before that it had been a couple of hours of mild contrax that I wasn't sure about). Also, my midwife lives 2 hrs away and my dh works an hour away. I have a serious fear of going into labor just before rush hour when it will take both dh and my midwife longer than usual to get to me.

Just for the logistical reasons that you listed, I'd consider the cervical massage, but I'd do it on a Friday morning (assuming your dh is off weekends) with the plan of going home after a few hours if nothing is happening. That way if it doesn't work you aren't pressured to stay in the hospital and keep trying. You can go home knowing that you have 2 full days before dh goes back to work. I'd also keep someone at the house on kid duty for the weekend so you don't have to make arrangements for them if you go into labor within that day or two. The reason I say this is because chances are if the cervical massage doesn't work immediately, it may irritate your cervix enough to throw you into labor sometime later like within the next 2-3 days. I think if it doesn't work and you go home empty handed, you can always top that off with sex, nipple stim black and blue cohosh, etc...

This plan may not guarantee that your doc is there for the birth, unless she's on call throughout the weekend but at least the problem of your dh and your kids would be taken care of.

I think that is what I'd do. In fact, since my midwife is 2 hrs away, we are considering doing a membrane sweep and possibly some natural induction methods on my EDD if baby hasn't arrived yet just to be sure that she's here for the birth.

[LoveChild421]

Originally Posted by kathywiehl

Just for the logistical reasons that you listed, I'd consider the cervical massage, but I'd do it on a Friday morning (assuming your dh is off weekends) with the plan of going home after a few hours if nothing is happening. That way if it doesn't work you aren't pressured to stay in the hospital and keep trying. You can go home knowing that you have 2 full days before dh goes back to work. I'd also keep someone at the house on kid duty for the weekend so you don't have to make arrangements for them if you go into labor within that day or two. The reason I say this is because chances are if the cervical massage doesn't work immediately, it may irritate your cervix enough to throw you into labor sometime later like within the next 2-3 days. I think if it doesn't work and you go home empty handed, you can always top that off with sex, nipple stim black and blue cohosh, etc...

good logistical points- I know quite a few ladies who have gone into labor the next day or so after a membrane sweep.

[zulupetalz]

I don't think cervical massage is a huge deal, I think if your body is ready, it will respond to it. IF not, it won't. The danger with it is that you get stuck having contractions that aren't strong enough to do a whole lot but annoying enough to be sort of uncomfortable. Which can lead to the doc wanting to break your water or introduce Pitocin. I wasn't clear about my train of thought before.

Good luck with your decision! I hope everything goes smoothly regardless of what you decide to do!