Very stressful experience- really need advice regarding induction

[JennaW]

So I had a mifwife appt today. That went fine. We did talk about induction but there was no pressure at all and the midwife even said it was still to early to set a date (41 weeks 1 day). At the appt I asked her about when/if we should do NST and she said she thought it would be a good idea to go ahead and do one today or tomorrow. It happened that there was an appt available at 1:30.

So DH and I went to that. They did an u/s to check fluid which looked great (10), then they did the monitoring. The baby's heartbeat was strong and good. So I was thinking everything was just perfect.

Well then when the tech had the CNM come to look at the strip she had some concerns because there were times when the heartbeat was dipping. Not that it was dipping below a normal rate but that it was dipping below my babies baseline. There was also some calcifications on the placenta. So she started to ask me about why I don't want to be induced (not in a confrontational way but truly wanting to know MY reasons). She told me that she understood but that she also was concerned with some of the things she was seeing and would like to try to "wake the baby up" to see if they could get some better readings before she felt comfortable letting me go home.

At this point I started to cry. I was so upset. You really can't know what its like to be put in that position until you are there.

So we did the additional monitoring and baby was active. Things looked good enough that the CNM said she felt like she could sleep tonight if we went home and came back for another NST on Saturday.

I have been trying so so so hard to be positive about being post dates and trusting my body but this just puts a big fat poop on my attitude. I'm scared on induction but I'm more scared of my baby not getting what they need.

The CNM did suggest trying to do some natural things to get labor going. She told me how to do castor oil if I wanted to. She said I also might want to try nipple stimulation and sex.

I'm just upset. I don't want to be induced but I feel like I have indications that if I don't go into labor on my own soon, it might be the wise choice. I'm just so scared of it. I read some of the induction stories and feel like scheduling a c-section would be less traumatic

Thanks for any support or advice.

[Emily12581]

Don't worry. Chances are you'll go into labor on your own anywas, and if you don't, induction isn't THAT bad! It isn't ideal, but not the end of the world either. You have to do what is best for you and baby. C-section is way worse than induction. I know the horror stories can be overwhelming, but everything will turn out fine!

[Materfamilias]

Maybe try some of the less invasion induction things first... I too am very leery of pitocin. Hate the whole idea. Stuff sounds just evil.

[JennaW]

Just to clarify I AM NOT going to schedule a c-section, I was just saying that some of the induction stories that end up in c-section anyways, it just seems like it would have been less traumatic for the Mama to have just had a scheduled c-section.

Also, I did decide to let the CNM check my cervix, it was closed but 60% effaced. Whatever.

[mama to 2 girls]

So sorry you are dealing with this! I also suggest trying some more natural things first. I am 41 weeks tomorrow and just went for reflexology and tomorrow I am trying acupuncture if this doesn't work. It's WAY less invasive than any other induction methods because these won't even work if your body isn't ready.

I did have my m/w check me today(first time) and I am not dialated at all, cervix is so high and posterior that she could barely reach it. We talked about doing a membrane sweep but she is totally cool with waiting and doing that as a last resort. Even a membrane sweep is invasive but is better than being induced with pitocin.

I DO believe that in the end it should come down to you and your babies health but I would definitely try some other natural things to get things started before going in for pit.

FWIW... I was induced with my first and while I vowed NEVER to let anyone come near me again with that stuff....like the op's have said it wasn't the end of the world. I did end up with an epidural but at least I didn't have to have a c-sec. I was still able to have a vaginal birth.

Just try to relax and not stress (I know easier said than done) because when you are stressed your body releases adrenaline and that only counter acts (so to speak) the oxcytocin your body is trying to produce to make you go into labor. I would DEFINITELY suggest the reflexology, I have never been so relaxed in all my life! And if you are skiddish about people touching your feet at least treat yourself to a prenatel massage.

[yamilee21]

It's a tough decision to make. I hope things will happen on their own very soon, or if they don't, that the natural induction methods will work for you.

[veganf]

I think at this point I'd try all the "natural" induction methods and reevaluate in 2 days.
Please keep us posted. I hope that you can get some rest!

[madiesmommy]

Try natural induction techniques NOW. Then start reading up on HOW inductions are done - cytotec, cervadil, pitocin, foley catheter, so you can have just as educated a dicusssion with the mw if they bring it up again about how you want to be induced if induced by them. I was induced with dd and had a great experience. I'm not doing it this time, and would request a different technique, especially if it is inducement for being past due date - really look at the foley catheter method...

[Tenk]

I'm going to 2nd Emily's post.....I would never suggest induction to you Jenna....but it really ISN'T that bad. I've been induced 4 times and each time was so much easier and less intense, and the easiest was only 12 hours of which maybe 7 of them were intense and I was post dates that time. You'll know what's right for you and Caroline. It's a tough decision on what to do but I totally disagree about things turning to a C-section, I think you'll do just fine. Your a strong, beautiful mama, with a strong healthy baby girl in there. I'll keep you in my thoughts Jenna!!!

[finnegansmom]

I'm sorry you are going through this. I was induced for high BP and while I didn't end up with a c section, it wasn't easy. But, I'll never know - what if I had waited? What if I got worse? I had a healthy boy and that's all that mattered.
I would definately try the natural methods. EPO for your cervix, sex, and then maybe some castor oil. I would do the castor oil tomorrow morning, it took me a day to "work it out" after I tried it.

[so_blessed]

Jenna,

I don't know if you are dilated at all right now....but I am one of the moms who had a positive experience w/ castor oil. I would do it all over again, and had no meds.

Beth

[goldingoddess]

There is something called a Bishop score that is used as an indicator of how successful an induction will be. It assigns point values based on dialation, effacement, baby's station, baby's position, and texture of the cervix. Essentially if the score is below a 5 induction with just pitocin, or just castor oil will likely not work, time needs to be spent ripening the cervix first (like through protaglandins(semen) and cervadil). However if you are above a 5 they chances are castor oil will get you going! If I were you I would wait to do castor oil until you can figure out your bishop's score, perhaps you can call your HCP and have her tell you what it is.

Hugs to you

[JennaW]

Well, I have calmed down a little bit.

I am now more grateful for my doula then ever, given her medical knowledge she is a really good person to talk to. She was telling me that some calcifications on the placenta, especially at this point in the pregnancy, are not necessarily signs of the placenta not working effectively but may be more of just a natural progression. She also reminded me that Saturday is a long ways off in terms of pregnancy and that if the CNM was really that concerned she probably would not have let me go home so easily.

I am trying to be calm and not stress out. I am going to go out to dinner with my parents. DH and I just DTD which was really nice and I got some "natural induction" out of it We are going to keep doing that as often as possible. I also have tried some nipple stimulation.

I think tomorrow morning I will try the castor oil.

Thanks to everyone for your support. I really do not want to be induced but now that my mind is starting to clear again I will re-read my information and put together comprehensive talking points for Saturday, in order to help me make the BEST and SAFEST decision for me and my baby at that time.

If you pray, please pray that I go into labor on my very own tonight.

[catnap70]

I am glad you had a chance to talk to your doula!! I read your post earlier but didn't have a chance to respond and was going to suggest just that, but you beat me to it! I don't personally have experience with castor oil but my understanding is that it works and can be kind of quick, so be ready. You are a smart mama and all along have made the best decisions for you and your babe. I know you will choose the right path now too. Keep us posted!

[pazerific]

i'll be thinking all sorts of great labor thoughts for you your new doula sounds more and more like the perfect person in your situation! if it makes you feel any better, we were planning to have a HB with dd, but had to transfer. i had pitocin at the hosp. although it was tough, i was still able to have a vaginal birth w/o an epi.

but you're not going to have to worry about that. you're going to go into labor all on your own and you and your LO are going to do wonderfully!!!

[logies-mom]

I am so sorry that you are going through this!

While I agree with everyone saying to try the natural induction stuff first, I also agree with the ones saying that induction with pitocin really isn't that bad. I'm going off of what I've seen and read... there really are good outcomes, it's just way easier for all of us to focus on the bad ones. I think that as long as your midwife is comfortable waiting until Saturday, and if you, in your heart think it's okay, then you should wait until then to see what the NST says. If there is anything in you saying that you shouldn't wait, by all means, get induced. Even in the worst case scenario where the induction doesn't work out the way it's supposed to, and you were to need a c-section, if it saves your baby or you from a bad outcome, it's still good. You know what I mean?

I hope that you somehow spontaneously go into labor any minute... if you don't though, know that the only thing that matters is that you and baby are safe and sound. If that means an induction, you can still make it a good birth story... you have such a wonderful attitude, I know that it will turn out fine. Good luck, and keep us posted!!!

[HulaJenn]

I am SO praying that you go into labour on your own, but I also believe that medical intervention is a blessing at times. You can trust in your body but the truth is that for some women really do need a little help. As long as you are looking at it as what's best for you and baby, and not against something because it wasn't what you had envisioned, or planned. In the end, a healthy baby in your arms is the important part right? All too often, the induction or c-section recommendation is brought about too early or unnecessarily and I think that really sucks because it does instill in those that truly need it, this great fear.
I hope you come to peace with whatever decision you make and I hope you have a good team to help make the right decision.

[AmyC]

Jenna, I'm so sorry for your stress. I spent the afternoon (after my OB appointment) crying today, over similar feelings/conflicts. Except I'm 38 weeks. It just seems so wrong.

The NST totally seems like a misnomer at times. "non-stress," yeah. I've only had two times that my twins weren't "reactive for the strip," and one was immediately after I took the 3-hour (4+ hour, really) glucose tolerance test (even though I'd passed the one hour screen a month earlier....yes, I'm still a little grrrrowly about that.) The second time was my first full day home after our ER run with the "stab wound" to the belly. The babies were having the accels & decels, I guess, but kept going on and off the monitor. By the end, the OB and a nurse were holding the transducers on me, moving around and trying to keep them on the monitor. Finally, my doc just turned it off.

So.....generally, my twins have been pretty easy to monitor, especially "for twins" (whatever that means) but those two times were very stressful.

I agree with your doula about the calcifications....the placenta nourishes but it also filters. There's some (maybe a lot of?) indication that heavy or regular use of products with calcium carbonate (such as Tums) results in increased placental calcifications, and I think that is very true. But as I understand it, the process of calcification also is a result of filtering toxins.

There are grades assigned to the placenta based on physical appearance, and progressing from grade I to grade II is NORMAL. A grade II placenta has a fairly decent amount of calcification evident (you can look up pics online), and I don't think it's considered ominous or unexpected.

I had an u/s on Tuesday, and the tech pointed out the calcifications and said, "That's a very tired placenta. That's a placenta that's done a lot of work and is tired." (Not the most reassuring comment, but I'd seen the printed report of my last biophysical profile and already knew about the "grade II appearance" and had looked it up, so I wasn't blindsided by the term or the inference.) And at the end, she did say everything looked great, including the cord flow in the Doppler imaging of the umbilical arteries for both babies, and of course in their behavior. (Plenty of indications of fetal well-being----avid and relentless movement, diaphragm/breathing activity.)

All of which the perinatologist echoed when he came in for the consult. He was so clear about that well-evidenced well-being, that babies in distress or who aren't being nourished well enough (by that "tired placenta") wouldn't expend energy practicing their breathing. And the fact that they keep estimating the twins as "big" for gestational age also attests to adequate placental performance.

And that's with, yes, calcifications. (Starting around 13 or 14 weeks, I ate a lot of Tums for a period. It was when my hyperemisis was combined with reflux...which actually went away as things got better for me on the vomiting front. I switched to papaya enzyme in an effort to be more "natural," but the products I found had calcium carbonate in addition to the papaya, so who knows?)

I think a grade III placenta is more calcified and may be failing some in its performance, but again--you should check that (I focused on investigating "grade II" at the time I was looking) and if they mention the CALCIFICATIONS in that kind of ominous and foreboding way again, you can ask if they'd call it grade II in appearance, and if that is not normal for this stage of pregnancy. And if they have other indications that the performance is failing in some way.

I could have written many parts of your post. I've been trying to think of how to express my upset and fears and my stress about confronting this issue head on (I'm supposed to call the office tomorrow with my decision about induction next week) in hopes of posting here and getting support. It is so hard to clarify what the variables are, and what my bottom line is.

I mean, of course I have a bottom line that involves two living babies, but what do you take statistically (as a threat to that bottom line) to justify or motivate behaviors that seem precipitous? At what point do you know that "it was the right thing"? I certainly don't want to look back on something tragic and regret that I resisted intervention, but it's also true that I don't want to look back on an experience that led where I feared it might (into heavier interventions) and always wonder if the fear (or caution) motivating it even was justified. Like, did I "have" to do that?

You wrote "I have been trying so so so hard to be positive about being post dates and trusting my body but this just puts a big fat poop on my attitude." That speaks well to some of my feelings....I have been trying so hard to GET to 38 weeks, to be positive about "lasting" this long, to be happy about NOT contracting and having a strong cervix. Now because of the clinical standard with mono/di twins (in which some studies indicate that complications go up after 37 weeks in previously uncomplicated pregnancies), my strong cervix (read: firm and closed) is a liability and if I don't go into labor spontaneously ASAP I must be induced? Nevermind my unfavorable Bishop's score indicates that an induction wouldn't likely take.... (though she recognizes that and recommends starting with cervadil and then moving to pitocin a few days later if necessary.)

It just feels very undermining. Yay, you're full-term. Now go into labor or else face induction. Where's my window?

Well, I've shared way more than I intended but I thought maybe the placenta grade stuff could help. Maybe I should cut and paste some of this into the thread I was intending to start about my situation.

[Kidzaplenty]

You are in my thoughts. I hope you will begin labor overnight and won't have to worry any more.

You will be holding your little one soon!

[JennaW]

AmyC-

It is a stressful place to be, huh?

As far as the grades of placenta, yes, DH was researching that the second we got home. From what we have looked at, we are definitely looking at Grade II type calcification and not Grade III, at least from the printed u/s images I saw.

Also, the more time I have had to think about and process this experience, the more angry I start to feel. My baby has been so active , several times a day with STRONG movement. If it weren't for this NST, I would have ZERO concerns about well being. In addition to that, I was explaining to my Dad last night what happened and I realized that I really think the midwife over-reacted. As I was telling him the story I said "You know, she is the first CNM I have met and did not like. Orginally I was pushing those feelings back, attributing my dislike with her as being correlated to this stressful experience but now that I think about it, I think it was because I didn't feel like she really meant some of the things she was saying." Examples:

"Well I know you want an all natural birth but if the placenta isn't working well the baby may not thrive well in labor, requiring a c-section and I know you don't want that." (to which I responded yes that could happen but induction puts you at a high risk for c-section also)

"I wouldn't be able to sleep well tonight if I let you go home now." (Just seems like an unprofessional comment IMO)

"If you asked me to induce you now, I would." (This is after the additional time on the monitor and seeing the baby looking good).

"I'm a midwife so you know what that is all about." (implying that she is all about all natural birth but here she is putting on the pressure to induce in this passive-aggressive way..hmmm...)

Also, my Dad has been practicing law for over 20 years, his specialty is civil defense, which includes a lot of medical mal-practice. After hearing my story his response was "It sounds like the CNM is trying to cover her ass."

So here we are. The pressure is on. It's 1 AM in the morning here, I've got a headache from the crying I did yesterday. I really want to go into labor. I don't want to deal with another NST, I just want to have my baby.