How late would go before being induced? - Mothering Forums

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Old 02-02-2009, 09:11 PM - Thread Starter
 
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Hello

I'm 40 weeks tomorrow and I know that my due date is totally accurate because I actually know the day that I conceived. This is my second pregnancy. During my first pregnancy my water broke at just after 38 weeks and I was with a high risk OB group at the time who started me on pitocin soon after.

This time I really wanted to birth naturally. I am with midwives and have hired a doula and am delivering at a hospital with a waterbirth tub. But I'm getting nervous that I am 40 weeks tomorrow and nothing seems to be happening. I'm not having any contractions, the baby has not really dropped and I'm only dialated about 2 cm. I want to go naturally but I don't want the baby to be at risk by staying in too long.

How long would you go past your due date?

Thanks
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Old 02-02-2009, 09:25 PM
 
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I wouldn't go by date alone but by indications on how well the baby was doing. If kick counts were good, you are healthy, baby appeared healthy no reason not to go as long as needed.

Remember that 40 weeks is Average. It does not means its an expiration date.

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Old 02-02-2009, 09:33 PM
 
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Until I had a true medical reason why I should be induced. For me, that means if myself or the baby's life were in danger.

40 weeks is full term & rates for all complications (including breastfeeding problems) tend to be lower in full term babies. I went to 41 weeks with both my girls. With both of them I was hardly dilated/effaced at all before going into labor. In fact, I asked the midwife not to check my cervix every week because I didn't want the pressure of this number which really means nothing hanging over me.

Trust your body. Your baby will NOT stay in there forever!

Wishing you a great natural delivery!
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Old 02-02-2009, 09:38 PM
 
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I would probably induce at 42 weeks if conditions were favorable (cervix already dilated and effaced, irregular contractions, etc). If conditions weren't favorable I would try and hold off a bit longer because I don't want to end up with a c-section. I would not induce before 42 weeks unless there was some issue that demanded it.
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Old 02-02-2009, 10:00 PM
 
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If mom & baby were healthy? I wouldn't even allow the word "induction" to come up until I was 42 weeks.

Last time around I gave in earlier & was induced at 41 weeks. Obviously, I wouldn't do that again. Of course if there were medical problems involved that would come into the decision to induce, but if we were healthy I wouldn't even consider it until I hit 42 weeks.
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Old 02-02-2009, 10:05 PM
 
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In the absence of a true crisis/reason to induce, you are better to just wait it out. It's quite unlikely you'll go beyond 42 weeks. Some do, but most go before then.
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Old 02-02-2009, 10:47 PM
 
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42 -43 weeks as long as everything is ok in there. Some babies just take longer to cook.

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Old 02-02-2009, 11:04 PM
 
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Originally Posted by layla983 View Post
If mom & baby were healthy? I wouldn't even allow the word "induction" to come up until I was 42 weeks.
And then the only forms of induction I'd consider would be natural.

No pitocin, etc., for me unless baby is in danger.

SAHM to Guinevere (04/05/06) and Eowyn (02/13/09)
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Old 02-02-2009, 11:32 PM
 
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"Due Date" is a completely arbitrary thing artificially created by a male. Average gestation is not 40 weeks, it is more like 41 weeks and a few days. And "Average" means some go less, and some go more. So personally, I wouldn't even consider thinking about induction (assuming mother and baby are healthy) until 43 weeks or so.

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Old 02-03-2009, 12:39 AM
 
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"Due Date" is a completely arbitrary thing artificially created by a male. Average gestation is not 40 weeks, it is more like 41 weeks and a few days. And "Average" means some go less, and some go more. So personally, I wouldn't even consider thinking about induction (assuming mother and baby are healthy) until 43 weeks or so.
I agree!

I was induced with #1 after going just a few days past my due date, and ended up with a c-section due to all the interventions. They don't tell you that inducing GREATLY increases your chances for a C-section, because usually your body is just not ready to give birth yet.

I will never be induced again, especially because it really increases the risk of rupture since I have a c/s scar. Even without the scar I would never do it again... going all natural this time!

Mommy to beauties DS1 (7), DS2 (4, autism), & DS3 (2)

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Old 02-03-2009, 01:14 AM
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Personally, I'm not comfortable going more than 10 days past my due date -- I know when I conceived, and I know how long my cycles were. BUT I also had low amniotic fluid around the 36 week mark and although we managed to get it up to a safe level, there really isn't much to spare and I'd rather be induced and have a shot at a vaginal delivery than lose so much fluid and have a vaginal birth become really risky.

I've also had a lot of pre-labour and early labour action & associated fatigue and discomfort, and honestly the thought of going another month makes me want to claw my eyes out.

In general I still don't think I'd go beyond 42 weeks.
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Old 02-03-2009, 01:24 AM
 
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Check the link in my signature. Lots of accounts where mom is sure of date of conception and still goes "late" and has good outcome.

GL!

Vanessa - aspiring Traditional Foods momma of Graham & Margot
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Old 02-03-2009, 01:32 AM
 
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So long as baby & I were fine, I wouldn't induce, at all. I know too many 10 month mamas.

mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

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Old 02-03-2009, 01:45 AM
 
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Check the link in my signature. Lots of accounts where mom is sure of date of conception and still goes "late" and has good outcome.

GL!
But what if you were on of the ones with a bad outcome?

I would be comfortable going to 42 weeks, then I'd be getting NSTs like crazy and having a serious talk with my midwife. Except my midwife has to hand over your care at 42 weeks, so I'm not sure that I wouldn't be induced at 41w6d to make sure I had a good birth attendant.
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Old 02-03-2009, 01:57 AM
 
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I might start considering natural induction methods a few days before 42 weeks (since, in WA state, my midwives are required to transfer care after 42 weeks-- although I need to get clarification as to whether they have to transfer at the beginning of week 42 or the end). Otherwise, my willingness to consider induction (after 42-43 weeks) would depend on the health of the baby and my Bishop's score.
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Old 02-03-2009, 03:10 AM
 
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But what if you were on of the ones with a bad outcome?
I'm just offering this mama something very positive to read. I don't think the suggestion of anything other than calmness is helpful to her at this point - she's 39w+6 today, and I think it's pretty early to start worrying. Honestly, it seems consistent with moms I know that the difficult outcomes are more frequent when the baby is "early" than when the baby is "late." It's heartbreaking when those outcomes happen, and my heart goes out to anyone who's lived through that, but that is by far the exception not the rule where "late" babies are concerned.

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Old 02-03-2009, 03:52 AM
 
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My ds was 43 weeks 5 days and not induced. I would do it again. He was not at all "overdone" and IMO would have had issues if born earlier.

-Angela
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Old 02-03-2009, 04:04 AM
 
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How long would you go past your due date?
It's hard to say. I went 4 days past my due date the first time, 9 days past the second time, and my date was accurate too, since I knew when I was ovulating and there was only the one time of intercourse.

I was pretty sure I wouldn't go into labor by 40 weeks, but I was hoping that I'd give birth before 42. I could feel that things were happening, and it really felt like all that my body was undergoing was all part of the labor process. If I had felt nothing, I might have been a little more worried, but I figured I'd take it one day at a time, monitor how I felt, how much the baby moved, etc.
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Old 02-03-2009, 05:08 AM
 
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But what if you were on of the ones with a bad outcome?
It would depend on what the outcome was and the reason for the outcome. If I had a bad outcome at 38 weeks, would I induce before then from then on out? Not likely unless it was due to a condition where the risks are increased with gestational age and then only if said condition repeated itself. Maybe something like ICP. But there are very few risks associated with going post dates in the absence of other complications. A big part of the increased risks with post-term pregnancy is with SGA babies due to congenital anomalies. However one could still have a bad outcome due to something completely unrelated to being post term. That can happen at any time.

That said, I would not consider induction for dates before 43 weeks and even after 43 weeks I would only consider it depending on other factors. So far, I've never had a baby before 42 weeks.

eta - just want to add that I totally believe in mama instincts. Even in the absence of an obvious indication. That trumps everything.
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Old 02-03-2009, 05:18 AM
 
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At 41 weeks by my correct date, I would start natural induction techniques. Honestly, I might start the mild ones even earlier, just priming the pump. Meaning I would take Evening Primrose Oil, engage in Relaxation, Nipple Stimulation, lots of intercourse, pineapple, cumin, hiking. I would wait to 41 or even later to do anything 'real', like membrane stripping (really I hate that one), the cohoshes, castor oil externally.

If I had to induce in a medical setting I would try the foley bulb, IMO.

I agree with PPs though that 40 weeks is too early to start worrying. But not too early to be getting in the mindset of getting your groove on! <3
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Old 02-03-2009, 04:33 PM
 
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I would have to go late - and late doesn't start until 42 weeks. Then it's case by case. I had to be induced at 42 weeks with my son since the placenta was breaking down and calcifying by 37 weeks. I had extra NST and BPP at the end so I could go all the way to 42 weeks.
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Old 02-03-2009, 05:45 PM - Thread Starter
 
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Thank you for all of the replies so far. I came across this article which is really scaring me.

http://www.sciencedaily.com/releases...1007091459.htm

It seems to be a pretty big study and has taken things into account like being high risk.

I'm 40 weeks today and according to the article that puts the baby at a higher risk of complications during and after the birth. I want to do the best thing for the baby which I thought would mean letting the baby come when he was 'ready' but now this article has me second guessing that.
:

I faxed the article to my midwife today but have yet to talk to her about it.

had anyone read this article before or have any thoughts on it?
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Old 02-03-2009, 06:06 PM
 
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Thank you for all of the replies so far. I came across this article which is really scaring me.

http://www.sciencedaily.com/releases...1007091459.htm

It seems to be a pretty big study and has taken things into account like being high risk.

I'm 40 weeks today and according to the article that puts the baby at a higher risk of complications during and after the birth. I want to do the best thing for the baby which I thought would mean letting the baby come when he was 'ready' but now this article has me second guessing that.
:

I faxed the article to my midwife today but have yet to talk to her about it.

had anyone read this article before or have any thoughts on it?


It's not a great time to be reading stuff that makes you feel scared!

Get out your math brain before getting sucked into studies that say things like "six-fold increase" because that's how that article describes the increase in rate of stillbirth from 0.035% at 37/38w to .212% at 42w per 100 babies. Look at the numbers they're starting with.

Here is the link to the AJOG paper: http://www.ajog.org/article/S0002-93...913-7/fulltext

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Old 02-03-2009, 06:08 PM
 
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had anyone read this article before or have any thoughts on it?
The one thing I am wondering is with the people who delivered between 41 and 42 weeks, were they induced?

Quote:
Both of these studies confirm that the risk of cesarean deliveries and poor maternal or child outcomes starts to increase as early as 40 weeks.
Quote:
The study found that infants delivered at 41or 42 weeks had an increased chance of death within 28 days, and that the elevated mortality rates persist across the entire range of normal birth weights.
Interesting, I wonder if they have a theory on this.

Nothing that I read there stated that the babies that were born after 40 weeks were spontaneous cases of labor, not inductions. That would be my first question. It's possible I just missed that, however. I did see it said that they had controlled for risks like previous caesareans, gestational diabetes, cardiac disease.

The one study reported a 40% increase in c-section with women who deliver babies at 41 weeks as opposed to 39 weeks.

It seems like it might note a link between better health outcomes for women who go into labor spontaneously at 39 weeks, since I am assuming that inductions are less likely to be performed at 39 weeks than at 41 or even 40 weeks. But if you don't happen to fall in that category, what would you do? Induce or have a c-section, both of which would have increased risks?

I think talking it over with your midwife is a good idea, and you can decide where to progress from here.
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Old 02-03-2009, 06:10 PM
 
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Thank you for all of the replies so far. I came across this article which is really scaring me.
I really think the most important thing to keep in mind with "studies" like that is that they do not take into account the difference between naturally occurring and iatrogenic problems.

Also keep in mind that they are lumping together C-sections with "poor maternal and fetal outcomes".

Ultimately you're going to have to decide what you want to do for yourself, but this study is fairly typical of the medical establishment covering it's own butt.

When you are forced to lie on your back, pumped full of labor enhancing drugs, subjected to fetal monitoring that gives lots of false positives, put on a strict timetable, subjected to constant interruptions, subjected to constant vaginal exams, and are "managed", which includes induction, forceps/vacuum extraction and c-section... all of those things carry their own risks. None of which are discussed by the doctors. On top of the risks of just being in a hospital to begin with. You don't see those types of problems nearly as often in a home birth, because generally in a homebirth nature is allowed to take it's course. Yes, death happens. Yes, defects happen. But they happen because that's natures way, not because they were caused by interference.

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Old 02-03-2009, 06:19 PM
 
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The due date is just approximate. You are considered "on time" two weeks before and after. I will not induce before 42 weeks unless medically mandated (not just a nervous m/w or doc).

Alicia, wife to an loving and faithful DH, and mama to three fantastic though nutty children (cs, then an HBAC, then a VBAC!!).
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Old 02-03-2009, 08:57 PM
 
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Originally Posted by gr33nie View Post
Thank you for all of the replies so far. I came across this article which is really scaring me.

http://www.sciencedaily.com/releases...1007091459.htm

It seems to be a pretty big study and has taken things into account like being high risk.

I'm 40 weeks today and according to the article that puts the baby at a higher risk of complications during and after the birth. I want to do the best thing for the baby which I thought would mean letting the baby come when he was 'ready' but now this article has me second guessing that.
:

I faxed the article to my midwife today but have yet to talk to her about it.

had anyone read this article before or have any thoughts on it?
The actual study is not that alarming. The operative delivery does go up, but at 41 weeks for a first time mother its at the national avg of 30%. So its not like its higher than the national avg then. Its just higher at 41 weeks than at 39 weeks. And given that you are more likely to be induced after your edd I think you are more likely to have a c/s then too. Esp now with drs not even doing a trial of labor if they suspect macrosomia. If you look macrosomia increases with gestational age. 4000 g is 8.5 lbs. I personally don't think 8.5 lbs is all that big. I didn't see anything too alarming in that study. Yes, things went up but not drastically and nothing I would personally want to induce to avoid. Meconium happens, For me that would not cause me to induce. Considering stress to the baby, which induction can lead to, can cause Meconium to be passed. I wouldn't induce to avoid a big baby either so that would eliminate that for me. Read the actual study its really not that bad.

If it makes you feel any better, which I doubt it will, I have had 7 post date pgs (thats beyond 42 weeks). All were born vaginally over intact perineum. They were big for the most part (avg 8.5 to 9 lbs), but all were healthy, all had high apgars, 6 were born at home. No vacuum or forceps, no meconium, no associated birth injuries to being post dates. And yes, I was sure of my dates with 5 of my pgs. The others not so sure of but even then we would be looking at me being more over due not less.

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Old 02-03-2009, 09:31 PM
 
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As long as everything is going well, my midwife will let you go about 3 weeks post. If you are very unsure of dates, she'd probably go longer. Babies aren't going to stay in there forever.

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Old 02-04-2009, 01:58 AM
 
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Thank you for all of the replies so far. I came across this article which is really scaring me.

http://www.sciencedaily.com/releases...1007091459.htm

It seems to be a pretty big study and has taken things into account like being high risk.

I'm 40 weeks today and according to the article that puts the baby at a higher risk of complications during and after the birth. I want to do the best thing for the baby which I thought would mean letting the baby come when he was 'ready' but now this article has me second guessing that.
:

I faxed the article to my midwife today but have yet to talk to her about it.

had anyone read this article before or have any thoughts on it?
Have you read the actual study? If not, I think you should and you will probably feel a lot better. Articles are full of twisted info and hype. This article is so vague that it is hard to come to any real conclusion based on reading it. Critical thinking is a good thing especially when examining actual studies. I've done extensive research on post dates pregnancy and it made me feel much better about going over.

Also to make yourself feel better, read the study that came out recently which showed the significant benefits for babies who were in the womb longer. I can dig it up for you if you'd like.
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Old 02-04-2009, 02:12 AM
 
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This study wouldn't make me want to induce to get the baby out sooner, I'd want the baby to come out on their own. As long as you can check to see how baby is doing in there, I don't see a problem with waiting.

Reading the study I kept thinking how most of the babies born past 40 weeks were most likely induced...so its the induction causing the problem not the baby being in there 'too long'.

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