How long past due date & would you choose induction or CS? - Mothering Forums

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#1 of 16 Old 08-21-2008, 02:48 PM - Thread Starter
 
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Hi!
I am 39 weeks and planning a vbac. We're starting to discuss how we want to handle going past my due date. My ob said he waits till 41 weeks and then likes to make a plan for induction. He does not like anyone going past 42 weeks (vbac or otherwise). He indicated that he is comfortable inducing at 41 weeks for vbac at least in my case since I'm already 2cm and 70% (and won't hit 41 weeks for another 2 weeks). His usual procedure for a vbac induction is to break the water and if things don't get started, then a little pitocin.
I know that the further past 40 weeks I go, a vbac is less likely to be successful and also that being induced makes it less likely as well as slightly more risky. So I'm leaning towards not wanting to be induced at any point, and actually favoring a repeat cs if I go too far, but I'm not sure how far is too far. I'm thinking maybe I would have a cs if I hit 42 weeks.
Has anyone else struggled with these questions? I really want a vbac but I'm not a risk taker at all so even the decision to try a vbac is a big deal for me.
Any thoughts?
Thanks!
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#2 of 16 Old 08-21-2008, 03:17 PM
 
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For me I would choose induction over repeat c/s, and only if I was over 42 weeks with a favorable cervix. I'd go for foley catheter or break my water probably. Of course I'd rather just wait it out and not do either, but if I had to do one or the other it would be induction.

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#3 of 16 Old 08-21-2008, 03:27 PM
 
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I think it depends on your family history. Did you go into labor with your last baby? Did your mother deliver early or late with hers? It's important to know what is normal for you before you decide what is too long to wait.

Incidentally, your risk of UR complications does not go up after 40 weeks. Decreased success of VBAC after 40 weeks is due to other issues, normal for all pregnancies. And don't forget that normal term is 38-42 weeks.

Anyway, I went with natural induction methods when I got to the point where I was concerned about time. You could consider those before allowing the doc to break your water, which puts you on a timeline and such. Also, natural inductions tend to be more gentle on your body. When your body is ready, it's ready!

I stayed active and took a very small dose of castor oil in some orange juice. Not everyone's first choice, but beats pitocin hands down!

Good luck and stay positive!
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#4 of 16 Old 08-21-2008, 03:36 PM
 
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For a VBAC, I was told a max of 41 weeks for my case. I did not feel comfortable with an induction for a VBAC with my body not seeming ready so it was a scheduled c-section. I was not dilated even a finger tip on Monday. I went into labor on my own Tuesday night. However, my first c-section was a true case of CPD and my second baby was thought to be about the same size as DS who was 10lb 8oz. They were wrong. She was 11lb 4oz. If we had thought the second baby was a little 9 pounder, then 42 weeks would have been the limit. (I did end up with a repeat c-section in the end but I'm glad I got to try! DD would have been a shoulder dystocia case if she had fit, which is likely why her chest got stuck and she didn't come down).
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#5 of 16 Old 08-21-2008, 04:41 PM
 
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Personally, I went 9 days past my EDD with my VBAC. My doc and I were willing to stick out out for 2 weeks past EDD so long as the baby looked fine on a NST. We did try and do a membrane sweep at 39 and 40 weeks, but I was too closed to allow that. (We would have done it at 41 weeks but my doc was out of town and the person I saw didn't feel comfortable doing that so I didn't let her anywhere near me). It would have been my first "line of defense" to prevent going too far post dates.

If the baby needed to get out sooner (like there was a non-reassuring NST), or it got to 2 weeks past EDD, I would choose to induce rather than schedule a repeat c/s. I'd opt for induction methods in this order:
0. castor oil (at home)
1. Nipple stimulation (at home)
2. Foley cathether to get dilation (this is where I'd have to have my doc in on the deal)
3. Rupture membranes (yes, this puts you on the clock, but if you're inducing, you're already pretty much on the clock anyway.)
4. Pitocin

I might opt for pit over membranes depending on the situation with me and the baby. For me, scheduling a repeat c/s was NOT an option because I just couldn't handle that - my first was scheduled at 39 weeks for breech presentation and I never even went into labor. I wanted to know what labor was like just ONCE in my life.

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#6 of 16 Old 08-21-2008, 05:21 PM
 
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Going past dates with a VBAC does not increase any risks, so I wouldn't really be concerned until I hit 42 weeks, or if genuine medical issue were to arise.

My doctor will not induce with a VBAC ( which is fine, I don't feel comfortable with it either), so I guess it would be a c-section ( after I tried every natural method in the book), but she is also very comfortable with me going into 42 weeks as long as baby and I both look healthy.
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#7 of 16 Old 08-21-2008, 05:32 PM
 
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past due is 43 weeks. normal human gestation is 38-42 weeks.
knowing what i know now, i would NEVER induce for going past 40 weeks, or even 42weeks! your body KNOWS what to do and it will do it.
some moms gestate a long time and have healthy babies as a result, its ok and its normal.
i was bullied into an induction with dd1 at 40 weeks exactly.
i trusted the CNM who i had care through. and she lied to me. she told me my placenta wouls start dying, that my baby would die and it would be all my fault. she really used alot of scare tactics to get me in for that induction. and because i trusted HER instead of my body and my baby i ended up with a failed induction leading to c-sec. turns out, she went on vacation the following day. she just wanted me to get it done and overwith for HER. not for my baby.
dd2 i had an amazing midwife, trusted my body and my baby. i birthed her happily at home at 40w4days. but had i gone longer we would have still been ok. women just dont fail to go into labor, but sometimes their labor doesnt start on their care providers timeline. thats where inductions come in. to appease the care provider.

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#8 of 16 Old 08-21-2008, 05:53 PM
 
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If it was an induce vs rc/s question due to medical necessity then I'd induce and take my chances. But I'd ONLY induce with a foley cath and I'd avoid pitocin or other chemical induction/augmentation methods.

If it's a "let's get that babe out because this is taking too long" then I'd say no. If there was some concern I'd agree to NST and fetal monitoring, but I wouldn't worry about anything till after 42 weeks. It's true that some studies show vbac success goes down after 40 weeks, but it's not a huge drop and the studies don't say "why" there is a drop (as in, the studies can't say the drop is due to anything related to the mother/babe... it could be due to hospital policies that induce vbac mamas after 40 weeks with the related decline in vbac success due to induction).

With my first babe labor began at 42 weeks 3 days. With my vbac labor began at 40 weeks 2 days. You may not "go long" even if you did last time, and there's nothing really out of the ordinary (biologically speaking) of gestating till 42 weeks.

Hang in there and happy birthing!

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#9 of 16 Old 08-21-2008, 05:59 PM
 
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I'm going to agree with the pp, I'd only induce if it was medically necessary. I would try the natural methods first (castor oil, nipple stimulation) and then if that didn't work - I would do the foley only. No pit - because its starting to be linked to an increase in UR. Slight - but there.

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#10 of 16 Old 08-21-2008, 06:58 PM
 
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I was 4cm when I went in at 39 wks to be induced w/ Ilana. I started pit at 10:30, but it didn't do much. They broke my water at 12:30 and she was born at 2:04. I would much rather be induced than have another c/s.

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#11 of 16 Old 08-21-2008, 09:42 PM
 
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My husband was a 44 week baby. My son was forced out at 42 weeks 3 days and had signs of prematurity. Both sets of parents had rock solids dates for pregnancies.

I would not induce or schedule anything until I was 47 weeks.

The risks of VBAC not "working" after a certain point are risks that are doctor-caused. Not baby/mama caused.


And actually I would never schedule anything at all. If there's an emergency, no scheduling. And I firmly believe that babies know when to be born, so there would be no scheduling. I'm not smart enough to know when a baby is ready to be born!
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#12 of 16 Old 08-22-2008, 01:52 AM
 
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I just want us to be careful here--not all past-term VBAC failues are because of doc ineptitude...

I went 42 weeks with my VBAC, refused any mention of induction. Though I stand by my decision from a philosophical point of view, it may not have been the best decision in retrospect.

I had a wonderfully supportive midwife with tons and tons of VBAC experience. However, my 42 week-old baby was 9 pounds 14 ounces, and failed to descend due to her size despite almost 3 days of labor. If I had let my mW strip my membranes, done other things to try to get baby to come sooner, I probably could have succeeded with my VBAC.

I just don't want to be too black-and-white here. Things are not always so easy or so simple.
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#13 of 16 Old 08-22-2008, 10:51 AM
 
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Hugs Googy.

I think there is also a big difference between the more "natural" inductions (EPO, Nipple Stim, Sex, Walking, RRL, even Membrane Sweeps and Castor Oil at the most interventionist end of that spectrum) and the more "medical" induction techniques like breaking the water and pitocin. The two types of inductions work differently... the first type is a nudge, the second type is a push.

There are no sure things in birth (though I desperately wish there were), but I still wouldn't induce using medical interventions unless there was a medical need.

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#14 of 16 Old 08-22-2008, 10:55 AM
 
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My midwife is willing to go 42w4d before turning me over to her backup doctor. I would have to do NST's from 41w4d on as well. I am not sure if I would choose induction or repeat. If I did choose an induction I would want to avoid cytotec/cervadil (and just use a low dose of pitocin) and I would also want to be carefully monitored since the risk for UR would increase due to the induction.
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#15 of 16 Old 08-22-2008, 10:59 AM
 
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I feel like I was in your exact boat exactly a year ago. I ended up going 12 days overdue and had a perfect VBAC (in my opinion). I decided I would never choose to have a repeat C/S. I was going to be induced at 42 weeks, but only because I was feeling a lot of pressure from the doc. I just didn't want to fight anymore. Luckily, things went naturally.
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#16 of 16 Old 08-22-2008, 05:51 PM
 
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There is really a lot in what you ask about. I would recommend really looking into what constitutes past due. The estimated due date is just that- an estimate. I wish I could find where I was looking up the info but there was a comment made that it is only an estimate, not an expiration date. As far as risks to the baby, the evidence points to after 42 weeks for an increase of baby troubles. You should be comfortable with whatever choices you are making but as far as risk goes there is a lot of info you could look into to allay your fears. There are way more risks associated with a c/s than with a vbac. That your doc is willing to let you go to 41 wks is great but that he is going to induce with pitocin leaves a lot of concern, considering that much evidence points to pitocin actually causing ruptures and other issues during delivery. If you are sure about either your LMP or your conception date you could get very close to the same estimate- 40 weeks from LMP and 38 weeks from conception. Statistically though women go 15 days past EDD for first babies and 10 days past EDD for subsequent babies. Women of Asian and African descent tend to have a higher occasion of going 10 days before EDD. There are no hard and fast rules and the problem with putting our babies on a calendar is that they don't know how to read one! The person who came up with the EDD was born 230 years ago! At that time I'm sure that it was more to be able to approximate and tell women when they might expect a baby, not so much to find out last possible induction date. I would urge you to look into past due dates and problems associated with it so you can be proactive in preventing possible difficulties. I would also highly encourage you to look into things on your own and collect your own info, not just take anyone's word for it, not even your doctor's. You're pregnant, not sick and docs have a little difficulty differentiating sometimes. My docs changed my due date twice and truly took the credibility out of the whole thing. I'm expecting # 6 and really am hoping to vba4c. I have had to revamp to think for myself and investigate anything because I have found I can't trust the current system that has failed me so many times. In my investigating and reading the medical journals and studies I have been astounded to find how many things are practiced against what the doc's own findings have been. I am thankful that today is the last due date they have given me which I think is rather off (it was a late u/s date) even by as much as 2 weeks. I feel I'm at least 42 weeks so I've started taking extra care of myself and baby. You'll feel so much better with the outcome regardless of method of delivery if you have taken some time to investigate and become comfortable weighing options with the whole picture instead of just the part a doc wants you to see. Just be sure that you do what you know is best for you and your baby, without any pressure. Good luck!
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