Is an induction inevitable? So upset... - Mothering Forums

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#1 of 30 Old 01-06-2011, 01:32 AM - Thread Starter
 
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So I went to my midwife three weeks ago when I was almost 37 weeks pregnant. Out of curiosity, I begged her to check my cervix to see if there were any changes.  At the time, I was -3 station, 0 cms dilated, 60% effaced.  This sounded like a somewhat promising start, and made me more confident that my body knew what it was doing.  Wanting to get things moving a little faster, I have been eating lots (LOTS!) of spicy foods, having lots of sex, walking a ton, nipple stimulation, bouncing on the birthing ball, accupressure, drinking gallons of rasperry leaf tea, in addition to a bunch of other things.  I got checked again today at 40 weeks, and am still -3 station, 0 cms dilated, and only 70% effaced!  I almost cried.  After three weeks of trying home induction techniques, not only has nothing has worked, I am now looking at having a medical induction in one week. 

Has anybody heard of this happening?  Being full-term, and baby no where ready to be born?  I do know my dates are spot on, so it isn't an issue of incorrect dating.  I feel like I am already doing all that I can to get my body ready and prepped for labor.  I know everybody is different, and we all birth at different times, but I sill feel like I have been betrayed by my body.  How could three weeks go by, and my baby show absolutely no signs of coming?  My whole pregnancy I have been very anti-induction/epidural/pitocin, but it looks like I may well be on my way to the whole "cascade of interventions" that I have been dreading the whole time.  In my head, I had always pictured a nice, serene birth, laboring mostly at home in the tub with my husband, being able to eat and drink all I want, walk around, basically, do whatever I needed/wanted to do gently bring my baby into the world.  Now I am horrified at the prospect of being confined to bed, hooked up to an IV, and strapped to monitors...  How on earth could one possibly avoid an epidural/pain meds in such an unfavorable and stressful situation?  It just doesn't seem possible.

I am really upset at the possible loss of my dream birth.  I know I have a week to go, but it just seems so unlikely that if I am not dilated, only 70% effaced, and baby hasn't dropped AT ALL (kiddo seems more likely to come out my throat!!), that all of a sudden my body will magically go into labor in the next seven days.  Has this happened to you or somebody you know?  If you had to be induced, were you able to avoid an epidural/c-section?  Any words of encouragement?  Please? 


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#2 of 30 Old 01-06-2011, 05:08 AM
 
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No, an induction is not inevitable!  You truly can have what looks like no progress and go into labor an hour later.  And by the way, -3 is engaged, it's just not super-low. 

 

The average first pregnancy length is 41 weeks 1 day.  So half of first-timers go into spontaneous labor before 41 weeks 1 day and HALF AFTER. That's Normal. You do not have to consent to a medical induction in one week if it's not what you believe is best, no matter what the policy of your care provider is.  You may go into labor before then, but you may not.  You need to start thinking what what your comfort level is wrt induction and then stand up for yourself if you do not want to be induced.  Induction does greatly increase (read: double to 40%) your risk of c/s.  You need to be sure that the risks of staying pregnant past 41 weeks outweigh the risks of induction before you consent.  Routine induction at 41 weeks is not an evidence-based practice, IMO, but it does cover their a$$es legally because it conforms to the "standard of care", which just means "what everyone else is doing", not necessarily what is medically most sound.  It sounds like you are aware of the cascade of interventions and you should take that to heart.  You might contact your local ICAN representative for help in navigating this situation, since one of their missions is to help prevent unnecessary cesareans.  She could likely direct you to good local resources or give you information about how your care provider handles a situation in which a mother does not want to be induced.

 

Take it from me (see my siggy), listen to your intuition and speak up for what you believe is best because you are the only one who has to live with the consequences of your decision.  Good luck to you.


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#3 of 30 Old 01-06-2011, 07:16 AM
 
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I have seen so many posts of "no progress / no signs of labor" when I stalk some of the DDCs to read birth stories... and then within a few days or a week there is a baby!

 

I would NOT get more cervical checks if it were me... doesn't really tell you anything.  My good friend was having early contractions and was 2-3 cm dialated by 36 weeks.  Her doc was concerned with pre-term birth etc. and she did not have her baby until 41 weeks along!   

 

In terms of your early efforts these last few weeks at 37-40 weeks most babies are not ready to be born and those types of "natural induction" methods you mentioned are pretty unlikely to do anything if your baby and body are not ready yet.  When your body is truly ready they might help - but then you would be super close to labor anyway!

 

You need to focus on relaxing and enjoying these last days of pregnancy.  Think about a plan and get information on induction so you are prepared to stand up for yourself and to make whatever choices you need to make if that route seems likely but after that plan is in place TRY (I know this is almost impossible) to put it aside and focus on yourself and your baby and being at peace.  

 

btw. I was basically not dilated at all.... and had a baby 8 hours later!    Turns out my body did know just what to do when the time finally came!

 

 

Good luck to you and best wishes on a wonderful birth.


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#4 of 30 Old 01-06-2011, 07:36 AM
 
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Wait it out--as long as possible and/or as long as your baby is healthy and happy in there.

 

My last two didn't arrive until 42 w 3 days.  I had braxton hicks ctx for *weeks* prior to that, but it wasn't progress, just annoyance.  However, when those babies were ready, they were *ready*.  4 hour labors. 

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#5 of 30 Old 01-06-2011, 07:50 AM
 
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Um, yeah, the time from my first contraction, at 4 cm, to baby was an hour.  That "labor curve" is complete bullcrap.
 

Quote:
Originally Posted by womenswisdom View Post

No, an induction is not inevitable!  You truly can have what looks like no progress and go into labor an hour later.  

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#6 of 30 Old 01-06-2011, 07:51 AM
 
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Adding more information - I just noticed you were also looking for information from anyone who was induced and had a natural birth.  So, since you asked you get a really long post and probably more info then you need (I am kind of long-winded).

-----------------------------------

 

What I did not tell you in my last post is that the labor/birth I mentioned WAS a fully pitocin induced labor/delivery and I did do it naturally.

 

My water broke 1 day before my due date.  After about 16 hours of trying some walking/ball bouncing/napping/ etc. etc. still no contractions at all...  I was using a midwife practice at a hospital so at that point we went in for induction (side note: I never planned for this and feel lucky we got that 16 hours although now that I know even more I might push for waiting a bit longer if I had no fever etc.).

 

At that point the MW did check me and I was "barely" 1cm dilated and somewhat effaced (can't remember how much - may 70% or something).  Baby had not dropped or anything yet either.   After pondering the options for awhile she suggested pitocin for induction instead of a cervadil type of thing.   So we started the pitocin drip on a course that slowly increased the dose every few minutes (can't remember exact number).

 

I did feel contractions once the pitocin was started - I hung out on a birth ball for awhile etc.   After about 2-3 (?) hours of increasing pitocin I was checked again and this time had gone from barely 1cm to definitely 1 cm ....  great.

 

It was getting late in the evening at this point.. maybe 9pm or so... and MW suggested turning the pit. drip down to a low setting and me taking a sleeping pill to get some rest (my water has broken at 3am that day so I had not had much sleep).  I agreed and they turned the drip down, DH and I got settled for bed etc.   After the drip being down for 20-30 minutes the nurse brought in the sleeping pill for me and I made some comment asking about how long it take for pit to move through the body because my contractions had been actually getting stronger after turning down the pit.   She said it should move through pretty fast and would expect them to lessen already or really soon.  After I took the pill and she was leaving she said "be sure to let me know if you feel nauseous, this can be a sign of active labor"   -  I think she knew something I didn't yet know - lol.

 

About 10 minutes later (contractions still getting stronger) I threw up for the first of many times...  Lo and behold my body had decided to join the labor party!

 

They kept the pitocin drip going at the same low level the rest of the time (if this happened again I would now argue this point more!)  I labored in the tub for most of active labor and into the start transition I think.    

 

A couple hours later I was at a point of really working hard to cope with each contraction and the nurse asked if I wanted anything for the pain (another point - this time I will tell them NOT to ask me).  I found it too hard to say no, so I said  yes cause I couldn't imagine doing that for much longer and I could not that close to delivery right?!

 

So she contacts the MW cause she would have to order the epidural (ie I think she woke her up, pretty sure until that point the MW thought I was resting and did not know I was in active labor).

 

30 minutes later (and moving through what was likely transition and the worst of the labor - I was having trouble staying calm and was kind of thrashing around a bit).  I am out of the tub and the MW gets there and checks me and tells me I am about 8cm (the nurse had also checked me just before that and had told me I was complete...).   MW asks if I still want an epidural... I said no... knowing I am close was all I need (that and the MW did a great job of helping  me relax and calm down during those last transition contractions... not long later I feel ready to push.  Ok, so my body was having involuntary "pushing" contractions - my SIL had the same thing and described it as "throwing up through your croch" haha. At that point they just told me to go ahead push a bit during contractions if I felt like it, but not to be straining too much or anything - this part was great compared to transition - the contractions totally changed and even with some ring of fire when her head came out it was totally doable!

 

15 minutes of "pushing" later = Baby Girl!    She was born about 2am... I think this was less then 8 hours after starting pit. and about 4-5 hours from when I was still 1cm and was supposed to be going to sleep =)   She was also my first baby.

 

----------------------------------------

Being pregnant again now, I have been talking to my current midwife (different practice/hospital this time) and she said that with the pitocin being at a low dose for those last few hours, it was likely mostly my own body's progress being made and although the contractions may have been stronger they were likely not as strong as those experienced by people on higher doses of pitocin.    She said that she and the other mws at her practice try to keep pitocin to low doses in those cases where they even use it.  

 

So, long answer to a short question - YES despite the increased percent risk of CS etc. with inductions there are cases of success full natural birth following induction - even with no signs of the body being ready to go.   I think the key to avoiding the epidural for me was that they had turned down the drip at the same time my body stepped up to help out.  I would suggest if you did end up with a pit. induction that you ask about keeping the level low OR doing trials of turning down the drip or even turning it off once contractions get pretty strong.   I was lucky in that my body seems to respond to pit. pretty well and it worked to get my bodies more natural labor process going.

 

There are a couple things I might have done differently or might now do differently but overall I was satisfied with the birth experience. 


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#7 of 30 Old 01-06-2011, 08:25 AM
 
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http://www.drmomma.org/2009/09/why-pregnancy-due-dates-are-inaccurate.html

 

This is a great article, every woman is unique. 

 

"Every woman's due date is calculated with the assumption that she has a 28-day menstrual cycle. In addition, it is assumed she ovulated on day 14. Then, the due date is 40 weeks from her last menstrual period.

This method of calculating due dates is extremely out-dated, presumptuous, and flawed. First of all, not all women have regular menstrual cycles. Secondly, one woman may have a 28-day cycle, while a second woman's cycle is 35 days, and a third's is 40 days. Healthy women have menstrual cycles of various lengths, and the length can even change throughout a woman's life or from one pregnancy to the next. As a result, due dates are often inaccurate."

 

I also found this one very interesting-

http://www.drmomma.org/2008/01/fetal-lungs-protein-release-triggers.html

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#8 of 30 Old 01-06-2011, 08:49 AM
 
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It is very possible to have an induction with the cervical gel ... with no IV, no epidural, no pitocin ... no drugs of any kind...and a completely "natural" birth. I guess it depends on your doctors/midwives and the hospital you go to... can you talk with someone about this? 

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#9 of 30 Old 01-06-2011, 08:53 AM
 
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I know EXACTLY how you feel! Exactly. I felt the exact same way myself. Frustrated & betrayed by my body, sickened & horrified at the thought of doing my entire labor in the hospital tied to tubes, doubting I could forgo an epidural in those circumstances. All of it - I felt EXACTLY the same way.

 

Ha, I was able to put a positive spin on it and state, "Well, I'm even less scared of labor now - cuz there's just no way normal labor pains could be worse than this MISERY of waiting & waiting (and dreading potential induction)!"

 

Quote:
Originally Posted by womenswisdom View Post
The average first pregnancy length is 41 weeks 1 day.  So half of first-timers go into spontaneous labor before 41 weeks 1 day and HALF AFTER. That's Normal. You do not have to consent to a medical induction in one week if it's not what you believe is best, no matter what the policy of your care provider is.  

 

YES! Look it up - Mittendorf is the guy who did a meta-analysis in the 1990s on average length of uncomplicated human gestation. Actually it's first-time white women who go to 41W1D average. Both multi-paras (women who've had at least one baby already) & other ethnic groups had slightly shorter gestations, but still many groups were beyond 40W0D as an average.

 

I'm not going to lie, there has been some research showing improved outcomes with induction vs. "expectant management" (wait & see, only interfere if a problem arises) at 41W0D, HOWEVER - I don't think they've separated out multiparas from primiparas (first timers) in that research. The lack of that differentiation complicates the issue for a few reasons: 1. 41W is "longer" for a multipara than a primip anyway! (Compared to averages for their peer group.)

 

But most importantly:

2. Induction is relatively riskier for a primip than a multipara. The primip is much more likely to have induction end in CS (About 50%!) than the multip who has already had one vaginal birth.

So, again, I see value in looking at the question differently for the 2 groups, & I think some of this research did NOT make that distinction.


I believe the official ACOG policy is routine induction at 42W, not 41W. (Not that I think obeying ACOG is very important, but you have that to support your choice!!) Technically the medical diagnosis of "post-dates" doesn't occur until 42W, NOT 41W. Especially as a first-timer, NO WAY would I consider induction purely for post-dates (with no other medical problems) before 42W and even then I might wait it out a bit longer still.

 

Policy at my very baby-friendly hospital was twice-weekly NSTs and AFIs from 41W0D on and routine induction at 42W0D, but one of the MWs flat out told me that she doesn't necessarily think induction at 42W is always best anyway! (LOVE her!) So if your HCP pushes you for induction at 41W, I'd ask for twice-weekly NST and AFI as a compromise. It might make you feel more comfortable with waiting too.

 

I didn't have any vaginal exams at all until I decided to try having my membranes swept at 41W4D. (It worked for me, but the MW was sure I would have gone into labor on my own probably that very night anyway.) I also highly recommend no more VEs! For one thing, you'll make yourself nuts worrying that "nothing has happened" when it doesn't even mean anything. (I wanted to avoid VEs in labor too for the same reason... I didn't want to end up doing "labor math" and thinking, "OH no, it too 12 hours to reach 6 cms, I have 8 more hours to go...Can I deal with this for that much longer?!" When I know it doesn't work like that. Intellectually I know it doesn't work like that, but I worried that emotionally it would bother me! Easier to skip those VEs since they're of no value anyway.


But yet another reason to skip VEs in late PG is the "Sneak-attack induction" i.e. you are 2cm and 80% effaced so your HCP declares, "Oh, you are in labor! Go check into L&D right now!" Then, lo & behold, you're not really progressing so they suggest pit & AROM. Um, no, you were never in labor to begin with & should therefore never have been admitted to the hospital! Hence "sneak attack induction." But it sounds like you already know it's better to wait at home until true active labor anyway.

 

Other induction notes:

I know there's a common policy of delivering within 24 hours of ROM - so if your water breaks & you don't go into labor on your own, they induce, & if you don't progress fast enough, they CS. I think this is ABSURD! I suggest reading up on it before consenting. Yeah, risk of infection goes up with ROM, but vaginal exams are what really increases the infection risk so keep them out of your vagina!! & you can monitor your temp for signs of infection. I would still wait at home a while before going in to the hospital if I had ROM and would also seriously consider lying to my HCPs about when my water broke if I knew the hospital had such a policy and my MWs agreed with it (and they might be FORCED through hospital policy to abide by it.)

 

Also, if you hit 42W or consider induction for whatever reason be sure to get a Bishop's Score!! The higher the score, the better the chances induction will be successful. So it's a crucial piece of data to have when weighing your options of induction vs. expectant management & considering all the pros and cons. There are plenty of pros and cons on each side! Never let them convince you one option is risky and endangering to your baby whereas the other is the "best path" - there are trade-offs both ways! Nothing guarantees you a perfect baby.

And if you consent to induction even with a low Bishop's Score, I'd put a lot of time & energy into researching the hospital's policies on CS & preparing for that likelihood.
 

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Great post!!  yeahthat.gif


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#11 of 30 Old 01-06-2011, 11:12 AM
 
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I kept reading your post thinking, what's the problem here?  Being 40 weeks and having no signs of labor is TOTALLY NORMAL!  There are some women who have short gestations (and 37-39 weeks for a first-time mom is definitely shorter than average) but plenty of women who have longer gestations.  I gather from your post that your midwife's policy is to induce at 41w.  I find this concerning -- I wouldn't be surprised by it coming from an OB, in fact the OB I saw this morning said this is how she had been trained -- because it is not typical for midwives to the best of my knowledge.  However, even if their preference is to induce at 41w -- assuming that you don't go into labor spontaneously in the next week, which you very well may -- you absolutely have the right to decline an induction and have monitoring instead until 42w.  It is highly likely that you will go into labor on your own before 42w.  If not, you can consider consenting to an induction then, but unless a BPP and u/s showed something of concern, I personally would not consent to an induction prior to 42w.  


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#12 of 30 Old 01-06-2011, 11:19 AM
 
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Quote:
Originally Posted by MegBoz View Post
I'm not going to lie, there has been some research showing improved outcomes with induction vs. "expectant management" (wait & see, only interfere if a problem arises) at 41W0D, HOWEVER - I don't think they've separated out multiparas from primiparas (first timers) in that research. The lack of that differentiation complicates the issue for a few reasons: 1. 41W is "longer" for a multipara than a primip anyway! (Compared to averages for their peer group.)

 


 


MegBoz, do you have any links or citations?  The OB I've been seeing for parallel care just told me this a.m. that she was trained to push induction at 41w because of the risk of meconium aspiration and stillbirth.  They would do the expectant management if that was what I chose (and this is really all theoretical because (a) I'm most likely having a home or birth center birth and (b) it's highly unlikely I would ever get to 41 weeks based on my previous pregnancies), but I am interested in learning more about why practitioners are now pushing "deliver by 41 weeks" because I think it's a step backwards in terms of trying to reduce the C-section rate and the induction rate, particularly for first-time moms.  I'd be interested to know if anyone has looked closely at whatever studies show improved outcomes with induction at 41w and if there are more studies saying the opposite.  [Sorry to hijack, but this is at least marginally relevant to the OP's question! :)]


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#13 of 30 Old 01-06-2011, 11:31 AM
 
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Just to give you hope.  With my DD I was 0cm dilated and not effaced at all at 39 weeks.  At my 40 week appointment (40w 3d) I was just barely 1cm (I can't remember how effaced I was, if at all).  I went into labor on my own the next night - 40w 4d - it started slow so I didn't really pay much attention but by 3am I was pretty sure it was for real.  Yet when I got to the hospital around 1pm I was only 2cm (after several hours of painful contractions!).  I went out to walk for just about 2 hours and was 3cm at my next check.  By the time they got me all checked in and in my room was up to 4 (less than a half an hour).  I made quick progress to 7 and then 8cm.  So it can start slow and pick up speed!  

 

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#14 of 30 Old 01-06-2011, 12:20 PM
 
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Quote:
Originally Posted by msmiranda View Post

MegBoz, do you have any links or citations? 

If you Google, "risks of labor induction versus expectant management," the first link you get is: http://emedicine.medscape.com/article/261369-overview

 

Some snippets:

------------------------------------------

"To date, more than 10 studies have been published of elective induction of labor, many of them at 41 weeks of gestation.49,34,50,51,52,53 The preponderance of the evidence from these studies, including meta-analyses, find that not only is rate of cesarean delivery not increased in women who were randomized to routine induction of labor, but also more cesarean deliveries were performed in the noninduction groups, and the most frequent indication was fetal distress. Even with multiple studies, very few neonatal differences have been demonstrated. However, the reduction in meconium is statistically significant and the rate of neonatal mortality is lower. 

 

In summary, routine induction at 41 weeks of gestation does not increase the cesarean delivery rate and may decrease it without negatively affecting perinatal morbidity or mortality. In fact, both the woman and the neonate benefit from a policy of routine induction of labor in well-dated, low-risk pregnancies at 41 weeks' gestation"

------------------------------------------

 

At least in these summaries, I see no mention of primips vs. multiparas. I've read VERY often that induction in primips increases CS rate significantly, so I find the above summary very questionable! & I imagine the contradictory finding must be highly attributable to the lack of distinction between primps & mutiparas.

 

 

Summary all the way at the very end:

------------------------------------------

"Summary

The management of postterm pregnancies is complicated and fraught with complex issues. The decision of whether to induce labor or to proceed with expectant management with or without antepartum fetal surveillance is not taken lightly. Data support inducing labor at 41 weeks' gestation in an accurately dated, low-risk pregnancy, regardless of cervical examination findings. This strategy, although not without its critics, averts the need for antepartum fetal surveillance and does not increase the cesarean delivery rate; in fact, it may decrease the cesarean delivery rate."

------------------------------------------

 

<emphasis added>

 

The bold part confirms what I already said about not letting them convince you that one option is risky and the other is "best" since there are no guarantees. It really ticks me off when HCPs do that - and it seems common. I feel the same way about GBS & whether or not to get anti-biotics. (I personally recommend & will follow the "risk-based" protocol they do in the UK, not the more aggressive protocol currently recommended by the American CDC.)

 

There are risks on either side. I think it's really tough with issues like induction for post-dates, homebirth, GBS, and VBAC. In all cases, the more "natural" pathway has the very slightly higher risk of serious negative outcomes like neonatal death or brain damage*** - whereas the medicalized choice has a much MUCH higher risk of non-life-threatening complications (CS risks of infection, high risk of thrush from antibiotics for GBS, etc.)

 

I think this is where intuition & personal values need to come into play. I personally vote for trusting nature.

 

Another quote from the above link:

------------------------------------------

"Cotzias et al calculated the risk of stillbirth in ongoing pregnancies for each gestational age from 35-43 weeks.17 The risk of stillbirth was 1 in 926 ongoing pregnancies at 40 weeks’ gestation, 1 in 826 at 41 weeks, 1 in 769 at 42 weeks, and 1 in 633 at 43 weeks"

------------------------------------------

 

OK, so waiting from 41 to 43 is a 33% increase in risk (if I did that math right. 41 to 43 W goes from .12% risk to .16% risk). While that may seem like a big increase the actual total risk is still very low. Again, I personally vote for trusting nature. But it is a highly personal decision. (LOL, something I forget sometimes since it's easy to think "I AM RIGHT" but it makes me so mad that so many HCPs pressure women or even don't give them a choice and just say, "OK, we need to schedule your induction." As if it's not an option. Grrr!

 

 

***Regarding HB risks, studies show mixed results on that for HB. I'm personally planning an HB & I don't deny the fact that there are SOME very rare cases where being in the hospital could save baby's life & being out could therefore lead to worse outcomes. I think this is a truth. But on the whole I don't feel the hospital is safer.

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#15 of 30 Old 01-06-2011, 01:18 PM
 
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I agree with the consensus that you really need to relax here - the stress you're imposing on yourself isn't doing anyone any good.

If you're looking for stories - I had my first VE at my 40 week appointment, a Tuesday. I'd never had a contraction (BH or otherwise), no dilation, cervix was so high the midwife could barely find the dang thing. Went home. Started having contractions the following weekend, showed up to my 41 week appt (at 40w6d) on Monday and found out I was 6 cm. Baby was born the next morning, no interventions.

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#16 of 30 Old 01-06-2011, 01:31 PM
 
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I'm not going to lie, there has been some research showing improved outcomes with induction vs. "expectant management" (wait & see, only interfere if a problem arises) at 41W0D, HOWEVER - I don't think they've separated out multiparas from primiparas (first timers) in that research. The lack of that differentiation complicates the issue for a few reasons: 1. 41W is "longer" for a multipara than a primip anyway! (Compared to averages for their peer group.)

http://www.sidscenter.org/TopicalBib/Stillbirth.html  While it might be longer for a multip multips offer protection somehow that primps do not.  Just wanted to point that out.

 

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By 41 weeks there was a substantial increase in the stillbirth risk in nulliparous women but not in parous women. The pattern of rise is such that the stillbirth risk is 2.9 times higher (95% CI 1.06-8.19) in nulliparous women at >42 weeks' gestation. Conclusion: Being parous appears to have a protective effect on fetal mortality in prolonged pregnancy. These findings question the need for routine induction of labour at 41 weeks in parous women.

To the OP:  Honestly this is why some women do not get checked AT ALL.  It tells you nothing useful.  With my 2nd I was sure I was in labor at 36 weeks.  Had my mw check me the next day and I was 4 cm and 100% effaced.  Still went to 42 weeks.  6 weeks I sat at 4 cm without changing.  6 weeks!  So being really dilated and effaced did nothing for me.  In fact I had a really long hard labor with that one too.  Actually, I have had 8 babies and every single one of them was born at or beyond 42 weeks.  I don't even bother be checked anymore. I know it won't tell me anything.  I will still go to 42 weeks, and I might still have a long labor.  Trust that your body knows what it is doing, that everything will happen when the time is right. 


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#17 of 30 Old 01-06-2011, 01:39 PM
 
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Oh yeah, I too never had a single contraction - I mean NOT ONE BH EVER the whole pregnancy! But when I had my membranes stripped at 41W4D, I was 3cm, went to 4 as she made a QUICK circle with her finger (like not even 2 seconds). Ctrx started 2 hours later, then 1st stage was over in less than 5 hours! I resisted the urge to push on the way to the hospital (didn't expect it to go that fast!) arrived & pushed him out in 45 min. No problems!

 

As I said though, I had the same sense of stress & frustration that you had regarding feeling 'betrayed' by my body. I remember my doula saying something about, "Relax. Being too stressed can actually inhibit labor."

 

That seriously pissed me off. I kinda felt like she was blaming me. Like, "You're only making it worse, Meg!" I find it a little ridiculous to propose that desperately wanting to go into labor could actually inhibit labor.

 

Don't get me wrong, I believe in "sphincter law" as Ina May Gaskin writes. I'm sure extreme stresses or pressures can and do inhibit both the onset and the progress of labor, but I don't think being irritated & frustrated at not being in labor is one such stressor.

 

IOW, don't beat yourself up, don't feel guilty, and don't put yet more stress on yourself thinking that your feelings are to blame or are contributing to your problem.

 

I personally was so worked up over it that I made a million phone calls to find a psychologist with a free appointment (I hadn't been to a counselor in like 10 years, since college!) When I described the frustration/ betrayed by my body feeling, compounded by feeling bad about the fact that I felt bad, she said, "Is there any way you can be more gentle with yourself?"

 

For some reason this really resonated with me. Yeah, exactly. Might as well not beat myself up even more. I guess I felt like I then "gave myself permission" to feel that frustration at not being in labor. I had trouble stopping myself from feeling frustrated, but I could at least not compound it by feeling guilt over the fact that I felt frustrated, ya know? Sorry... rambling...

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#18 of 30 Old 01-06-2011, 02:49 PM
 
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Induction is not inevitable. At 40 weeks I was a fingertip dilated and 80% effaced. At my 41-week appt I was only 1 cm dilated and still 80% effaced. My MW did an NST and checked my amniotic fluid with ultrasound. Fluid level was marginal so she told me I had to come back in 3 days for another check and started talking induction. Like you, I desperately wanted to avoid medical induction. Well, I left her office at 1pm, went into labor spontaneously about 4 hours later, and delivered at 11:29 p.m. that day! I was doing Hypnobabies and just kept listening to positive affirmations and a track called "Baby Come Out". I also ate a "labor salad" (greens, gorgonzola, beets, walnuts, balsamic vinegar) that day and the day before. I hadn't tried any other natural methods of induction up to that point.
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#19 of 30 Old 01-06-2011, 05:33 PM
 
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It's definitely not inevitable.  I was so undilated at my 41 week appt that she couldn't FIND my cervix.  I'm talking completely closed.  That was Friday.  I went into labour on Monday.  On my own.


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#20 of 30 Old 01-06-2011, 08:14 PM
 
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I skimmed through the other posts and found that a lot of what I was going to say and a TON of fabulous information!

 

I also wanted to add that with my last, I was 42 wks along when I got my first cervix check by my mw. I got that one because she wanted to strip my membranes because I was so far overdue. At 42wks, my cervix was barely a fingertip dialated, almost no head engagement (I had also had had a u/s that day just to check up on things and we got facial profile pics of DS), little effacement, but my cervix was soft. I went into labor on my own a little over 24hrs later and had a 4 hr labor. How dialated your cervix is or isn't has little to no bearing on when labor will actually start and how things will progress once labor does start!!


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#21 of 30 Old 01-07-2011, 02:25 AM - Thread Starter
 
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Wow, thanks for all of the good replies!!!  It does make me feel better to hear about other people in my situation.  And thanks for everybody who posted the studies about the getting inductions!  They were really helpful, but perhaps I should have included more info in my first post.  My midwife doesn't routinely induce until 42 weeks, but the reason that we are moving that up a bit is because my baby has an umbilical cord anomoly that can lead to growth restriction/fetal distress/slightly increased risk of stillbirth.  The studies on it and the implications are somewhat inconclusive, and the baby seems to be doing fine as of now, but there is some concern about letting the baby cook for too long.  I had been getting serial ultrasounds to check the baby's growth, and even though the growth is still appropriate as of 5 weeks ago, there had been a steady decline in the growth curve throughout my pregnancy.  It is likely to be normal and no big deal, but then it could also be pathologic.  Realistically we really just don't know, and the concern is that if it is pathologic, as the pregnancy goes longer and longer we could have a progressively more stressed baby and be setting ourselves up for more complications than one would normally see.  So, I guess you could say that I am OK with the logic behind the induction - it isn't just some willy-nilly, well you hit the 41 week mark, let's kick the kiddo out sort of thing.  And I do know that inductions can be very stressful for babies - mostly why I am so concerned about having one!  I do like the idea that somebody had mentioned about just trying the cervadil to get things moving along a bit.  And I guess that I could always talk to my midwife about if it doesn't look like the induction is going to be successful, maybe just calling it a failed induction and come back in a few days to see where we are.  Has anyone done that?  Know if it is a possibility?  I do really like my midwife, and it seems that she might be willing to work with me. 

And, THANK YOU, MegBoz for sharing about your doula trying to tell you that you were inhibiting labor by being stressed out!  It isn't that easy to just go ahead and flip off the stress button, and it doesn't feel great thinking that people are blaming you for your cervix not dilating.  I am not trying to hold this baby in.  My Mom just tells me to relax, and that will put me into labor.  Gee, thanks Mom.  Really helpful.

At any rate, I am going to plan for the worst and hope for the best.  I do love the birth stories, they really do help make me feel like I can still successfully vaginally birth my baby without an epidural.  I am going to bring a birthing ball to the hospital and they have a squat bar there already (I think), so that might help move things along or ease some pain if I do have to get induced.  My hubby will sneak me some snacks and juice to help keep my energy up.  I am going to limit vag exams.  My midwife isn't huge into them anyway - she only did the two in my whole pregnancy, and that was because I asked her - stupid, STUPID, I know, but I was just soooo curious!  Any other suggestions to make childbirth more easy if I must be confined to a bed or a five foot radius around it?  Thanks. 


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#22 of 30 Old 01-07-2011, 05:59 AM
 
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Quote:
Originally Posted by MomRunner View Post

And I guess that I could always talk to my midwife about if it doesn't look like the induction is going to be successful, maybe just calling it a failed induction and come back in a few days to see where we are.  Has anyone done that?  Know if it is a possibility?  I do really like my midwife, and it seems that she might be willing to work with me. 

 

<snip>

Any other suggestions to make childbirth more easy if I must be confined to a bed or a five foot radius around it?  Thanks. 



Yes, you could stop an induction that was not progressing and go home.  One thing to make sure of if you are considering that is to NOT let them break your water.  Then you are on a clock.

 

In terms of dealing with an induction, all of the clients I have had be induced (which admittedly is not that many) have done it without any pain meds, which is a better record than my clients not getting induced honestly!  You definitely do not have to stay in bed.  There are lots of things you can do around and in the bed to make your labor easier.  Also, many hospitals have telemetry so that you can be continuously monitored and still move anywhere you like.  In bed, you can do hands and knees, kneeling over the back of the bed, do kneeling lunges, knee/chest to help malpositions, tailor sitting and sidelying; and next to the bed you can use the birth ball, squat, lunges, standing/leaning over a birth ball on the bed or on the bed itself.  If you are able to get telemetry, many of those can even go into water, so you could shower or get in a tub if available as well as walking.  Do you have a doula?  That can make the experience better, since she'll likely have a lot of ideas about things you can do for comfort even while an induction is underway.  If not, it's possibly not to late to find one!


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#23 of 30 Old 01-07-2011, 07:50 AM
 
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MegBoz,  Totally argree with you about the ROM thing... for some reason I had never seriously considered that would happen without labor starting... and of course it happened!  That is one of the things I would do differently now if everything was looking ok (temp. etc.), I would wait a bit longer for induction instead of going in after 16 hours.  


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#24 of 30 Old 01-07-2011, 09:08 AM
 
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:) I'm glad my ramblings were helpful.
 

Quote:
Originally Posted by womenswisdom View Post

Yes, you could stop an induction that was not progressing and go home.
<snip>
Do you have a doula?  That can make the experience better,

ITA with that whole post!

 

I was going to mention a doula too. Since induction means you're already deviating from a normal, physiological birth, I think having someone there with lots of experience & knowledge is even more important.

 

Personally I would also say it's important to alter your expectations. I don't mean to be discouraging saying you can't forgo an epidural with an induction because I know it certainly CAN be done, but I personally wouldn't want to put as much pressure on myself to forgo the epidural. Knowing what I know about how pitocin acts, I was personally much less confident in my ability to forgo the epi if I had to be induced.

 

I'd try to think that if the medical intervention of induction was for the best - really the best course of action for the baby - and it inhibited my ability to cope to the point where I felt I definitively crossed that line from experiencing pain to actually suffering, then the epi would probably be the best choice. I wouldn't want to reach a point where I felt it was horrific and I was going to be faced with PTSD from the pain & not want to give birth again! It's certainly possible to have a positive birth experience with an epidural - I've known lots of women who have.

 

I'd focus more on maximizing my chances for a vaginal birth - so getting the epi later in labor to make sure I'm progressing well (and thus the labor slow-down-effect of the epi would leave me less likely to end up with an FTP diagnosis.) Making sure baby was in a good position before getting the epi (since you can't really move around to help baby GET into the right position once you have the epi.) and making sure they never jacked the pit level up so high so there wasn't as great of a chance of fetal distress, avoiding AROM, and making sure my MW was patient - also avoiding hourly or every-2-hours vaginal exams.

 

Sending labor vibes your way!!!

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#25 of 30 Old 01-07-2011, 09:14 AM - Thread Starter
 
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Yes, you could stop an induction that was not progressing and go home.  One thing to make sure of if you are considering that is to NOT let them break your water.  Then you are on a clock.

 


Thanks, this is helpful information.  I do like the idea that I am perhaps not obligated to see a failed induction to the end.  I did discuss with my midwife about the ruptured membranes, and she doesn't really have 'clock' to c-section.  After 24 hours of ruptured membranes, I will definitely get antibiotics, but she doesn't section people on a time clock.  Most hospital policies of getting major surgery to avoid infections seems kind of stupid!

Unfortunately, I am fairly certain that my hospital doesn't have telemetry monitoring so getting too far from the bed is likely not an option greensad.gif.  I have discussed getting a doula with my husband, and he feels very strongly that he would like it to be just us when I am laboring.  We'll see, at this point I don't know if we could get to know somebody well enough.  Thanks for the tips, I am going to give them a shot!.


Vegetarian, breastfeeding, cloth diapering and EC'ing mama to my bare-foot, TV-free, free-range toddler and loving it!!!

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#26 of 30 Old 01-08-2011, 04:28 PM
 
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Sounds close to my first but I wasn't effaced at all when the doctor checked. I had her 3 days later after 16 hours of labor. Not to bad since it was my first baby.


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#27 of 30 Old 01-08-2011, 06:46 PM
 
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I also had cervical gel (high BP at 37 wks), and then a pitocin free, drug free natural delivery in less than two hours. If it's any encouragement, I was 9 cm and -3 station, and five minutes later my baby was out and in my arms. So your body can work fast when it's ready. I think many of those natural induction methods only work when your body is either just about to start labor or is in early labor.

 

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#28 of 30 Old 01-08-2011, 09:00 PM
 
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How dilated you are on any given day, at any given time, how far the baby has dropped, etc... it has NOTHING to do with when you will go into labor and give birth. I spent a solid month at 2-3 cms and 70-80% effaced with my daughter at -1 or even 0 station and had regular bouts of false labor. Trust me, you will be MUCH more comfortable with your cervix tightly shut and your baby's head out of your pelvis and not having painful contractions every five minutes every night for weeks.

 

I know this time is really hard and you just want it to be over with and meet your baby! But try not to drive yourself crazy about when it's gonna happen- it'll happen when your baby is ready.


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#29 of 30 Old 01-08-2011, 09:56 PM
 
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OP, your story is exactly why I didn't get cervical checks while pregnant! I gave birth three weeks ago and like you, there were absolutely no signs of labor being imminent towards the end. I ended up being induced at 41 w 4 d. We started with the cervical gel and altho that started contractions, they were irregular and after being in the hospital 25 hours (and having my waters broken by the midwife), I got the dreaded pitocin drip. It was definitely not the route I envisioned my birth going but I got through it ok. On the positive side, I had an very fast labor for a first time mom-after the pitocin was administered, it was only 4 hours to pushing and then just an hour of pushing for me. I'm a little disappointed in my experience and I felt bullied by my CNM, but the induction wasn't as bad as I thought it would be either. I made it through without an epidural. I did get some pain medicine in my iv but by the time I got it, I was almost to transition without knowing so all it did was make me sleepy and feel drugged between contractions. If I could do it again, I would definitely not get the analgesic. I would also strongly advise you to talk with your provider about exactly how they will administer pitocin if it comes to that. I received an increase in dosage every 20 minutes and once it got things going, it really got them going for me. Eventually I had my husband tell the nurse not to continue increasing the dosage and I think that helped me gain some control over the contractions. Also, I tried different positions while being strapped to the stupid monitor and IV pole and I actually found that being on my back in the bed during contractions and pushing was most comfortable and productive for me, which I was really not expecting. I definitely didn't have a great range of movement but I could get on the birthing ball and rocking chair easily as well as a lot of positions using the bed/table for support, so some movement was possible.  One last tip-make the nurses put the IV into your non-dominant hand/arm. They put it in my dominant hand and it was such a pain to have it in my way for the two days it was in. I really hope to have a labor that is allowed to start and progress on its own in the future but I thankfully don't feel traumatized or "cheated" by my birthing experience either. My daughter was breech until about 38 weeks so between that and setting the induction date, my expectations were lowered from "natural labor process that gives me time to labor at home" to "ANYTHING BUT A C-SECTION" so I think I'm still just relieved I was able to get her out vaginally! I really hope your little one decides to come out on their own and you can forget about all the advice you receive in this forum, but also take heart that you can still have a lot of the aspects you want in your labor if it is an induced one.                                     

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#30 of 30 Old 01-25-2011, 12:37 PM
 
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Quote:
Originally Posted by JulianneW View Post

http://www.drmomma.org/2009/09/why-pregnancy-due-dates-are-inaccurate.html

 

This is a great article, every woman is unique. 

 

"Every woman's due date is calculated with the assumption that she has a 28-day menstrual cycle. In addition, it is assumed she ovulated on day 14. Then, the due date is 40 weeks from her last menstrual period.

This method of calculating due dates is extremely out-dated, presumptuous, and flawed. First of all, not all women have regular menstrual cycles. Secondly, one woman may have a 28-day cycle, while a second woman's cycle is 35 days, and a third's is 40 days. Healthy women have menstrual cycles of various lengths, and the length can even change throughout a woman's life or from one pregnancy to the next. As a result, due dates are often inaccurate."

 

I also found this one very interesting-

http://www.drmomma.org/2008/01/fetal-lungs-protein-release-triggers.html



Hi!

I really like your answer.

Two induced labors. I would say that most of the time they miscalculate. In my case, my husband and I are very well aware of the days we had intercourse or not...My DH is Jew. We have special rules. When I explain that to the doctors they have that funny faces, probably thinking that I have forgot that I had intercourse with my husband. My miscarriage (in December) led me to a Jewish Doctor, I was so anxious and so unhappy with my previous traumatic experience with induced labor... That Doctor, after listening to me carefully for half an hour, said that it is very possible that they miscalculate, and they give you a due date  inaccurate.

 

 

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