AROM when to do it? *UPDATE* - Mothering Forums

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Old 04-15-2004, 05:26 PM - Thread Starter
 
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It looks like we're looking at an induction I was really hoping to avoid it. I'm due 4/16, next OB appt is 4/20. If I haven't gone into labor by then (which I'm actually hoping not to, the on call doc for the weekend is a little too knife/intervention happy for my comfort), we'll be scheduling an induction. After voicing that I would be comfortable (so to speak lol) going to 42 wks or so, I of course got the scare tactics - still born baby, etc. It was a bit upsetting to say the least.

My last labor was forced - pitocin, AROM, episiotomy, vaccuum, etc. I'm trying to learn all I can to avoid another forced labor.

Anyone know if an induction can be stopped if labor doesn't seem to be progressing? In my thinking, if they start all the drugs and my body still doesn't respond and go into labor....its just simply not time. The docs on the other hand I'm sure will assume I haven't had enough drugs or intervention and remedy that as best they can : (Can you tell I regret not finding a midwife for this pregnancy?).

Also, I don't want them to rupture the membranes early on (and as I read more, I'm not sure I want them to do it at all). When is a "good" time to allow the docs to do this? Any certain point of dilation?

Thanks!
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Old 04-15-2004, 05:55 PM
 
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I read that membranes rupture most often while pushing begins, or shortly thereafter. So maybe if yours were ruptured at 9 cm, it wouldn't be so bad. Mine were ruptured at 6 cm and as soon as they did it the pain really intensified. It didn't shorten labor, either, it just made it worse. I'm not letting anyone near the membranes this time!

Your due date isn't for another 2 days. Anything could happen then. And if you're afraid to deliver on your due date because of the doctor you'll end up with, your body will know it and labor won't start. I bet they won't be willing to stop the induction if you don't have the baby within a certain number of hours; most likely they will bully you into a c-section.

42 weeks is normal. I've never heard of anything saying that a 42-week gestation has a greater risk of stillbirth than a 40-week one. I've read that the risk increases very slightly after 43 weeks; still, I think induction has more risks.

The best way to avoid an induction is to not show up. Tell them you were halfway into a really good book and just forgot.
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Old 04-15-2004, 06:42 PM
 
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As far as increased risks for baby and mother, the statistics show that in non-induced laboring, approximately 25% of babies are born by 39 weeks, 50% are born by 40 weeks, 75% are born by 41 weeks and about 95% are born by 42 weeks. (I'm sorry I don't have any sources for this... : ) The risks to baby increase about 3 times AFTER 43 weeks and about 7 times after 44 weeks. (I think this is from Ina May's book, but my pregnancy brain shouldn't be trusted...) Ask your physician for some resource material, too, so you can make a well-educated decision from the information they are looking at as well. Read it and then go to the same sources (probably www.pubmed.com at the NIH) and find some contradictory evidence and ask them about it. And let them know that you feel like they maybe are trying to bully or scare you into a choice that you don't think you have enough information to make. Sometimes physicians just need some honesty and self-awareness pointed back in their direction.
Quote:
Originally posted by Greaseball
The best way to avoid an induction is to not show up. Tell them you were halfway into a really good book and just forgot.
And this is the best idea I've heard, too! And don't answer the phone that day either!


edited to add:

From the Spinning Babies website
Quote:
Keeping your water intact, at least until you are past the 5th centimeter, can help avoid trouble when you start to push. By the time you are 5 cm., it is usual for the baby to be rotated in a straightforward labor. In a very slow labor, you might ask to wait until the bag of waters appears after pushing has been established. The bag of waters can break on its own, and then the matter is settled. Babies are born with intact waters only occasionally and that’s fine and healthy.
warmly,
claudia
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Old 04-15-2004, 08:04 PM
 
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Sheila Kitzinger quotes a stat in one of her books that unexplained stillbirth is 1 per 1000 at 40 weeks, 1.2 per thousand at 41 weeks and 1.3 per 1000 at 42 weeks. Pretty puny difference.

As for the increased incidence of meconium in post-dates babies, I find that I see it more with the kind of long, drawn-out labors you get with inductions.

What about a compromise like agreeing to frequent monitoring once you get past 40 weeks?

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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Old 04-15-2004, 08:40 PM
 
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Check out Henci Goer's books. In "The Thinking Woman's Guide to a Better Birth" she writes,

Quote:
You may be surprised to learn that the conventional forty-week pregnancy length is completely arbitrary. It was established by a German obstetrician in the early 1800s. He simply declared that a pregnacy should last ten moon mnths, that is, ten months of four weeks each. However, when researchers in a 1990 study followed a group o fhealthy, white women, they discovered that pregnancy in first-time mothers averaged eight days longer tahn this, and the average was three days longer in women with prior births.
There's a whole section on induction, and she's made extensive summaries of the medical literature, and includes a bibliography of clinical studies that back her up. Check it out if you want some info to present to your doctor, in addition to just saying 'no'.
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Old 04-15-2004, 10:27 PM
 
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It's never too late to switch care providers. My mw has mothers who are in their last weeks and days call her all the time. It's not an ideal way to have to change, but it's YOUR birth, your baby, and your body. Just a thought. I know the prospect might be scary, but just wanted to throw that out there.

Thinking of you!

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Old 04-15-2004, 10:50 PM
 
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With any intervention you have to ask yourself- why am I doing this? And what are the risks/benefits?

The risks are...
prolapsed cord
asynclitic baby (which can mean longer/ more difficult pushing)
increased interventions if the waters are stained (which are sometimes needed but often not)
increased risk of infections
depending on the method, the hook could hurt the baby
there are more...

The benefit is that the baby's hard little head applied to the cervix will dilate it faster than a soft bag. It just reminds me how much the medical model is a time based model, not a wellness based model.

Can you get a wellness assesment and then go from there? If you have to do these things it would be nice to know there is a reason.

If they start and you aren't responding to the induction, you will always have the choice of telling them to stop, however you will most likely be doing this AMA (against medical advice) and that can be complicated ans set you up to be in an adversarial position.

Good luck to you.
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Old 04-16-2004, 01:25 PM
 
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Beautiful, wise words, mamas.

You could forgo the AROM for SROM...spontanious rupture of membranes. Allow your own body to ROM; you don't have to worry about when to let your OB snag your bag--you can let your baby and womb determine the time.

Quote:
Anyone know if an induction can be stopped if labor doesn't seem to be progressing?
(first off, I abhore that a failed induction is blamed on the woman as failure to progress)

I would guess that an induction could be stopped, if mom's bag of waters is intact. Once on the show Birth Day on Discovory Health Channel, I saw a woman attended by a family practice MD, who was induced, but it didn't take, so the pregnant woman went home, and came back later.

Since most OBs want a woman in the hospital if her water breaks spontainiously, I think it would be hard to escape a slow induction with a broken bag.

It's okay to trust your body to labor effectively and let your body succeed. My first labor was induced--AROM & Pit, because my cervix was favorable and it would be convienent to have a baby on Wednesday, my OBs surgery day (logic: he's at the hospital anyway.) I had to work through some feelings of trusting my own body, when it was time to birth my second baby.

If you really want my advice, and you really want to avoid a forced labor, why not hang out at home until your labor is well under way (which it will be, 'cause your body can grow a baby--it can also contract one out! )

Good luck to you as you make the choices you want for your birth!
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Old 04-16-2004, 05:33 PM - Thread Starter
 
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Thanks for all the info and suggestions everyone

I decided that I'm just going to tell him I want to wait at least another week. Or maybe tell him I'll schedule an induction so long as my membranes aren't artificially ruptured, and that I can stop if labor isn't progressing.

My main reason for not wanting AROM is I don't want that kind of time limit on me to give birth. If that baby isn't out in 24 hrs, its almost certain I'll have a csection. When I was induced with my first, it really wasn't so bad - it went fast (about 5 hrs) with basically no pain (except for the pain of the docs interventions and healing from them ), so I'm hoping if I am induced, it will be another nearly pain-free quick one.

Thought I'd also mention, when I told him that I would really like to avoid another forced labor, he said he would too....first thing out of his mouth was that it means more paperwork Made me feel like thats all I was to him (that and probably the money he gets...).

Georgia - that is exactly what has been going through my mind. I wonder if the midwife here would go for such a thing. I have a feeling it won't be a possibility this late in the game though, I think there's only one in town
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Old 04-16-2004, 05:57 PM
 
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The only thing that would make me nervous about going ahead with induction, but telling them to not AROM is what if they 'ooops' and break your water 'accidentally'?

I don't understand why waiting would be bad for your doc. A baby born at 38 weeks is considered full term and healthy, why would a baby born at 42 weeks be a problem? It's not like the timer turns off and baby is done right at 40 weeks anyway.....

Michelle -mom to Katlyn 4/00 , Jake 3/02, and Seth 5/04
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Old 04-16-2004, 07:36 PM
 
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Yeah, and it always seems to be that if your water is broken - even if it's obvious that labor isn't progressing (contractions every 10 minutes or so) they are always sticking their fingers up there! Ugh! You're better off protecting your baby and your body by refusing induction and definitely by letting your water break on its own. Breaking water is hard to do with a vaginal exam between contractions. Once the contx starts, however, some firm pressure against the bag will break it. So, rule of thumb: no vaginal exams during contx!!

It sickens me how many exams women get - and even more so with ruptured membranes. I wonder if the GBS infection rate would drop if they would stop doing VE on women with ROM.
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Old 04-16-2004, 07:38 PM
 
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It doesn't make any sense that doctors tell you not to have sex with ROM but are still anxious to get their own fingers in there.: Does this go back to that old belief that the hands of the physician couldn't possibly be unclean?
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Old 04-17-2004, 07:28 PM
 
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I always find it odd how OBs listen to ACOG in reference to things like VBACs, but ignore them when it comes to inductions. ACOG states nothing should be done as far as inductions until a woman has completed her 42nd week of pgcy! I was induced and it was awful! You don't want want AROM at all, just let it happen on your own. My ctxs went from me barely feeling them to OMG I think I'm going to die when they broke my water at 2 cms. Yes, 2 cms! I believe b/c of this, my baby wasn't able to move and ended up in a crappy position making it impossible for him to come out vaginally. Good luck w/ whatever you decide.

Jennifer, LPN and nursing student, Doula, CPST, and VBAC mama x3 to
AJ (5/03), Evan (12/04), Ilana (11/06), Olivia (2/09), and Unity (8/2012)

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Old 04-18-2004, 12:54 AM
 
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Jodi ~ hugs

Give that midwife a call! What can it hurt?

Also, there should be an article in the Mothering archives on the Hormonal Blueprint of Labor. I can't remember if it's the same as the article entitled "The Ecstasy of Birth" or if it's in another article. : I'll try to look it up.
Meanwhile, lol, my point is that there is this intricate dance your body does in normal labor. E.g. your uterine contractions produce natural oxytocin when it's time... OBs like to "add" more oxytocin to the mix, thru the oxytocin in the bag of waters as well as thru increasing Pitocin (synthetic oxytocin).

But when your body produces natural oxytocin, the brain triggers other hormones later - endorphins, seratonin & later prolactin if I remember. Give a natural high, relaxes mama, enhances bonding feelings and milk production. Hope I have all this right, but it's something like this.

My point is that while measures should be taken in emergency situations, there is a lot to be said for the wisdom of normal birth, when mom & baby are okay.

(So when my water broke for instance, & labor didn't begin, I consented to monitoring my own temp for fever and doing a nonstress test but not to induction.)

One intervention will lead to others, most of the time. (Not all)
Oftentimes as a doula I see AROM => super intense ctx => epidural => slowed labor => pit => baby's heartrate fluctuates => manually assisted delivery (forceps etc) or c-sec

I'm so glad that wasn't the case for you last time. Every labor is so different. But trust in the process of normal labor and get support with you!!! If you can't switch to a midwife, can you get a doula with you? Then at least whatever decisions you & the doc make, you can work on creating a calm & suportive atmostphere for yourself -- Your feelings of wellbeing will help to create those positive hormones flowing. Fear & stress produce adrenaline and other stress hormones. Work on creating the *good* vibe.



Good luck & keep us posted!

mb

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Old 04-18-2004, 01:57 AM - Thread Starter
 
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Quote:
Originally posted by mamabutterfly

One intervention will lead to others, most of the time. (Not all)
Oftentimes as a doula I see AROM => super intense ctx => epidural => slowed labor => pit => baby's heartrate fluctuates => manually assisted delivery (forceps etc) or c-sec

I'm so glad that wasn't the case for you last time.
Unfortunately, this isn't too far from what happened I skipped the intense ctx, epidural, slowed labor, but I sure got the pitocin, AROM, fluctuating heart beat, and manual assistance (episotomy and vaccuum).

Its amazing how much a doc can make you doubt yourself. I started getting all worried last night that the baby wasn't moving enough and thinking I should go ahead and induce. The baby doesn't move as often as they say he should, but when he does, he sure is strong lol I decided to trust my body and we're not going to induce until April 30th (14 days past the due date), I'm pretty sure I'll go into labor by then

That article sounds really interesting, I'll have to look for it

Also, how would I go about finding a doula? There's no doula listing in the yellow pages lol Anyone know if insurances pay for this (or how much it might cost out of pocket)?
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Old 04-18-2004, 02:04 AM
 
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Jodi, I had a client recently transfer to my practice as late as 37 1/2 weeks. I'd call her.
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Old 04-18-2004, 08:13 AM - Thread Starter
 
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Well, isn't this just dandy? I woke up at about 3 am and my water broke. I decided I was going to be holding this little guy in all weekend until my regular doc got back on Monday...but no, he must be a stubborn little guy lol Guess I'm going to have to see the on call doc anyway.

Just curious, how long can I safely stay at home with ROM? And what precautions do I need to take? I wanted to labor as long as I can at home - and hey, I'm willing to labor well into Monday afternoon just to have my real doc back lol

Edited to add:

Thought I'd mention, its clear The baby has also been engaged at 0 station for about 2 wks now so I don't have to worry about prolapsed cord or anything right?
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Old 04-18-2004, 11:32 AM
 
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Oh, shoot! I was going to send you to the doula listings atwww.dona.org . I don't know where in NM you are...

Anyway, by now you've probably called the hospital & they will want you to come in there - I have my own thoughts on this but you do need to work with your care providers at this point, right?
They will want to check for signs of infection. If you aren't ctx, question frequent vag, exams as pam said.

The fantastic part is - things will probably get moving now! Your last labor sounds quick, your baby's engaged, you made it to 40 weeks. I think it all sounds great!

In case you haven't left yet, focus on whatever can help you deeply relax - tell your partner exactly what would help you most.

If ctx haven't started, some people find success with nipple stimulation (hand or pump). I ate spicy food. :LOL It worked right away.

Happy birthing vibes! I will be thinking of you all day. C'mon baby!!!

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Old 04-18-2004, 01:13 PM
 
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sending you peaceful birthing vibes...

hoping you get to meet your beautiful babe very VERY soon!!!

warmly,
claudia
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Old 04-18-2004, 02:29 PM
 
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There is no one answer on how long a woman can safely have ROM before infection. Some say as many as 48 hours, some say as little as 2 hours. If you skip the vaginal exams (which you can do, even the one that allows you to be admitted, no matter what your doctor says) your chance of infection is a lot lower.

I think it's risky to go to the hospital before regular contractions.
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Old 04-18-2004, 05:07 PM
 
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I am so excited for you. What a fantasitc day this is!!!! Yipeee!!!!
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Old 04-18-2004, 05:43 PM - Thread Starter
 
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When I woke up this morning I was positive I did not pee on myself lol I got up to go to the bathroom, then laid back down with dry undies on, got up about 25 mins later to see if all stopped, and of course it didn't. I had to change again so I assumed my water broke.

I get to the hospital around 7:30 and they said there is no amniotic fluid. Is it normal to stop like that? I was also having ctx about 5-7 mins apart, but I couldn't really feel them (couldn't really feel them with my first either). It was just a dull achey feeling, like menstrual cramps.

Its a blessing they sent me home. For one, I am strep b pos, which my doc did not tell me so I haven't read up on it at all - I know practically nothing about it.

Also, I could tell it was going to be a real fight to explain that I'd rather be monitored if the baby isn't born in 24 hours than be induced. An induction is the last thing I want - a friends cousin just had a baby yesterday - she was 4 wks early but the docs said her baby was 8lbs, they had to induce. She stalled at 4 cm and ended up with a csection - to deliver a 6 lb baby! Lets hope when my water is leaking again that I'm at 7+ cm already lol

So, I'm just waiting it out again. Maybe there's still time to get ahold of that midwife.....
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Old 04-18-2004, 05:52 PM
 
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If you don't want an induction, don't let them start an IV. They can easily slip pitocin into that. They say you have to fill out consent forms for induction, but if labor is already started it's considered "augmentation" which does not need consent.
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Old 04-18-2004, 06:32 PM
 
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There is a simple, effective way to prevent infection:

NOTHING in the vagina. (NO EXAMS!) No baths, either. Simply monitor your temperature every hour or two to make sure you're not getting a fever.

Women can go for a week or two with ruptured membranes and never get infected. As long as you monitor your body temp, it's fine.
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Old 04-19-2004, 09:57 PM - Thread Starter
 
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We're going to see a midwife tomorrow. She's a CNM delivering at a hospital. Its kind of scary just switching this late in the game, but even the comfort of having someone non-intervention minded delivering and who will at least be willing to listen to what I want will be helpful during labor. I don't want to be worrying about what uneccessary procedure the doctor is going to want to perform next.

Would you say its a bad move just switching over to a midwife without first meeting her? It really makes me nervous, but so does the idea of sticking with the docs I have now :

What are some specific questions I need to ask when I meet her tomorrow? Do you think going over my list of "birth preferences" will be enough?

Thanks
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