what's with this trend of starting labor < 40 weeks? - Mothering Forums

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#1 of 110 Old 06-21-2004, 11:32 PM - Thread Starter
 
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my own OB told me he prefers to deliver babies at 36 or 37 weeks because then they aren't "too big" ~ because according to him, any babies closer to 40 weeks come out and are like "shoving a huge table through a small doorway." personally i think that's BS, and that babies come when they are ready, be it at 37 weeks (like my first), or 42, and that in almost all cases, a mama can birth whatever baby she can grow.

i was just reading through another forum for pregnant mamas (one that's a bit more mainstream) and nearly everyone there are talking about how their doctors are pushing them to have the babies, and they're all around 37 weeks! a few are actually scheduled for induction at 38 weeks, simply because "it's time." one woman's doctor told her that if she went to 40 weeks, she'll "need" a c-section, because "that's just too long to keep a baby in there."

is this some new obstetrical trend?

what's going on??
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#2 of 110 Old 06-21-2004, 11:37 PM
 
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I have no answer for you. I'm just shuddering at the horror of it!

I have absolutely no doubt that my nearly 42 weeker would certainly not have been ready to greet the world at 37 weeks.
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#3 of 110 Old 06-21-2004, 11:39 PM
 
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I haven't dealt with that. My OB is comfortable with letting me go past my due date up to 42/43 weeks, then we'll talk about delivering. It was one of the first things I asked her.
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#4 of 110 Old 06-22-2004, 12:37 AM
 
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DH's SIL just called tonight to say she is being induced tomorrow (37 weeks) due to how "big" the baby is at about 7lbs...she has said all along she plans on having a "natural, drug free birth" when I said something like she must be disappointed about not having a natural birth she said that pitocin "didn't count" because it wasn't a pain medication...hopefully everything will go brilliantly tomorrow but I have bet with DH that she winds up with a c/s....my theory on Docs wanting to induce so soon is that they can plan around any golf games/vacations and they don't have to catch/lift something *so* heavy and more $$$$ for the hospital if the baby/momma has to stay longer and especially big $$$$$ for the hospital if the NICU is required. I'm sure some docs get a commision or bonus for earning extra $$$$ for the hospital...rolling my eyes....

So sad!

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#5 of 110 Old 06-22-2004, 12:45 AM
 
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The mothers and the babies pay the high price for this trend.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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#6 of 110 Old 06-22-2004, 01:01 AM
 
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Hmm. I've said this at least 1/2 a dozen times in various forms, but... I recently had a 9+ lb VBAC at not quite 42 wks. No, it wasn't hard to push him out (dh and I are tall, and frankly, I'd be surprised if we had "short" or "small" babies). And "late" babies seem to be more mature and easier to take care of...
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#7 of 110 Old 06-22-2004, 07:30 AM
 
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Ya know I've notice this too and think it is awful sad. My cousin was all set to have natural birth and the doc told her that her baby was too big and she'd have to have a c-sec. and she went for the c-sec he was only 9 lbs 1 oz
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#8 of 110 Old 06-22-2004, 07:39 AM
 
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That is shocking. We don't have that problem here in the UK because of the NHS. In fact our local hospital trust changed the rules this year so that you can go 12 days overdue rather than 10 before they want to induce you. They are very keen to lower the C-section rate (due to phenomenal cost as well as Mum/baby welfare) although the practical realities of doing that are more complex.

I was found to be having a big baby (9 llbs 1oz) and although I am quite short they were happy for me to go into labour naturally and have a natural birth. Unfortunately my stupid uterus didn't know how to do it's job properly (I never got past 4 cms) and ended up with a C-section but it was nothing to do with the size of my baby.

The maternity services in the US is really in a shocking state if this is the kind of route they are taking there.

Seems like a lot of the recommendations are all about the Dr's convenience (and pocket?) and little to do with what is best for Mum and baby.
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#9 of 110 Old 06-22-2004, 08:04 AM
 
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Ds no 6 was 37 weeks 5 days and had a cry like a preemie.he came early and unexpectedly.I was only in labor a couple of hours.I can't imagine wanting a baby to come early like that : I sure whish 20/20 or 60 min.would do a major expose` of u.s. obstetric practices and how they don't mesh with who recommendations.If mainstream mamma's saw something like that maybe they'd wake up and make more of an effort to educate themselves and question their docs
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#10 of 110 Old 06-22-2004, 08:47 AM
 
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Convenience and a failure to practice evidence-based care.


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#11 of 110 Old 06-22-2004, 10:41 AM
 
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This really pisses me off. I am absolutely agast at so many ob/gyns cavalier attitude toward the possibility of a PREMATURE baby. WTF? As someone who spent 11 weeks in NICU I am flabbergasted as to why anyone would induce < 40 weeks without a darn good medical reason. Such a gamble. I am also stunned that they do not expalin the RISKS of induction/early delivery to the parents. Like it's no problem everythings fine and dandy. My sister just was induced at 41 weeks (no medical reason, ended up with a c/s) and the attitude was ho-hum and she wasn't even informed of the risks AT ALL. THAT is unethical. I just can't believe they not only don't inform... but they LIE! She was told their are no risks. : :

It astounds me. I miss lots of things from home... but, this crap I don't miss and I am glad I don't have to deal with it. Switzerland is bloody mecca compared to the US and we aren't even so hot compared to other countries.

I'll shut up now. I can feel my blood pressure rising...

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#12 of 110 Old 06-22-2004, 10:56 AM
 
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Quote:
Originally Posted by applejuice
The mothers and the babies pay the high price for this trend.


I want to go around putting "Caution" signs on certain doctors' offices! (Not yours, doctorjen! )

I just feel that there are a small number of medically warranted inductions, and a huge and growing number of unwarranted & infuriating ones! Why can't more doctors just leave well enough alone & trust the natural process of labor?! I just want to cry...

Also worth adding that the 'ability' of our bodies to birth 'large' babies is tied to our being free to labor/move/push etc as we intuitively need. It's probably true that many women will have difficulty pushing out any size baby on her back, numbed, feeling scared, etc.

There would need to be so many changes to create a peaceful, private, upright, emotionally safe, suportive (Clock free!) environment in hospitals - where most families currently chose to birth.

So much of this would need to change to make more of the full term births go well and discredit the notion of women not being able to birth a baby bigger than 7 pounds. Where's my :big-sigh smilie?

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#13 of 110 Old 06-22-2004, 11:13 AM
 
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Wow. I had not even heard of this trend. Scary stuff.

I had an induced labor with ds at 38 because of preeclampsia, and I would certainly never choose to have another induction. Ds weighed 7 lbs, 1 oz, and I can't help but wonder if our breastfeeding problems would have happened had he been a bigger, more mature baby.

This baby and I have an understanding - she is going to stay inside and grow to be the biggest baby she can be! We'll make our "outside world" introductions as close to her due date as we can manage.
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#14 of 110 Old 06-22-2004, 11:26 AM
 
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This happened to me too.

First with my twins I was told I needed an emergency c-section at 36.5 wks. I asked about the babies lungs, would they by developed? Doc said yes, no worries. Fast forward to reading my records in prep for son's birth. The doc wrote that she had warned me of danger of having babies with underdeveloped lungs, the possibility of a stay in NICU, etc. Um, no she didn't! Quite the opposite. There are many other reasons I know that the c-sec was done for convienience but it's OT.

Then I was seeing an OB for my son. He was very encouraging about VBAC, I have a great scar, etc. Over the next 5 months I would ask questions. He told me I would not be permitted to go past 38 weeks. At that point I would be induced. I told him induction was rather dangerous for a VBAC, right?
Needless to say, I changed providers to a wonderful midwife and had a lovely home waterbirth at almost 42 weeks. 8lbs. 14ozs. No signs of being overdue.

My MIL is an RN and she says that without a doubt docs induce and or do c-secs to go on vac, make appts, watch football games. She says it happens all the time.

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#15 of 110 Old 06-22-2004, 12:02 PM
 
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There is a fairly large practice in my city that is routinely inducing women at 39 weeks.

It's all about perceived "risk" and complete management and control over the labors.

Why aren't women more outraged?

All this adds to the increase in stories where women say, "I [or my baby] would have DIED if we had a homebirth!"

Ugh.
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#16 of 110 Old 06-22-2004, 12:47 PM
 
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Quote:
my own OB told me he prefers to deliver babies at 36 or 37 weeks because then they aren't "too big" ~ because according to him, any babies closer to 40 weeks come out and are like "shoving a huge table through a small doorway."
Typical scare tactics, IMO
Doctors know their services are totally not needed for most pregnant/laboring women, so they have to plant doubts in our minds when it comes to trusting our bodies to do what they were designed to do. That, and most of them really do seem to believe we need them in order to give birth, that there is some sort of inherent flaw in human women's bodies that makes it impossible for us to give birth without their help.

Oh my, imagine what would happen if women actually started believing in their bodies to give birth without modern medical techniques! :
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#17 of 110 Old 06-22-2004, 01:13 PM
 
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Let me just say thanks for bringing up this topic- I have seen this trend for a long time and whenever I said anything to anyone, they would look at me like I had 2 heads. Most women these days are so afraid of their bodies and don't trust in their natural instincts that they seem to prefer a total stranger (or even not so total) to take control for them.

I don't understand how a baby can get "too big" for a mother that they need to induce. What is going to happen? Is the baby going to stay in there for a few years and set up camp or something? Maybe if they spent more time encouraging mom to have faith in her body and instincts or even try helping mom to deal with any deep seated issues about the birth, we wouldn't have this problem, and we might have a few more empowered moms.

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#18 of 110 Old 06-22-2004, 02:04 PM
 
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I've actually heard providers tell women that babies gain a pound a week that last month. Can you imagine? Whoa!

Really, it's more like a quarter pound - and just how is two weeks going to make your baby unbirthable?

I get so annoyed by this. Thank goodness for MDC. I feel bad for many of the women at americanbaby.com or babycenter.com!
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#19 of 110 Old 06-22-2004, 03:02 PM
 
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I saw Penny Simkin give a wonderful talk on this, called "The Seduction of Induction". She painted OBs as people who prey on the fragile emotions of very pregnant moms. See, they see them all pregnancy long, always hoping for some kind of connection (all women want that, right?). Then, towards the end, kind Doc, who has never given the woman more than 8 minutes of his time says,
"Geez, I really want to be at your birth! I'm going to be off call/ on vacation soon and I just don't wanna miss it. If we induce next week, then I can be there and you'll have the birth you want."

Now, if you've ever been pregnant, you know how vulnerable you can be at the end. And, of course all of the horrors of the "big" baby, etc.... are there too. UGH!

You can check out the power point presentation of this talk at her website
www.pennysimkin.com- interesting stuff.

Thank goodness there are enough women who have the sense to say no.... but I do shudder when I think about all of the women in my community who are succumbing to the OBs desire to put predictability in birth.
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#20 of 110 Old 06-22-2004, 04:07 PM
 
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Quote:
Originally Posted by klothos
my own OB told me he prefers to deliver babies at 36 or 37 weeks because then they aren't "too big" ~ because according to him, any babies closer to 40 weeks come out and are like "shoving a huge table through a small doorway."
Remember the old Monty Python movie with the charge on the castle? "RUN AWAY! RUN AWAY!" Seriously, any OB who says this is an idiot.

There is a trend in OB that they believe that smaller babies are easier to deliver, mostly b/c it *is* harder to get a baby out (esp. a first time mom) that is a good size WITH AN EPIDURAL, propped on your back, legs in stirups. And since that is all most OB's see, they believe it to be reality.

Quote:
Originally Posted by pamamidwife
I've actually heard providers tell women that babies gain a pound a week that last month. Can you imagine? Whoa!
Yup, hear that one all the time.
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#21 of 110 Old 06-22-2004, 04:22 PM
 
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I was put in the position of having to let them induce at 41 wks 6 days or leave the hospital AMA and be stuck w/ the bill I couldn't pay. DD was 7 lbs. 13 oz. It ended in a C-section because DD didn't respond well to the induced contrax. My gut told me she just wasn't quite ready.

In a similar situation in future, I will tell them to shove their pitocin and RUN AWAY. Money notwithstanding. Not every baby takes the same exact amount of time to gestate, just lik they don't all gain weight exactlly the same once they're born or learn to roll over on the same day, etc.

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#22 of 110 Old 06-22-2004, 04:51 PM
 
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Quote:
Originally Posted by Malama
I saw Penny Simkin give a wonderful talk on this, called "The Seduction of Induction". She painted OBs as people who prey on the fragile emotions of very pregnant moms. See, they see them all pregnancy long, always hoping for some kind of connection (all women want that, right?). Then, towards the end, kind Doc, who has never given the woman more than 8 minutes of his time says,
"Geez, I really want to be at your birth! I'm going to be off call/ on vacation soon and I just don't wanna miss it. If we induce next week, then I can be there and you'll have the birth you want."

Now, if you've ever been pregnant, you know how vulnerable you can be at the end. And, of course all of the horrors of the "big" baby, etc.... are there too. UGH!

You can check out the power point presentation of this talk at her website
www.pennysimkin.com- interesting stuff.

Thank goodness there are enough women who have the sense to say no.... but I do shudder when I think about all of the women in my community who are succumbing to the OBs desire to put predictability in birth.
I agree 100%. I think its also a matter of fragile exhausted emotional moms just wanting to see their long-awaited babies. If a doc offers you the option to pick a day- and you will have your baby- I know of very few women who would pass up that chance. Besides, they figure that the doc wouldn't offer to do anything that was unsafe.

I just wish that more women would chose to research this crap instead of investing all of their energy in picking out crib sheets and layettes!

Its not like there is no one who has written a freakin book about it! Sorry, but, WTEWYE is not the pregnancy/childbirth bible...kay?!?

This stuff makes me mad. I know that a good portion of the blame lies with the doctors, but if women were more educated it would be a heck of a lot harder for the doctors to victimize them!
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#23 of 110 Old 06-22-2004, 05:30 PM
 
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There is a very good reason why we have never discovered the fossilized remains of a woman pregnant with a 3-year-old child.

It's because even before pitocin and hospital births, no pregnancy EVER went on forever! That's why I don't understand women who say "I am not capable of going into labor on my own; I needed pit with all of my children." How can someone know they'll never go into labor? Have they tried waiting 40 weeks? What about 42 weeks? Maybe try waiting 48 weeks and see what happens.
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#24 of 110 Old 06-22-2004, 05:48 PM
 
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Quote:
Originally Posted by klothos
my own OB told me he prefers to deliver babies at 36 or 37 weeks because then they aren't "too big" ~ because according to him, any babies closer to 40 weeks come out and are like "shoving a huge table through a small doorway."

i was just reading through another forum for pregnant mamas (one that's a bit more mainstream) and nearly everyone there are talking about how their doctors are pushing them to have the babies, and they're all around 37 weeks! a few are actually scheduled for induction at 38 weeks, simply because "it's time." one woman's doctor told her that if she went to 40 weeks, she'll "need" a c-section, because "that's just too long to keep a baby in there."

is this some new obstetrical trend?
I guess it must be because on my mainstream birth board there were tons of women at 36-38 weeks getting induced for BS reasons (doctor fears baby getting "too big", tired of being pregnant, family coming in town, etc) and I simply don't understand it. One woman was *considering* an induction and asked why so many were being induced so I posted a list of the possible dangers or induction and got blasted for it... : Apparently it's rude to try to educate people (yes, I was actually told that in so many words)

I understand being anxious to hold your baby, or being tired of being pregnant, but I've seen so many women inducing for what, IMO, seem like really selfish, stupid reasons and it just makes me really sad. And shame on the doctors who push to induce routinely... baby getting too big my arse, as you said, it've very uncommon for the body to grow something it can't birth. But most doctors (and women unfortunately) have no faith in the human body...


Maybe someone else knows why docs like to induce so early... but gosh 36 weeks isn't even full term...
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#25 of 110 Old 06-22-2004, 10:09 PM
 
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My OB's with my son started pushing induction at 37 weeks. I was told that my son was going to be "at least 10 pounds!" I allowed an induction attempt at 41 weeks- it didn't take. Luckily my OB did it and he sent me home agianst hospital policy to aviod a c/section. We planned another induction attempt at 5am Tuesday (1st was at 5 am Sunday) my son was born at 1:11am Tuesday.

I avoided many of the things they wanted to do to me- have the staff dr break my water at 5 cm, epidural (they offerred this several times AFTER being told very firmly by myself, my OB, and everyone else involved with me to lay off.) I did end up with about 1/3 the recommended dose of Stadol- I started about 4 hours before my son was born, by that time I had been having pitocen contractions for close to 2 days and I was tired. My OB broke my water at 9cm and I pushed my son out shortly thereafter. I am so grateful that we both came through that with minimal trauma- I think it was horrible btu it could have been worse. My son was a whopping 7lb 6oz at birth- so much for "too big"

This time (I'm 34 weeks pg now) I went with a midwife. The whole experience has been more relaxing. I will not be on a time clock during my labor - her philosophy is that the baby will come when the baby is ready, not before. I wish I had stuck up for myself last time- I allowed my family to pressure me into doing what they were comfortable with.
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#26 of 110 Old 06-22-2004, 11:03 PM
 
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This whole topic is scary and infuriating at the same time. I feel SO grateful to have access to awesome midwifery care, so I don't have to worry about some doctor telling me my baby has to be born early.

I have a friend who used an OB for both of her births and was told both times that her babies were getting "too big". The first one weighed 7lbs even (so huge!) the second weighed 7lbs 6 oz. He actually told her that her body was not capable of birthing anything larger and that an 8lb baby would require a c/s. He determined this by just looking at her, nothing scientific whatsoever. And she believes him completely! She thinks without him, she'd have been in big trouble. And this is an intelligent educated woman we are talking about here. So sad.... it's like some doctor's want their patients to literally believe they can't give birth without them. Is this an ego trip? I can't help but think this is some form of deep rooted misogyny. As in women are too defective to birth babies without the help of modern medicine. Yes, modern medicine is awesome when there is an emergency and truly needed, but this is the exception and not the rule!
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#27 of 110 Old 06-22-2004, 11:37 PM
 
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This is despicable. I thought our "post dates" inductions (40weeks and 1day) [tongue in cheek] were pretty bad, but I can't believe that they are inducing earlier!!! I don't care if the baby is 12 pounds at 36-37 weeks...he/she is still not ready to come out! In this malpractice happy society, you would think that OB's would be scared to induce early for fear of being sued over a preterm baby! I have heard some of our more liberal providers say that truely there is no scientific evidence that inducing early will make the baby fit threw the pelvis..if its gonna fit, its gonna fit when its good and ready (and it usually does) In fact, probably the WORST shoulder dystocia I ever saw was born to a mom who was induced at 38 weeks for gestational diabetes. She had a wonderful anesthesia free labor, but those shoulders wouldn't budge for anything.
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#28 of 110 Old 06-22-2004, 11:40 PM
 
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Wow - I hadn't even heard about this one. That's absurd - 36 weeks isn't even full term; their lungs might not even be developed yet. I do know of a few women who have been told they had to have inductions because the baby was "too big" - and they had 7 lb babies. Now personally I wouldn't want to be delivering an 11 or 12 lber, but that really doesn't happen very often (especially now that they can look for gestational diabetes). It's very much like taking the average timea woman was in labor and making it the maximum time they would allow a woman to labor (can't remember all the books I've read that one in) - in all their time in med school did they not learn about averages? Evidently they're taking the same path for size - 7 lbs is average so anything over that is just too big. Why, oh, why are we stuck with this medical system?
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#29 of 110 Old 06-23-2004, 12:03 AM
 
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I know many OB providers are truly awful when it comes to pushing inductions, but believe me, there are plenty of pregnant mamas pushing, too (no pun intended.) It's to the point that I almost dread doing prenatal visits for some of my patients in the last month. I've heard every reason under the sun for why someone just has to be induced. Most recently, a woman pregnant with her 3rd child asked me to induce her at 36 weeks so she and her family could go to Disney World when she should be 38 weeks. I kid you not. I sat there with my mouth hanging open so long, she thought I was actually considering it.
I had one dad call me day and night, and eventually park himself and his wife in the hospital and refuse to leave. They needed the baby out NOW because he's a truck driver. ( )
I spend many of these last month visits warning about the dangers of induction, talking up how wonderful it is that baby is still cooking (at like the ripe old gestation of 37 weeks) and talking about how much easier natual labor is. I tell moms how induction with an unripe cervix means at least a 50% chance of cesarean. And moms still drive me nuts begging for induction. I must say "but you aren't even due for a week yet" several times a month!
I'm thinking about telling everybody they're due 2 weeks later than they actually are. I actually do suggest to moms that they tell their families that their "due date" is 2 weeks later than it actually is.
When I was pregnant with #3 my family doc explained apologetically when I was 41 weeks that due to hospital policy, he couldn't schedule an induction unless something was wrong until 42 weeks. I was thrilled not to have to argue about it. I had a beautiful delivery at 41 wks 2 days, with a lovely slow, gentle labor.
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Originally Posted by doctorjen
Most recently, a woman pregnant with her 3rd child asked me to induce her at 36 weeks so she and her family could go to Disney World when she should be 38 weeks. I kid you not. I sat there with my mouth hanging open so long, she thought I was actually considering it.
I had one dad call me day and night, and eventually park himself and his wife in the hospital and refuse to leave. They needed the baby out NOW because he's a truck driver. ( )
What is it with these selfish people? I read things like this on mainstream boards ALL THE TIME and it truly sickens me. It's bad enough that women just take whatever their doctors tell them for the indisputable truth and do absolutely no research (that's the doctor's job and the doctor would never do anything to harm them or their babies...) but to put their baby's (and their own) LIFE at risk for something so trivial is just mind boggling. I just don't get it. They're completely detatched from their bodies... pregnancy isn't something they experience, it's something that happens to them, they let other people let them know what's going on with their bodies when if they would just educate themselves they would know on their own!

I am reminded daily that we (MDC mamas) are the exception and not the rule, and it really saddens me. How can people be so out of touch and ignorant and selfish?

BTW, DrJen... it really is great to see a doctor who urges her patients to actually experience their bodies and take responsiblity for what happens to them throughout their care. Where can we find more docs like you?
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