Induction, non-stress test, "overdue" baby - Mothering Forums

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Old 02-27-2005, 06:24 PM - Thread Starter
 
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I am now four days "overdue" with our 3rd child. I sought pre-natal care for all three with the same provider, an OB. Our first two were uncomplicated, unmedicated, standard hospital births. All three of my pregnancies have been entirely without issue.
At our last appointment, the OB said that it is "standard procedure" to induce labor at 41 weeks gestation to curtail the ever-increasing risk of stillbirth.
Up to this point, he did not know that we were planning an unassisted home birth. I was reluctant to tell him due to rumors ranging from OB's refusing to continue providing pre-natal care to OB's seeking court orders forcing women to birth in a hospital.
Our OB's reaction was great. He said that due to my pregnancy and childbirth experiences, I'd be a "perfect candidate" for an unassisted birth. He added that if we did need help to call.
So, instead of scheduling an induction, we have a non-stress test scheduled for the day after tomorrow, i.e. six days "overdue". I have no idea what the purpose of this test is or what it may or may not indicate "to do" post-testing. I did not have a non-stress test with either of our first two babies. Also, I neglected to ask the OB, fully expecting to have the baby by the test date.
At this point, I have about 48 hours until I am expected to submit to this test.

My questions are:
What can I do to naturally encourage this little one to meet his/her family?
What should I expect from the non-stress test?
Is there any literature available about a lack of evidence of "overdue" babies and stillbirth?
Regards,
Jenna
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Old 02-27-2005, 06:39 PM
 
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Well I can tell you about the non-stress test. It's continuous electronic fetal monitoring for about 20 minutes or so looking for movements of the baby, essentially, indicated with a rise in the heartrate. There's some info about it here.

The risk of stillbirth is about the aging placenta.
Quote:
Hilder et al. examined 171 527 births in the North East Thames Region in London and reported that the rate of stillbirth increased six-fold from 0.35 per 1000 ongoing pregnancies at 37 weeks of gestation to 2.12 per 1000 pregnancies at 43 weeks (Figure 1). When neonatal and post-neonatal mortality rates are included, the overall risk of death increased from 0.7 per 1000 ongoing pregnancies at 37 weeks to 5.8 per 1000 pregnancies at 43 weeks1.
From this site. I wouldn't say that those rates are huge at all, but there's the risk, I suppose. The increase is pretty significant, but not a huge incidence overall. How sure are you about your dates? When did you deliever your previous children? I honestly wouldn't worry about going post-dates at this point at all, personally.

As far as encouraging this one to come naturally, I would say that the best recommendation is to have sex. There are lots of things you can do beyond that, but nothing will work if it's not the right time. Do you have a nursling still? Nipple stimulation is supposed to be an excellent induction. With my first pregnancy, I tried a million things to get it going and nothing worked. But I later learned that my dates were pretty off.

anna kiss partner to jon radical mama to aleks (8/02) and bastian (5/05)
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Old 02-27-2005, 06:44 PM
 
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I had a non stress test at my midwife's office. I was feeling really weird about it but it was no big deal. I just sat there with a monitor on my belly that tracked the baby's heart rate and contractions (if I had any - which I did). It prints out a graph for you. They just want to see normal heart activity. I've heard that when they do it at hospitals or doc's offices they sometimes put a silly parenting instruction movie on or something like that. So just bring a book.
If there is anything abnormal about it they might suggest having an ultrasound done to check the amniotic fluid levels and placenta health. That's called a biophysical profile. Instead of scheduling mine, I took the kids to play at this slide at the top of a hill so I had to do lots of stair walking. Stairs have worked for me every time. I went into labor the next morning.
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Old 02-27-2005, 07:49 PM
 
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i have also had a few non stress tests in my day.. other pregnancies, but found them to be no big deal, and in fact was an excellant way for me to *show* medical staff that baby and I are doing great..
the whole overdue thing is weird...i know the last little while waiting is soo hard for some of us.. i am only in my 36th week and already it is getting to be a challenge for me...but the due date was some random number in my opinion (not totally of course).. but not a science either..with a certainity within two weeks of accuracy.. but when that due date comes and goes.. people are on you like your a bomb about to blow...i have read many times that human gestation is more likely 41 weeks than 40, the average woman is supposedly term between 37-38 weeks (depending on who you ask) till about 42 weeks.. with *complications raising in risk after 43-44 weeks, and even than with montiering I personally don't see the issue...it is assuming the due date is dead accurate, and assuming you will fall into the small number of women who experince post dates complications to discuss induction (my opinion)..
but i think it is great your ob is supportive.. what a load off i bet!!!
anyway I am sending you some nice baby blessings.....
with my last baby..i used homeopathics to get things going after 42 weeks came and went, i generally wouldn't, but for some reason i just felt it was rigth for baby and me...i htink she was ready to come...and taking them was more like a ritual for me to prepare myself and set the intention out that I was giving birth that day..
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Old 02-27-2005, 09:37 PM
 
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You must trust your ob if you keep going there! So I would take the test! Its really quite simple and it lets them gauge the babys stress levels! (HR and movement) Its really no big deal! There is something to be said about an ob that is willing to support you home birthing! So I would do it! Let them continue to gauge you and your babies health! It couldn't hurt!
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Old 02-27-2005, 10:31 PM
 
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Post dates info

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

Midwifery. 1991 Mar;7(1):31-9.Related Articles, Links


Quote:
A contemporary view of the human placenta.

Fox H.

Our current knowledge of the human placenta is briefly reviewed. Particular stress is placed upon the considerable functional reserve capacity of the placenta, the unimportance of most visible abnormalities of the placenta, the lack of any evidence that the placenta ages during gestation and the lack of significance of placental weight. The effects on the placenta of infection and of maternal cigarette smoking are considered and the concept of placental insufficiency critically discussed. It is concluded that most cases of 'placental insufficiency' are, in reality, examples of maternal vascular insufficiency resulting from inadequate placentation during the early stages of pregnancy.

http://www.midwiferytoday.com/articles/timely.asp

A Timely Birth
by Gail Hart

http://www.birthlove.com/free/ten_month_mama.html

Birthlove’s 10 month mama page – extensive references.

Quote:
Suspect Diagnoses Come with Biophysical Profiling
by Gloria Lemay
© 2004 Midwifery Today, Inc. All rights reserved.

[Editor's note: This article first appeared in Midwifery Today Issue 69, Spring 2004.]

Many North American women are being told at the very end of their pregnancies to go to an ultrasound clinic and have a biophysical profile done. Most are impressed by the thoroughness of their practitioner and have no idea what this test involves or what sort of harm could follow from consenting to this diagnostic procedure. They will probably not be told that there is no scientific basis for having faith in the test results and that no improvement in health has been proved from large numbers of fetuses being "profiled." Certainly, no one will mention that the only benefits of the procedure are: 1) the ultrasound clinic will earn $275; and 2) the medical practitioner will be able to cover themselves legally in the very rare instance that a baby might die in utero.
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Old 02-27-2005, 10:36 PM - Thread Starter
 
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Thank you for the feedback. I am not worried about the health of the baby whatsoever. My main concern is keeping to our plan of being at home when the baby is born. I'd just hate to have the non-stress test, have the medical community conclude that something is wrong, and insist on immediate induction or a c-section. I have read a lot about electronic fetal monitoring being wrong as often as it is right and am somewhat suspicious that the same may be the case with the upcoming test.
As for "tricks" to get things going, I've tried the ones suggested. If the baby wants to stay where he/she is for now, that's fine with me. It is just slightly unnerving that the baby's choice may not be fine with the labor and delivery staff and my OB. I suppose we'll cross that bridge if and when we come to it.
Thank you again for your insights and knowledge.
Regards,
Jenna
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Old 02-28-2005, 12:42 AM
 
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I personally would not agree to the test, particularly if I was not sure how it would affect the rest of my pregnancy. Does that make sense?

I would find out FROM YOUR OB exactly what they're looking for, what the range for "normal" results is, how accurate the testing is, what will they suggest if XYZ presents, how flexible are they about that, etc. AND I would do my own research ahead of time about all these things (you can't really research your OB's policies, but the other stuff), so that you are knowledgeable about the REAL risks without your OB's opinion coloring it.

I have heard/read a LOT of anecdotes where Mom agrees to NST, and the results indicate a huge problem, which is proven NOT to be a problem at all - of course, that's AFTER the induction/immediate c/s/ medical rigamarole. I know that there ARE problems that are found and prevented through monitoring, but *IMO* many more are made up in the interest of forcing Mom to conform to the medical model.


Like someone else asked, how SURE are you about your dates? And I mean how sure are YOU - not the u/s, not the OB, YOU?? Were you charting? How have you calculated your dates? I ask b/c I am currently one or two weeks "overdue" with my second child, depending on which medical professional you ask. An OB that I interviewed decided my due date was Feb 13, based ONLY on my LMP (which I didn't exactly remember, anyway). So I'm two weeks "late", according to him. I said "thanks, but no thanks" to that, lol. The midwife I saw reluctantly agreed to put my due date somewhere between the 15th and the 20th, based on my (guesstimated) LMP and the fact that I knew with my first baby that I had ovulated a week after the "normal" two-week magic number. So she "allowed" me some extra time.


However, I have "known" from the beginning (I didn't know why I was pushing so hard for a later due date, but I was) that this babe would be "late", according to their dates. I wasn't charting, so I can't say for sure when I ovulated, and like I said, I don't remember my LMP, but I'm still nursing DS so things can easily be a bit off from the medical model's charts.


I'm not even considering any testing yet. I can still feel baby moving around, and I am comfortable allowing baby to take his/her time in arriving. But I know that were I seeing anyone for prenatal care, the pressure would be on and test would be "suggested".


I would just recommend you educate yourself as much as you can about the NST, how the results are calculated, and particularly the margin of error. I know that some see it as being a benign test, but *I* do not.


Good luck.

Kinsey
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Old 02-28-2005, 01:08 AM
 
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please read the link to a Timely Birth--
I think that your doc is being overly cautious,
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Old 02-28-2005, 01:45 AM - Thread Starter
 
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Dear JanetF and Kinsey43-
Thank you for your references to the studies and personal insights. After reading over these, I have decided (though not yet consulted with/told my husband) that I am going to call my OB tomorrow and cancel the non-stress test. After all, six days "overdue" is a fraction of time in a 280-day average gestation period.

My first baby was a day early and pitocin-induced because four hours after my membranes had spontaneously ruptured I had "failed" to get into a contration pattern.
My second baby was five days late. No induction.

I think that the "conventional wisdom" that subsequent pregnancies are shorter than previous ones is essentially urban legend.
I have heard of far too many women whose pregnancies get longer with each baby. The "Ten Month Mama Page" certainly seems to indicate that.

So, I will now try to relax and let all these ideas of heightened risk of stillbirth due to "aging placenta" fade away.
I can feel this little one moving about and I believe in his/her ability to choose when to enter this crazy world of ours.
Regards,
Jenna
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Old 03-03-2005, 02:30 AM
 
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Good thinking, Jenna. The medical model of birth is inherently flawed and you're stepping outside of it anyway if you're planning to UC. Dating is pretty ludicrous other than as a guestimate and neither helpful nor useful in supporting women with healthy pregnancies - and not much chop for anyone else either LOL. The induction epidemic terrifies and angers me. You just hold that baby right there, in the best place possible, until they decide to make an appearance. There's always one thing for sure at this point in a pregnancy - there's a lot less ahead than behind Goes for bellies and dates
I can't wait to read your birth story!
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