What is with all this induction talk? - Mothering Forums

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#1 of 63 Old 12-17-2007, 08:23 PM - Thread Starter
 
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I just don't get it. What is with all this early induction by midwives? Mine has never even mentioned induction, and the way I understand it, 42 or even 43 weeks is still completely within the normal bell curve. Why would midwives pressure you to induce at 41.5? I mean, OBs it wouldn't surprise me. But midwives? Half of us haven't even hit our due dates yet and it seems like every damn thread in the last two weeks has been obsessing over induction. And why is everyone freaking out about not being in labor when they're not even 40 weeks? I thought the whole point of natural pregnancy and delivery was letting nature take its course.
I mean, if you're at 42 weeks and seeing signs of fetal distress, sure, thank goodness for pitocin. But otherwise? Can't we just relax?

Jen, journalist, policy wonk, and formerly a proud single mama to my sweet little man Cyrus, born at home Dec. 2007 . Now married to my Incredibly Nice Guy and new mama to baby Arthur.
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#2 of 63 Old 12-17-2007, 08:35 PM
 
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Heather, ds Dante (12.28.07) and due in April.
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#3 of 63 Old 12-17-2007, 08:37 PM
 
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I agree and I think it has to do completely with politics. That being said... I know in some states there are some rules midwives have to follow.... and I have to respect that of my midwife if that occurs... I just would probably be going AMA at that point cuz no one is coming near me with pitocin... EVER.
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#4 of 63 Old 12-17-2007, 09:17 PM
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Yes. The induction talk is getting tiring.
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#5 of 63 Old 12-17-2007, 09:44 PM
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In many areas midwives are not allowed, legally, to attend home births after 42 weeks.

Also, when I was using an OB in my previous pregnancy, she told me (I am not sure how true this is - I'm just repeating what she said) that placental funciton begins to decline at around 40/41 weeks and that by 42 weeks the risk of stillbirth and fetal distress is increased to the point where an induction should be considered. Again, I'm not saying I agree or that this is even true, but just sharing what the mentality behind the inductions might be.

And of course, some moms are just really uncomfortable and miserable and want their pregnancies over with.

Lets just hope all of our babies are quite on-time so we don't even have to think about this! And yeah, I can't for the life of me understand why anyone would choose a "conveneince" induction prior to 40 weeks.. I have a friend who just did this at 37 and is encountering a lot of problems that near-term infants have (poor nursing, sleepy, weak suck, etc.)
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#6 of 63 Old 12-17-2007, 09:47 PM
 
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I think it has to do with liability.

I am convinced EVERYTHING has to do with liability in Florida.
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#7 of 63 Old 12-17-2007, 09:54 PM
 
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I agree. I think the induction talk with my mw has to do with the fairly conservative area that I live in. My aunt works at a hospital in my state and says that almost all of their births are inductions and they rarely ever see babies that are over 8 lbs and most are all born around 38 weeks.

My mw said they wont let me go 10 days past my due date, which I dont know if that is office policy, hospital policy or some other policy that I am not aware of. My delivery will be at the hospital, so maybe that makes a difference too versus a home birth or birthing center.

It is nice to have a place to complain about being pregnant though even though we may not be 40 weeks but are just uncomfortable and tired. I would never want my baby to be in danger and I would stay pregnant for 50 weeks if I had to but when it gets near the end and my body doesnt feel like my own and I just cant wait to see what my baby looks like it is nice to be able to whine a little with women who know what it feels like.
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#8 of 63 Old 12-17-2007, 11:06 PM
 
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Originally Posted by MCKH View Post
In many areas midwives are not allowed, legally, to attend home births after 42 weeks.

Also, when I was using an OB in my previous pregnancy, she told me (I am not sure how true this is - I'm just repeating what she said) that placental funciton begins to decline at around 40/41 weeks and that by 42 weeks the risk of stillbirth and fetal distress is increased to the point where an induction should be considered. Again, I'm not saying I agree or that this is even true, but just sharing what the mentality behind the inductions might be.
I think that myth was put to rest in Pushed or one of those books... basically that's not true.

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#9 of 63 Old 12-17-2007, 11:18 PM
 
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I'm not in your ddc. It came up in new posts.


Actually the risk of stillbirth does gradually increase the longer the pregnancy continues. It's well accepted. HOWEVER the risk is still very very smal and the risks of induction exist too. It should be up to the woman solely & the risks of stillbirth shouldn't be made out to be larger than the risks of induction.
Here is a cochrane review about induction at or post term http://www.cochrane.org/reviews/en/ab004945.html
The difference was small, but there.

Inductions still should only be done with medical indications as there is no reliable test for placental function & the body should be trusted to do it's work. We, as a species, didn't survive this long without developing some internal mechanics for deciding when and being able to start labor naturally.


ETA-- not that it applies to this conversation completely, but here's the cochrane review of induction for suspected fetal macrosomia http://www.cochrane.org/reviews/en/ab000938.html

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#10 of 63 Old 12-17-2007, 11:21 PM - Thread Starter
 
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Well, I just realized, reading over my original post, that I sound quite petulant and cranky. I think I went about 45 minutes too long without eating.
I don't mean to trash mamas who are having a difficult end of the pregnancy--it's great to have a safe space where we can vent a little. I mean, jeez, when Mrs. head-over-heels-in-lurve mushy pants Zjande actually started griping about her husband, I figured that was a clear sign she'd be snuggling her baby within three days, tops.
But I think what disturbs me about the induction talk is I'm not hearing mamas say, "I hate being 38 weeks pregnant and I want to induce." I'm hearing mamas say, "My midwife is threatening to induce me and I really don't want that but it's the rules."
Studies show that the average first pregnancy lasts a few days longer than 40 weeks, and I find it surprising that midwives--not OBs, but midwives--would pressure clients to induce so early. I guess there is legislation in some states or policies in some hospitals, but being 41.5 weeks is not an immediate cause for concern, as far as I can tell. I was doing some research about post-term pregnancies, and it looks like they haven't even proven that up to 43 weeks is automatically dangerous. I personally might consider going in for an ultrasound at 42 weeks to check fluid levels, but I wouldn't jump to induction.

Jen, journalist, policy wonk, and formerly a proud single mama to my sweet little man Cyrus, born at home Dec. 2007 . Now married to my Incredibly Nice Guy and new mama to baby Arthur.
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#11 of 63 Old 12-17-2007, 11:39 PM
 
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I think this is where a discussion of what a "midwife" really is, and all the levels of midwifery is needed.

Ideally, every women would have the option to interview multiple midwives in her area, get to know their birth philosophies, and their policies, and would be able to hire the person she felt most comfortable with. But with the state-to-state confusion on who can practice midwifery, how they can legally respond to women, the fact that insurance will not cover many midwives, etc, women are often ushered into a practice that they took to be one thing, but ends up being not so dissimilar to the situation they were trying to avoid.

A title does not define a person's philosophies. Personally, our first birth was with a very clinical midwife, who was very pro-birth, but worked strictly on a medical level with her clients. Our current midwife is almost her exact opposite, and is a much better fit for us. They are both midwives, but have completely different takes on their role in birth. Heck, my sister's births were with a midwife in a hospital, who induced her, gave her episiotomies and discouraged rooming-in/breastfeeding.

I feel lucky that we found our current midwife (who never brought up induction to a friend of mine who went 45 weeks!) but I know that she is not the norm. I think our first midwife (Medwife?) is much more common, and I would guess that the mama's who are being pushed towards induction bought the "midwife" ticket without reading the small print...

(nursing, eating dinner and typing - forgive my rambling)

Ivory, partner to Tom, mama to Ella (12/9/05), Alice (12/8/07), and our newest addition, Rebecca (4/1/10).
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#12 of 63 Old 12-18-2007, 01:29 AM
 
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my awesome midwife has suggested stripping my membranes prior to 40 weeks but that is b/c my last baby was 10 lbs and did have shoulder dystocia. She wants to try to lower the odds of that happening again, esp. since this baby seems to be following on the same path of weight gain.
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#13 of 63 Old 12-18-2007, 02:33 AM
 
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Originally Posted by *MamaJen* View Post
I don't mean to trash mamas who are having a difficult end of the pregnancy--it's great to have a safe space where we can vent a little. I mean, jeez, when Mrs. head-over-heels-in-lurve mushy pants Zjande actually started griping about her husband, I figured that was a clear sign she'd be snuggling her baby within three days, tops.
.

I have nothing intelligent to add to this conversation, I just wanted to share how much coming across this made me laugh out loud & I read it to my husband.


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#14 of 63 Old 12-18-2007, 02:37 AM
 
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Weight isn't necessarily a factor in shoulder dystocia.
Can happen with 6lb babies as well.
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#15 of 63 Old 12-18-2007, 03:09 AM
 
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I'm just glad that my midwife is being a very calm port in my own personal storm....i just posted in the daily thread about my own EDD confusion, and she called me tonight to check on me, and it was actually she who suggested I take a look at whether my dates were totally accurate, or if we could jiggle with them a bit so I could relax.

And even though I'm still confused, it actually worked--I can feel my mindset shifting gears just enough that I am less cranky and more wait-and-see about it. So, that being the case, it'll prolly happen tonight, LOL!

But seriously, I'm so glad she's not adding to my stress at this point. She's totally cool with going as long as the baby goes! Actually, knowing how contrary I like to be, maybe if she HAD said something about induction I'd have been that much quicker to say "Don't you dare! This baby just isn't ready yet!" But that's just because I happen to be.....ornery! : Betcha wouldn't have guessed that!

Sarah, Queen of Hearts, raising a Full House with Michael, King of my Heart!
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#16 of 63 Old 12-18-2007, 06:24 AM
 
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One of my midwives said I should be going into the hospital today to pencil in an induction date at 41.5 weeks (December 28th) just in case I go that far. Because "no woman here is allowed to go past 42 weeks" :

I am obviously NOT going and I don't care what their "rules" are -- this baby is coming when it is ready AT HOME!
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#17 of 63 Old 12-18-2007, 08:13 AM
 
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One of my midwives said I should be going into the hospital today to pencil in an induction date at 41.5 weeks (December 28th) just in case I go that far. Because "no woman here is allowed to go past 42 weeks" :

I am obviously NOT going and I don't care what their "rules" are -- this baby is coming when it is ready AT HOME!
I thought this was just a U.S. thing because medical professionals here are such triggers for being sued. I was actually about to post about this-then I saw your post. I am so sorry that they are treating you like this!

Karen, mother to a wonderful active three year old.
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#18 of 63 Old 12-18-2007, 09:04 AM
 
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The good thing here though is, because they are state funded, all they can do is to scare women into doing what they want.

By law, they MUST attend my birth at my home, or wherever I please even if I go to 44 weeks : And they cannot force me to do anything by threatening to withdraw care

See, my American midwife was private so she could just say "sorry, I am not going to let you give birth at the center after 42 weeks" but here they can't!

Unfortunately, most women here just believe these lies and scaremongering They do try to talk women into inducing to make it easier for themselves, but there are great organizations here created to help women know their rights
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#19 of 63 Old 12-18-2007, 09:20 AM
 
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That's good!!! I feel lucky that my MW's will let me do what I want and just tell me options. Yesterday when I was exhausted and talking about wanting to be induced-my MW just said to me-go to sleep-we'll talk when you can make the best decision for you. She just keeps telling me to tell her what I want-her job is to make it safe. She even told me I could refuse antibiotics at the hospital even though I am GBS positive-and then told me under what circumstances she would worry, and when she wouldn't! However, I know that I found a gem of a MW-and many people are not so lucky. I don't know what they would do if I were to go past 42 weeks-but from my own experience with them-I think they would just tell me what they have to say to do the CYA thing-but then let me make my choices-at worst they would make me sign something. I do know that I would not be able to use the hospital birthing center though-I would have to be in a regular hospital room.

I am glad that your MW's have to attend your birth-and that you know your rights. So many women don't know their rights and are bullied by HCPs everywhere in the world!

Karen, mother to a wonderful active three year old.
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#20 of 63 Old 12-18-2007, 11:41 AM
 
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My midwives cannot attend my birth if it happens past 42 weeks. It has to do with state regulations, licensing, and retaining their backup providers. If I go to 42 weeks, I have to transfer to the care of a physician and birth in the hospital or go unassisted (which I'm not comfortable doing).

So, I am very nervous. And I don't know exactly how the midwives handle "post dates" and at what point they start suggesting and/or pressuring natural induction methods (most of which I'm not comfortable doing...esp castor oil which I am adamantly against b/c of my history of irritable bowel syndrome).

I want to mostly leave things alone until I hit 41 weeks (b/c I think something like 80% of babies are born by then) but I'm already worrying *now*. I don't want a hospital birth, by induction or natural, and I'm under a timeline to get this baby out or that's what I'm facing.

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#21 of 63 Old 12-18-2007, 01:41 PM
 
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My midwives cannot attend my birth if it happens past 42 weeks.
So basically, the government feels that it is safer to have a UC?

Wow, that rocks!




I have an appointment today, I am...40 weeks and 3 days today. I am sure she is going to start talking to me about induction, by way of stripping membranes. She knows I am waiting for Saturday though so my other midwife can come to the house to help me with birth.

I am prepared to talk about it today though and get a feel for what they are looking for.

I feel like the BC is very anxious to get this baby born. Maybe its because of the holidays?

I plan to use the "I also have another due date that falls on Dec 24th we can use" defense. Not that I should have to have an excuse...but it will make it less of a fight anyways...in case there was going to be one.
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#22 of 63 Old 12-18-2007, 04:06 PM
 
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My birth attendant said she just makes up her mind that no one is ever going to have a baby, and that way she doesn't get anxious to start inducing. I'm under no pressure at all from her. This is part of why I switched midwives three times. Totally worth it.

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#23 of 63 Old 12-18-2007, 05:41 PM
 
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Originally Posted by *MamaJen* View Post
I mean, jeez, when Mrs. head-over-heels-in-lurve mushy pants Zjande actually started griping about her husband, I figured that was a clear sign she'd be snuggling her baby within three days, tops.
...
Studies show that the average first pregnancy lasts a few days longer than 40 weeks, and I find it surprising that midwives--not OBs, but midwives--would pressure clients to induce so early.
at the 1st part. and yeah isn't it 41w1d as the average gestation? doesn't that make 41.5 weeks very NORMAL if 41 & 1 is AVERAGE? my mw's policy is to induce at 42w2d which isn't bad for a hospital birth... i'm very surprised to see a lot of otherwise mellow-sounding practices pushing induction sooner than that.

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#24 of 63 Old 12-18-2007, 06:32 PM
 
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BTW, my nervousness over induction talk does not at all appropriately respresent my midwive's take on "post dates"

Everyone was very encouraging at today's appointment. They did do a NST (baby looked great, no ctx on the monitor and offered, but did not push or insist on a VE (I refused). We won't start talking natural eviction procedures until next week. *sigh*

Christa
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#25 of 63 Old 12-18-2007, 10:10 PM
 
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My MW tried to strip my membranes *I am pretty sure* today without my consent.

I drew a conclusion really fast about her motives but actually, that isnt really fair.

I still feel a little bit like it shouldn't have happened but maybe I misscomunicated? (Despite the fac that I said "I dont want to mess with anything like induction until my next week appointment.")

I hope I dont go into labor tonight because I feel funny about what she did and like I *need* my homebirth midwife-who is out of town till saturday.

i kinda feel like its the holidays and inconvenient.

this is a hard time of yr to have a baby!!!! my 2nd xmas baby too.
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#26 of 63 Old 12-18-2007, 10:45 PM
 
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We haven't even gotten to the point of Vaginal Exams, much less talking about induction. I know the 'timer' is 'ticking', but I've got a good way to go on that timer before anyone starts making any sudden moves... I'm legally allowed to be attended by a midwife up until 42 completed weeks, and they'd have to transfer care on the first day of week 43. Considering there's some fairly ample "wiggle room" in my dates, we could probably push it until 43 weeks according to the earliest U/S which would put me at 43w5 or 6 days. Of course in either instance the moment I got to the hospital someone would probably whack me over the head with a snow shovel and have me in the operating theater in a panic before they could even get my mukluks off because "OMG! Teh Baby! So Overdue! PANIC!!!"

The thing is, I don't bear even a tiny bit of ill-will toward my midwives for this policy. We JUST got legalized midwifery in this state THIS SUMMER, despite a hugely high-profile criminal case brought by the WI Attorney General involving a home stillbirth in the next town over. My midwifes practice out of the only freestanding full-time birth center in the state which is also a huge community resource. I've had lots of talks with the head midwife about all the political arse-kissing and begging that went into getting the place licensed -- including looking for malpractice insurance and a supervising physician. In the great scheme of things, I think it would be really selfish and inappropriate *for me* to ask her to sacrifice all of that, all the other women and babies she could help AND her way of making a living, just so I can not have to have a hospital induction.

I understand that reasonable minds can differ on that, but I did want to offer my perspective.

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#27 of 63 Old 12-19-2007, 12:18 AM
 
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Weight isn't necessarily a factor in shoulder dystocia.
Can happen with 6lb babies as well.
That's true - shoulder dystocia can occur with 6 lb babies but odds statistically increase in babies over 9 lbs. And that is one scary part of my last delivery that I really don't want to repeat if I can help it.
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#28 of 63 Old 12-20-2007, 10:31 AM
 
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I'm really lucky with the midwife I have. I was all set to have her massage my cerxix at 39 weeks and she checked and told me that I wasn't even close to being ready. So, we're waiting. I asked her if the others would start giving me a hard time about it and she said just to schedule a NST for 2 weeks. I don't even have to talk to anybody until the 31st if we don't go into labor first! Now, I just have to fend off all the people who want to know why I'm 40 weeks and there's no baby here.
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#29 of 63 Old 12-20-2007, 12:16 PM
 
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Threads like this make me sad. They seem to assume that women who choose induction (or feel that the choice has been made for them) are, for the most part, uneducated idiots who cannot make appropriate care choices for themselves and their little ones. I find this pov extremely offensive, honestly. I read thread after thread on this subject and usually I keep my mouth shut, but ya'll are my peeps, so I'm going to speak up. I am facing a difficult next week, and I feel I cannot post about it here, for fear of being subjected to tisk-tisking and and eye rolling. I know there is a good chance someone will come and tell me to abandon my midwives and UC, which would be horrible and unsupported advice in my situation, but PC here on mdc.

Some women feel most secure going to a hospital (*gasp*). Just because mdc supports the position that nfl is best does not specifically exclude people who have so-called natural births in a hospital environment. Personally, I have an additional health concern that could negatively impact a new born child. I have done my research and decided that birthing with a medical-based midwife is best for me. I went through three sets of midwives in order to find the practice that I was reasonably happy with. This does not make me any less supportive of or interested in nfl or "natural" birth. It does mean that I am receiving care from midwives who are bound to certain rules. One is that their patients cannot go much past 42 weeks. Now, at 41w3d, I have had no vaginal exams, and we have not discussed induction beyond offering to strip my membranes in a hope of avoiding a chemical induction next week. I do know that if I am still pregnant at my m/w appointment next wednesday (at 42w2d), I will be scheduled for induction.

I take offense to people who pop in every.single.induction.thread and state that the op should go UC to avoid induction and that their midwives must actually be "medwives" who are all about saving their own asses. Know what? I know that induction is hell and pitocin is the devil. Thanks for pointing that out AGAIN. Know what else? Yes, my midwives must push induction after 42 weeks for liability reasons. The chances of a true post term baby being born in distress is much higher than a 42 week baby being born in distress. People here seem to like to point out that "43 weeks is a version of normal" because it fits into the normal bell curve. Yes, so what? In a normal bell curve, the top 2.5 and bottom 2.5 percent are within the bell curve, but the bottom 2.5 percent, in terms of grades, are FAILING grades.
I guess that, true, it is a version of normal to get a failing grade, and a version of normal is to have a baby born in distress.

I am going to see the "crunchiest" midwife today (four m/w practice). I know she will offer to strip my membranes. I don't know what to do and I am scared. She does not want to see me stuck in the induction hell, and I am heading that direction quickly. My cervix (based on an u/s measurement) is still 3cm (although it started at 6cm, so we are making progress). I have had no vaginal exams, so I don't know where we stand with that. I had a biophysical profile and nst yesterday and baby scored a 10. The u/s tech said the placenta was in beautiful shape with no signs of aging. She said the baby weight estimate (fwiw, which isn't much) was 8lbs, plus or minus a 1.5 lbs. They are not claiming this is a giant baby. Everyone is healthy. No one wants to evict her. But, rules are rules. And they suck. And everyone agrees. And if I post this, I will get replies that lament the current medwife system, and posts that suggest I should jump ship and go it alone. And know what? None of those posts would be helpful. And they would not be supportive of my situation. But they would be popular and everyone would feel good about themselves for agreeing.

I'm going to go back to lurking and posting in fluff threads, but I needed to speak up, so I did.

Mama to E (12/07) and M (01/11). homebirth.jpg
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#30 of 63 Old 12-20-2007, 02:03 PM
 
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Jenn, I'm glad you posted. I'm in a similar place with similar restricitons (except I was planning a homebirth, but with a CNM). I can't decide if I will consent to stripping tomorrow or not. I'm contemplating an u/s (I'm sure it would be a biophysical profile).

I don't really know what to do. But I have come to the mind that I will schedule a hospital induction (hopefully with a CNM in my mom's hometown) if baby isn't here by Christmas. I won't intentionally UC and if I am induced, I'm pretty sure I'll go with the epidural despite my 2 natural births...pitocin ain't natural and I don't feel that I can handle it naturally. : Not what most ppl around here would do or recommend, but we have to make what we think are the best choices for ourselves and our families.

Christa
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