Overdue - To induce or not to induce, that is the question. - Mothering Forums

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#1 of 14 Old 05-20-2011, 08:39 AM - Thread Starter
 
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I was due yesterday 5/19 and as of Tuesday am only 1 cm dilated.  My doctor said that she would let me go 2 weeks past my due date and she'd prefer that.  But she said that if I wanted to be induced that could be something we could discuss at my next appt, which is Tuesday.  Monday, if I still haven't given birth, I'm going for a bio-physical ultrasound to make sure there is enough fluid and the baby is moving well still...

 

What is your opinion on induction?  My doctor said I could become very frustrated if I get induced because labor can stop and start.  Plus, she thinks as a first time mom, I should let it happen naturally.  Anyone have experience with this????

 

Thanks in advance for your help!

 

xoxo

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#2 of 14 Old 05-20-2011, 10:42 AM
 
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if you would have asked a week ago I'd say I am very against convenience inductions. They do hurt more, they don't always work, and they require more interventions like IVs, clock management, fetal monitoring and most women who have them really do need the epidural. And they don't always work especially in first time moms who are not ready to go.

 

I'm consideering one now though. I'm almost 39 weeks and over it! My OB wouldn't do it until at least 41 weeks, so it's still a while off but I think that there is a big difference between an induction for a 4th birth which I would be than a first. As in, it would be more favorable to work and work quickly in my case than in yours.


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#3 of 14 Old 05-20-2011, 10:48 AM
 
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Try to eat well, take long walks and don't stress. Its really better if babies pick their own time. Like a fruit, they drop when ripe.



http://www.mothering.com/pregnancy-birth/the-case-against-inducing-labor
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#4 of 14 Old 05-20-2011, 01:36 PM
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it is frustrating but it is much less of a risk to the baby to let it go naturally...maybe you just have to think of it that way. (i know, easier said than done, my ob is a big induction fan and he's been luring me with it now, it's hard not to succumb.)

 

so my deal is that dd1 was induced after my water broke and labor never started. on the one hand, it was very "successful" in that it went very fast (i think i went from 1cm to 9 in 1.5 hours...i felt the need to push and the nurse didn;t even want to check me at that point since it was "too soon.") 

however, pitocin is one crazy beast. i definately couldn;t have some it without an epidural. even being a 1st timer i knew the contractions were very unnatural. the baby went into some scary decels with each contraction, my BP went up and i had to lie flat on my back the whole time. because of that she went posterior and the ob had to manually turn her (yep, hand up in "there" turning her by the head.) i'm sure i'm forgetting something.

in the end she was born 100% healthy and vaginally but my very experienced doula said she was shocked i avoided a c-section with the decels. 

 

anyway, i'm trying to keep all that in mind to stay strong against the induction temptation. to this day, my OB keeps saying that induction is fine and that he "has it down to an art." when i bring up all the crazy stuff that happened in dd's birth he admits that he wasn't there for that part (he was at a concert and came running in to catch her.)


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#5 of 14 Old 05-20-2011, 03:11 PM
 
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There are risks to induction and it is better to avoid it unless the benefits outweigh the risks. Especially for first time moms, elective inductions double the risk of cesarean. There is good evidence that routine inductions at 41 weeks are justified, they have been shown to reduce perinatal (baby) deaths, as well as certain kind of morbidity like meconium aspiration. Still the absolute risks are low. See here: http://childbirthconnection.org/article.asp?ck=10652

 

Inductions change your labor and make it much more medicalized, in my experience. I would consider agreeing to an induction at 41 weeks (with a ripe cervix), and would definitely agree to one at 41 1/2 weeks. The risks of stillbirth and other complications increase the further past 40 weeks you go.

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#6 of 14 Old 05-20-2011, 05:00 PM
 
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The risks of induction in an otherwise uncomplicated pregnancy vastly outweigh the risks of a TOL (trial of labour) and waiting it out. :)

 

I went to 43 weeks, 0d with my last!


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#7 of 14 Old 05-20-2011, 07:30 PM
 
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I went into labor at 41+1 weeks with my first, I was a very 'bad' candidate for induction, and was more than willing to wait, I was even trying to figure out how to get around being induced if I went all the way to 42 weeks (their limit I think)

I ended up on pitocin anyway, since my labor was taking forever and my contractions were 'dysfunctional' - I labored for 3 says - so he was born 11 days late.

the pitocin was definitely odd - though it didn't even work that well for me. It made the contractions closer together I guess, but labor didn't really 'get going' until my water broke - 8 hours or so of pitocin dilated me maybe a cm (from 5 to 6). It also did do wonky things to Z's heartrate which made them almost consider a c-section, they turned it down once I started dilating fast and was pushing. She told me later that if I had had an epidural, I most likely would have had a c-section, since pushing still took so long even w/out an epidural, etc. I'm not sure what a fully-no-pitocin labor would have been like, but I'm guessing induction wouldn't have worked for me at all given how little the pitocin did in labor anyway.



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#8 of 14 Old 05-20-2011, 07:43 PM
 
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Quote:
Originally Posted by littleteapot View Post

The risks of induction in an otherwise uncomplicated pregnancy vastly outweigh the risks of a TOL (trial of labour) and waiting it out. :)

 

I went to 43 weeks, 0d with my last!


Yep. My CNMs whom I adored said they would let ladies go to 43 weeks if they felt like she was still eating well.
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#9 of 14 Old 05-21-2011, 03:29 AM
 
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Quote:
Originally Posted by philomom View Post


Yep. My CNMs whom I adored said they would let ladies go to 43 weeks if they felt like she was still eating well.


Mine too! I'm in BC Canada and up until recently midwives were only allowed to attend births at home up to 42 weeks, now it's 43 provided they follow the "rules". The rules the midwives need is an OB consult and at least one NST. They have to recommend them regularly, but you can refuse. As long as you've had *one* past 42 weeks, they can still attend. ;)  It's pretty rare that a woman goes past 43 completed weeks, so my midwife group has never had to come up against that situation as far as they said.


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#10 of 14 Old 05-21-2011, 05:47 AM
 
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 The risks of stillbirth and other complications increase the further past 40 weeks you go.



My understanding is that the risk of stillbirth only increases beyond 42 weeks.  In much of Europe full term is considered 41 weeks and in the UK induction is scheduled (as standard) at 42 weeks for this reason.  40-42 weeks is considered no increased risk over here.

 

Friends I know who were induced before 42 weeks had problems with their labour (not progressing even with pitocin, assisted delivery) and wished they had at least waited until 42 weeks.

 

Personally, I wouldn't consider it before 42 weeks unless there was a specific medical indication.  At 42 weeks I'd have a tricky decision - I probably would go for it, though I may wait a few more days with careful monitering of movement and extra u/s to check there wasn't a problem.

 

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#11 of 14 Old 05-21-2011, 06:54 AM
 
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"My understanding is that the risk of stillbirth only increases beyond 42 weeks. "

 

Nope, as a matter of fact, stillbirth and neonatal death rates begin rising at around 39 weeks. I'll find some info for you. However, the link I posted to talking about the evidence for 41 week inductions is from a natural birth promoting organization, run by midwife Amy Romano. Did you look at their conclusions? Even though the risk of stillbirth begins rising even before the due date, its risks have to be balanced against the risks of induction. There is good evidence, from multiple sources, that inducing at 41 weeks doesn't raise the cesarean rate like earlier inductions, and some evidence says it actually lowers it, and besides reducing the stillbirth and neonatal death rates it also reduces certain kinds of morbidity like meconium aspiration. Again, the absolute risk for an individual remains low -- the Childbirth Connection estimation is that there would have to be 369 inductions at 41 weeks to save one baby. Still, on a population level, that would make a significant difference. These studies compare induction to expectant management -- which means monitoring via biophysical profile or nonstress tests.

 

http://emedicine.medscape.com/article/261369-overview

"Perinatal mortality (defined as stillbirths plus early neonatal deaths) at 42 weeks of gestation is twice that at 40 weeks (4-7 vs 2-3 per 1,000 deliveries, respectively) and increases 4-fold at 43 weeks and 5- to 7-fold at 44 weeks.[15, 16, 17] These data also demonstrate that, when calculated per 1000 ongoing pregnancies, fetal and neonatal mortality rates increase sharply after 40 weeks.[16]"

 

"Some of the fetal risks such as presence of meconium, increased risk of neonatal academia, and even stillbirth have been described as being greater at 41 weeks of gestation and even at 40 weeks of gestation as compared with 39 weeks’ gestation.[22, 23] For example, in one study, the rates of meconium and neonatal acidemia both increased throughout term pregnancies beyond 38 weeks of gestation. In addition to stillbirth being increased prior to 42 weeks of gestation, one study found that the risk of neonatal mortality also increases beyond 41 weeks of gestation.[44] Thus, 42 weeks does not represent a threshold below which risk is uniformly distributed. Indeed, neonatal morbidity (including meconium aspiration syndrome, birth injury, and neonatal acidemia) appears to be the lowest at around 38 weeks and increase in a continuous fashion thereafter.[45]"

 

This article: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1998.tb10047.x/full has more info including tables of numbers.

This paper from the CDC has a discussion of the effect of gestational age on still birth and neonatal death rates, you can find it and a visual on pages 6 and 7: http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_06.pdf

This image shows a sharp rise between 41 and 42 weeks: http://www.nature.com/jp/journal/v30/n5/fig_tab/jp2009158f1.html#figure-title

And here's another article with a nice visual, showing the rise in rate of still birth starting at 39 weeks: http://www.bmj.com/content/319/7205/287.full/reply

 

 

 

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#12 of 14 Old 05-21-2011, 07:06 AM
 
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There are so many factors included in these studies...why not just take each woman, monitor her individually, and do what's best for her and her baby?  I would never consent to an induction because I'm X days overdue and X study has these conclusions (or because X mothering.com member made it to 43 weeks, therefore it's safe for everyone, no offense to their success).  That's just so illogical.  There are so many individual factors to consider.


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#13 of 14 Old 05-21-2011, 11:14 AM - Thread Starter
 
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Wow..thank you for all that information...it was really valuable.  My doc is very against inducing..but we brought it up because since its our first, we are nervous about going late.  But I'm gonna do what my body says and just wait-as long as everything is fine.

 

Thanks again for all of your help and insight....Its sooooooo much appreciated since this is my first go round!!!!

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#14 of 14 Old 05-21-2011, 12:22 PM
 
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Quote:
Originally Posted by lovebeingamomma View Post

There are so many factors included in these studies...why not just take each woman, monitor her individually, and do what's best for her and her baby


For what it's worth, the recent studies compared routine induction at 41 weeks to exactly this -- close monitoring of mom and baby and making individual determinations based on their health -- and still found that routine induction had the benefit of reduced mortality, reduced morbidity for mom and baby, and some studies found fewer cesareans because of the decreased risk of fetal distress. 

 

Again, the absolute risk is still relatively low for an individual, although definitely significant enough to make a difference in the population and for an individual woman to take into account when making her own decisions.

 

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