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Sigh. I mostly don't enjoy my near term clients

883 Views 12 Replies 10 Participants Last post by  courtenay_e
I suppose this is mostly a vent. I realized today as I was seeing a 38 + wk mama, that for the most part I really don't enjoy these end of pregnancy visits. And the reason I don't enjoy them is all the pressure to get the pregnancy over with for them. I must be the last health care provider left in my state that doesn't do elective inductions at 38 1/2 weeks for every pregnant person. Visit after visit at the end of pregnancy involves moms telling me how they "just can't take much more" and "how long will you make me be pregnant?" And it often starts at like 35-36 weeks. It seems like most of my end of pregnancy visits are mostly me explaining and convincing folks that it's a good idea to go to term and go into labor on your own.
I start at the first prenatal visit, especially with my first time moms, telling them due dates don't mean anything, and that babies are more likely to cook longer left to their own devices. I go on and on about the risks of induction, and especially how it makes labor harder, longer, and less likely to go smoothly. And of course the risk to the baby of being truly premature, and having distress in labor, and needing cesarean delivery. And yet no one seems to care.
Today, the mama in question is having her 5th baby, and tells me horror stories of her 3rd induced labor that took almost 3 days, and multiple meds, and no food for all that time, and how awful in was in one breath, and wants me to induce her with the next breath. At 38+ weeks!
Sigh. What else can I do?
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Sigh, that so sucks. I admire your restraint!
Perhaps telling them I know you're uncomfortable and ready for that baby to be in arms rather than in womb, but,that research on sheep shows that the fetus initiates labour and it's nature's design may help.
Or maybe joke that you'll sacrifice your next rubber chicken dinner to the labour fairy for them for luck.
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First off, I'd like to say that I really admire you for sticking to your guns, I'm sure it's not easy living in the medical world and having some alternative views. It sounds to me that you are doing the "right" thing by informing them. I often show my clients the Bishop Score and explain how an induction probably wouldn't do much for them and would likely be painful and increase their risk for a c/s b/c their body isn't "ready" to give birth yet.
You know, I'm all for having a due date range. Like your baby is due anywhere from June 17 to July 5.. So that it's impossible to fixate on just one day.

Babies/children are just not meant to be convenient, and that's ok!
Oh yeah... that due date is such a bulls eye and everyone wants to beat the clock - ick.

That said, I've heard from a wise woman that labor never starts before the mama gets to that "I can't take ONE more day" point. I suppose that's just part of the emotional/physical grid of labor and pregnancy as much as it isn't fun for those of us who have to convince them to have patience.

The end is hard - you hurt all the time, you can't breathe, you can't do anything (including sleep or go longer than 30 min. without peeing) and I don't blame those who agonize over the discomforts. I think when they are at that point your only job is to encourage them even if it helps for a few hours. It can be awfully frustrating knowing that something uncomfortable can last several more weeks.

Seeing as I'm pretty uncomfy at 20w I can only imagine how it's going to be 20 more from now - with each one it gets worse.

I keep telling my sister (due with her first 2 days before me) to EXPECT to go over - nothing crushes you worse than bypassed expectations (or dates).
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That said, I've heard from a wise woman that labor never starts before the mama gets to that "I can't take ONE more day" point.
Hmmm, that describes EXACTLY how I was feeling last week... yet here I am. Ugh.

I'm sorry it's getting discouraging. I can't STAND reading mainstream "birth boards" for the most part because of this attitude. People scheduling their "medically necessary" inductions for TWO DAYS past their ESTIMATED due date, people griping about how their doctors are "crazy" because they won't start talking induction until after 41 weeks (WOW, a doctor who actually has some sense... and a smidge of respect for the natural process! What a jerk... he's obviously enjoying torturing you).

I'm 4 whole days past my EDD, and I'm EXTREMELY uncomfortable, discouraged by all the prodromal labor that's been jerking my chain for the past two weeks, and to top it all off, the other two women who were my "pregnancy buddies" IRL have both already had their babies. One of them was due a MONTH after me! (Her water broke at 33 weeks, they kept the baby in 2 more weeks, she had a medically necessary c-section at 35 weeks, baby is fine, momma is fine. I'm very grateful everything turned out well, but you know it's still hard seeing a person who was supposed to be due WELL after your baby arrived already holding her little one when you're SO ready and still stuck in limbo!)

Keep up the good work. Just think of all the babies you've saved from complications and whatnot by educating the mommas instead of breaking out the calendar and telling them to "pick a date" when you'll induce them. To those babies you are a HERO.

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Kathryn -
Every day that passes is a day closer to your baby! Something that always made me feel good when I was over was to plan something every day just to pamper myself, like a long bubble bath, or a pedicure, or a massage, or dh managing the whole evening with the other kids while I lay on the couch with my feet up. I was actually bummed last time because I didn't go over (dd came on her "due date") and didn't get any time to focus just on me.

I'm a fan of the due date range, too, but every mama in my practice has at least one stupid book or hangs out on the internet enough to know how to calculate their own due date.

And then there are stupid news articles about how the average pregnancy is now only 39 weeks, usually quoting some "expert" about how we induce at the due date now because the risk of still birth is "so high" after that.

And then a local to me practice induces EVERYONE, any time they want after 38 1/2 weeks. So all their friends get to have their babies whenever they want, but if you come to me, I force you to wait (this is the argument I get all the time.) Nevermind that said practice also has an almost 50% cesarean rate. One mom told me she was induced because she lives 45 minutes away at 38 weeks, because they "just couldn't risk having me ride in the car in labor." This was a second baby and this time her second stage was so short that it was so lucky she was there already because even as it was the doctor "barely got her gloves on in time to do an episiotomy." Oh boy, so lucky the doc got in their before the baby just fell out on it's own or something.

Any way, it's helpful to vent about it, even if it doesn't change anything. At least the longer I practice, the more folks self refer themselves to me because they are wanting the style of care I offer - but still the majority of my clients are completely mainstream.
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for every four women who are induction crazy and not utilizing your gentle methods of attending births, there is one woman who is grateful - and her baby is even more so - that you are who you are and you have the philosophy you do.

that one woman is the woman you're doing this for.
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As someone who went 10 days past her "due date" I was forever saying to my MW "when is this baby coming". However the issue of induction was NEVER mentioned and I am so grateful for that. I ended up with a section anyway
but I would have felt so much worse had I had a meddled labor. At least now I can say to myself, "I did everything in my power to prevent a section". I would have such a hard time coming to terms with the birth if I'd been induced.....a lot more "if only" would be said.
There are women and definately babies who appreciate your endeavours
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I had a conversation with one midwife (CNM) that went something like this:

ME: My mom is one of 13 children, seven of whom were girls. Of those seven girls, ONE of them gave birth to her only child on her due date. The rest gave birth a minimum of two weeks past their "due" date. Two aunts actually went a full forty four weeks with all of their babies (and there were eight babies between them). Of my 40 cousins, 24 are female and 6 have had babies...all of them were born at a minimum of 41 weeks 6 days, and none of them have been induced. My family's babies seem to take longer to cook, and I will not be induced before my baby is ready to be born.

MIDWIFE: Well, our hospital doesn't allow scheduled inductions before 41 weeks, but I promise that I will not allow you to go beyond 42 weeks!

ME: So, what, you're going to come to my house, drag me to the hospital and chain me to a bed so that you can keep me here for an induction? And I left.

The next midwife I spoke to was much more like you. She said, "Great! Then we're on the same page. I hope you remember this conversation as we get past your due date and you get uncomfortable, because if you even blink at an induction, I'll remind you! And , while we're talking about the birh, have you signed up for a childbirth class yet? I have a great one for you, it's called hypnobirthing. Every one of my clients who have used it have had a drug free vaginal birth!..." Well, I am the freak in my family, and my babies were born (with perfect nutrition and exercise, I promise, and we knew the exact date of conception with both of them...) at 38.5 weeks and 37 weeks exactly. So, it hasn't been an issue yet.

All that said, I want to tell you how much easier doctors like you make MY job(as a doula). It's so nice to hear women who have been properly educated say that there is definately no scheduled induction in their future. I know so many new moms who just didn't know any better, and the only reason they weren't induced was that they were LUCKY enough to be referred to a GREAT doc who refused to induce and told them why. And every one of those women who APPRECIATE the care you're giving will go on and tell their friends and family, and send more women to you, to be educated and cared for properly. Thank you for doing the job you do. You are a rare and wonderful creature, doctorjen! You really do make the world a better (and gentler) place!
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And you never know when that baby should be born - maybe their bithday will put them in a class with so-and-so for a particular reason... or they'll have a birthday party at a restaurant and meet so-and-so and it'll be important... or they'll be in a particular place at a particular time b/c of it. Maybe that's way out there, but that's one more reason to leave it to babies... they really do choose their birth day for more than a few good reasons.

Originally Posted by doctorjen
Sigh. What else can I do?
Lie to them about their due dates? I'm mostly kidding....

But hey, if other doctors can push due dates up 2 weeks because of faulty U/S readings, why can't you push them back 2 weeks?
: If only we knew when they first came in which ones to "fix" the dates on... But as doctorjen said, mostly, people know how to figure it out on their own now, which, as a rule (knowing about your body and it's processes, I mean) is a good thing! We just have to accept that we have to put the education out there, and hope that these women have the common sense to soak it up! Often, with mainstream women, this doesn't happen (s'pecially when the only births they've heard about/experienced have been managed/induced, etc., and it's just commonplace to them), and we just have to sit back and watch, and know that we did our job to the best of our abilities, and maybe, just maybe, affected one person who otherwise would have been lost to the "savior complex" of mainstream docs...and their baby, too, which, in the end, makes two people!
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