Jump to content

Menu

Why are healthy overdue moms induced?


Indian summer
 Share

Recommended Posts

I've never gone past my due date, but I remember my doc saying if I went beyond 10 days past, induction would be necessary. Why? Beyond emergency situations like preeclampsia, is it dangerous for an overdue baby to remain in there too long? Is the induction about the mothers comfort? Or about the size of the baby becoming an issue? What if it's clearly a smallish baby of, say 7lbs.? Would it then be okay to let the baby come on its own time? What did they do in the days before c-sections and induction meds? Was this a big problem that caused a lot of death to mothers and babies?

 

I'm not expecting, nor do I plan to have more children, I've just been curious about this for a long time and never thought to ask.

Link to comment
Share on other sites

I asked this question of my doctor, and he said the placenta starts to degrade at about 8 months, and the longer you go past full term, the less-functional the placenta becomes.  I guess that might be one reason infant mortality is lower than in the past for viable babies.

 

ETA:  I had one doc let me go almost 2 weeks past due, and another had a shit fit because I was 3 days past due.

Link to comment
Share on other sites

Yes, it's a placenta issue. I delivered all of my boys at 39 1/2 weeks and their placentas were DONE. With my most recent pregnancy the doctors all agreed they would induce me at 40 weeks if I got that far because it was just too risky to let a placenta get any older than that for me. When it gets too old it stop transferring food and oxygen to the baby properly and can result in stillbirth.

Link to comment
Share on other sites

With my two girls, I went 42 weeks.  My dates could have been off but I highly doubt it.  40 weeks is an average time.  All women and babies are different.  I know some women who normally go 38 weeks and others who go 42 with every baby.  One midwife I used had to have inductions with every baby because she lost her first one when the placenta shut down and labor didn't start. With most women, the placenta shutting down is one factor in triggering labor.  But in some women that doesn't happen soon enough.  I understand doctors being cautious.

Link to comment
Share on other sites

I've been overdue by at least a week - three times. (two of them I knew to the day when I got pregnant)  the placenta starts to work less efficiently and it can tax the baby.  I had a non-stress test at 10 days with 2dd.  she went to sleep during the test.  very uncooperative.  they gave me juice (sugar) and the nurse pushed on my stomach to try and wake her up. the results were she was fine.   My induction was scheduled for day 17 (a Monday.  it probably would have been sooner if my dr hadn't left town for five days *after* my due date.  he got back, looked at me and said "you're still here".  yep.).  I had her on day 14. (Friday). the only baby I've ever seen with a neck.  she liked transverse.  more room to stretch-out.

 

2ds was induced at 7days poste.  I had a dr appointment that morning, he called L&D to see if they had room for me and I went in that afternoon.  ARoM worked like a charm.

 

 

eta: yes - as someone up thread mentioned - meconium is a huge risk if you go too long.  the baby will pass it inutero.  they end up inhaling it and it gets in their lungs.  that can kill the baby.  at the very least, you will have one very sick newborn.

Link to comment
Share on other sites

Why are healthy, not due moms induced? Where I live, doctors always deliver the babies between 37 and 39 weeks. It is always scheduled. They do tours of the hospital on Sundays because no one is in the hospital then, because they were all forcibly delivered during the week.

 

This is actually a trigger subject for me. I wish I had done a home birth or birth center birth with my first, prenatal care here is soooo bad!

Link to comment
Share on other sites

that sounds like convenience for the drs and L&D/maternity.  or a very paranoid group who got sued for letting some mom go too long with a bad outcome. 

I'd be looking for a birthing center - or another hospital.

Why are healthy, not due moms induced? Where I live, doctors always deliver the babies between 37 and 39 weeks. It is always scheduled. They do tours of the hospital on Sundays because no one is in the hospital then, because they were all forcibly delivered during the week.

 

This is actually a trigger subject for me. I wish I had done a home birth or birth center birth with my first, prenatal care here is soooo bad!

 

Link to comment
Share on other sites

I went to 41 weeks with my youngest, my OB wanted to induce. I declined but was told at 42 weeks it was the practices policy to induce regardless of moms wishes. Not sure what would happen if you declined at that point.

 

My 3rd was the only one of my 3 to spend time in NICU and was there a week.

Link to comment
Share on other sites

My brother came really late.  I don't remember how late.  There was no fluid left.  He was born looking like a shriveled prune and was severely dehydrated.  Very scary.  Today, Mom would have been induced long before it got to that point.

 

I was induced with both kids.  One was a tiny bit late, according to their estimates, but honestly I regret getting induced.  She wasn't ready and the labor went on a long time and was not progressing.  The placenta was fine and she was small.  We could easily have waited a bit longer.  It was a horribly painful, extremely long and exhausting process and put both of us under a lot of stress.  I just didn't know to question what the doctor was telling me.

 

The other was actually a tiny bit early but he was getting really large and I am really pretty small.  And he ended up being larger than they had estimated so even though I had determined that with my second pregnancy I would not induce unless absolutely necessary, I guess it was just as well that they determined it to be necessary.  I nearly ended up having a C section mid-labor.  

Link to comment
Share on other sites

My understanding is placenta decline, baby gets too large and meconium are risks.

 

This is my understanding as well....  I'm all for letting nature take its course, but there is a reason mortality from childbirth has gone down....  for both the mom and the baby.

Link to comment
Share on other sites

The placenta thinning and not supplying vital life support  but also the increase chance of meconium inhalation.  This is when the baby has a bowel movement in utero    which is sterile unlike post birth but still causes respiratory distress.  THis has a higher chance of occurrence in late term delivery  or other incidents of fetal distress.

 

I decided against induction as a younger mom (23) and  a young nurse.  I was feeling well and all fetal signs were good.  My water broke and had natural delivery 7 days after official due date.

 

I think you have to make the best decicsion for you.  I know having both of my kids in my 20's I was much more with the I feel good and young.  I may of made a different decision if I was overdue and 38. 

 

Link to comment
Share on other sites

Statistics. That's basically what it comes down to. 

 

Statistically, at a certain point it's more risky for the baby to stay in than to be induced.

 

Decline in placenta function is definitely true, but it happens at different points for different people. Ideally, the timing of induction would be entirely individual, based on maternal and fetal wellness indicators. 

Link to comment
Share on other sites

The placenta thinning and not supplying vital life support  but also the increase chance of meconium inhalation.  This is when the baby has a bowel movement in utero    which is sterile unlike post birth but still causes respiratory distress.  THis has a higher chance of occurrence in late term delivery  or other incidents of fetal distress.

I didn't realize the chance increased in late term deliveries.  Our next door neighbors, who had a little girl I would babysit, had their son swallow meconium.  It was a late term delivery.  Sadly, he died.

Link to comment
Share on other sites

My ob told my in his residency that the only time he saw a baby die was when it had gone too far overdue. He thought ideally babies would be born at thirty nine weeks. His motivation was in the interest of the baby.

My second ob said he wouldn't let me go past 40, and my third ob just suggested we induce at 39. I don't know his motivation, but it seemed routine.

Link to comment
Share on other sites

In a healthy, well-fed mother, placentas should last at least to 42 weeks.  Doctors are misinterpreting some studies that came out to make it look like past 41 weeks was bad.  Then, just to be sure, they decided that "hey, a baby is at term at 37 weeks, so lets induce when it is convenient for us!" not understanding that so much brain development happens in those last few weeks.  In first time mothers (white) where labor is left on its own, the AVERAGE length of gestation is 41 weeks 1 day.  That means that most go longer than that.  With two of my siblings, my mom went close to 44 weeks. 

 

Here are a couple of links:

 

Childbirth Connection - Induction

 

Evidence Based Birth - Induction

Link to comment
Share on other sites

I spent most of my nursing life, before teaching nursing, so about 30 years, doing high-risk and critical care labor and delivery.

Post-maturity in the infant and postdate pregnancy are not the same. About 5-10% of pregnancies continue past 40 weeks. The most reliable indicator for dates is an early ultrasound. There are many risk factors for postdate deliveries for both the mom and the baby:

Maternal: doubled rate of CS, cervical rupture, labor dystocia, shoulder dystocia, postpartum hemorrhage, to name a few.

Infant: stillbirth, neonatal death, septicemia, low Apgar scores, and many others.

 

 

 

Link to comment
Share on other sites

Why are healthy, not due moms induced? Where I live, doctors always deliver the babies between 37 and 39 weeks. It is always scheduled. They do tours of the hospital on Sundays because no one is in the hospital then, because they were all forcibly delivered during the week.

 

This is actually a trigger subject for me. I wish I had done a home birth or birth center birth with my first, prenatal care here is soooo bad!

 

:grouphug: 

 

Link to comment
Share on other sites

This is my understanding as well....  I'm all for letting nature take its course, but there is a reason mortality from childbirth has gone down....  for both the mom and the baby.

 

http://www.usatoday.com/story/news/nation/2014/05/02/maternal-deaths-united-states/8602637/

 

"The United States is one of just eight countries in the world where deaths related to pregnancy and childbirth rose between 2003 and 2013, a new report says. That puts it in the company of countries such as Afghanistan, Belize and El Salvador."

 

Not encouraging. 

 

From what I gather, the US actually has the worst outcome in developed nations and spends more money on healthcare than other first world nations. The nations with the lowest mortality rate have either a high homebirth rate and/or encourage mothers to freely choose their place of birth.

 

Link to comment
Share on other sites

Statistics. That's basically what it comes down to. 

 

Statistically, at a certain point it's more risky for the baby to stay in than to be induced.

 

Decline in placenta function is definitely true, but it happens at different points for different people. Ideally, the timing of induction would be entirely individual, based on maternal and fetal wellness indicators. 

 

My brother whom I will never have the chance to know was a statistic.  He died in utero the day before my mom gave birth, and the doctor said it was due to "calcification" of the placenta.  I would not risk it on that alone.  But that is just me. 

Link to comment
Share on other sites

I'm convinced that part of the explanation for the rise in autism is due to the overuse of oxytocin to induce labor. http://consumer.healthday.com/cognitive-and-neurological-health-information-26/autism-news-51/inducing-labor-linked-to-autism-risk-679185.html

 

My first two kids had medical reasons for being induced, but with my 3rd, I was just impatient and had an elective induction at 40.5 weeks. My midwife was fine with it because I'd had two previous successful inductions but I feel guilty about pushing her for one. I didn't know about the link between induction and autism at the time.

Link to comment
Share on other sites

My brother whom I will never have the chance to know was a statistic.  He died in utero the day before my mom gave birth, and the doctor said it was due to "calcification" of the placenta.  I would not risk it on that alone.  But that is just me. 

 

I'm very sorry about the loss of brother, but please note that I'm not suggesting anyone just ignore the health of postdates babies or avoid inducing entirely. I'm just against the idea of inducing on arbitrary days without taking the actual status of that individual mother and baby into account. There are definitely real problems that can occur, but close monitoring should indicate if placental functioning is starting to decline before it gets to a dangerous point.

Link to comment
Share on other sites

Why are healthy, not due moms induced? Where I live, doctors always deliver the babies between 37 and 39 weeks. It is always scheduled. They do tours of the hospital on Sundays because no one is in the hospital then, because they were all forcibly delivered during the week.

 

This is actually a trigger subject for me. I wish I had done a home birth or birth center birth with my first, prenatal care here is soooo bad!

 

No way. :huh:

 

I'm afraid I would not have been very cooperative...

Link to comment
Share on other sites

Here's a chart (page 9) from the CDC showing fetal mortality rates compared to gestational age (from 2006). Essentially, there is a significant uptick in mortality rates the longer the pregnancy continues. This chart doesn't reflect outcomes though; I'd guess that a 34-week baby would require more medical intervention than a 40-week baby.

 

http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_08.pdf

 

Link to comment
Share on other sites

I was a way post-term baby. I was due to come by mid June. I was born at the very end of July. My mom told me I was discolored, I had ridiculously long hair and nails and while I was huge, I wasn't baby plump. They never would let it go that far today. They only did then because when June came and went with no birth, the OB practice decided that maybe they'd messed up dating the pregnancy. Note, in order for that to happen they would have had to told her she was pregnant more than a month before she was and she would have had to been dealing with morning sickness before conception.

 

Note also that I was born in a very hot Texas summer. My mom was 44+ weeks in a heatwave. I am sure she would have been all over an induction if offered one! I certainly didn't get to complain about the Seattle June heat when I was reaching my 7/2 due date, lol.

 

Oh and when I did come, I was born in the front seat of the car in the hospital parking lot. My mother was getting out of the car and realized that birth was imminent. The hospital orderly was trying to get her to sit in a wheelchair and she sat back down in the car and voila, baby. When I was ready, I guess I was really ready.

Link to comment
Share on other sites

Why are healthy, not due moms induced?

In my case (induced at 39 weeks), it was a combination of things that weren't problems yet -- so, technically, baby and I were healthy -- but which could have gone south very quickly. There was an indication of a possible placenta problem on an ultrasound, I was having severe unexplained headaches, and my blood pressure was creeping up. I was also not getting much sleep due to the headaches, contractions that had started, and having 10 1/2 month old twins at home, and we have no family locally so had to arrange childcare for the twins when the time came.

 

Between the potential for one or more of the health issues escalating into a full-blown emergency, the not-sleeping, and the chilcare logistics, even our doula agreed that inducing at that point was a good idea. :)

 

I should add that there was no pressure from my OB (an M.D., and a male one at that! ;) ), he was very helpful in sorting things out but was supportive of whatever we decided. He visits his patients at the hospital every night after gis office hours, he had no problem letting the induction go slowly over 2 days, and even had them disconnect the IV overnight and bring in a more comfortable bed so I could get some sleep (the nurse thought he was kidding until he said he's tried sleeping on the L&D beds and it stinks).

Link to comment
Share on other sites

http://www.usatoday.com/story/news/nation/2014/05/02/maternal-deaths-united-states/8602637/

 

"The United States is one of just eight countries in the world where deaths related to pregnancy and childbirth rose between 2003 and 2013, a new report says. That puts it in the company of countries such as Afghanistan, Belize and El Salvador."

 

Not encouraging. 

 

From what I gather, the US actually has the worst outcome in developed nations and spends more money on healthcare than other first world nations. The nations with the lowest mortality rate have either a high homebirth rate and/or encourage mothers to freely choose their place of birth.

 

 

Ok - but you realize we are one of the "most" reporting countries on the list (many underreport), and that people with many multiples and very premature infants actually count in our score - whereas other countries don't count under (I think - about) 37 weeks as being mortalities?  We also have many more moms who are able to get closer to term before something bad happens because of our supportive care....  And we count those lost babies.  Many other countries just don't.  You can make statistics say anything....

Link to comment
Share on other sites

My understanding is placenta decline, baby gets too large and meconium are risks.

My first baby went one week past my due date before my doc would induce. There was meconium when she was born and a lot of concern and stress. I demanded induction with my others no later than the due date. A healthy child can (rarely) die going over dates because of placenta issues/distress. I have a friend who suffered this tragedy, and I have been sick about it ever since, whenever I think about it. :(

Link to comment
Share on other sites

I do think they are doing some funky things these days.  Like c-sections.  Why is it that pretty much everyone I know, all my relatives, etc. all had c-sections?  It seems like too many to be that they were all absolutely necessary.

 

While my first one was probably unnecessary (I was only 16 and easily told to just "have a c-section because you're too small to deliver vaginally), the subsequent ones were, if I recall, because the hospitals associated didn't allow vbacs and the doctors I chose didn't perform them (I think it had something to do with their insurance?).

To be honest, though, I wanted the subsequent sections, and I do not think I would have opted for a vbac even if given the option.

Link to comment
Share on other sites

I'm very sorry about the loss of brother, but please note that I'm not suggesting anyone just ignore the health of postdates babies or avoid inducing entirely. I'm just against the idea of inducing on arbitrary days without taking the actual status of that individual mother and baby into account. There are definitely real problems that can occur, but close monitoring should indicate if placental functioning is starting to decline before it gets to a dangerous point.

This.  For every story of a baby that theoretically could have been fine if induced the day before (without the added risks of AROM and cord prolapse as well as very real and common complications from induction and a tripled mortality rate for c-sections), there are many stories where a child died or was injured from an unnecessary induction. My son is one of these.  Their u/s was entirely wrong.  He was supposed to be "huge".  Nevermind that I had been bf and got pg with him shortly after having my daughter without a return of menses.  He was small, premature, and has permanent neurological issues.  Not to mention the traumatic induction for me that led to severe hemorrhaging, shock, and seizures. That absolutely would not have happened if I was allowed to go to my EDD (they induced me the week before because he would be "huge" by their estimates).  It took them an hour to break my water (!!!!), and he was basically forcefully ripped from me because neither he nor my body was willing or cooperative. 

 

Why do doctors do it?  Convenience.  That and a focus on deflecting lawsuits for the extremely rare stillbirth case that possibly could have been prevented if baby was born sooner.  Though with a watchful doctor/midwife and healthy mom, it's not common and only God can really predict those.  There's always a "what if".  Unfortunately when it comes to birth and parenting, that "what if" becomes very valuable. 

 

FWIW, it's extremely common with my friends and family for them to be induced because they were "sick of being pregnant". Even as early as 36 weeks. Very risky.  I can't believe doctors are ethically allowed to do that with the risks to mother and baby.  First do no harm...Mother's choice should be top priority, but not every woman is informed of the risks.  This is something women really need more education on.

Link to comment
Share on other sites

In my case (induced at 39 weeks), it was a combination of things that weren't problems yet -- so, technically, baby and I were healthy -- but which could have gone south very quickly. There was an indication of a possible placenta problem on an ultrasound, I was having severe unexplained headaches, and my blood pressure was creeping up. I was also not getting much sleep due to the headaches, contractions that had started, and having 10 1/2 month old twins at home, and we have no family locally so had to arrange childcare for the twins when the time came.

 

Between the potential for one or more of the health issues escalating into a full-blown emergency, the not-sleeping, and the chilcare logistics, even our doula agreed that inducing at that point was a good idea. :)

 

I should add that there was no pressure from my OB (an M.D., and a male one at that! ;) ), he was very helpful in sorting things out but was supportive of whatever we decided. He visits his patients at the hospital every night after gis office hours, he had no problem letting the induction go slowly over 2 days, and even had them disconnect the IV overnight and bring in a more comfortable bed so I could get some sleep (the nurse thought he was kidding until he said he's tried sleeping on the L&D beds and it stinks).

To me, that would not be a healthy situation to leave for waiting with signs of preeclampsia.  We are talking otherwise healthy pregnancies, I thought?

Link to comment
Share on other sites

I do think they are doing some funky things these days. Like c-sections. Why is it that pretty much everyone I know, all my relatives, etc. all had c-sections? It seems like too many to be that they were all absolutely necessary.

Indeed. My friend just had her first baby via a scheduled csection because baby was measuring "big"... He was born 8 lbs 3 oz. The doctor said she could go naturally but you never know what complications could occur. Really.

Link to comment
Share on other sites

My late one didn't have enough fluid in the sac.

This happened to me and the baby was not past due. I was induced three weeks prior dates because critically low amniotic fluid. (4mm); (10mm is minimum)

Link to comment
Share on other sites

My midwife was willing to let it go past the 42 weeks.  I'm the one who asked to be induced at that point.  I had had enough!  Plus, I didn't want to be in the hospital on my birthday.  :laugh:

 

My 42-weeker was born 3 days after my birthday. I spent days hoping he wasn't going to give me breakfast in (a hospital) bed, lol.

Link to comment
Share on other sites

This is anecdotal, but I was told by a friend that back in the 70s, her sister was more than 2 weeks overdue, went in for the next appointment, and the baby was dead.  She said that her sister's case was included in a round of medical papers at that time that led to the new medical standard of not allowing more than 2 weeks.  Yes, they think it was a placenta issue.  The implication is that after that time the possibility of harm to the baby increases dramatically.

Link to comment
Share on other sites

Guest submarines

Why are healthy, not due moms induced? Where I live, doctors always deliver the babies between 37 and 39 weeks. It is always scheduled. They do tours of the hospital on Sundays because no one is in the hospital then, because they were all forcibly delivered during the week.

 

This is actually a trigger subject for me. I wish I had done a home birth or birth center birth with my first, prenatal care here is soooo bad!

:grouphug:  Where do you live? These numbers are insane!

Link to comment
Share on other sites

My dd was 3 weeks over, in the last week and a half I had to go to the hospital every second day and have the baby monitored. It was a real pain as the hospital was 100 km away and I had to find someone to mind my other children. when I reached 43 weeks I was induced. She was too big for me and got stuck at the shoulders. I have always felt it would have been better to have been induced at 41 weeks instead.

 

Link to comment
Share on other sites

With my first my waters broke at 38.5 weeks. My cervix was nowhere near ripe and 3 days of pessaries had no effect. The obstetrician said she would put in a drip if I liked but she thought there was only a 5 - 10% chance of a sucessful birth. I had a c section. My second was a vbac. He was a full week late, the midwife was claiming I couldn't have an induction because of the scar and the obstetrician told her of course she could induce me she did it all the time. They were going to let me go to 1 week and 5 days (they don't like to schedule for Friday or weekends). Luckily he decided 41 weeks was enough and came quickly without complication.

 

This is a round about way of saying that a lot of early inductions must fail and a lot of babies are naturally late. I was nervous though because I was worried about placenta breakdown (I was 40 as well).

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...