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Inducing labor question


lynn
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Is it common for ob to tell a patient "your due date is x but you can choose which to be induced before then. " ?   There are no complications with this pregnancy.  She said her aunt and sister used this ob and it's common practice with him.  Just curious.

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It was such a common practice here that the hospital at which I birthed told us during the class that they absolutely forbid elective inductions. I can’t remember exactly how they put it, but they wouldn’t allow a physician to induce before 39 weeks without very good reason and the docs had to agree or else they wouldn’t be allowed to deliver there.  And they told us multiple times about how “the circle of intervention” can get out of hand.   It was def weird.  

When I asked my doc about it, he confirmed that rule and said their practice has the same policy.  

SIL’s doc, on the other hand, was apparently super-pushy with inducing starting at 37 weeks.  And when I had my DD (a million years ago), they just scheduled me for an induction and I went. In retrospect, I’m angry about that, but at the time, I had no idea ?

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There was actually a large study just published in the New England Journal of Medicine recently finding that elective induction at 39 weeks actually LOWERED the c-section rate. That goes against the conventional wisdom and may lead to more doctors offering elective inductions at 39 weeks: https://www.nih.gov/news-events/news-releases/induced-labor-39-weeks-may-reduce-likelihood-c-section-nih-study-suggests

I have had 3 inductions. The first was for medical reasons after my doctor didn't like the results of the non-stress test done at 41 weeks. He broke my water and immediately I went into full-blown labor without any Pitocin necessary. The second was done at 39 weeks because at the time I lived an hour away from the hospital and my first labor had only been 3 hours total. The third was completely elective at 40.5 weeks because I'd had two previous successful inductions and I was sick of being pregnant.

This time around I won't be allowed to go past my due date because at almost 42 the risks of stillbirth are higher, and they go up pretty dramatically after 39 weeks. I've never gone into spontaneous labor by my due date so I'm anticipating another induction.

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I was induced unsuccessfully before my first baby.  I see no reason why there would be more c- sections unless it was that babies grew too large.  I can see inducing a baby that is already quite big but my son was 6 lbs, 8 oz when he was born a week later (with a new OB).  Nobody suggested anymore inducements for 2 and 3 and I think each was born at 41 weeks and each was in 6 lb range.

I am not a fan of the natural birth movement in some aspects (I think pain medication is helpful), but inducing before the body and baby is ready doesn't actually work- at least not with me.  I had that pitocin drip for hours and hours and nothing happened.

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I was offered an unsolicited induction with my first, but for a day or two before my due date. (Circa 1998)

I went on to two different practices for the rest of the kids. OB okayed a 41wk induction. I had to demand ones at 42 weeks and 39w4d from my midwives, who were opposed. 

(Middle kid, for whom I had no reason or desire to induce, weirdly liked her projected due date!)

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1 hour ago, Crimson Wife said:

There was actually a large study just published in the New England Journal of Medicine recently finding that elective induction at 39 weeks actually LOWERED the c-section rate. That goes against the conventional wisdom and may lead to more doctors offering elective inductions at 39 weeks: https://www.nih.gov/news-events/news-releases/induced-labor-39-weeks-may-reduce-likelihood-c-section-nih-study-suggests

I have had 3 inductions. The first was for medical reasons after my doctor didn't like the results of the non-stress test done at 41 weeks. He broke my water and immediately I went into full-blown labor without any Pitocin necessary. The second was done at 39 weeks because at the time I lived an hour away from the hospital and my first labor had only been 3 hours total. The third was completely elective at 40.5 weeks because I'd had two previous successful inductions and I was sick of being pregnant.

This time around I won't be allowed to go past my due date because at almost 42 the risks of stillbirth are higher, and they go up pretty dramatically after 39 weeks. I've never gone into spontaneous labor by my due date so I'm anticipating another induction.

Kids 3 & 4 were induced at the suggestion of my high risk ob (and were my 2nd and 3rd VBACs). This is fairly common in some perinatology/high risk ob circles and has been for the last 5-8 years.

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This is how it worked with my SIL with her first baby.  Doctor let her pick a day to induce, and she wasn't even beginning to dilate or anything.  She ended up tearing badly and they had to vacuum the baby out- the little six pounder is doing well today, but it was a very traumatic birth and labor for mom.   There was no medical reason to induce at all, no high risk, babies were comfy, the doctor just wanted the convenience of a scheduled L&D I think.  SIL saw nothing wrong with it and continued with that doctor for all five of her kids.   If I remember right, she was induced again for the second and third. The fourth and fifth she actually went into labor on her own.  

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In my area it used to be super common to be induced between 37-38 weeks, especially with second and third children. Then the hospitals started saying they wouldn’t allow induction unless there was a medical reason.  I had friends who just had to have elevated blood pressure during their appointment in order to be induced, one friend went walking around the doctors office mid appointment  to get her bp up. Previous large babies were another reason I’ve seen given for induction.

My ob offered induction with my last two, but I opted to wait. I had pretty long labors when I started on my own, I didn’t figure being induced would help. With my last child I was told that at 42 weeks my ob would require me to be induced, I went into labor at 41. 

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I've been induced twice for medical reasons, and I've never understood why women would voluntarily choose to have one.  My pitocin labors were much more painful and more difficult than my spontaneous, non-induced-or-augmented labor.  Although I've heard that it's common to augment labors that started spontaneously, so maybe most women don't know what it's like to not have pitocin or some other augmentation done.

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Common. My second was thought to be high risk for me, but we got to due date just fine and OB did not want to wait any longer. He was not pushy, just cautious. He was my favorite. My third was induced on her due date for our own convenience. I needed a sitter for the first two and couldn’t find anybody to be on call. But that OB was pushy. 

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1 hour ago, forty-two said:

I've been induced twice for medical reasons, and I've never understood why women would voluntarily choose to have one.  My pitocin labors were much more painful and more difficult than my spontaneous, non-induced-or-augmented labor.  Although I've heard that it's common to augment labors that started spontaneously, so maybe most women don't know what it's like to not have pitocin or some other augmentation done.

 

I voluntarily chose one for my last two (although my most recent baby was born before I could be induced) because I have very fast labors and a low pain tolerance.  My 5th child (and also my 3rd) was born without pain meds as I went too fast, and it was quite traumatic.  I never want to have another unmedicated labor if I can possibly avoid it.  Induction allows me to have the epidural in place.

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Where I live OBs are not allowed to induce before 39 weeks unless there is a valid medical reason to do so. Fortunately, most OBs are moving away from the break-the-water-administer-pit method and are going with more gradual, gentle induction methods over the course of days if need be. So while women can come in wanting inductions they can't get them which proves problematic for those of us who have labors that are about an hour in length and would rather have things a bit more planned/controlled.

I'm not against inductions if things are favorable (cervix) and the induction is gradual. For some women it works way better to have something planned rather than to be throwing kids into the van because one can't get hold of one's husband (who was told to ANSWER HIS PHONE) and one is racing for the hospital hoping there isn't an accident blocking traffic which would cause the baby to have a mile marker as a birth place. Yeah, that was fun.

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I never want to have another unmedicated labor if I can possibly avoid it.  Induction allows me to have the epidural in place.

Yes!! I call ahead to the hospital and somewhat yell at whomever is unlucky enough to answer the phone that I'm coming in and the anesthesiologist needs to meet me at the door with the epidural. Traumatic is a good word.

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3 hours ago, forty-two said:

I've been induced twice for medical reasons, and I've never understood why women would voluntarily choose to have one.  My pitocin labors were much more painful and more difficult than my spontaneous, non-induced-or-augmented labor.  Although I've heard that it's common to augment labors that started spontaneously, so maybe most women don't know what it's like to not have pitocin or some other augmentation done.

5 babies, 4 induced, one with an epidural, one with Stadol, the rest without pain meds. For me (me, me, me, my experience) pitocin and no pain meds wasn’t any more uncomfortable than no pitocin and no pain meds. Longer, though!

But it was better than trying to manage small children in the delivery room. ?

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10 hours ago, Crimson Wife said:

There was actually a large study just published in the New England Journal of Medicine recently finding that elective induction at 39 weeks actually LOWERED the c-section rate.

If you look at the study, it was more about induction early versus induction late, not about induction early versus allowing the woman to go into labor naturally. Not enough women were allowed to actually just go into labor when ready to make a recommendation, in my opinion. But I'm probably biased since  I've had 4 babies, and my one that was at just before 39 weeks was my c-section, and the ones near or at 42 weeks were easy vaginal births. The one at 42 weeks exactly was when I was a month shy of 41 years old, and I'd planned on accepting induction if I was still pregnant the next day. That said, I do highly recommend careful monitoring...I've done biophysical profiles at 41 weeks with any that went late, and this last one I started them at 38 weeks due to my age. I also went in for a full work up including bloodwork, non stress test, biophysical, etc when I hit 42 weeks, with the idea that if everything wasn't picture perfect I'd stay at the hospital and be induced. But it was picture perfect, so I checked out AMA , went into labor on the way home, and had a happy home birth 2 hours later. 

In my circle it seems unusual to do the monitoring I did...most OB's seem to either do induction early or nothing at all. In those circumstances I can see how inducing early could be better than doing no monitoring. I was comfortable with the middle ground of frequent monitoring (weekly biophysical if all was perfect, plus twice weekly midwife visits to check heart tones and my blood pressure..so three visits a week at the very end). I also have a history of long pregnancies with healthy babies, and was actually born 3 weeks late myself. We just cook them longer in my family. 

Edited by Ktgrok
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My most recent, born the day of my scheduled induction (but 8 hours before the induction!) was a 2.5 hour labor and I lived 45 minutes from the hospital.  In my previous experience, between the time I arrived at the hospital and the time I got the epidural (or the time when they said sorry, we won't have the epidural in time) was about 2 hours.  First they want you to wait an hour to make sure you're really in labor, then they draw your blood and run labs, then they page the anesthesiologist, then they page him again, then they tell you sorry, no epidural (or then he shows up and you get the epidural and it is good). But my most recent baby was a different experience - I'd called ahead like I always do and told the nursing staff that I DEFINITELY WAS GOING TO HAVE THE BABY WITHIN 2 HOURS OF SHOWING UP and that I HAD A VERY LOW PAIN TOLERANCE AND BECAME IRRATIONAL AND LOUD DURING TRANSITION.  I was super duper clear this time.  When I showed up I was sure I wasn't getting the epidural.  I'd gone into labor up the mountain, left the house after 3 10-minute spaced contractions with pain a 2, and by the time I was down the mountain at the hospital they were 3 minutes apart and pain was a 5.  From my own experience, if I get to the hospital after pain is a 4 (for me pain is almost precisely correlated to cm dilated and yes, I do get to 10 with no epidural), it's too late.  So I showed up and was pretty upset and the triage nurse said, god bless her, "oh, I remember you from on the phone." and then she paged the anesthesiologist right then, told me I didn't have to have labs run, and admitted me on the spot, no hour long waiting session.  I told her when I got rich I'd buy her a car, I was so happy.

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5 hours ago, forty-two said:

I've been induced twice for medical reasons, and I've never understood why women would voluntarily choose to have one.  My pitocin labors were much more painful and more difficult than my spontaneous, non-induced-or-augmented labor.  Although I've heard that it's common to augment labors that started spontaneously, so maybe most women don't know what it's like to not have pitocin or some other augmentation done.

My first labor was induced for medical reason at 39 weeks. Second, my water broke and labor started naturally. Third and fourth were induced at 39 weeks because there was no one to call on short notice to watch my other kids. Our family was hours away. 

My experience was that pitocin labors weren’t any more painful than the natural one, but it seemed to start on the middle of the pain level rather than gradually ratcheting up. 

I did tend to walk around dilates to 3 cm for most of my last trimester so it takes very little to get things going. 

 

 

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7 hours ago, Ktgrok said:

In my circle it seems unusual to do the monitoring I did...most OB's seem to either do induction early or nothing at all. In those circumstances I can see how inducing early could be better than doing no monitoring. I was comfortable with the middle ground of frequent monitoring (weekly biophysical if all was perfect, plus twice weekly midwife visits to check heart tones and my blood pressure..so three visits a week at the very end). I also have a history of long pregnancies with healthy babies, and was actually born 3 weeks late myself. We just cook them longer in my family. 

My 42 week (4th successful) pregnancy had me getting a million biophysicals (with midwives.) We were up to every other day at the very end, and I lived just over an hour away from the office and hospital. (On the bright side, I had decent insurance at the time!)  They didn't want to induce because everything looked great, but they wanted to start monitoring DAILY.  Um, no. Get the little monster out! I think I threatened to sleep in the parking lot to avoid the commute.

I still don't know how, with SOOOOO many ultrasounds, the techs never noticed a 2x nuchal cord plus true knot (or at least one of those things,) but they didn't. I realize it's a bit irrational, but it made me more cynical about so much monitoring.

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On the general "is it common" theme... It seems to me like it's become more common to change "due dates".  That's where my main concern with 39 week inductions would be.  My sister, who has no intention of inducing, had her due date adjusted by an entire week by a mw practice, which seems especially odd to me.  She knows her dates with absolute certainty.  She had an early ultrasound because of her medical history, and they insisted on using measurement dates.

To me, that seems so much more stressful.  It's one thing to face "this baby could come at any time".  She's over there, 36/37 weeks or so, facing the idea that this baby is likely to arrive in 1-6 weeks. ? I just think that's mean!

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19 hours ago, TravelingChris said:

I was induced unsuccessfully before my first baby.  I see no reason why there would be more c- sections unless it was that babies grew too large.  I can see inducing a baby that is already quite big but my son was 6 lbs, 8 oz when he was born a week later (with a new OB).  Nobody suggested anymore inducements for 2 and 3 and I think each was born at 41 weeks and each was in 6 lb range.

I am not a fan of the natural birth movement in some aspects (I think pain medication is helpful), but inducing before the body and baby is ready doesn't actually work- at least not with me.  I had that pitocin drip for hours and hours and nothing happened.

 

They did three tries at inducing.   The easy way, the hard way, the hard way.   I'd set a deadline in my head, that if nothing happened by then, we were going to pack up and go home regardless of what anyone said.  DD was born about an hour before that.  

 

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I was induced the first time because of low amniotic fluid at 39 weeks. They started me with Cytotek and said in 8 hours they'd give me some more and 8 hours after that they'd start pitocin. But none of that happened because he was born 6 hours later.

2nd time was not induced and labor was less than 2 hours start to finish and we barely made it to the hospital in time.

3rd one was induced at 39 weeks because of my last fast labor and it was March with a chance of big snow and I live 45 minutes from the hospital on bad country roads that sometimes don't get plowed very quickly. Again, Cytotek for a few hours then he broke my water when I was at a 1 and she was born less than 3 hours later.

4th one was an elective induction at 40 weeks because the Dr was on call that night and I was tired of being pregnant. No Cytayek this time, he just broke my water and she was born 4 hours later (after being stuck at a 5 for 2 of those hours).

5th one was induced at 40 weeks mostly out of habit I think ? Cytatek and a few hours later he broke my water when I was at a 2 and she was born an hour and a half later. That one was traumatic as I went from a 2 to a 5 literally while the nurse was checking me and there was a huge pain and a gush of fluid and her heart rate dropped and there were a dozen people in the room and I had to get on my knees with my butt in the air and my face in the pillow and I just prayed that Jesus would let my baby live. All was fine, she just reacted a bit to the big hurry my body always seems to be in during labor.

Now that I'm pregnant with #6 it's going to be a different ballgame I think. My OB for all the other kids died a couple of years ago so I have a new Dr who doesn't know my history and quirks like he did. Since I'm 44 this time I'm wondering if what was said upthread about inducing older moms because of the increased risk of stillbirth will apply. If necessary I think I would prefer just a Cytotek induction vs them breaking my water this time. I don't know for sure that that would make it a little slower or less intense, but I wonder if it would. More like my 1st labor.

I liked my natural labor the best, but I'm worried about a baby being born in the car. We seriously only made it with about 40 min to spare last time.

Edited by Momto5inIN
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That was not my experience in military healthcare. I went to 42 weeks and a questionable level of remaining amniotic fluid they were willing to have #1 induced.  She was 9lb 1oz.  It was a 12 hour labor, epidural complication and had to be removed so unmedicated delivery. Next two went over by just a few days, unmedicated, *fast* labors and delivery (one was within 2 hours of entering the hospital and the other was about 45 min). Recovery was so fast. Last one was induced at 41 weeks, and it was also unmedicated but it was a longer and more uncomfortable labor than previous two.  Contractions on pitocin are brutal. Last one was 9lb 2oz baby.  I was actually surprised they were talking about induction at 41 weeks, but she would have been quite the big baby had we waited longer.

So, maybe areas (and the military, though geographically spread in reality functions as an “area”) of the country/world have different standards.

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On 9/21/2018 at 3:02 PM, forty-two said:

I've been induced twice for medical reasons, and I've never understood why women would voluntarily choose to have one.  My pitocin labors were much more painful and more difficult than my spontaneous, non-induced-or-augmented labor.  Although I've heard that it's common to augment labors that started spontaneously, so maybe most women don't know what it's like to not have pitocin or some other augmentation done.

I didn't find the labor where I didn't receive Pitocin to be any less painful than the 2 where I got Pitocin. The non-Pitocin labor was the shortest at 3 hours total vs. 8 hours and 4.5 hours.

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21 hours ago, Ktgrok said:

 In my circle it seems unusual to do the monitoring I did...most OB's seem to either do induction early or nothing at all. In those circumstances I can see how inducing early could be better than doing no monitoring. I was comfortable with the middle ground of frequent monitoring (weekly biophysical if all was perfect, plus twice weekly midwife visits to check heart tones and my blood pressure..so three visits a week at the very end). I also have a history of long pregnancies with healthy babies, and was actually born 3 weeks late myself. We just cook them longer in my family. 

I started twice-weekly Non-Stress Tests (1 of which includes the biophysical profile) with the perinatologist at 32 weeks due to my age. My blood pressure this time around has been a bit iffy but so far the urine has been clear. I am supposed to go daily to have my blood pressure checked and then call the clinic if it's over 140/90 as they'll have me come in (or go to L&D if it's outside business hours). Pre-eclampsia would be a reason to deliver me sooner rather than later so I am hoping that everything stays clear.

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In my area, for 2 OBs, I was not given the option to induce early, at least not earlier than 39 weeks. With #3 he was looking pretty large so they said I could induce at 39 weeks if I wanted, but they would not induce any earlier unless it was a medical emergency. (We ended up going to week 42 with him, and I finally scheduled an induction for 7:30am on a Sunday. I went into labor at 5am and he was born at 7:20, so apparently he just needed to know there was a deadline, lol). 

One of the OBs actually did a big speech how they will not induce any earlier unless it's a medical reason, they have been asked too many times to induce early for convenience. But, they simply wouldn't unless it was for the baby/mother's medical needs. 

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