External Monitoring starting on due date?

Hello Everyone--

Yesterday I had my regular appointment with my OB (I am at about 38
weeks plus 3 days).

As we were going about the appointment, she told me that she would
induce once I am 10 days past my EDD. This didn't bother me TOO much,
as 10 days is better than I expected from her...I thought she'd be
talking about inducing much sooner than that.

Anyway, she also said that starting on my DUE DATE she would be sending
me to the hospital every 3 days for monitoring. I found it odd that she
would start doing this on my actual EDD and I asked her about it...she
said it was routine and they need to do it to watch out for things like
stillbirth (thanks, like I needed something else to worry about). She
seemed a bit annoyed with my questioning this and said that it's no big
deal, takes 1/2 hour and is non-invasive.

My question: Is this really routine? Any one else out there who has
had their doctor suggest or do the same thing? Am I over reacting by
thinking this is not necessary, especally as early as ON my due date (as
if that date is set in stone)? By the way, in case it matters I have
had no complications during my pregnancy, and this is my first.

Thanks for any insight!
Kathy

"Kathy" wrote in message
...

Hello Everyone--

Yesterday I had my regular appointment with my OB (I am at about 38
weeks plus 3 days).

As we were going about the appointment, she told me that she would
induce once I am 10 days past my EDD. This didn't bother me TOO much,
as 10 days is better than I expected from her...I thought she'd be
talking about inducing much sooner than that.

Anyway, she also said that starting on my DUE DATE she would be sending
me to the hospital every 3 days for monitoring. I found it odd that she
would start doing this on my actual EDD and I asked her about it...she
said it was routine and they need to do it to watch out for things like
stillbirth (thanks, like I needed something else to worry about). She
seemed a bit annoyed with my questioning this and said that it's no big
deal, takes 1/2 hour and is non-invasive.

My question: Is this really routine? Any one else out there who has
had their doctor suggest or do the same thing? Am I over reacting by
thinking this is not necessary, especally as early as ON my due date (as
if that date is set in stone)? By the way, in case it matters I have
had no complications during my pregnancy, and this is my first.

Thanks for any insight!
Kathy


It is certainly not routine where I am (Victoria, Canada). They only time I
went for monitoring is when I hit 9 days past my EDD and I had every right
to refuse that if I wanted (I chose to be monitored). I would have had
another at 12 days past my EDD if I had chosen not to get induced on that
day instead. The reason for the second was to keep an eye on my amniotic
fluid as it was on the low side. But maybe monitoring is routine where you
are, however, you still have every right to refuse it. The choice is yours
not your OBs and don't feel bullied into anything you are not comfortable
with.

Nadene

"Kathy" wrote in message
...

Hello Everyone--

Yesterday I had my regular appointment with my OB (I am at about 38
weeks plus 3 days).

As we were going about the appointment, she told me that she would
induce once I am 10 days past my EDD. This didn't bother me TOO much,
as 10 days is better than I expected from her...I thought she'd be
talking about inducing much sooner than that.


Is this regardless of the baby's condition and regardless of the
favorability of your cervix? I'm not sure why a hard and fast rule like
this would be in any patient's interest. Induction can be hard on mothers
and babies when it is not medically necessary.

Anyway, she also said that starting on my DUE DATE she would be sending
me to the hospital every 3 days for monitoring. I found it odd that she
would start doing this on my actual EDD and I asked her about it...she
said it was routine and they need to do it to watch out for things like
stillbirth (thanks, like I needed something else to worry about). She
seemed a bit annoyed with my questioning this and said that it's no big
deal, takes 1/2 hour and is non-invasive.


Watch out for things like stillbirth? If the baby has died, it's beyond
help and doesn't need to be monitored. Maybe what she means is, "The risk
of fetal demise from longer gestation doesn't really go up too much until 42
weeks, and then it is still very small. However, since obstetricians are
rarely sued for unnecessary induction, but about 30% of obstetrics
malpractice cases involve "late" babies, I'm going to make sure I'm in a
position to recommend induction if there is anything I might interpret as
distress, and that you and/or your husband are in a suitable state of alarm,
fatigue and frustration to take my recommendation." (Of course that's the
cynical version.)

My question: Is this really routine? Any one else out there who has
had their doctor suggest or do the same thing? Am I over reacting by
thinking this is not necessary, especally as early as ON my due date (as
if that date is set in stone)? By the way, in case it matters I have
had no complications during my pregnancy, and this is my first.


Maybe you should get a second opinion.

The average first-time mom goes to (according to the study) 41w1d or 41w3d
(if I remember right). Meaning your doctor wants to hard and fast induce
you at the average for first-time birth.

This article seems reasonably balanced while still obstetrics-oriented.

http://www.obgyn.net/fm/articles/postdates_pg.htm

Good luck-- Dagny EDD 10/6/03

Ericka Kammerer wrote:

There is no medical evidence that all this monitoring
helps at all, and it is most definitely not routine.

Post dates?

It is true that babies can die in utero late
in pregnancy without warning. Fortunately, this is
blessedly very, very rare. And it's sad but true that
most of these can't be predicted or fixed--and there's
no evidence that monitoring every three days will do a
damn thing to prevent it.

Depends when monitoring commences. Besides the studies quoted in the link
Dangy provided, there are *many* studies showing a significant improvement
in perinatal outcomes when monitoring was used after a certain date (what
date exactly is a point of controversy, but not the actual need for
monitoring at some post-date point).

Inductions carry risks! Why accept them without good
inducation?

You mean good indication, right? ;-)

Let me say that I don't think ANY of this is routine, and that your
doctors overly conservative approach creates more risks than it
avoids. I would suggest Henci Goer's book, "The Thinking Woman's
Guide to a Better Birth," but you will have to read it fast to
avoid unnecessary interventions.

Kathy writes:

: Hello Everyone--

: Yesterday I had my regular appointment with my OB (I am at about 38
: weeks plus 3 days).

: As we were going about the appointment, she told me that she would
: induce once I am 10 days past my EDD. This didn't bother me TOO much,
: as 10 days is better than I expected from her...I thought she'd be
: talking about inducing much sooner than that.

"she would induce you" First, let me say that you have the right to
refuse any medical procedure. While it is only 4 days different, the
standard is to talk about induction after 2 weeks. There are alternatives
to automatic induction. This includes a weekly ultrasound to check
the viability of the placenta and the volume of amniotic fluid, the
two most reliable indicators of the baby's health.

: Anyway, she also said that starting on my DUE DATE she would be sending
: me to the hospital every 3 days for monitoring. I found it odd that she
: would start doing this on my actual EDD and I asked her about it...she
: said it was routine and they need to do it to watch out for things like
: stillbirth (thanks, like I needed something else to worry about). She
: seemed a bit annoyed with my questioning this and said that it's no big
: deal, takes 1/2 hour and is non-invasive.

OK. I think you should have gotten some more information. (Unless you
actually did and just didn't post it here) She probably means a Non-
stress Test (NST), where they measure heart rate accelerations and
decelerations. I think that it is just a reliable to have you do a kick
count every day, and this is something you can learn to do in your own
home. Again, her recommendations seem like overkill.

Even more worrysome is her being annoyed at your asking intelligent
questions to help you manage your own health care. (Reinsert plug for
Henci Goer book here~ :-) This is a red flag to me and raises other
questions in my mind.

First regarding her: What is her induction and augmentation rates?
Does she do episiotomies? What is her episiotomy rate? What is her
cesearian rate? What percent of her births are natural unmedicated
births?

Next regarding you: What are your expectations for this birth? Do you
plan/want to go unmedicated? Have you even thought about it or researched
the information to find out if you think it would be better for your and
your baby? Have you discussed it with your doctor?

I am sorry that it is a bit late to bring all of these things up, but
it is better to think of all these things now than to walk into the
hospital for labor and be blindsided by both the doctor and the hospital
protocols.

: My question: Is this really routine? Any one else out there who has
: had their doctor suggest or do the same thing? Am I over reacting by
: thinking this is not necessary, especally as early as ON my due date (as
: if that date is set in stone)? By the way, in case it matters I have
: had no complications during my pregnancy, and this is my first.

: Thanks for any insight!
: Kathy

I think these things are NOT routine, and from what you have described,
your OB is a throwback to times when women took less personal responsibility
for their own well being. I also think that she is dictating some
pracitces to you that have not proven to be beneficial. I do know know
if it is serious enough (yet) to suggest changing care providers, but I
do know that for your own well being and peace of mind that your should
revolve this quickly, before you present for labor.

Good luck,
Larry

"E. 123" wrote in message
et...
Dagny wrote:

The average first-time mom goes to (according to the study) 41w1d or
41w3d (if I remember right).

I have read this study before (41w1d), but doubt the validity of its
findings.

(a) anecdotally, there is absolutely no way half of primiparas go beyond
41w1d.
(b) more importantly, studies examining the percentage of pregnancies that
actually reach 42w found that merely *3%* of them will reach that
stage when accurate dating was confirmed by early US. If that is the
case,
the finding that *half* of primiparous pregnancies will go beyond 41w1d,
simply does not add up.


You're right that the 41w1d study involved median not average. My bad.
Also it was just white women with no obstetric complications, health
problems or unreliable menstrual histories. But it was a review of *17,000*
pregnancies.

But it was a review of *17,000* pregnancies.

I know, amazing! But honestly, from your own life experience, do you find
this data reflective?

IRL, I know the details of about 20 first-time pregnancies. Of those, only
*3* went beyond 41w, and only one reached 42w. I simply find it strange,
but, as I said, it is purely anecdotal.

My mom had me at 41 weeks.

So, she also does not qualify for the half population that goes
past 41w1d ;-)

In the overeducated first-timer over-thirty well-insured crowd I run in,
most of my friends wouldn't be reflected in the data because of
preeclampsia, breech, preterm labor, elective induction, overzealous
induction, amniotomy instead of sending her home to develop real
labor on her own, etc.

That is impressive!

I think we run in the same crowds, but I only know two women
who went through an induction. I do not know where you live, but
maybe the difference is due to the fact that my crowd is mostly
made of Europeans (who live in the US)?

Just a couple of comments:

Kathy writes:

: Just to answer a few assorted questions that came up...she definitely
: said "external monitoring" and not non-stress test. She said that she
: would do a non-stress test at 1 week "overdue".

In this case I am even less impress with her. External monitoring has
shown to be of NO benefit an uncomplicated pregnancies. It makes me
wonder what her (and the hospital's policies are for when you present
in full labor. Is she/they going to require a 15 minute strip at admission,
a 15 minute strip every 2 hours, CEFM? This is something you need to
find out. The wrong policy could have a disasterous effect on your
ability to go med free! More on this below where you mention it.

: As for induction, I'm aware that I can refuse that and other procedures.
: I will cross those bridges when I come to them...I was "relieved" to
: hear her say induction at 10 days, as I thought I'd be fighting her at 3
: days overdue.

This is the best part I've seen so far.

: Concerning my plans and how prepared I am, I feel I am fairly well
: prepared, as is my DH. We both had medical check-ups before starting to
: try, we interviewed OBs (and were fooled into thinking this was the one
: for us) and I had a Gyno exam. I changed my diet, gave up alcohol and
: took vitamins before conceiving. I've had prenatal care all along, have
: read many books, read the posts here daily and have taken classes on
: childbirth, childcare and breastfeeding. I attended LLL meetings as
: well.

Well, I haven't seen you reading and posting questions in
misc.kids.breastfeeding. :-) Seriously, I personally think that resource
is worth all of the LLL meetings in, say, North America. Mind you, I don't
have anything (well, at least, not much) against LLL. I just think that
mkb is a better, more responsive, and more positive resource. Go! Read!
:-)

: well. I have a birth plan stating all of our preferences and plan to do
: my best to go pain medication free by using the non-medical coping
: techniques I've learned. I say "plan to go med free" because this is my
: first baby and I have no idea what it will really feel like or what my
: pain threshold will be...that is why I have checked into pain meds and
: have a very specific plan as to what I would start with and what I would
: refuse if necessary.

Hmmm. I don't know how to say this gently enough, but if your plans on
remaining med free are this wishy washy and non-specific, I wonder if you
have done your homework, and know what the real pros and cons are, first
baby or not.

In the first place, your comfort level during labor, and hence, your ability
to remain med free are *DIRECTLY* dependent on your hospital's (and OB's)
rules regarding what you can or cannot do during labor. For example, doing
the 15 minute EFM strip places you in an very uncomfortable position where
it is hard, if not impossible to get relieve from discomfort by moving around.

Next, if your are not allow to eat or drink during labor, it is hard to avoid
dehydration or exhaustion during labor, which intensifies any pain. If they
insist on an IV to make up for the liquids they won't let you have, they again
limit your mobility, increasing the pain.

For pain free birth without meds, it is best to have:
No EFM,
No IV,
Eat or drink when your want,
Labor and give birth in the position you want
Not have limits on labor time

BTW: In general you also want to AROM unless you have already gone through
transition, and are almost complete.

OK. Lets go back and talk about that "Labor and give birth in any position"
line item above some more.

You want to avoid laboring, or especially pushing while lying on your back or in
the semi-sitting position. In particular, you want to have the option to birth
in the position of your choice. How supportive is your OB of this arrangement?

You want to be able to use a birth ball, jacuzzi (if they have one), shower, or
other similar comfort measure during early labor and transition. You don't
what to have to stop and do an EFM strip when transition is nearing and you're
concentrating on remaining relaxed. You also don't want to have to lie down
for an internal in this circumstance either.

I could go on for pages and pages here, but I'll just let you read the Goer book.
:-)

It is not clear from your post that you have thought through these scenarios, or
that you know what your hospital's or OB's policies are. You should. Also,
you have said that your insurance will not let your change providers. In this
case, perhaps you should hire a doula. At $200 or $300, it could be an
inexpensive "insurance policy" that your wishes are respected.

: So, I feel pretty well prepared...and when I compare myself to 95% of
: the women I know who have had babies, I feel like an expert because most
: if not all of them just go along with anything their doctors say...they
: question nothing and end up with all sorts of interventions.

: Just to clarify, I would LOVE to change doctors, however my insurance
: will not allow it. Dh and I tried to change months ago and were told it
: was too late. We could've gone through a hearing at the hospital (OB
: would have been present), but we were informed by several sources that
: it would be highly unlikely that they would allow the change. We didn't
: want to risk being stuck with her after such a hearing figuring she
: would be hostile and even more difficult. So we decided to stick with
: her and just use our power to veto her ideas as we go along. Going to
: another doctor without insurance isn't an option financially, so we're
: stuck. This OB came off as ideal at my initial interview with her, but
: has slowly changed her tune over the past months...I feel I've been a
: victim of "bait and switch".

: Thank you to everyone for responding...this is a great place to go to
: for answers.

: Kathy

Good luck,
Larry

E. 123 wrote:

But it was a review of *17,000* pregnancies.


I know, amazing! But honestly, from your own life experience, do you find
this data reflective?


Of course not...but how many women do you know who are
"allowed" to go much beyond 41 weeks? Most women I know get
induced by then or earlier. I know fewer and fewer women
who go into labor on their own.

Best wishes,
Ericka