quick update on my pregnancy

In message QVQOc.63932$eM2.38193@attbi_s51, zolw
writes
But this is not the issue at hand. I am already past my due date (today).

& actually in many parts of the world they deliver women who are
expected to have a c-section at 38-39 weeks. They don't wait tillthe
woman gets into labor. This makes me think that it is safe to take the
baby out early, as long as it is full term.

The concern here is more for you than for the baby. Induction,
especially if your body isn't ready, can lead to an increased risk of
you ending up with either a Caesarean, forceps or vacuum delivery, all
of which can cause you a considerably slower recovery and a fair bit
more in the way of potential long-term problems than a normal delivery -
possibly including problems for babies that you may have in the future.

As I said, that has to be weighed against an extremely small increased
risk of losing the baby if the pregnancy goes past 41 weeks (something
in the region of an extra risk of 1 in 500 to the baby - to put that
another way, if 500 women went past 41 weeks with their pregnancies
you'd probably expect 1 of them to have a dead baby that might well have
been alive with an induction at 41 weeks, and there's no way of knowing
whether you'd be that woman or one of the 499 other women whose babies
were fine).

So it's not an easy choice either way. I don't think there is a right
or wrong choice in this case - I know what I'd do, but that isn't
necessarily what you or somebody else would choose to do. However,
since everybody seemed to be giving you just the advantages of waiting
past 41 weeks without the disadvantages, I thought it was fair for you
to have both sides of the story in order to make up your mind.

Anyway, best of luck to you, and here's hoping that you're one of the
majority of women (and it _is_ a majority) who has a perfectly normal
delivery with absolutely none of these dire consequences, whatever you
choose to do!


All the best,

Sarah

--
"I once requested an urgent admission for a homeopath who had become depressed
and taken a massive underdose" - Phil Peverley

Jenrose wrote:


What the statistics do not and cannot present in most of those studies is
how a failed induction affects future fertility. My sense is that a
c-section due to a failed induction is *far* more likely to have an impact
on the viability of future pregnancies than a postdates pregnancy is to
result in a stillbirth.

They do know that c-sections do cause an increase in
the rate of infertility and subfertility (by 50 percent or so),
though the relationship appears to be complex. Five years
after delivery, the rate of women who feared future childbirth
was more than twice as high among those who'd had c-sections
as those who'd had vaginal birth, so there is also a "voluntary
infertility" aspect as well.

Best wishes,
Ericka

Sarah Vaughan wrote:


Oooops, my minor mistake - it wasn't _a_ study, but a meta-analysis. The
reference given is the Cochrane database, which might be why it wasn't
on Medline

Actually, the Cochrane stuff is in Medline as well.

I got this from "A Guide to Effective Care in Pregnancy and Childbirth"
(Enkin, Kierse, Renfrew, and Nielson):

"A policy of elective induction of labour at or beyond term has been
shown to result in a decrease in perinatal deaths not due to lethal
anomalies. Although none of the trials individually was large enough to
show a statistically significant difference, the combined results of the
seventeen randomised trials that have assessed this outcome show a clear
picture. There was only one such death among the almost 3500 women
allocated to elective delivery, compared with nine among a similar
number of women in the surveillance arm of the trials. This difference
is both important and statistically significant.

This particular review hasn't been updated since 1996.
More recent reviews cast some doubt. This one from 2003
(http://tinyurl.com/6a2zc) shows a *barely* statistically
significant reduction in c-sections (the CI goes up to
0.99) and an insignificant reduction in perinatal mortality.


That doesn't necessarily mean the statistics are valid, of course. It's
interesting that you found a meta-analysis that didn't show a
difference, because it suggests that the meta-analysis results are quite
sensitive to the selection of studies.

Of course they are--which is why more recent studies
and more studies usually result in more accuracy (depending
on the inclusion criteria).

Well, here's one intriguing tidbit from the same chapter of "A Guide To
Effective Care In Pregnancy And Childbirth":

"Active induction policies are not associated with an increased use of
caesarean delivery; indeed, the trials show a small but statistically
significant decrease in the use of caesarean section for women in whom
labour is induced at or beyond term. This challenges a widely held
belief that there is an inherent association between elective delivery
and an increased risk of caesarean section."

However, it then goes on to qualify this encouraging finding with:

" This unexpected finding may reflect the characteristics of the women
who participated in these trials, for example the 'ripeness' of their
cervices, and of the methods used for inducing labour."

Which means we can't necessarily be reassured by this as to the risk of
induction in a woman with an unripe cervix. Then again, we don't know
whether this woman is going to have an unripe cervix by next Thursday.
All we know is that she had one on whatever day her last antenatal
appointment is.

In addition, many of these trials had protocols
that included some pretty intensive nursing care during
labor. Without that (as is the case for most women),
the c-section rate could be *much* higher. Many of these
studies are heavily confounded with protocols that are
known to independently reduce the c-section rate.

No disagreement from me on that one. What I was concerned about was the
psychological effect on the OP, if she does decide to opt for an
induction on that date, of going in believing she's bound to end up with
a Caesarean anyway. I don't have to tell you that those sorts of
beliefs can end up being self-fulfilling prophecies. :-(

Absolutely, I believe it making the decisions based
on as many "facts" as one can muster, rather than on wishy-
washy words like "most" or "some" or whatever. That's why
I try to include numbers when I can. On the other hand,
sometimes numbers are misleading too, and the research that
produces the numbers isn't always sound. I don't think she
should go in expecting a c-section, but I think that if
her Bishop score isn't favorable and she's barely to 41
weeks, I think she should recognize that she may well be
increasing her c-section risk significantly (along with
her risk of a difficult labor due to pitocin or malpresentation
and her risks of an instrumental delivery, which many studies
show to be more traumatic to some women than c-section).
That doesn't mean she's guaranteed any of those things;
however, her doctor's approach *also* substantially increases
those risks.
The way I look at it is that you have to decide
what consequences you're willing to accept. If she is
willing to accept those possible outcomes, then it can be
a reasonable choice for her in her situation. If she
doesn't like the sound of those possibilities, then perhaps
she wants to tip the odds in another direction--her choice.
The only situation I *hate* like hell to hear is someone
say, "I am so disappointed I ended up with X; I really
wanted Y" when their decisions had a significant impact
on X happening in the first place. Women who are fine
with their births don't particularly bother me, even when
their choices are very different from those I would have
made.

Best wishes,
Ericka

"Ericka Kammerer" wrote in message
news
Jenrose wrote:


What the statistics do not and cannot present in most of those studies
is
how a failed induction affects future fertility. My sense is that a
c-section due to a failed induction is *far* more likely to have an
impact
on the viability of future pregnancies than a postdates pregnancy is to
result in a stillbirth.

They do know that c-sections do cause an increase in
the rate of infertility and subfertility (by 50 percent or so),
though the relationship appears to be complex. Five years
after delivery, the rate of women who feared future childbirth
was more than twice as high among those who'd had c-sections
as those who'd had vaginal birth, so there is also a "voluntary
infertility" aspect as well.



Which basically means that the whole "dead baby" scare tactic never takes
into account the never-to-be-born babies.... for example, of a woman who
would have had 3-4 kids but stops voluntarily after 2 or has a hysterectomy
on her first during a c-section. So to save the one baby, there are 1-3
other kids who will never be, when the first baby probably wasn't in that
much danger (or wouldn't have been without overmedical intervention) in the
first place...

Jenrose

"H Schinske" wrote in message
...

"Circe" wrote in message
news:8LSOc.25025$mg6.7755@fed1read02...

Honestly, if you WANT to be induced in 5 days, go for it. It sounds to
me
as
thought you'd PREFER to have a c-section than to experience labor and,
having been a first-time mother who'd never experience labor with all
the
normal fears and anxieties about labor, I can understand that. And if
you
go
for the induction on the 5th with your Bishop's score unchanged, I
predict
you'll get what you want--a c-section.

There is actually a fairly reasonable chance her Bishop's score will
change,
though, and quite a good chance she'll have the baby by then. According to
http://www.nice.org.uk/cms/htm/profe...mpleted.induct
ionlabour/17321/article.aspx ,

"Population studies indicate that the risk of stillbirth increases from 1
per
3000 ongoing pregnancies at 37 weeks to 3 per 3000 ongoing pregnancies at
42
weeks to 6 per 3000 ongoing pregnancies at 43 weeks.
A policy of offering routine induction of labour after 41 weeks reduces
perinatal mortality without increasing the caesarean section rate.


This assumes that in the "real world" situations most of us deliver in, they
have research-quality protocols and similarly low general c-section rates.
WHAT the induction protocol is is absolutely critical to the outcome.
Cytotec may well more likely result in a vaginal birth, but at what cost?
Prostaglandin gel followed by AROM and only THEN pitocin is a recipe, IMO,
for disaster--because the chances that the gel won't work enough, or that
they'll arom and then baby will react badly to pit... those are high enough
that I'd be suspicious. Any time you mix AROM in, you're basically
committing to delivery. Fine if you're inducing for medical reasons (baby is
not doing well, mother is not doing well) but ****ty if you're in a
situation where turning it all off and waiting a day or two is a viable
option if you don't break the waters.

Jenrose

In message , Ericka Kammerer
writes
Sarah Vaughan wrote:


I got this from "A Guide to Effective Care in Pregnancy and
Childbirth" (Enkin, Kierse, Renfrew, and Nielson):
"A policy of elective induction of labour at or beyond term has been
shown to result in a decrease in perinatal deaths not due to lethal
anomalies. Although none of the trials individually was large enough
to show a statistically significant difference, the combined results
of the seventeen randomised trials that have assessed this outcome
show a clear picture. There was only one such death among the almost
3500 women allocated to elective delivery, compared with nine among a
similar number of women in the surveillance arm of the trials. This
difference is both important and statistically significant.

This particular review hasn't been updated since 1996.
More recent reviews cast some doubt. This one from 2003
(http://tinyurl.com/6a2zc) shows a *barely* statistically
significant reduction in c-sections (the CI goes up to
0.99) and an insignificant reduction in perinatal mortality.

Ah - thank you! Fortunately the journal is in our local hospital
library - I'll have to try comparing the studies used in this one and in
the one that 'Effective Care' mentioned, to see where the differences
lie. I'd like to avoid induction if possible even if I do go post-term,
so it's good to have more information about it.

[....]
Well, here's one intriguing tidbit from the same chapter of "A Guide
To Effective Care In Pregnancy And Childbirth":
"Active induction policies are not associated with an increased use
of caesarean delivery; indeed, the trials show a small but
statistically significant decrease in the use of caesarean section for
women in whom labour is induced at or beyond term. This challenges a
widely held belief that there is an inherent association between
elective delivery and an increased risk of caesarean section."
However, it then goes on to qualify this encouraging finding with:
" This unexpected finding may reflect the characteristics of the
women who participated in these trials, for example the 'ripeness' of
their cervices, and of the methods used for inducing labour."
Which means we can't necessarily be reassured by this as to the risk
of induction in a woman with an unripe cervix. Then again, we don't
know whether this woman is going to have an unripe cervix by next
Thursday. All we know is that she had one on whatever day her last
antenatal appointment is.

In addition, many of these trials had protocols
that included some pretty intensive nursing care during
labor. Without that (as is the case for most women),
the c-section rate could be *much* higher. Many of these
studies are heavily confounded with protocols that are
known to independently reduce the c-section rate.

So one thing the OP really needs to hope for is that she'll get good
nursing care!

No disagreement from me on that one. What I was concerned about was
the psychological effect on the OP, if she does decide to opt for an
induction on that date, of going in believing she's bound to end up
with a Caesarean anyway. I don't have to tell you that those sorts of
beliefs can end up being self-fulfilling prophecies. :-(

Absolutely, I believe it making the decisions based
on as many "facts" as one can muster, rather than on wishy-
washy words like "most" or "some" or whatever. That's why
I try to include numbers when I can. On the other hand,
sometimes numbers are misleading too, and the research that
produces the numbers isn't always sound. I don't think she
should go in expecting a c-section, but I think that if
her Bishop score isn't favorable and she's barely to 41
weeks, I think she should recognize that she may well be
increasing her c-section risk significantly (along with
her risk of a difficult labor due to pitocin or malpresentation
and her risks of an instrumental delivery, which many studies
show to be more traumatic to some women than c-section).
That doesn't mean she's guaranteed any of those things;
however, her doctor's approach *also* substantially increases
those risks.

My main concern is the reason he gave for inducing her. I have a
sneaking suspicion that he might be quite the interventionist type. Oh,
well.

The way I look at it is that you have to decide
what consequences you're willing to accept. If she is
willing to accept those possible outcomes, then it can be
a reasonable choice for her in her situation. If she
doesn't like the sound of those possibilities, then perhaps
she wants to tip the odds in another direction--her choice.
The only situation I *hate* like hell to hear is someone
say, "I am so disappointed I ended up with X; I really
wanted Y" when their decisions had a significant impact
on X happening in the first place.

Indeed - so sad when that happens.


All the best,

Sarah

--
"I once requested an urgent admission for a homeopath who had become depressed
and taken a massive underdose" - Phil Peverley

In message , Jenrose
writes

"Ericka Kammerer" wrote in message
news
Five years
after delivery, the rate of women who feared future childbirth
was more than twice as high among those who'd had c-sections
as those who'd had vaginal birth, so there is also a "voluntary
infertility" aspect as well.



Which basically means that the whole "dead baby" scare tactic never takes
into account the never-to-be-born babies.... for example, of a woman who
would have had 3-4 kids but stops voluntarily after 2 or has a hysterectomy
on her first during a c-section. So to save the one baby, there are 1-3
other kids who will never be, when the first baby probably wasn't in that
much danger (or wouldn't have been without overmedical intervention) in the
first place...

Speaking purely for myself - if that actually is what the choice comes
down to, then that's the way I'll make it. I'd rather save an existing
baby at the cost of hypothetical ones. Which is not of course to say
that everyone else would or choose the same thing.

The question, of course, is how great the danger actually is, and
whether it exists in the first place. I'd take a c-section to avoid
even a fairly small risk to my baby, if it was a genuine risk. Don't
much fancy the idea of having one for a risk that never existed in the
first place. :-(


All the best,

Sarah

--
"I once requested an urgent admission for a homeopath who had become depressed
and taken a massive underdose" - Phil Peverley

Sarah Vaughan wrote:

Speaking purely for myself - if that actually is what the choice comes
down to, then that's the way I'll make it. I'd rather save an existing
baby at the cost of hypothetical ones. Which is not of course to say
that everyone else would or choose the same thing.

Actually, I think almost *everyone* would make that
decision. (A few wouldn't, but I think it's pretty safe to
say the vast majority would decide the same as you.) That's
why the argument is so very effective. All you have to do is
call into question the safety to the current baby and poof!
Nothing else matters. Still, the waters get pretty murky
when the risk of the bad thing happening to this baby are
in the 1 in tens/hundreds of thousands and the risk of the
bad thing happening to the future baby are in the 1 in tens
or hundreds and you want more babies.... In that case, the
risk to the current baby is in the same ballpark as all sorts
of freak accidents, but the risk to the future baby is very
real and serious.

The question, of course, is how great the danger actually is, and
whether it exists in the first place. I'd take a c-section to avoid
even a fairly small risk to my baby, if it was a genuine risk. Don't
much fancy the idea of having one for a risk that never existed in the
first place. :-(

Therein lies the rub.

Best wishes,
Ericka