quick update on my pregnancy

In message , Larry McMahan
writes
zolw writes:
: Hi all;

: So, it seems that my little girl is a stubborn little one She is
: refusing to give any indication of being born any time soon. I am only
: 1/2 cm dilated (my due date is tomorrow, 07-31-04).

1. There is no indication between dialation and when a baby will be
ready to be born. How dialated you are in immaterial.

2. If you are a first time mom, and your official due date is 7/31,
then on average you could expect to deliver on 8/7. This is quite
normal

: The doctor has decided that we are going to induce labor on thursday
: 08-05-04 around 10 30 pm. This probably means that I would deliver some
: time on friday. He also says that my chances of going naturally into
: labor before then are about 20 - 25%.

Why has he decide to induce before 42 weeks? This is generally not
wise, and you should challenge him on this. Heck, you should just
decline the procedure.

You're pretty well informed about this, and may very well have
information that I've missed, as I haven't done a literature search on
this. However, I was reading up on this just the other day, and there
_has_ been a large randomised controlled trial done that showed that,
although there was no advantage in routinely inducing before 41 weeks,
stillbirth rates did increase in pregnancies over 41 weeks that were
left to run their course, compared to those that were induced at 41
weeks. Obviously, it's a rare outcome, but the study did show a
difference.

According to that evidence, the doctor is only jumping the gun slightly
in inducing on the 5th, though it _would_ be perfectly reasonable to put
it off until the OP is a full week overdue rather than just 5 days - the
extra couple of days might just give her enough time to go into labour
on her own, or at least to ripen more.

Personally, if I go to 41 weeks of pregnancy (well, plus an extra 5 days
to allow for the fact that I think the scan dates were out by at least
that much, but that's by-the-by), I'll opt for an induction, unless you
or anyone can post evidence to the contrary. I really hope it doesn't
come to that because I do know of the problems with inductions, but if
there really is an increased stillbirth risk with running further over
term then I don't want to take that risk. I know it's very rare, but
that wouldn't exactly be much consolation to me if I was one of the
unlucky ones.

BTW, in response to something somebody else said: An induction certainly
doesn't _guarantee_ a CS. It increases the risks quite substantially,
and that's a good reason to try to avoid it if possible, but that is
_not_ the same as guaranteeing that it will happen, and claiming that it
is may be counter-productive.


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:

You're pretty well informed about this, and may very well have
information that I've missed, as I haven't done a literature search on
this. However, I was reading up on this just the other day, and there
_has_ been a large randomised controlled trial done that showed that,
although there was no advantage in routinely inducing before 41 weeks,
stillbirth rates did increase in pregnancies over 41 weeks that were
left to run their course, compared to those that were induced at 41
weeks. Obviously, it's a rare outcome, but the study did show a
difference.

Hmm...I searched Medline, and I couldn't find a study
showing a statistically significant difference (I saw a recent
meta analysis that showed a slight difference, but it was not
statistically significant). I saw many studies that did not
show a difference.

According to that evidence, the doctor is only jumping the gun slightly
in inducing on the 5th, though it _would_ be perfectly reasonable to put
it off until the OP is a full week overdue rather than just 5 days - the
extra couple of days might just give her enough time to go into labour
on her own, or at least to ripen more.

HOWEVER, one has to ask the question: We know that
the median length of gestation is different for nulliparas
and multiparas. There are also studies showing that nulliparas
are more likely to have the bad outcomes from induction for
postdates (e.g., c-section, instrumental delivery, etc.). One
has to ask whether it might be prudent in nulliparas to wait
those extra few days to at least give a fighting chance at
spontaneous labor first! As one review put it, *many* more
babies die between 37 and 42 weeks' gestation than die
afterwards (even allowing expectant management after 42
weeks). Should we therefore induce everyone at 37 weeks?
It would make for a significant drop in the stillbirth rate.

Personally, if I go to 41 weeks of pregnancy (well, plus an extra 5 days
to allow for the fact that I think the scan dates were out by at least
that much, but that's by-the-by), I'll opt for an induction, unless you
or anyone can post evidence to the contrary. I really hope it doesn't
come to that because I do know of the problems with inductions, but if
there really is an increased stillbirth risk with running further over
term then I don't want to take that risk. I know it's very rare, but
that wouldn't exactly be much consolation to me if I was one of the
unlucky ones.

But you also have to take into consideration some very
bad statistics going on here. There is a background risk of
miscarriage/stillbirth throughout pregnancy. Whenever you
take a baby at X weeks, you "prevent" any stillbirths happening
at any future weeks. By this logic, we'd prevent a hell of a
lot of stillbirths if we induced as soon as the age of viability
hit, just because there'd be fewer opportunities for stillbirth.
However, you have to ask what price you're paying for that in
terms of mortality and morbidity to mother and baby *because*
of the intervention. How many consequences are we willing to
accept to how many other babies and mothers to save one
stillbirth? Obviously, these questions are emotionally charged
and very difficult to answer. If it's *your* baby, then no
price is too high to save him or her. On the other hand, you
could be one of the ones bearing the consequences. And frankly,
I think we seriously underestimate the morbidity and mortality
associated with interventions, especially those interventions
that increase the c-section rate, especially in light of the
recent (and not so recent) research showing an increase in
unexplained stillbirth at term in pregnancies after a c-section
(not to mention the morbidity and mortality associated with
placenta previa, placenta accreta/increta/percreta, and
uterine rupture). One might even have to ask how much of these
stillbirth rates are the legacy of an increasing primary
c-section rate (particularly likely to be a research problem
given that the vast majority of studies looking at the issue
of stillbirth and postterm pregnancy are retrospective studies
because it's very difficult to get the huge numbers necessary
to get enough power to assess the effect on as rare an outcome
as stillbirth in a RCT).

BTW, in response to something somebody else said: An induction certainly
doesn't _guarantee_ a CS. It increases the risks quite substantially,
and that's a good reason to try to avoid it if possible, but that is
_not_ the same as guaranteeing that it will happen, and claiming that it
is may be counter-productive.

In nulliparas without a favorable cervix, the numbers
get very high. True, that doesn't make it a certainty...but
combined with a doctor who favors this approach, well, the
odds aren't great.

Best wishes,
Ericka

"zolw" wrote in message
What nonmedical induction? I am going on thursday for a medical
induction, first they will try the gel to help me dilate, if this
doesn't work, then they will try to rupture my amniotic sac & then the
last resort would be an injection. Now if all fails, that's when we will
go for a c-section.

A nonmedical induction means that the mom or baby is not in distress or
having problems. If the only reason you are inducing is because you are a
few days late, then that is not a problem unless there is a problem with mom
or baby. Do you really want a C-section though? I wanted to avoid at all
costs unless there was a really good reason for it, but that's me. I wanted
the lowest intervention in having a baby that I could possibly have and did.
--
Sue (mom to three girls)

Well the reason why the doctor decided to wait only 5 days, is that I
wanted him to be the one on duty & thursdays/fridays he is. If he waited
he'd have had to wait for another week (making it a week 5 days)

Also most doctors where i live induce between 5 -7 days after the due
date. I know that people always want to go the natural way, but I dn't
believe that your body ALWAYS knows what is best for you. Both of my
sisters and many of my cousins did not get into labor & when induced did
not get any contractions.


Mona



According to that evidence, the doctor is only jumping the gun slightly
in inducing on the 5th, though it _would_ be perfectly reasonable to put
it off until the OP is a full week overdue rather than just 5 days - the
extra couple of days might just give her enough time to go into labour
on her own, or at least to ripen more.

Personally, if I go to 41 weeks of pregnancy (well, plus an extra 5 days
to allow for the fact that I think the scan dates were out by at least
that much, but that's by-the-by), I'll opt for an induction, unless you
or anyone can post evidence to the contrary. I really hope it doesn't
come to that because I do know of the problems with inductions, but if
there really is an increased stillbirth risk with running further over
term then I don't want to take that risk. I know it's very rare, but
that wouldn't exactly be much consolation to me if I was one of the
unlucky ones.

BTW, in response to something somebody else said: An induction certainly
doesn't _guarantee_ a CS. It increases the risks quite substantially,
and that's a good reason to try to avoid it if possible, but that is
_not_ the same as guaranteeing that it will happen, and claiming that it
is may be counter-productive.


All the best,

Sarah

Should we therefore induce everyone at 37 weeks?

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.

zolw wrote:
Well the reason why the doctor decided to wait only 5 days, is that
I wanted him to be the one on duty & thursdays/fridays he is. If he
waited he'd have had to wait for another week (making it a week 5
days)

Which would be a more reasonable date to induce you, since you would be in
the 41st week and very close to the 42nd. Statistically, nulliparas are more
likely to have successful induction in the 41st week than before or after.
Add to that the fact that fully half of all nulliparas won't give birth
spontaneously before 41w1d, and it looks like most women's bodies just
aren't ready to birth prior to the 41st week with a first pregnancy.

Also most doctors where i live induce between 5 -7 days after the
due date.

If all doctors in your area recommended you jumped off a cliff, would you do
it? (Yes, I know that's snarky and silly, but really, sometimes your
mother's logic was *right*. Just because everyone is doing something doesn't
mean it's a good idea.)

Honestly, suppose you had a mildly unpleasant but mostly benign medical
condtition other than pregnancy and your doctor said, "There's about a 95%
chance that this condition will resolve itself within the next two weeks. I
don't want to wait for it to get better, though, and instead I want to give
you a treatment that will cure your condition now, but given your current
status, there's a very high likelihood that the treatment will result in you
needing major surgery. If we wait another two weeks and you don't get
better, I'll use exactly the same treatment I'm proposing to use now with
roughly the same potential outcomes. The only difference is that if I use
the treatment now, you'll *certainly* experience all the risks of the
treatment, whereas if we wait another two weeks, there's only a 5% risk
you'll have to experience them." Would you take that risk? I know I
wouldn't! Heck, I'm not sure it would even be considered ethical for the
doctor to offer such a treatment for an illness that resolves itself 95% of
the time. Why is it that with pregnancy, we seem to toss so many of the
rules of medical ethics and common sense?

I know that people always want to go the natural way, but
I dn't believe that your body ALWAYS knows what is best for you.

No, it doesn't. But the fact that, as a nullipara, you haven't gone into
labor on your own by 40w5d isn't ANY sort of indication that your body
doesn't know what's best for your and your baby. Since the MAJORITY of
first-time mothers won't have gone into labor by 40w5d if left to their own
devices, going to 40w5d just makes you very NORMAL. It doesn't mean it's
time to intervene unless there are other indications that the baby or you
are not doing well.

Both of my sisters and many of my cousins did not get into labor &
when induced did not get any contractions.

And if their OBs blithely induced them prior to being truly post-dates and
with Bishop's scores as low as yours sounds to be, it's no great surprise.

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. Sorry if that sounds mean or
condescending, because it's not intended to be. It's just that the writing's
on the wall.
--
Be well, Barbara
Mom to Sin (Vernon, 2), Misery (Aurora, 5), and the Rising Son (Julian, 7)

This week's suggested Bush/Cheney campaign bumper sticker:
"Leave no child a dime."

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

zolw wrote:

Should we therefore induce everyone at 37 weeks?

But this is not the issue at hand. I am already past my due date (today).

That wasn't my point. My point was that if you
buy the logic for induction at 41 weeks, the same logic applies
(even more strongly, as you save more babies) for induction
at 37 weeks.

& 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.

Not quite. 1) Not everyone practices evidence
based medicine (even/especially in the US), so just because
it's common practice doesn't mean it's a good thing or
supported by the evidence. 2) If there is a danger to the
woman going into labor, then sometimes it is quite valid
to take the baby before she could go into labor--but that's
only because the danger of the woman going into labor
*offsets* the dangers associated with taking the baby
earlier than the baby wants to come. Under normal
circumstances, it is better for the baby not to schedule
the c-section in advance and do the c-section (if it
is necessary) once the woman has gone into labor,
indicating that the baby is ready to be born.

"Safe" is a relative term. It only applies in
relation to the other options at hand. For a woman
who has a condition making it dangerous to go into
labor, doing a c-section earlier can be saf*er* than
her alternative, which is to possibly go into labor.
You have to compare induction at 41 weeks (before
the majority of nulliparas will have gone into labor)
with expectant management. In that particular case,
there is little evidence that routine induction is
safer than expectant management. And the combination
of a low Bishop score (if that ends up being the case)
plus being a nullipara plus induction *does* significantly
increase your odds of a c-section (one study gave only
50/50 odds), and having a c-section significantly
increases the risks for any future babies you might
have. If you have a good Bishop score, odds are
better. If you wait until after 41 weeks 1 day, you'll
have better than 50/50 odds of going into labor on
your own (and anyone who says they can predict when
you'll go into labor or not by how effaced and dilated
you are now is flat out wrong). At this stage of the
game, even single day makes a big difference! The
difference between the number of women who've gone
into labor by 41 weeks 1 day and 41 weeks 6 days
is something like 50 percent to 90 percent--that's
like 9 percent of women per day (assuming it was
linear, which it probably isn't).

Best wishes,
Ericka

"Ericka Kammerer" wrote in message
...
zolw wrote:

Should we therefore induce everyone at 37 weeks?

But this is not the issue at hand. I am already past my due date
(today).

That wasn't my point. My point was that if you
buy the logic for induction at 41 weeks, the same logic applies
(even more strongly, as you save more babies) for induction
at 37 weeks.

& 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.

For me, labor is hazardous, so the choice is either to deliver early, or to
put me in the hospital under monitoring, where I can be delivered more
quickly if I start to show signs that labor is imminent. That will be
decided when we see how things are going closer to 38 weeks.

I'm pretty sure that many innductions and planned C-sections are scheduled
as much for the OB and hospital's convienence as anything else. I suspect
that even if there weren't medical reasons for a c-section in my case, the
OB would prefer NOT to have me deliver sometime between December 24-26
(which is the range of dates the ultrasounds have given for expected due
date)-the CNM already told me that she expects that they'll have me out of
the hospital by Christmas.

"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. Sorry if that sounds mean or
condescending, because it's not intended to be. It's just that the
writing's
on the wall.

See, here's what happens, and we have seen it many times:

Doctor says "I always induce at X weeks." Says he only does cesareans if
necessary. Mom goes along with it.

Mom's body isn't ready. Mom's baby isn't ready. Insert cascade of
interventions, including epidural

Mother develops epidural fever, which is mistaken for infection-caused
fever. Or, baby goes into distress for any number of doctor/induction-caused
interventions. Or baby fails to descend because epidural-paralysed mother
cannot change positions, and attempts to deliver flat on her back.

Mother has "emergency" cesaean.

Mother is absurdly grateful that she was induced and had a cesarean, because
otherwise she and baby would have died. Isn't it obvious?

Mother is forbidden attempt to VBAC in next pregnancy because she has had a
cesarean.

Mother tells everyone she knows that it was a good thing she was induced at
X weeks because if she hadn't been, they'd both have died like women used to
do way back when.

Someone she talks to believes her, and goes along with her doctor when *she*
gets to X weeks.....

--angela

"zolw" wrote in message
news:nwwOc.198756$JR4.88047@attbi_s54...
Hi all;

So, it seems that my little girl is a stubborn little one She is
refusing to give any indication of being born any time soon. I am only
1/2 cm dilated (my due date is tomorrow, 07-31-04).

The doctor has decided that we are going to induce labor on thursday
08-05-04 around 10 30 pm. This probably means that I would deliver some
time on friday. He also says that my chances of going naturally into
labor before then are about 20 - 25%.

He is also worried that because of the lack of dilation, they might not
succeed in induction. So, there is a chance of c-section. He says that
he will try to avoid c-section as much as possible.

So far he believes that my little girl will be 3.5 - 4 kg (8 lb. &
above, sorry i am metric). That's why he does not want to wait too much
before induction, cause she will only grow larger.


I was told my baby was that big already at 36 weeks.

She was smaller than that 4 weeks later. No signs that she'd lost
weight...she just had a long, rangy bone structure that fooled a midwife and
a doctor. She was born 1/2 ounce lighter than I was when I was born, and an
ounce and a half heavier than my sister... I think the doc was misled by
both my size and her bone structure. She still has huge hands, feet and
bones in general despite her average size otherwise. (She's about 5 feet
tall at age 11, but wears a size nine shoe and has hands almost as big as my
man-sized mitts.)

Please take the size estimates with a grain of salt--I know women who've had
no trouble birthing 10, 11, even 13 pound babies vaginally--and your chances
of having a baby that big are slight. 8 or 9 pounds just *isn't* all that
big, really. The fat is usually in the torso, too, not the head.

If you're going to be induced, avoid having your waters broken... if they
try with pitocin and gel and fail, then they can just turn it off and wait a
couple days. If they break your waters, you're stuck And if they suggest
Cytotec, PLEASE read about it first before consenting.

Jenrose