3rd Trimester

Inducing at 41w vs. 42w

I was all prepared to go to 42w (have showed 70% effacement/no dilation since 36w) and then my doctor started threatening me about meconium poops in utero at my appt yesterday even tho we had previously discussed going to 42w.  I had a mini breakdown and didn't know what to do that was best for the baby and called my good friend who is a pediatric hematology fellow at an excellent research hospital and did her pediatric residency at one of the best pediatric hospitals in the country.  I actually trust her more than my doctor.  Well, she has connections with the ob fellows of course and asked him about induction at 41 vs. 42 weeks and did a little of her own research.  I just thought some of you would be interested in her summary, which I pasted below.

"As I mentioned on the phone, I did a bit of research this morning and talked to my OB friend.  In the large review that I read of almost 8,000 healthy pregnant women studies, induction of labor at 41 weeks (as opposed to waiting it out until 42 weeks) was associated with fewer prenatal deaths.  Now, the reduction in risk was pretty small, but it was measurable.  Also, there were no added complications for the baby if induction was done at 41 weeks instead of 42 weeks.  Moreover, there were fewer babies with meconium aspiration in the group induced at 41 weeks (this, too, was a small change, but measurable).  There was no change in the risk of needing a c-section in those induced at 41 vs 42 weeks. Bottom line: sounds like you can't go wrong with choosing to induce at 41 weeks.

In talking with my friend , he confirmed that the recommendation from the American Board of Obstetrics is to induce at 41 weeks.  He also said that it is fairly routine for physicians/parents elect to induce a few days before the actual 41 mark simply because the induction process itself usually takes 48-72 hours.  There is not really any benefit to a baby who is already known to be fully developed and to have grown to a good size to stay in the womb any longer than 40-41 weeks.  Being induced offers a more controlled way to have the baby be born because of all the monitoring that is associated with the induction."
Lilypie - (7gcp)

Lilypie - (S3If)

Re: Inducing at 41w vs. 42w

  • If I have no progress at 40 weeks I want to be induced then. I am uncomfortable, miserable and just plain ready for it to be over.

    Right now I am 38 weks 1 day and 0cm!

  • Being induced offers a more controlled way to have the baby be born because of all the monitoring that is associated with the induction.

    The flip side of this statement is that you are more likely to have multiple interventions because of the induction - epidurals, further labour augmentation, vaccuum or forceps assisted delivery, and c-section - because of all the monitoring associated with induction.

    Whether that is a problem is at least in part up to you. I know my doctor will want to induce at 10 days overdue, and I am (at this point, at least) fine with that plan.

  • Induction isn't something to be taken lightly. There is also the camp that says babies come when they are ready. If you truly think induction is the only possible way for you to get this baby out of you, then it sounds like there really isn't an advantage to waiting the extra week. If you trust your friend more than your OB, and your maternal instinct says it is okay, go with 41 weeks. Trust yourself it will help out a lot in the long run.
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  • I am in the camp of do whatever scientific research shows will statistically have the best outcome for the baby.  DH and I are both scientists so we think very logically/based on facts.  Whether it be wait until 42w and try to let him come naturally (but no later than 42w) or to get induced at 41w, whatever research shows has a lower occurrence of complications for the baby, that's what I will choose.  Of course I know that statistics can't predict the outcome of my birth but I trust the research.
    Lilypie - (7gcp)

    Lilypie - (S3If)

  • Thank you for posting this!  As I am approaching my due date I find myself wondering the same thing (41w vs. 42w).  I have an appt. with my MW tomorrow morning and will definitely ask her what her stance is!
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  • image Cassie730:

    I was induced at 41 weeks. Don't be scared of induction because everyone has a horror story about everything. You're going to find pros and cons of anything you decide. Just remember as long as you end up with a healthy baby in the end that's all that matters....not some dream about how labor is "supposed" to be or what was "supposed" to happen. Everyone is different. You are lucky to have a baby who decided to bake for 41 weeks. Plenty of people have the opposite problem. I would rather be faced with the choice to induce at 41 weeks vs. 42 weeks than be on bed rest because of Pre-term labor and fighting to keep my baby in just one more week to keep him/her healthy.

    GL!!!! Everything will be fine and your baby will be perfect :-) Trust your doctor that you have chosen and make the best decision for YOU and YOUR BABY.

    Yes Yes 

  • I know I've posted this before--but honestly, I wouldn't go past my due date if possible--- or at least much past 41 wks.  So much can happen that is tragic--is it worth it????  You'll have a healthy baby--don't risk it. 

    Go with your gut--but if it were ME--do 41 wks.

     

  • I was induced at 10 days late- 41 weeks with my DD. There was meconium in the fluid and we were stressed out all day. There had to be a nurse from respiratory and a nurse from pediatrics in the room plus my OB and my l and d nurse. They had to take my DD away to the corner of the room as soon as she was born. They had to clean out her airwaves to make sure she didn't cry and inhale any of the meconium. I didn't get to hold/see her for about an hour. It was horrible.

    This baby I will not go past my due date because I will not take the risk of my DS having meconium in the fluid. I will wait until as close to 40 weeks as possible.

  • Unless there is a medical reason such as low amniotic fluid, there is no reason to induce before 42 weeks. 80% of women go into spontaneous labor at 41 weeks and 90% by 42 weeks. Perhaps you can ask your doctor what your Bishop score is. This might help you determine whether or not you want go ahead and be induced at 41 weeks. If you do decide to be induced at 41 weeks, I suggest a couple of things (from experience) that might prevent an unnecessary c-section.

    1. Don't let them break your water too early. This puts you "on the clock" so to speak. It also increases your risk for infection, especially with a lot of internal exams.

     2. Hold off on the epidural until you're at least 5+ cm dilated.

     3. Don't let them increase your Pitocin more frequently than every 30 minutes and more than 3-6 ml per unit. The package insert for Pitocin reads:

     The initial dose should be 0.5 ? 1 mU/min (equal to 3-6 ml of the dilute oxytocin solution per hour [10 units oxytocin in 1000 ml saline was suggested a few paragraphs earlier ?piggy backed? with plain saline]). At 30-60 minute intervals the dose should be gradually increased in increments of 1-2 mU/min?[. Once] the desired frequency of contractions has been reached and labor has progressed to 5-6 cm dilation, the dose may be reduced by similar increments.

     A lot of nurses abuse Pitocin and just pumping you full of it not only puts your baby at risk, but also puts you at risk of blood loss and uterine rupture.

     4. If your uterus becomes hyper-stimulated and they tell you that your baby is in distress, ask them to turn the Pitocin off.

     Hope this helps. 

     

  • To the OP, your friend's email is comparing inducing at 41w to inducing at 42w.  This leaves out the very likely scenario that if you do not get induced at 41w, you will spontaneously go into labor before 42w... and that is the whole hope in not getting induced earlier, to give it a chance to all happen naturally.  I'd be curious about studies about the health benefits and intervention rates of induction at 41w and spontaneous labor at past 41w.
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  • image MiraclePending:

    Unless there is a medical reason such as low amniotic fluid, there is no reason to induce before 42 weeks. 80% of women go into spontaneous labor at 41 weeks and 90% by 42 weeks. Perhaps you can ask your doctor what your Bishop score is. This might help you determine whether or not you want go ahead and be induced at 41 weeks. If you do decide to be induced at 41 weeks, I suggest a couple of things (from experience) that might prevent an unnecessary c-section.

    1. Don't let them break your water too early. This puts you "on the clock" so to speak. It also increases your risk for infection, especially with a lot of internal exams.

     2. Hold off on the epidural until you're at least 5+ cm dilated.

     3. Don't let them increase your Pitocin more frequently than every 30 minutes and more than 3-6 ml per unit. The package insert for Pitocin reads:

     The initial dose should be 0.5 ? 1 mU/min (equal to 3-6 ml of the dilute oxytocin solution per hour [10 units oxytocin in 1000 ml saline was suggested a few paragraphs earlier ?piggy backed? with plain saline]). At 30-60 minute intervals the dose should be gradually increased in increments of 1-2 mU/min?[. Once] the desired frequency of contractions has been reached and labor has progressed to 5-6 cm dilation, the dose may be reduced by similar increments.

     A lot of nurses abuse Pitocin and just pumping you full of it not only puts your baby at risk, but also puts you at risk of blood loss and uterine rupture.

     4. If your uterus becomes hyper-stimulated and they tell you that your baby is in distress, ask them to turn the Pitocin off.

     Hope this helps. 

     

    Great advice.  A lot of my reading has suggested stressful labors (such as induction with too much pictocin too fast) can be hard on LO and more likely to cause distress, which increases meconium in the fluid as well...  Sort of makes me wonder if it is a chicken-or-the-egg sort of thing.  Do we need to induce and speed up labor to prevent this from harming LO, or is this more likely to put LO in a situation where they are in distress and releasing meconium?

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  • The statistic I heard is that 1st time moms on average go 8 days over due (when allowed to start labor spontaneously that is). Also, how sure are you that your due date is accurate? I was just talking to someone who knew her conception date, but the dr's used the date of her last period/ultrasound measurements and they were a week off (so she'd have been 40 weeks when they would've said she was already 41). 

    There are lots of natural things you can try to bring on labor, but once you're medically induced, the interventions have begun & you're on the clock.

     

     

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