Inducing at 41w vs. 42w
blondie10m
member
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.
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!
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.
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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.
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Notes:
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.
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?
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.