3rd Trimester

Induction during 39th week?

After my growth ultrasound Tuesday, the doctor I saw (who is not my regular doctor) said that baby girl is full-term and my March 7th due date is more than likely wrong.  She's already weighing in at 8.5lbs.  Normally, the doctors never schedule an induction before 40 weeks, however the doctor on Tuesday said that they may make an exception since she's already so big and I have a rather narrow pelvis. Even with an early induction, there is a risk that she may be too big for me to deliver, and I may need a c-seciton.  We couldn't confirm anything because my regular doctor was out ouf town.  I'm going to see her next Wednesday.  I'm just nervous because I was hoping to go into labor on my own. Plus, I've heard that inductions can lead to longer labors and I don't want to be in labor for 16 hrs and then have to have a c-section anyway (which is the story that the ultrasound tech tod me about her daughter-in-law who "was in my exact situation"). I'm so ready for baby girl to be here, and I was told it could be any day, but now I'm getting nervous.

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Re: Induction during 39th week?

  • I would not consent to an induction based on suspected large size. I would also refuse to see that doctor again as they do not follow ACOG guidelines.

    http://www.aafp.org/afp/2001/0701/p169.html

    Summary of Recommendations

    The ACOG committee provides the following recommendations for the management of fetal macrosomia:

    Recommendations based on good and consistent scientific evidence (Level A):

    • The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold's maneuvers).

    Recommendations based on limited or inconsistent scientific evidence (Level B):

    • Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes.

    • Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes.

    • With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery.

    Recommendations based primarily on consensus and expert opinion (Level C):

    • Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

    • Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery.

     

  • Personally, I don't think I would base my decision to induce solely on the fact that the u/s estimate shows my baby as being big.

    For one thing, those estimates aren't exactly known for their accuracy. Also, if I had to choose, I would rather have a c-section baby than a baby that was evicted before it was ready (even if the baby is full term). And even if you do induce, that is no guarantee you won't need a c-section anyways.

    But then again, that's just how I feel. In the grand scheme of things though, I feel both options are safe enough - You just need to choose what you are most comfortable with.

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  •  Also, if I had to choose, I would rather have a c-section baby than a baby that was evicted before it was ready

    I agree with this.

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  • Just in the past two weeks I've seen two mamas give birth to babies who were estimated to be huge and whose doctors were considering early inductions or c-sections. Both were born vaginally with minimal complications after going into labour naturally at 39 weeks. One was 9 lbs 3 oz and one was 8 lbs 6 oz.  Anecdotal I know, but u/s estimates can be way off. I'd seek another opinion. 
  • I was actually speaking with a colleague today about me being late and she said to avoid being induced. She was induced and was not a pleasant experience. I am 39 weeks, not dilated and 70% effaced. My back-up dr said they would consider inducing me after a week.
  • Token pretty much posted what I was going to post. 

    At my 39 week appt (obviously with DD) my OB sent me for a BPP. At that u/s they estimated DD was going to be a "good 8 and a half pounds." She was 6lbs 11oz.  

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  • That is very reassuring. Thank you!
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  • image tokenhoser:

    I would not consent to an induction based on suspected large size. I would also refuse to see that doctor again as they do not follow ACOG guidelines.


    Ditto. I'm measuring big, baby is supposedly in the 90th or so percentile right now. My OB has not mentioned induction or the possibility of a CS at all. My first child measured similarly; he was born 3 days late at 8 lbs.1 oz.  

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  • there is like a 1 chance that your body would make a baby that is too big to deliver. weight estimates are usually wrong and 8.5 isnt even that big. it would be the baby's head circumference not weight that would be an issue anyway. please dont induce based on this appt. induce if there is a real medical reason. dont let the doctormake you doubt your body or ability to birth your baby.



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  • image Monsieur_et_Madame_Ha:

    Personally, I don't think I would base my decision to induce solely on the fact that the u/s estimate shows my baby as being big.

    For one thing, those estimates aren't exactly known for their accuracy. Also, if I had to choose, I would rather have a c-section baby than a baby that was evicted before it was ready (even if the baby is full term). And even if you do induce, that is no guarantee you won't need a c-section anyways.

    But then again, that's just how I feel. In the grand scheme of things though, I feel both options are safe enough - You just need to choose what you are most comfortable with.

    This.  They kept telling me my son was going to be at least 9 if not 10lbs based on the ultrasounds.  Nope.  He was 8lbs 4 oz.

    I was induced though due to GD.  It took 3 days and I have a narrow pelvis and my kid had an enormous head and I was still able to deliver vaginally FWIW.

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  • image jinnymb:
    there is like a 1 chance that your body would make a baby that is too big to deliver. weight estimates are usually wrong and 8.5 isnt even that big. it would be the baby's head circumference not weight that would be an issue anyway. please dont induce based on this appt. induce if there is a real medical reason. dont let the doctor make you doubt your body or ability to birth your baby.

    This. My mom gave birth to my sister and I vaginally and we were both over 10lbs. My son was 8lbs 8oz, and I delivered him vaginally just fine. Don't let them induce you based on your baby's weight.

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  • image jinnymb:
    there is like a 1 chance that your body would make a baby that is too big to deliver. weight estimates are usually wrong and 8.5 isnt even that big. it would be the baby's head circumference not weight that would be an issue anyway. please dont induce based on this appt. induce if there is a real medical reason. dont let the doctormake you doubt your body or ability to birth your baby.

     Exactly, don't let anyone doubt your ability at this point in your pregnancy.  Most won't induce until 41 weeks at least as long as everything is otherwise ok.   You can also look up more natural methods to get labor going if they keep pushing it.  

      

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  • image MrsWindyCity:
    image tokenhoser:

    I would not consent to an induction based on suspected large size. I would also refuse to see that doctor again as they do not follow ACOG guidelines.


    Ditto. I'm measuring big, baby is supposedly in the 90th or so percentile right now. My OB has not mentioned induction or the possibility of a CS at all. My first child measured similarly; he was born 3 days late at 8 lbs.1 oz.  



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  • image tokenhoser:

    I would not consent to an induction based on suspected large size. I would also refuse to see that doctor again as they do not follow ACOG guidelines.

    http://www.aafp.org/afp/2001/0701/p169.html

    Summary of Recommendations

    The ACOG committee provides the following recommendations for the management of fetal macrosomia:

    Recommendations based on good and consistent scientific evidence (Level A):

    • The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold's maneuvers).

    Recommendations based on limited or inconsistent scientific evidence (Level B):

    • Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes.

    • Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes.

    • With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery.

    Recommendations based primarily on consensus and expert opinion (Level C):

    • Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

    • Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery.

     

    This exactly. US are not the best way to measure growth, especially when est a large baby. I would do your research and trust your gut. If you believe you can wait until your baby and body are ready, then wait. 

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  • Lurker here.

    I was scheduled for an u/s at 40 wks 2 days and was induced that afternoon due to low fluids. But my doc and I agreed that if I could carry him safely I was going to wait for natural labor. My labor lasted 9 hours and I had him out in 20 minutes, and I'm a FTM. In utero measurements aren't an exact science. Unless there is a medical reason for an induction, let the baby come when he/she is ready. Women have been doing this for thousands of years. Trust your body.




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