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Natural Birth
when is induction necessary?
many people say they don't agree with induction unless it is necessary. so when do you think it is necessary? sometimes people say diabetes makes it necessary? but gestational diabetes is very different from type I or type II diabetes. so if diabetes is one of your answer please clarify which type or all forms.
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Re: when is induction necessary?
To me, it is necessary ONLY in the instance of medical necessity. Some examples of this would include:
Proven IUGR
Clotting disorders where anticoagulants are used (I'm still not entirely sure how to decide on this one b/c it's hard to tell when baby is ready, but I would definitely make sure mom's body is ready for induction and not just randomly schedule. If her body is ready then most likely baby is ready, too)
Mod/severe or progressing pre-eclampsia (and I mean protein in urine, everything...not just the high blood pressure - although i would recommend close monitoring and if it is creeping up then try treating it before delivering)
PROM > 24 hours (I am not setting a max time limit on waiting for contractions, but a min that I believe they should wait before thinking about inducing)
Post-term pregnancy (>42 weeks. I would only CONSIDER it at this point, but would still monitor)
Here's is a link to a pretty decent article.... it's on ehow.com, but it seems to cover everything and be written pretty well.
I would say induction is medically indicated anytime the risks of continuing the pregnancy outweigh the risks of inducing. Joelsgirl gave good examples of that kind of scenario.
It's not always a black and white situation either.
Not completely true...The only difference between GDM and Type I/II DM is the fact that it develops during pregnancy and resolves after pregnancy. Just like with Type I/II, ladies with GDM have different severitiesof GDM, meaning that some can control with diet, some with meds, and some must start insulin.
Other than that, I agree with most of the responses from the PPs.
This.
Also, type 1 and type 2 diabetes themselves are not a reason to induce. However, sometimes diabetes causes other risk factors that ARE reasons to induce. Such as, the placenta begins to deteriorate/stop functioning early, this is sometimes seen as early as the second tri. That's a BIG problem and would indicate a need for a c-section.
Same with GD. Alone, not a reason to induce. However GD can cause complications that would indicate a need to induce. I'm not familiar with common complications of GD because I don't have it, so I've spent my time researching things that apply to me.
A reason NOT to induce would be a macroscopic baby. ACOG recommends against inducing for this reason, stating that there is no evidence that it helps. Meaning the risks of induction in this case outweigh the risks of a full term pregnancy. They do however state that, in the case of TRUE a macroscopic baby, (over 11 pounds for non GD, and over 9 pounds if you have GD) a c-section should be considered. Contrary to popular believe, there are serious risks to delivering a large baby. There are also serious risks to csections though. Also growth estimates are notoriously inaccurate, so there needs to be several factors indicating that the baby actually is large. here you'll find the acog guidlines for fetal macrosomia.
and here is another link
It is from the mayo clinic, so I'd consider it a good source of information.
They don't recommend induction unless the woman is at least 10 days past EDD, for a normal pregnancy.
Good luck in your research. Feel free to ask any more questions.
Morgan's Birth Story: http://www.fullcirclemidwifery.com/2009/06/morgans-birth/
Chloe's Birth Story: http://www.fullcirclemidwifery.com/2012/04/chloes-birth/
Ditto. I never would have said PUPPS was induction worthy until I was out of my mind and willing to carve the baby out with a spoon (after 24 hours of cervadil and no progress, I still went home to wait it out to avoid a c-section.)
Ok this made me laugh. I can just picture laying the hospital bed trying to do this!
In addition to factors listed above, failed NST or BPP
Not always, with this one...I specifically brought it up with my (high-risk)OB at the first opportunity(I've had three clots previously, in addition to a genetic clotting disorder, and am basically on blood thinners of one sort or another for life), and she said unless there's some other complication(s) closer to time that would lead to needing it done, they're not going to try and make the baby come out early. She also said that they'd encourage me not try going past my EDD because "there's no good reason to keep them in there past 40 weeks," but that they wouldn't force me to get induced before my body was good and ready. This is the same doctor who said she'd much rather her patients deliver vaginally than via c-section, because "it's a lot less work for me to show up and catch the baby than to scrub down and do surgery."
Ugh! I had PUPPS with DS and was lucky that it only lasted from 15w6d until about 5 weeks later. I even ended up at a derm with a biopsy b/c they were sure that couldn't be it b/c it was so early. If I had had it the whole time I would have died. Killed myself, carved my eyes out with a spoon, I dunno. It is THE most miserable feeling I have ever had in my life. It's like chicken pox on crack that never ever goes away. I was so doped up on atarax and benadryl and I smelled like an old lady from the sarna lotion. Blech
And about the clotting disorders, she asked for reasons to CONSIDER. But, like I said, if mom's body isn't ready for induction then it's not a good idea. I don't have personal experience with this one except that they were watching me closely b/c grandma has Von Willebrands, but I was talking more about the people who are on heparin and those kind of things.
Ditto.
With twins, if you get to 39-40w it's usually medically indicated, as well. (Studies show that from 40w on the risks of continuing the pregnancy really increase with twins and there are zero benefits to delivering past 40 weeks compared to 38-39.)
And I so relate to the pp with PUPPS; I had a similar rash and it was torture! Definitely made me even more eager to have those babies.
Sometime you can't wait for mom's body to be ready though and your choices are either to try an induction anyway or go straight to a cesarean. An induction can still work even when mom's body isn't ready and she has an unfavorable Bishop's score. The risk of having a cesarean for an unsuccessful induction is a lot higher but it's not guaranteed. So in that case, I guess it's a matter of personal preference. Unless the baby really needs to come out ASAP and a cesarean might be the best course.
I figured it was meant as a more generalized thing, but that's why I chimed in...so there'd be something from one of "the people who are on heparin and those kind of things." I am Factor V Leiden homozygous(which means not only do *I* have a clotting disorder, but any children I have will ALSO have it, guaranteed), have had three cases of DVT, and have been on coumadin/warfarin for years. I had to be put on Lovenox before we were even allowed to start TTC, and I will be switched to plain ol' heparin at about 35 weeks, for "just in case"(mostly if something does go wrong, and they need to place an epidural after all). Having a higher risk of clotting means that yes, there's a chance that something else could go wrong (I'm going to be getting additional u/s, etc, every 4 weeks after my anatomy scan, to make sure the baby's getting appropriate bloodflow), but as long as there aren't additional problems with me or the baby, they're ok with me having this baby the way I want to.
I have every intention of "going natural" and have spoken with both my OB and MFM about this, and NEITHER has said anything to lead me to believe that I would not be permitted to go into labor on my own and deliver vaginally with few to no interventions. I can't speak for everyone in similar circumstances, and a lot of it depends on who you have looking after you/offering medical advice, but from what I have been told about MY situation, a clotting disorder(even one that is active, with a past history of serious clots) by itself is not medical cause for an induction.