Induction questions

munica00 · January 2011

My doctor may be inducing me at 39 weeks due to our baby not getting enough fluid, so he thinks bringing her into the world sooner than waiting for me to go into labor is safer for her. I'm wanting to do a med-free birth, but if I am induced, how much greater are my chances of having to use more interventions? I know some hospitals say that after X hours and you aren't fully dialated they will do a c-section. Which I definitely do not want. Does anyone have any answers for me? If I can avoid being induced I will, but after an ultrasound yesterday the doctor was pretty adamant that he would want to induce me for the baby's safety. Thanks!

desmerelda317 · January 2011

Does your doctor mean that he believes the amniotic fluid is low?? I don't know how a baby would "not be getting enough fluid" - it isn't like babies in utero are supposed to have 8 8oz glasses a day, ya know? Now you on the other hand should definitely be staying hydrated. I guess I'm just confused as to the reasoning for induction here.

If your doctor's concerns are low amniotic fluid, then I'd recommend doing some research, and getting a second opinion. Amniotic fluid levels are notoriously difficult to predict on ultrasound - a lot of factors can change the estimate, including baby's position. If you're really wanting to avoid induction, go for a second opinion with another doctor and then decide what to do.

And as for interventions - usually inductions mean more interventions. You're likely to be on EFM, which means stuck in the bed - though don't let that keep you from moving around in the bed to get comfortable and stay off your back. You'll have an IV. And pitocin contractions are supposed to be more difficult than natural ones, so a lot of moms do choose the epidural. But you don't have to choose the epidural. It is all about what you want as far as pain meds. A lot of moms have been able to handle pitocin just fine without an epidural. To that end, I'd encourage you not letting them do an amniotomy (breaking your bag of waters) because the amniotic fluid cushions the baby/placenta/umbilical cord and can keep those contractions from causing heart decels by putting to much pressure on the umbilical cord. Also, it might make the contractions easier for you to handle as well. Think of it this way, even in med-free labors, about two thirds of women make it to second stage labor (pushing) before the bag of water breaks - even nature keeps that bag in tact for as long as possible. There are real benefits to making it as far as possible with an intact bag. Another thought is that if the pitocin gets your labor really going, ask if it can be turned off completely. Some moms find that their bodies will keep on going in labor and all they needed was a "jump start" from the pitocin and it doesn't always need to be on the entire time.

Those are some recommendations I've recently read about in "The Thinking Woman's Guide to a Better Birth." It is a great book with lots of good info. About ten years outdated - but truthfully, the way women give birth in this country hasn't changed much since then so I think a lot of the info is still really valid. Maybe check it out from the library - she's got good recommendations on things to do if you need to be induced HTH and good luck! I hope you get the experience you want.

trulil · January 2011

desmerelda317:
Does your doctor mean that he believes the amniotic fluid is low?? I don't know how a baby would "not be getting enough fluid" - it isn't like babies in utero are supposed to have 8 8oz glasses a day, ya know? Now you on the other hand should definitely be staying hydrated. I guess I'm just confused as to the reasoning for induction here.
If your doctor's concerns are low amniotic fluid, then I'd recommend doing some research, and getting a second opinion. Amniotic fluid levels are notoriously difficult to predict on ultrasound - a lot of factors can change the estimate, including baby's position. If you're really wanting to avoid induction, go for a second opinion with another doctor and then decide what to do.
And as for interventions - usually inductions mean more interventions. You're likely to be on EFM, which means stuck in the bed - though don't let that keep you from moving around in the bed to get comfortable and stay off your back. You'll have an IV. And pitocin contractions are supposed to be more difficult than natural ones, so a lot of moms do choose the epidural. But you don't have to choose the epidural. It is all about what you want as far as pain meds. A lot of moms have been able to handle pitocin just fine without an epidural. To that end, I'd encourage you not letting them do an amniotomy (breaking your bag of waters) because the amniotic fluid cushions the baby/placenta/umbilical cord and can keep those contractions from causing heart decels by putting to much pressure on the umbilical cord. Also, it might make the contractions easier for you to handle as well. Think of it this way, even in med-free labors, about two thirds of women make it to second stage labor (pushing) before the bag of water breaks - even nature keeps that bag in tact for as long as possible. There are real benefits to making it as far as possible with an intact bag. Another thought is that if the pitocin gets your labor really going, ask if it can be turned off completely. Some moms find that their bodies will keep on going in labor and all they needed was a "jump start" from the pitocin and it doesn't always need to be on the entire time.
Those are some recommendations I've recently read about in "The Thinking Woman's Guide to a Better Birth." It is a great book with lots of good info. About ten years outdated - but truthfully, the way women give birth in this country hasn't changed much since then so I think a lot of the info is still really valid. Maybe check it out from the library - she's got good recommendations on things to do if you need to be induced HTH and good luck! I hope you get the experience you want.

Oh. What college did you get your medical degree from?

desmerelda317 · January 2011

Trulil: Wow, okay. If things I said are wrong, you're welcome to correct me. I'm okay with constructional criticism. I said I was confused about the reason for induction because I've never heard of a fetus having problems from "not getting enough fluid." I just don't know how that would work - getting fluid, vice just nutrients through the placenta - and I stated my confusion and asked if she meant something else. And as for the rest of it, like I said in my post, these are recommendations I've read about recently and simply offered her the information I've gleaned. At the very least, a second opinion is never a bad idea. Her doctor wants to induce at 39 weeks - her ticker says she's 36 and change. She's got time for a second opinion if she wants one. I don't think what I said was wrong about low amniotic fluid being difficult to measure accurately via ultrasound. Everything I've researched has stated such. It is a legitimate reason to induce, but getting a second measurement from another doctor just to verify the diagnosis is never a bad idea, is it? And since her induction isn't scheduled for tomorrow, she's got the benefit of time on her side.

Again, if things I said or suggested are wrong or bad advice, correct me. You obviously don't agree with what I wrote. So offer a rebuttal. Getting advice from various sources is a good thing. But don't insinuate that I gave bad advice and then leave the poor woman hanging wondering if there's something else she should know. People throw around medical advice on these boards constantly. Very few of us actually have medical degrees. I hope most of us are intelligent enough to discuss these things with our doctors and midwives before we actually take an internet stranger's advice. But if you are one of the few on these boards that does have a medical degree, please weigh in on the conversation and correct me where I'm wrong. I can take constructional criticism, but I don't appreciate the rude comment.

achh83 · January 2011

The chances of medical interventions will greatly increase once you've had one. If they induce with pitocin you will not be allowed to walk around to get labor moving. You are limited in the positions and pain management techniques you can try.

I just attended a birth on Wednesday where the mom was induced for the exact same reason. Low fluids. Turns out once the baby was out the fluids weren't low after all. Mom was induced and it snow balled into every medical intervention possible short of a c-section.

Do your research before making a decision. Never be afraid to seek a second opinion no matter how far along you are. and ALWAYS listen to your mommy instinct.

munica00 · January 2011

Thanks for the info girls! With my fluids being low, the way I understood it is that they did an ultrasound and the fluids in my uterus were at the low end of the scale- low enough for my doc to be concerned. I didn't know what kind of fluids he meant until i figured out from these boards that it was the AF. I've been sick the past week and it's hard for me to stay hydrated, so I thought that may have something to do with it. I'm going in for check-ups twice a week and I'll meet a new doctor on Monday at the same practice. I want to get his opinion on this and see if the fluid amount does improve, is induction necessary? I don't want to be confined to the hospital bed during contractions, which sounds like what will happen if I am induced with Pitocin. Also, I can ask to be taken off Pitocin if I am laboring well? That may be an option. Also, reading some birth stories on here, it sounds like many women have been induced with Pitocin and gone on with out any other meds, so it is possible. However, those are more success stories and women that had a delivery that did not go as planned (the opposite of those stories) may not be posting as frequently. So I will try to get a second opinion and stress to my doctor the importance of trying to be med-free as long as possible, even if I have to get induced. Thanks for the information and debate! All information has been helpful and welcomed.

kesrya · January 2011

Amniotic fluid decreases as pregnancy progresses - that is inevitable. But you can improve your fluids by staying well hydrated. If you were already well hydrated, I would say you probably cannot increase them, but can prevent them from dropping lower. However you said you've been sick and have not stayed well hydrated - so it is totally possible for you to increase them by really increasing them.

What the two PPs said is true -- there is much medical debate over amniotic fluid levels. The biggest debate is what treshold is to consider something "too low". One patient of mine was induced by her OB when hers got to 5 centimeters. Another patient of mine dropped down to 1 1/2 before she went into labor on her own and her midwife was not concerned given the fact that there were no other signs of fetal or maternal distress. Below 5 is considered to be low, but what exactly that means and whether low fluid really is a big enough problem to induce early is up for debate.

I think your decision to get a second opinion and to stress to your doctor how important a natural, non-induced birth is to you is a great idea. Make them convince you it truly is necessary to induce by giving you all the information needed to make an informed decision. The fact that you didn't even know what fluids they were talking about tells me your doctor isn't into giving you as much information as you need and deserve. Ask questions - ask them what your fluid level was this last u/s and what it has changed to. Is it still decreasing, or has it remained the same? Ask them why they consider the low fluid a problem? Are there other signs of fetal distress they are concerned about? What are the risks of allowing yourself to progress naturally to 40weeks? What are the risks if the medical induction is unsuccessful?

These are the questions and answers that should help you make your decision - and if your doctor is unwilling or unable to spend the time discussing this with you, that too would be a sign to me that the doctor is just pushing for a protocol without good backing.

iris427 · January 2011

Is your doctor basing this on one ultrasound measurement, or is this something that has been going on longer and has been measured on multiple measurements?

I've read that if a mother has low fluid measurements in one ultrasound, an alternative to inducing can be to hydrate the mother a lot for 24 hours (drink lots of water or possibly have IV fluids) and then have a different person remeasure her fluid levels the next day. So if that's the case, maybe your doctor would be ok with taking a more conservative approach?

If it's been an ongoing issue that has been seen on multiple ultrasounds, that may be a different kind of scenario but you can still ask your doctor about expectant management (lots of hydration and close monitoring) vs. induction.

Here's two articles you can read that have some studies cited in them.

https://www.themidwifenextdoor.com/?p=1141

https://www.medscape.com/viewarticle/551032_4

thebigmare · January 2011

trulil:
desmerelda317:
Does your doctor mean that he believes the amniotic fluid is low?? I don't know how a baby would "not be getting enough fluid" - it isn't like babies in utero are supposed to have 8 8oz glasses a day, ya know? Now you on the other hand should definitely be staying hydrated. I guess I'm just confused as to the reasoning for induction here.
If your doctor's concerns are low amniotic fluid, then I'd recommend doing some research, and getting a second opinion. Amniotic fluid levels are notoriously difficult to predict on ultrasound - a lot of factors can change the estimate, including baby's position. If you're really wanting to avoid induction, go for a second opinion with another doctor and then decide what to do.
And as for interventions - usually inductions mean more interventions. You're likely to be on EFM, which means stuck in the bed - though don't let that keep you from moving around in the bed to get comfortable and stay off your back. You'll have an IV. And pitocin contractions are supposed to be more difficult than natural ones, so a lot of moms do choose the epidural. But you don't have to choose the epidural. It is all about what you want as far as pain meds. A lot of moms have been able to handle pitocin just fine without an epidural. To that end, I'd encourage you not letting them do an amniotomy (breaking your bag of waters) because the amniotic fluid cushions the baby/placenta/umbilical cord and can keep those contractions from causing heart decels by putting to much pressure on the umbilical cord. Also, it might make the contractions easier for you to handle as well. Think of it this way, even in med-free labors, about two thirds of women make it to second stage labor (pushing) before the bag of water breaks - even nature keeps that bag in tact for as long as possible. There are real benefits to making it as far as possible with an intact bag. Another thought is that if the pitocin gets your labor really going, ask if it can be turned off completely. Some moms find that their bodies will keep on going in labor and all they needed was a "jump start" from the pitocin and it doesn't always need to be on the entire time.
Those are some recommendations I've recently read about in "The Thinking Woman's Guide to a Better Birth." It is a great book with lots of good info. About ten years outdated - but truthfully, the way women give birth in this country hasn't changed much since then so I think a lot of the info is still really valid. Maybe check it out from the library - she's got good recommendations on things to do if you need to be induced HTH and good luck! I hope you get the experience you want.
Oh. What college did you get your medical degree from?

I'm not usually a snarky comment poster, but your comment bothered me. Who are you with your 7 posts to judge anyone on this board? Everyone gave the OP really good advice and all you did was leave a rude comment.

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