Disappointing doctor's visit :(

Bekkers · September 2012

Hi there, ladies. Just need to have a mini-vent to people who will understand my disappointment. I went in today for my regular growth checkup (I go twice weekly; once for an ultrasound and once for a NST) and since I've had quite a few contractions lately I asked to be checked for dilation. They would have done it next week anyway since I'll be 38 weeks tomorrow, but I was so curious! I'm 75% effaced but no dilation yet. Not too worried about that; it'll happen when it happens.

On to the disappointing part. Because I have a variety of high-risk factors (questionable test results during first tri, protein deficiency/ clotting disorder, and a baby at the 15% percentile size-wise) my doctor is started to talk pretty seriously about inducing. He knows I want to go natural and has been quite supportive the whole time, but he says this is for concerns over stillbirth if we wait too long. I just don't really see how a couple of days after my due date is "too long". I have friends who went two weeks over! Also, if she's small anyway I figure it makes sense to give her time to keep cooking! DH and my mother say "they are the experts, listen to the doctors" (my husband in a very supportive manner, my mom not as supportive) but I'm just so worried that an induction will lead to all kinds of other interventions. Grrrrr! Now I just have to hope that she's as stubborn as her momma and decides to come before we can induce just to spite them! Thanks for letting me get that out

wifeofadam · September 2012

Can you elaborate on what he means about the stillbirth risk? Does it have to do with the protein/clotting disorder or the early test results?

Size-wise, I agree with you. If your baby is small, I would think inducing early could lead to problems. More time to cook could mean more time to grow, especially if the lungs are underdeveloped or something like that.

But honestly, I don't know enough about the clotting disorder and the other things to say whether or not I agree with the doctor. Does your office have more than one OB? Could you maybe schedule an appointment with another OB to get a second opinion?

After you do your research and come to a conclusion, remember that no one can make you do anything. If you don't want to be induced, no one can make you do it. Good luck!

WearingRed · September 2012

in utero growth restriction [IUGR] is nothing to fool around with. So measuring very small could be a big deal. And IUGR can cause stillbirth as the baby basically starves to death inside you. I am not say this is the case but is something you should talk to your care provider about. The only way to make a decision is to have ALL the facts. So you have to ask ask ask what is really going on? Why do you want this? What are all the options?

jellybeanjean · September 2012

WearingRed:
in utero growth restriction [IUGR] is nothing to fool around with. So measuring very small could be a big deal. And IUGR can cause stillbirth as the baby basically starves to death inside you. I am not say this is the case but is something you should talk to your care provider about. The only way to make a decision is to have ALL the facts. So you have to ask ask ask what is really going on? Why do you want this? What are all the options?

This. As and L&D RN, I see inductions for IUGR/SGA all the time. There are a wide variety of reasons why IUGR happens in the first place, but basically, if it's severe enough, baby will grow and thrive and be much healthier on the outside than on the inside. They've stopped growing (or slowed way down) for some reason (placental insufficiency, high BP, whatever), so often the best course is to get them out. I know it seems counter-intuitive, but that's how it works.

Like the PP said, I'd be asking a lot of questions. I'm not saying every IUGR/SGA baby needs to be induced, but I'd for sure get more details re: his plan of care.

SushiNoMore · September 2012

jellybeanjean:
WearingRed:
in utero growth restriction [IUGR] is nothing to fool around with. So measuring very small could be a big deal. And IUGR can cause stillbirth as the baby basically starves to death inside you. I am not say this is the case but is something you should talk to your care provider about. The only way to make a decision is to have ALL the facts. So you have to ask ask ask what is really going on? Why do you want this? What are all the options?
This. As and L&D RN, I see inductions for IUGR/SGA all the time. There are a wide variety of reasons why IUGR happens in the first place, but basically, if it's severe enough, baby will grow and thrive and be much healthier on the outside than on the inside. They've stopped growing (or slowed way down) for some reason (placental insufficiency, high BP, whatever), so often the best course is to get them out. I know it seems counter-intuitive, but that's how it works.
Like the PP said, I'd be asking a lot of questions. I'm not saying every IUGR/SGA baby needs to be induced, but I'd for sure get more details re: his plan of care.

Coming out of lurkdom to agree with the above. As a preemie mom, I've encountered plenty of mamas with IUGR babies. It's serious business. I know that you don't want the interventions (I'm a big believer in natural birth myself), but IUGR falls into the category of situations where you really need to intervene. If the baby is small due to insufficient placenta, he / she can die. Period.

I don't say the above to be snarky. I'm just trying to portray the potential seriousness of the situation. And, it IS possible to have an epidural-free birth with an induction. Not ideal, but possible.

I'm sorry you're going through this. Sending you lots of labor dust in the hope that you go into labor tonight. ;-)

ncbelle · September 2012

I am no fan of early inductions but I'd echo what the pp's have said about the fact that there can be real risks involved in going too long for some women and some babies. If I were in your shoes, I'd press the doctor for a more thorough explanation about why an induction might be medically necessary so that you could feel more confident that it is the right thing to do. Good luck to you!!

amandaleigh1 · September 2012

My baby growth was estimated to have slowed down from 29 weeks to 40 weeks when it was checked by ultrasound. However, this was not why I was ultimately induced (they said I had IUGR even though I had a 7 lb 4 oz baby, wth!). I was ultimately induced because I had declining fluid levels-- they declined so much on the estimation over 1 weeks time, that I believed it to be true. At that time I was 41 weeks 3 days, so pretty close to my 42 week ultimatum anyhow.

I also had a baby with SUA, which also increases still birth risk.

We chose to manage my situation with a lot of monitoring, but I was willing to do the BPPs and NSTs so long as I got to keep my baby cooking.

Why not just suggest close monitoring, and let you cook longer?

Even if it does come to induction, nothing says you can't still go natural. I did it.

Temp76535187505890 · September 2012

Is your doctor a perinatologist? If not, I would ask to be referred to one so I could get a second opinion and go from there.

mystrana · September 2012

As others have mentioned, IUGR is a good reason to bring a baby into the world sooner rather than later, as these babies can thrive better on the outside.

It's important to know that while, on average, there's nothing wrong with going over 40 weeks, each pregnancy and each woman is unique.

Make sure to communicate with your doctor about your concerns

lkm2006 · September 2012

WearingRed:
in utero growth restriction [IUGR] is nothing to fool around with. So measuring very small could be a big deal. And IUGR can cause stillbirth as the baby basically starves to death inside you. I am not say this is the case but is something you should talk to your care provider about. The only way to make a decision is to have ALL the facts. So you have to ask ask ask what is really going on? Why do you want this? What are all the options?

This. My DS was growth restricted and stillborn was also a concern The reason for concern might be different, but my placenta started dying early in my pregnancy so while your friend may be able to go 2 weeks late, your baby may really need to get out early.

My MFM explained it as your baby is on a strict diet and really doesn't need to be. Also, he explained that while in the womb is usually the very best place for babies, sometimes babies have special conditions that means the outside world is a much better place for them.

shutupanddance07 · September 2012

I end to sit the fence between what you're saying and what your husband and MIL are saying. Doctors are experts that should advise us on what we're up against, what the risks are, what they think the best option is, and why. You get to make the choice in the end, but it's important that it's a well informed one. I think you should have a discussion with your doctor about it. Ask why it's so important to get your baby out sooner, and ask what could happen if you wait until 40 weeks, and then 42. You, your husband, and your doctor should all feel comfortable with the choice you come up with. If there's a stillbirth risk, why, what's causing it, and is there a fix. If the fix is induction, what are the risks to the baby, or to you.

You need to use your doctor as a team member, here. Natural childbirth is great for healthy, low risk pregnancies. If yours isn't one, you need to consider other options. The ultimate objective is to get baby out safely, then as naturally as possible. Talk to your doc and come up with a plan that you're comfortable with and that keeps your baby safe.

Bekkers · September 2012

Thank you, ladies, for all the advice and support! I am glad to hear that there were some who were induced and still went natural from there on. I have another appt on Tuesday, so I'm going to take many of these questions with me. I should have been more clear- her growth to this point has been fine, as are my placenta and fluids. That's why I'm so confused by this sudden push for induction! Now that I'm over the initial shock, I'll be able to have a much more informative discussion with my doctor this week. Thanks for letting me have a little vent and giving so much great advice!

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