Induction, or wait?

lindsey1427 · August 2013

Well, I'm still pregnant and now the doc is talking induction. I'm 4 days past due date and they estimate that the baby is about 9 lbs. He said he's willing to let me wait until Monday. However, the longer we wait, the more likely an otherwise successful induction could turn into a c-section instead. I want natural birth as my first choice but an induction with medication would be a close second. I'd want to avoid a c-section if at all possible. I tried castor oil yesterday (1 tbsp) and nothing happened for 3 hours. Then I drank some iced raspberry leaf tea and felt some cramps/contractions on and off for about 30 minutes, then they went away and nothing ever developed. I'm guessing that's at least in part because I took such a small dose. They did an ultrasound yesterday and they said everything looks fine and if I want to wait, I can, but she's already quite large and getting bigger every day!

I have an appointment tomorrow for a non-stress test and an appointment for Monday for another NST and a biophysical. My plan, as of now, is to try the oil again tomorrow after my appointment, but in a larger dose (2 tbsp, maybe a bit more afterwards?). Hopefully labor kicks in and I won't have to make any induction decisions, but I'm worried that won't be the case. So, should I re-think induction and schedule one for tomorrow? Should I go to the appt and try the oil and see what happens? And if that doesn't work, should I really wait until Monday to even schedule an induction?

Bah. Sorry for all the random info, but I'd appreciate any guidance. It seems that every person I talk to just recommends whatever they did, and anything else is 'silly'. Friends that have had inductions or medicated births or have been given pitocin are trying to convince me that waiting is ridiculous, when induction is a perfectly safe (and preferred) option. Any advice (or words of encouragement!)?

huntjul · August 2013

A few thoughts...

Doctors and ultrasounds are notoriously inaccurate at estimating the size of a baby. So to me, that alone is not reason enough to induce.

I would also disagree that the longer you wait, the more likely an induction will turn into a c-section. Yes, baby will be a little larger, but most of that is fat weight and not head circumference, so I'm not sure a few days or a week will make any significant difference in difficulty birthing the baby vaginally. However, the most common cause of a failed induction leading to a c-section is that the cervix isn't ready to dilate. The status of your cervix can become more favorable in even just a few days, which will improve the likelihood of success of an induction (as well as giving you more chance to go on your own).

Have you looked into acupuncture and/or chiropractics? I don't know of studies that have compared them, but there certainly are a number of women who say they went into labor very shortly after having them.

IMO four days past due isn't reason to give up on a natural birth unless there's compelling evidence that something is wrong. Give your body and baby a chance to come on their own. If you're still here in a week, then let's talk induction.

AmyRI · August 2013

Well, I don't consider induction a perfectly safe and preferred option until you're past 41 weeks. 4 days overdue really isn't that much. The weight estimates are often wrong, and your baby isn't going to magically gain a pound in the next few days, so what's the rush?

I'd wait for Monday and do the NST and BPP. Assuming all looks good, I'd schedule an induction for Wednesday(ish). (This is the exact schedule I had laid out with my MW when I had DD - I went into labor on my own at 40w6d and delivered a 9 pound baby naturally.)

I also wouldn't try castor oil. I don't get the appeal of making yourself sick. Just give her time.

mysticl · August 2013

huntjul said:

A few thoughts...

Doctors and ultrasounds are notoriously inaccurate at estimating the size of a baby. So to me, that alone is not reason enough to induce.

I would also disagree that the longer you wait, the more likely an induction will turn into a c-section. Yes, baby will be a little larger, but most of that is fat weight and not head circumference, so I'm not sure a few days or a week will make any significant difference in difficulty birthing the baby vaginally. However, the most common cause of a failed induction leading to a c-section is that the cervix isn't ready to dilate. The status of your cervix can become more favorable in even just a few days, which will improve the likelihood of success of an induction (as well as giving you more chance to go on your own).

Have you looked into acupuncture and/or chiropractics? I don't know of studies that have compared them, but there certainly are a number of women who say they went into labor very shortly after having them.

IMO four days past due isn't reason to give up on a natural birth unless there's compelling evidence that something is wrong. Give your body and baby a chance to come on their own. If you're still here in a week, then let's talk induction.

Pretty much what she said. Every time I have heard of a baby's weight being estimated the baby ends up being smaller. I've heard the same thing about the cervix. If you start an induction with it closed or only slightly dilated you are more likely to "fail to progress" and have a c-section, which is what happened to me. I would try to avoid induction if it at all possible.

sschwege · August 2013

First of all you must give consent to all medical procedures, so the fact that your doctor says he is 'willing' to let you wait till Monday means nothing. Induce, don't induce, but you have the final say, end of story.

It is troubling to me that he is putting so much stock into this weight estimate. Unless you have other medical concerns (GD for example) baby's weight alone is not a good reason to induce. Here is what the ACOG has issued regarding this matter:

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 :

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.

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

This is merely anecdotal mind you, but DS was 8lb12oz, with a head in the 75% and I had him out in two pushes. He was my second baby so I know that helped, but still he was almost a pound bigger than his sister.

Also I would stay away from the castor oil, honestly. That is the only natural induction technique my MWs cautioned against. Good luck!

AACaHa13 · August 2013

I would wait. You still have some time. Unless there is a medical reason to induce, I'd wait until 42 weeks. I have GD so I am faced with induction if LO doesn't come by 41 weeks. It sucks! I am trying a lot of natural ways to get things going but obviously it won't work unless my body is ready, which I am aware of. The tea is not going to induce you. It is simply to tone your uterus for more consistent contractions. I would walk a lot and bounce on an exercise ball. Have sex... I've heard that really help soften up the cervix. I mean you could start those things now and maybe it will push you over to labor! I would personally skip the castor oil. Try acupressure or acupuncture. These are all safe ways when your body is ready and you are full term. I know facing induction is scary but remember the prediction of a big baby is nonsense.

A37licia · August 2013

I agree with everything that has been said. I will only induce at 42w or if a medical issue arises in me or baby. Suspected big baby is NOT a medical issue, but OBs overall get VERY nervous about it. Many have little faith in a woman's ability to birth a larger than average baby, if those weight estimates are even right (which they're often very wrong as said above).

I'm glad you posted here, and hope you have the confidence in yourself and support around you to advocate for what you believe is healthiest for you and your baby. I'm glad you're taking the advice around you with a grain of salt!

pdilly2b · August 2013

How confident are you in your due date? Were you charting when you got pregnant? Could be that it's wrong.

I have about 5% confidence in weight estimates. I wouldn't even let anyone assess me for that because they are so unreliable.

What is your bishop score? I would absolutely refuse an induction at this point if its not favorable.

Sounds like you are doing the right thing with the NST. Hang in there and don't let yourself get bullied into a non medically necessary induction.

rooftop · August 2013

Definitely wait. A failed induction is more likely than a big baby to result in a c-sec.

MannaPants · August 2013

PPs have given a lot of the scientific research I was going to point out. But my own personal choice will be no induction till 42 weeks.
You have the final say, it's your body and your baby. Your OB does NOT get to choose when you will have an induction. He can only recommend. Don't let him bully you if you decide to wait.

nodito · August 2013

And just to interpret the ACOG recommendations a bit, 5,000 g ~ 11 lbs. So what they're saying is that unless they think your baby will be over 11 lbs there's no reason to hesitate to try a vaginal delivery. Even if baby gains a full half pound a week from here on out, and even if he really is 9 lbs (which is difficult for them to accurately assess), you've still got lots of wiggle room.

lindsey1427 · August 2013

Thanks so much for the words of encouragement! I'm still pregnant. I've tried almost everything, including an acupuncture session yesterday. I'm trying to stay positive but wow, this is hard!

nosoup4u · August 2013

Aw, hang in there! The last bit is the hardest, I lose my mind at the end of pregnancies. No fun at all. Good luck, and I hope that baby comes soon!

sschwege · August 2013

lindsey1427 said:

Thanks so much for the words of encouragement! I'm still pregnant. I've tried almost everything, including an acupuncture session yesterday. I'm trying to stay positive but wow, this is hard!

So much can change in so little time! With my first, there was very little indication that anything was going on. Then contractions started and by the end of the day I had my baby girl in my arms, totally unexpected!

lindsey1427 · August 2013

sschwege said:
So much can change in so little time! With my first, there was very little indication that anything was going on. Then contractions started and by the end of the day I had my baby girl in my arms, totally unexpected!

It's posts like this that get me through the day!

A37licia · August 2013

lindsey1427 said:

Thanks so much for the words of encouragement! I'm still pregnant. I've tried almost everything, including an acupuncture session yesterday. I'm trying to stay positive but wow, this is hard!

Hang in there and complain here all you want! You can do it. Have a good cry if you need to.

huntjul · August 2013

lindsey1427 said:

Thanks so much for the words of encouragement! I'm still pregnant. I've tried almost everything, including an acupuncture session yesterday. I'm trying to stay positive but wow, this is hard!

Baby won't stay in there forever! Just give him/her a little more time. We're rooting for you!

mockingjay · August 2013

It's crazy to start talking about induction at 4 days past! The average birth date for a non-induced labor is 41 weeks! Why are doctors so dang induction-happy? It makes me nuts. Glad you're hanging in there.
Also, inducing when you're body isn't ready can very easily lead to a c-section. So if you don't want one, keep putting it off. As others have said, 42 weeks is still in the normal range.

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