Have you ever 'just said NO' to induction?

BabyShahmirza · August 2014

Hi Mommas,

FTM here. I'm almost 39 weeks, and it's a little early to be worrying about going past my due date. However, at my last appointment, my cervix was still closed, no effacement, and baby at -4 pelvic station. My OB brought up induction at 41 weeks. I have Kaiser and, apparently, their policy is to induce at this time if baby doesn't come on his/her own. She mentioned they'd likely break my water and put me on pitocin. I just flat out don't want to do this. Can I say no? Anyone else had any experience with this?

Thanks for your help!

sschwege · August 2014

I don't have any experience personally, but provided you are mentally capable of making your own decisions, you can refuse any and all medical treatments. So yes, without a doubt you can absolutely say 'no'.

Probably what would happen is the doctor would explain to you why he/she thinks induction at 41w is a good idea, maybe you would be asked to sign something acknowledging that you understand the recommendation and are declining it. Then you should be good to go. The OB could theoretically drop you from care, although I think that would be unlikely. Either way if you show up at the hospital in labor and asking for care they can not turn you away, so basically someone would have to deliver your baby regardless of who your provider is or isn't.

iris427 · August 2014

Yes you can say no. I said no to being induced once with my first, but did end up being induced a few days later anyway. What are your concerns about inducing? Have you talked about them with your doctor and asked why they recommend inducing at 41 weeks? I think it's good to have an honest conversation with your doctor.

Just FYI, there are studies finding that inducing at 41 weeks results in better outcomes and fewer cesareans than waiting until 42 weeks. This is why a lot of doctors and hospitals encourage inducing at 41. Just something for you to consider.

sschwege · August 2014

iris427 said:

Yes you can say no. I said no to being induced once with my first, but did end up being induced a few days later anyway. What are your concerns about inducing? Have you talked about them with your doctor and asked why they recommend inducing at 41 weeks? I think it's good to have an honest conversation with your doctor. Just FYI, there are studies finding that inducing at 41 weeks results in better outcomes and fewer cesareans than waiting until 42 weeks. This is why a lot of doctors and hospitals encourage inducing at 41. Just something for you to consider.

Really! That is the first I'm hearing of this, could you provide a link, so I could read more? (honest curiosity here

marriedinaugust · August 2014

I have no experience but I would definitely try every at home technique before I let the OB just pop my water and hook me up to Pit. I would probably decline the offer for induction as long as baby still seemed fine but nearing 42 weeks I would probably let them attempt something. I can't remember what the other options are for hospital inductions but I would hold off on Pit for as long as I could.

iris427 · August 2014

sschwege said:

iris427 said:

Yes you can say no. I said no to being induced once with my first, but did end up being induced a few days later anyway. What are your concerns about inducing? Have you talked about them with your doctor and asked why they recommend inducing at 41 weeks? I think it's good to have an honest conversation with your doctor. Just FYI, there are studies finding that inducing at 41 weeks results in better outcomes and fewer cesareans than waiting until 42 weeks. This is why a lot of doctors and hospitals encourage inducing at 41. Just something for you to consider.

Really! That is the first I'm hearing of this, could you provide a link, so I could read more? (honest curiosity here

sschwege Here's a few I found from a quick Google. It's not a new thing because when I had my first baby 6 years ago, my OB had already changed her recommendation from 42 to 41 based on the literature.

https://www.ejog.org/article/S0301-2115(04)00486-5/abstract

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3231911/

https://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004945.pub3/abstract

https://www.sciencedirect.com/science/article/pii/S0029784403003429

That said, I'm sure you can also find studies that show it's better or just as good to wait until 42. I think either way, with proper monitoring, it's low enough risk to go to 42 weeks that either option is reasonable (personally, I wouldn't feel comfortable past 42. At that point I think the risks to the fetus far outweigh any benefits from staying pregnant). And of course, these are just general discussions, and one has to take into account their own medical history, parity, how favorable their cervix is, what their doctor/MW says, etc. But I guess my point is that inducing at 41 weeks usually has good outcomes and isn't an automatic ticket to the OR or anything like that, so I think it's worth considering.

xc1148 · August 2014

I'm taking a Bradley class and our instructor just covered this, You can absolutely say no, the only time you technically can't is if there is danger to you or the baby.

Regarding what previous people mentioned, either at 41 weeks or 42 (I think 42) the risk of induction is the same as risk of letting the pregnancy continue so at that point it may not be worth fighting. But if you don't want to be induced, ask if there is a medical reason they are doing so, and if not, they will just have you come back in every few days.

MangomamaFL · August 2014

I went to 43 weeks with a previous pregnancy. The birthing center ordered a couple of U/S s when I went past dates. My son was born when he was ready. I was not induced.

JCWhitey · August 2014

I would definitely ask for an u/s to check on your fluid levels and the condition of the placenta along with saying no. Show them that you are not just flat out saying no, just that you want to be more educated into how dire an induction really is. Also see if they'd consider a membrane sweep before inducing.

Also, I would try to see if you can dictate the induction a bit. If they literally want to break your water and then start Pitocin when you're not even dilating yet that seems really out of order. Once your water breaks you are on the hospital's clock and once on that clock it would be hard to get off of it. I'd push to get Pitocin first and see if you can get into active labor before they break you water.

mb314 · August 2014

You can refuse any medical test/intervention, including an induction. You may just get a lot of pressure from your provider, but in the end they can't make you do anything. I have heard stories of people simply not showing up at the hospital for their inductions. I wouldn't downright refuse an induction, but I would ask for more tests to get more information on how your baby is doing. In Bradley classes, we were taught to ask things like "what's the risk of the intervention"? "What's the risk of NOT having the intervention?" etc.

Here's my experience:

My midwife recommended an induction at 40 weeks because I had a history of pre-existing high blood pressure, and my blood pressure was creeping up (on the lower end of "high"). I felt like the blood pressure wasn't high enough yet to merit an induction without some other sign that the baby was better on the outside than the inside.

We didn't refuse the induction, but we did ask for additional testing to see how the baby was doing before agreeing to an induction. We had a non-stress test and an ultra sound. The non-stress test was inconclusive because DS was "sleeping" and refused to move at 8 am. The ultra sound showed that my fluid levels were low and my placenta looked like it was "aging" (I can't remember what the term was they used). I still wasn't comfortable with an induction, but after those tests, I felt like I could be irresponsible if I didn't have the induction. I felt like the decision to have an induction was based on my actual situation and the state of the baby/placenta - not on an arbitrary "rule" the midwives/OB had about when to induce.

In the end, like 4 hours after agreeing to the induction, my labor started on its own at 38 weeks, 5 days (2 days before the scheduled induction). I just got lucky that I went into labor when I did (I was only less than 1 cm dialated earlier in the day). My placenta was apparently 1/2 the size it should have been, and I think there was a good medical reason for the induction in my case.

jennypolkadots · August 2014

A good friend of mine just gave birth. Her water broke at 38 weeks. She waited 18 hours before going in to the hospital. By that time, she was at least in natural labor, it was just slow going. She was 2 cm dialated, baby at -2 position, weak contractions 10 minutes apart. If you are at least in labor then the pitocin is much more likely to work. They hooked her up to pitocin and slowly increased it. Due to the induction, she was bed ridden and the contractions were just too intense for her natural birth plans. I think some of it is that she mentally was just not ready to have her baby at 38 weeks. She got the epidural. Within 12 hours she had delivered a perfectly healthy, albeit small, son!

You can absolutely decline induction. Especially at 41 weeks. ACOG and other reputable OB groups recommend waiting to 42 weeks. You should also consider factors like if this is your first baby, how long your menstral cycles are, when you ovulated, etc. when determining a good due date rather than just going by the LMP date.

If it were my baby, I would request an ultrasound at 41 weeks to see that there is plenty of amniotic fluid and the baby is well positioned. At 42 weeks you may try natural methods such as having sex, nipple stimulation, membrane sweep, and water breaking. Relaxation can help a lot. After having your water broken, you need to limit vaginal exams until you are in intense labor to reduce the occurrence of infection. You waters can replace themselves for several days so that is not a worry. If labor does not start up on its own after 24 hours and baby is still doing fine in there, then get the pitocin. This would be my plan, but I am working with midwives who will not induce before 42 weeks unless there is an emergency. Babies come when they are ready, trust your body.

MsMacual · August 2014

I have no experience with an induction, but I agree that you can say no. I also agree that discussing the method of induction is a good idea as there are some that are more conducive to a drug free/low intervention birth than others. I'd also discuss the dosage of pit if you need to go that route- the dosage given often is higher than what the mom needs to get her labor going, which leads to very strong contractions and the potential to need pain meds or other interventions. Perhaps, your doctor would be open to starting you on the smallest dosage possible and increasing it very slowly? Definitely do your homework on the different induction methods and decide what you are comfortable or not comfortable with doing.

KittyMisha · August 2014

BabyShahmirza said:
Hi Mommas,

FTM here. I'm almost 39 weeks, and it's a little early to be worrying about going past my due date. However, at my last appointment, my cervix was still closed, no effacement, and baby at -4 pelvic station. My OB brought up induction at 41 weeks. I have Kaiser and, apparently, their policy is to induce at this time if baby doesn't come on his/her own. She mentioned they'd likely break my water and put me on pitocin. I just flat out don't want to do this. Can I say no? Anyone else had any experience with this?

Thanks for your help!

Funny enough, I have Kaiser and was just told that they will not induce before 42 weeks without a valid medical reason. I'm not even having my first nst until my 41 week mark. I wonder if the discrepancy is regional?

Regarding induction, you can absolutely refuse or specify which techniques you are comfortable with. And your amount of dilation/effacement is not even remotely indicative of when you will deliver, so I find it weird that your ob would bring it up.

For what it's worth, I was induced with my first, and I can tell you there is a huge difference in intensity between Pit contractions with intact water and Pit contractions with your water broken. If I were in your shoes I would absolutely not let them break my water, even if I accepted the Pitocin.

jennypolkadots · August 2014

It's my first baby but I have never heard of an insurance carrier deciding when to induce a mother. It is up to the doctor and the insurance usually accepts the doctors recommendations. Do you think the doctor may be using this as an excuse? Perhaps what he means is, starting at 41 weeks your insurance will pay for an induction? I've just never heard of this.

KittyMisha · August 2014

jennypolkadots said:
It's my first baby but I have never heard of an insurance carrier deciding when to induce a mother. It is up to the doctor and the insurance usually accepts the doctors recommendations. Do you think the doctor may be using this as an excuse? Perhaps what he means is, starting at 41 weeks your insurance will pay for an induction? I've just never heard of this.

In the case of Kaiser, the doctors and the insurance carrier are interchangeable. You can only go to Kaiser doctors, and Kaiser doctos cannot see anyone except Kaiser patients. They are housed in these huge medical complexes with sometimes hundreds of other doctors of every possible speciality, all exclusively serving Kaiser. Kaiser doctors all follow the same guidelines, typically based on whatever is published as best practices for the given specialization. It's an unusual set-up if you haven't run into it before, but it pretty much means your insurance dictates your treatment.

That being said, I've had Kaiser for many years and I have no complaints. It hasn't been difficult for me to get treatment for anything I've needed.

JCWhitey · August 2014

Insurance dictates a lot in the medical field. Not just your personal health insurance, but the malpractice insurance held by the doctor. Which is why there are so many rules and regulations in hospitals.

jennypolkadots · August 2014

@kittymisha Thanks for the info, I had no idea it worked like that. Very interesting!

jinnymb · August 2014

I said no to induction with my first baby. I knew when I ovulated and it put my due date 5 days later than what they had. The early ultrasound even backed me up, but they still refused to change it. Once I was "overdue" they kept crying induction and I said no, absolutely not.

We did the non stress test twice that week and that gave everyone piece of mind. I'm glad I waited because my water broke on it's own and I had a pretty easy labor.

With my second two I flat out told them, unless they can prove to me medically that I need one it is not on the table.

I think it is completely unethical for doctors to put women who are 40 weeks+ pregnant under so much stress trying to get their baby's out because of the threat of induction. It makes it hard for women who really need them, to trust their doctors.

Good luck to you!

jinnymb · August 2014

Oh also it doesn't matter what state your cervix etc... are in. My body went from 0dialation to my water breaking with my first. With the 2nd two, I was only like 1 centimeter and went into full blown labor.

If you do decide on induction, like the other ladies said, know your options. YOU choose how you are induced, not the doctor. YOU are the customer remember. Also, you want to make sure you have a high bishop score, that will make your induction more successful.

JCWhitey · August 2014

What @jinnymb said is so true! State of your cervix and how dilated you are during pregnancy means very little! I have a poor friend who was told at her 38 week u/s two weeks ago that she was already 3cm dilated and would probably go into labor at any time. 2 weeks later she is still only 3cm dilated and not in labor at all.

So another way to avoid that part of the induction talk is to just not do vaginal exams anymore. They tell you absolutely nothing about when you'll go into labor.

be888 · August 2014

You can definitely say no to the induction. I was induced at Kaiser at 41 week and one day. I had a very favorable score for an induction. They started my induction with a balloon catheter, that started contractions without the need for Pitocin. A lot can change in the next two weeks, but you can definitely discuss with them the method of induction they are planning to do.

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