Just found out this afternoon I'm going to be induced on Monday. We've known/ worried a little all along that he's been measuring big, but at our last ultrasound a couple weeks ago they noted that one of his kidneys is bigger than the other. I had a repeat ultrasound today and it showed increased amniotic fluid, so that with the enlarged kidney, and his large size, is a concern. The dr thinks inducing is in the best interest of the baby, and has warned us that due to his size, we may end up with a c-section, though he also said my cervix is favourable to avoid one. The dr let us decide, Saturday, Sunday or Monday, and we thought we'd want the weekend to finish off any last minute stuff but now I'm just sitting at home kinda lost. I should be excited that he's coming soon and we have a date for him, and I'm not upset about the idea of being induced, but I just don't know what to do with myself.
I mean really, nothing has changed except now we now when he's coming, so why do I feel so blah about it?
@jennyleigh16 I felt the same way before getting induced. I had some emotions about missing out on the excitement/surprise of my body naturally going into labor on its on and the progression that goes with it. There is just something different about laying in a bed when they break your water and watch for contractions. I am glad my dude got here safe no matter what but definitely had mixed emotions around the whole thing.
@theshannondee Thank you. I'm glad I'm not alone. I think I just don't know how to feel about it. MH and I sorta joked about what we do this weekend. Do we go back to normal? Do we have a last hurrah night out? Do we hold each other on the couch and cry?
@jennyleigh16 go out to a nice dinner tonight or tomorrow. Celebrate that you're going to be adding a LO in a couple days! Focus on the big picture that's what helped us.
Going in Monday at midnight for my induction (at 37 weeks on the nose -- due to medical concerns with the tyke). I'm terrified. Which is odd because I was also induced with my first. Just want Monday to get here. Good luck to all you other induction mammas
@randishane011804 Thanks! This is turning in to quite the process. Yesterday I went in for my last round of dopplers. And they informed me the baby was no longer heads down (He was heads down at midnight the night before when I went in for a failed kick count, so he made a fast flip). So the Dr cancelled the induction and scheduled a c section for 11 the next day (today). So i con in today for the section and they ultrasound again and,low and behold, heads down again. So now I'm chilling with cervidil in and hoping he doesn't flip again before we can get him out. We'll see. LOL
@ktomorrow Thanks. Trying just hoping we dont do hours and hours of labor just to end up back in c section land. But as long as baby is in my arms soon, I'm good.
@jennyleigh16 I felt the same way when I was induced with my first. It was strange loading up the car, and going into the hospital without my water breaking or having contractions or anything. On the way to the hospital, MH joked that we should smash mailboxes or pumpkins (it was October) to make it a little more eventful, so we had a good story to tell. All in all, I actually liked having a date and going in, but I wish that we would have done something together the night before (or even the hours before) heading in. My grandma was in town and everyone was getting together for dinner, so we ended up at my aunt's house, only for them all to be an hour or two late getting there (because they were all shopping). None of them knew that we had to be at the hospital at 8pm, and we didn't want them knowing, so we sat around waiting for them (they finally got there at 7pm, and it is a 45min drive to the hospital from my aunt's house), then each ate a taco (quickly), came up with a lie on why we needed to leave, and then headed out. If I could have done it different, I would have spent the day/evening doing fun stuff....with just him...making spontaneous plans along the way.
When did everyone start talking induction with your doctor or when did your doc bring it up? I have my appt at 36+2 this week and don't want to be jumping the gun since we are weekly now.
My doctor told me at 20 weeks that the goal is for me to be able to go on my own but that he wouldn't let me go past 41 weeks. That's all we have said about it. I'm 36 + 4 now so I still have time before induction talk needs to be discussed more seriously. @mrsmommya
@mrsmommya today at my apt with my due date being Friday. My doctor won't let you go past 42 weeks. I have two induction dates depending on when they fit me in, either the 8th or the 11th if I don't have the baby before then. A final date between the two depends on when the hospital has an opening.
@mrsmommya I just asked because I needed to know for my sanity. Also so uncoils more accurately count down. I asked at 38 weeks but ask whenever. It seems that every doctor is different when it comes to this. Mine doesn't go beyond 41 weeks.
Originally my OB wasn't going to discuss induction until I was past 40 weeks. However, due to a few complications and health concerns my OB told me at my 34 week visit that she may want to induce at 38-39 weeks depending on the results of my next perinatal visit which is tomorrow. She said that she told me early to prepare me for the possibility of being induced which I appreciated.
Last time my doctor first brought it up at 39 weeks. They also don't "let" people go past 41 weeks. I was induced at 41+4 because I really didn't like the Monday doctor (who suggested elective induction at my 39 week appt.) so went on Friday. If you don't want an induction and don't have a medical reason for it, do your own research before agreeing to anything. I understand many women are happy to be done by then and it is a personal decision, but I did not let my doctor bully me into something that wasn't right for my family.
My induction was brought up yesterday at my 39 week appointment and I got a phone call today saying that I am to head to the hospital at 40 +6 to be induced.
Married: August 2012
TTC #1: July 2015
BFP 1: October 30, 2015; EDD: July 6, 2016- Team Pink
I'm due 7/26 but my OB has already told me that if I haven't gone into labor on my own by 7/25, I'll be going in that day for an induction. I know my hospital doesn't let women go past 41 weeks, but I think they're inducing me earlier because of GD as well as my size (I was overweight prior to getting pregnant and am now considered obese, so that's great for the self esteem, LOL).
I'd rather avoid the induction and want to try to get things started on my own once I get closer (hello, old wives tales!) but am not sure when it's considered safe/what is considered safe to try. Anyone know?
I brought it up around 34 weeks, just to set my expectations. She told me she would induce once I hit 39 weeks (40 weeks according to my conception date, which is what I have been going by all along). I would bring it up sooner than later especially if you are delivering at a busy hospital because mine is booking non-emergency inductions over a week out. To give yourself a piece of mind and end game I would say the sooner the better.
I am with a midwife and she says she legally has to have me sit down with an OB at 42 weeks to talk about an induction but ultimately it is my choice. Personally I know the dates they have for me are wrong as I was tracking ovulation so I am ok going a few days over. I guess we will see when I get to that point. I have had a really uneventful pregnancy (very thankful for btw) other than HG. So unless something medically necessary comes up I won't be scheduling anything. For now I feel like going naturally would be best for baby and me.
Those that do need/want to be induced - there was just an article posted in May that the ACOG now has a consensus that inducing at 39 weeks is preferable.
Induction at 39 Weeks Is Better for Mother and Baby
WASHINGTON,
DC — The optimal time of delivery for women with low-risk pregnancy has
been a continuing source of controversy, but a debate on the elective
induction of labor at 39 weeks here at American Congress of
Obstetricians and Gynecologists 2016 Annual Clinical Meeting turned out
to be a statement of consensus.
The two presenters agreed that evidence is mounting that waiting beyond 39 weeks is not advisable.
"Continuing
the pregnancy beyond 39 weeks is riskier than previously believed for
the fetus," said Errol Raymond Norwitz, MD, PhD, chair of the Department
of Obstetrics and Gynecology at the Tufts University School of Medicine
in Boston. In addition, risks to the mother associated with routine
induction "are lower than appreciated," he said.
"I was
absolutely opposed" to the elective induction of labor at 39 weeks, said
Charles Lockwood, MD, dean of the Morsani College of Medicine at the
University of South Florida in Tampa. In fact, he was prepared to debunk
the notion.
But after much reading, "it's overwhelmingly evident that elective induction of labor is the logical strategy," he said.
Members
of the audience in the crowded ballroom were won over by Drs Norwitz
and Lockwood. Before the presentations, 20% said that it would be best
to deliver most women at 39 weeks, 17% were unsure, and 63% were against
the idea.
After the presentations, 81% of the attendees
said they changed or reconsidered their view. In fact, 70% said they
agreed that it is best to deliver most women at 39 weeks, 21% were still
unsure, but only 9% were against the idea.
Stillbirth a Bigger Danger Than Realized
Even
though higher rates of stillbirth after 39 weeks have been reported
since the late 1980s, it still seems to be underappreciated, said Dr
Norwitz.
He pointed to several studies that showed that stillbirth is a greater risk at 40 weeks of gestation and beyond.
"Antepartum
fetal deaths account for more perinatal deaths than do complications of
prematurity or SIDS," he said, citing a report that estimated that
there were at least 26,000 stillbirths in the United States in 2004 (BMC
Pregnancy Childbirth. 2015;15[Suppl 1]:A11).
Those findings have "been recapitulated in multiple datasets," he explained.
And
one study he described showed an increasing risk for stillbirth and
neonatal mortality with each passing week of gestation (Br J Obstet
Gynaecol. 1998;105:169-173).
It is not known why the rate
of stillbirth increases, but it could be related to uteroplacental
dysfunction. It might also reflect the failure to identify risk factors,
such as multiple pregnancy, infertility, low blood pressure,
intrauterine growth restriction, and having previously delivered a
small-for-gestational-age infant, he said.
No Increase in Cesarean Rates
The
major risk associated with a failed induction at 39 weeks is cesarean
delivery, but both Dr Lockwood and Dr Norwitz said that there does not
appear to be any evidence of an increase, and that perhaps it might even
decrease rates, compared with expectant management.
Some
studies have indicated that the rate of cesarean delivery increases in
multipara with an unfavorable cervical exam, said Dr Norwitz.
However,
data comparing rates of cesarean delivery and other outcomes after
induction at 39 weeks and after expectant management at 41 weeks are
weak to nonexistent, in part because it would take 2 million to 12
million pregnancies to get good answers, Dr Lockwood explained.
So
he and his colleagues conducted a comparative-effectiveness analysis.
"We evaluated every conceivable outcome that we could think of," he
said. The model involved probabilities for 60 outcomes. The team then
created a Monte Carlo microsimulation to map out head-to-head
effectiveness.
Expectant management was associated with
higher rates of cesarean delivery than induction at 39 weeks, and "a
clear increase in perinatal mortality," he reported. Maternal death
rates were not significantly different in the two groups, but severe
complication rates were lower for both the infant and the mother in the
induction group, said Dr Lockwood.
The bottom line is
that "elective induction at 39 weeks is always a better strategy" than
expectant management at 41 weeks, he said.
Both Dr
Norwitz and Dr Lockwood said they agree that success with induction
requires very accurate dating of gestational age. "If you're off, you
could endanger the patient," said Dr Lockwood.
He also cautioned that induction "has to be a real induction of labor — not one that ends at five o'clock."
Dr Norwitz and Dr Lockwood have disclosed no relevant financial relationships.
American Congress of Obstetricians and Gynecologists (ACOG) 2016 Annual Clinical Meeting. Presented May 16, 2016.
There is two main doctors at my hospital that look after all the pregnant ladies. One of them will allow you to go over by ten days and the other (my doctor) will induce you any where around the 40 week mark. While that's a relief to know, I'd still rather it not be an option unless completely necessary. I don't want to be able to just pop in and say "Oh I'm 39+5, induce me" I'd rather baby came whenever he was ready. Ask me again closer to the date though, I'm sure I'll have changed my mind lol.
Really interested on hearing thoughts on that article. It's got me thinking but also vey confused! Maybe I shouldn't let my doctor wait until I'm 41 weeks after all.
@tennisbabymama It's not the official ACOG recommendation (yet), but I think it gives a lot of validity to going at 39w and not waiting until 41 weeks with the expectation that the "baby will come when ready". Other articles I've read have indicated higher rates of aspirations due to meconium, cords around the neck, and general fetal distress because of waiting past 40 weeks.
The research is there that I don't think doctors should be thrown into a box of rushing to get the baby out for convenience when they suggest inducing earlier.
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No formatter is installed for the format bbhtml
The main problem with inductions is that sometimes they just don't work (and thus result in a C section). I want to have my own birthing experience that doesn't involve being hooked up to a bunch of drugs and monitors. I understand if I start going overdue I will have to start weighing the benefits/risks of having an induction vs. waiting for labor to start, but I think my doc and I can figure that out together. Plus EDD's are estimates and are likely not exact.@tennisbabymama if you are having a normal and healthy pregnancy there is likely nothing wrong with going to 41 weeks, as long as you're being monitored closely by your doctor. But if you want to induce sooner than that and your doc agrees, more power to you!
@rnyland1 I absolutely agree with your birthing experience, I've wanted to go as med free as possible for my labor but being a FTM I also know that it's very possible to go over and onto that 41 week mark. I will research more and talk with my doctor for his opinion. Right now I'm sticking with my plan and hoping to be able to go on my own still but it's definitely got me thinking, that's for sure. Thanks for your input!
The thing is, as you said, this is not an official ACOG recommendation - It's the viewpoints of two individual doctors. They bring up some interesting facts, but the overall tone in comments like this:
Norwitz argued against simply letting nature take its course.
“Nature is a terrible obstetrician,” he said, referring to the “continuum” of pregnancy and birth: the large number of zygotes that never implant, the 75 percent lost before 20 weeks, and stillbirth.
.. makes a little ragey and mistrust where they are coming from. Believe me, I am more than grateful for modern science and how it helps save lives. But I feel like some doctors, through being able to "hack" the human body through certain medical procedures develop this misplaced sense of superiority and forget what a speck of dust they are in comparison to the astounding complexity, sophisticated-ness (is that a word?), and beauty of the human body and of nature and the universe as a whole... Leading them to think EVERY situation should be actively managed because clearly they know better than nature...
That study still doesn't change my mind. I will be monitored closely by my midwife at the end but I am planning an at home birth with little to no interventions; induction is not in the plans for me this time. I was induced last time to some made up bullshit reason and my daughter came out just fine even though they convinced me she would have so many issues. (Born at 40+2) I am a young mom who has had zero complications (again very thankful). Studies are just that, based on a group of people that we don't know the full history of each individual person in. Correlation does not equal causation. North America has turned pregnancy into a huge medical thing where financially we as mothers and family lose. I don't believe all pregnancies need to be as "controlled" as they are. I am not saying that I am ungreatful for the care we get or the medications to help ease discomforts or illnesses of pregnancy because without anti-nausea med I likely would have had to abort this pregnancy to save my life but birth it's self is too micro-managed in my opinion.
Interesting. I may do some more research soon. At the time DD was born, I couldn't find a convincing case for induction before 42 weeks. She was born without any complications and actually only 7 lbs. 1 oz. at 11 days after due date (despite me gaining a healthy 37 pounds). I expect baby will be late again, but am open to an earlier induction if I believe the evidence says it's safer.
I just had my 40 week appt and induction was mentioned for the first time. I was told that because I've had a healthy pregnancy that it is essentially my call. She said if I go over I'll have a BPP at 40+6 and if that goes well I can have a few more days and then have an NST and as long as that looks okay I can have a few more if I want them but they don't want me going over 42.
@theshannondee I told her I'd rather avoid it, despite my misery at still being pregnant haha. But I also told her I will do it without argument if there's any sign that he's under distress. She would rather I go into labor on my own and so would I, but I'll do what needs to be done at the end of the day.
@stellaluna14 that makes total sense. Well I just saw your update on the other thread and it looks like you're well on your way! Fingers crossed your little guy is about ready!
@theshannondee that's what I'm hoping! If after all that I still have wait two more weeks and be induced I will be...slightly annoyed. Happy however I get my healthy baby...but annoyed nonetheless...
Personally, I would be terrified to go over 40 weeks - BUT TOTALLY UNDERSTAND those who do. My opinion is probably shaped by the fact that my first OB had a theory that nothing good happens after 40 weeks -- so she induced me at 39+1 with first. This one was an IUGR baby, so it made me even more nervous... because there is such an increase in stillbirth risk. Hence my induction at 37 weeks.
@ESchreinerWrites ok but you have circumstances that makes it dangerous to go past a certain date, not everyone does and ok let say "nothing" happens past 40 weeks...Who's to say they got the date right? And why would anyone want a stressful, timed induction (because yes you are on a clock when you are induced) when baby may show up two days later on their own with my own hormones rather than synthetic ones? Not everyone is "at risk" and I can't imagine a mom putting their baby at risk if they are told something is wrong just because they want to go past 40 weeks, frick it's hard enough making it to your due date being uncomfortable and all.
Re: Inductions
The dr let us decide, Saturday, Sunday or Monday, and we thought we'd want the weekend to finish off any last minute stuff but now I'm just sitting at home kinda lost. I should be excited that he's coming soon and we have a date for him, and I'm not upset about the idea of being induced, but I just don't know what to do with myself.
I mean really, nothing has changed except now we now when he's coming, so why do I feel so blah about it?
Married May 16th 2015
July BMB June Siggy
I'd rather avoid the induction and want to try to get things started on my own once I get closer (hello, old wives tales!) but am not sure when it's considered safe/what is considered safe to try. Anyone know?
Induction at 39 Weeks Is Better for Mother and Baby
WASHINGTON, DC — The optimal time of delivery for women with low-risk pregnancy has been a continuing source of controversy, but a debate on the elective induction of labor at 39 weeks here at American Congress of Obstetricians and Gynecologists 2016 Annual Clinical Meeting turned out to be a statement of consensus.
The two presenters agreed that evidence is mounting that waiting beyond 39 weeks is not advisable.
"Continuing the pregnancy beyond 39 weeks is riskier than previously believed for the fetus," said Errol Raymond Norwitz, MD, PhD, chair of the Department of Obstetrics and Gynecology at the Tufts University School of Medicine in Boston. In addition, risks to the mother associated with routine induction "are lower than appreciated," he said.
"I was absolutely opposed" to the elective induction of labor at 39 weeks, said Charles Lockwood, MD, dean of the Morsani College of Medicine at the University of South Florida in Tampa. In fact, he was prepared to debunk the notion.
But after much reading, "it's overwhelmingly evident that elective induction of labor is the logical strategy," he said.
Members of the audience in the crowded ballroom were won over by Drs Norwitz and Lockwood. Before the presentations, 20% said that it would be best to deliver most women at 39 weeks, 17% were unsure, and 63% were against the idea.
After the presentations, 81% of the attendees said they changed or reconsidered their view. In fact, 70% said they agreed that it is best to deliver most women at 39 weeks, 21% were still unsure, but only 9% were against the idea.
Stillbirth a Bigger Danger Than Realized
Even though higher rates of stillbirth after 39 weeks have been reported since the late 1980s, it still seems to be underappreciated, said Dr Norwitz.
He pointed to several studies that showed that stillbirth is a greater risk at 40 weeks of gestation and beyond.
"Antepartum fetal deaths account for more perinatal deaths than do complications of prematurity or SIDS," he said, citing a report that estimated that there were at least 26,000 stillbirths in the United States in 2004 (BMC Pregnancy Childbirth. 2015;15[Suppl 1]:A11).
Those findings have "been recapitulated in multiple datasets," he explained.
And one study he described showed an increasing risk for stillbirth and neonatal mortality with each passing week of gestation (Br J Obstet Gynaecol. 1998;105:169-173).
It is not known why the rate of stillbirth increases, but it could be related to uteroplacental dysfunction. It might also reflect the failure to identify risk factors, such as multiple pregnancy, infertility, low blood pressure, intrauterine growth restriction, and having previously delivered a small-for-gestational-age infant, he said.
No Increase in Cesarean Rates
The major risk associated with a failed induction at 39 weeks is cesarean delivery, but both Dr Lockwood and Dr Norwitz said that there does not appear to be any evidence of an increase, and that perhaps it might even decrease rates, compared with expectant management.
Some studies have indicated that the rate of cesarean delivery increases in multipara with an unfavorable cervical exam, said Dr Norwitz.
However, data comparing rates of cesarean delivery and other outcomes after induction at 39 weeks and after expectant management at 41 weeks are weak to nonexistent, in part because it would take 2 million to 12 million pregnancies to get good answers, Dr Lockwood explained.
So he and his colleagues conducted a comparative-effectiveness analysis. "We evaluated every conceivable outcome that we could think of," he said. The model involved probabilities for 60 outcomes. The team then created a Monte Carlo microsimulation to map out head-to-head effectiveness.
Expectant management was associated with higher rates of cesarean delivery than induction at 39 weeks, and "a clear increase in perinatal mortality," he reported. Maternal death rates were not significantly different in the two groups, but severe complication rates were lower for both the infant and the mother in the induction group, said Dr Lockwood.
The bottom line is that "elective induction at 39 weeks is always a better strategy" than expectant management at 41 weeks, he said.
Both Dr Norwitz and Dr Lockwood said they agree that success with induction requires very accurate dating of gestational age. "If you're off, you could endanger the patient," said Dr Lockwood.
He also cautioned that induction "has to be a real induction of labor — not one that ends at five o'clock."
Dr Norwitz and Dr Lockwood have disclosed no relevant financial relationships.
American Congress of Obstetricians and Gynecologists (ACOG) 2016 Annual Clinical Meeting. Presented May 16, 2016.
article:www.medscape.com/viewarticle/863383
--------------------------------------------------------------------------------
DS#1 July 2016
Baby #2 July 2018
It's not the official ACOG recommendation (yet), but I think it gives a lot of validity to going at 39w and not waiting until 41 weeks with the expectation that the "baby will come when ready". Other articles I've read have indicated higher rates of aspirations due to meconium, cords around the neck, and general fetal distress because of waiting past 40 weeks.
The research is there that I don't think doctors should be thrown into a box of rushing to get the baby out for convenience when they suggest inducing earlier.
@melodramatic26 I read a Washington Post article the other day that talks about this study. It also brings in a few other viewpoints about it that I thought were interesting, particularly from the founder of Evidence Based Birth: https://www.washingtonpost.com/national/health-science/should-pregnant-women-be-induced-at-39-weeks/2016/06/27/e1bb9d16-27fe-11e6-b989-4e5479715b54_story.html
The thing is, as you said, this is not an official ACOG recommendation - It's the viewpoints of two individual doctors. They bring up some interesting facts, but the overall tone in comments like this:
.. makes a little ragey and mistrust where they are coming from. Believe me, I am more than grateful for modern science and how it helps save lives. But I feel like some doctors, through being able to "hack" the human body through certain medical procedures develop this misplaced sense of superiority and forget what a speck of dust they are in comparison to the astounding complexity, sophisticated-ness (is that a word?), and beauty of the human body and of nature and the universe as a whole... Leading them to think EVERY situation should be actively managed because clearly they know better than nature...
Married May 16th 2015
July BMB June Siggy