Man, I just had a whole long reply typed out, then hit the wrong key and lost it.
Do research. Please. What your doctor is telling you, however obliquely, is that your cervix is not favorable to an induction, and if the induction fails she will want to perform a c-section. I have talked to
far too many women who went down the path you are being steered towards and wound up wondering what the **** happened and how they wound up with an "emergency" c-section. (There's no emergency like the one the doctor creates!)
Being past due, in and of itself, is NOT a good reason to induce. Google the term "postdates pregnancies" if you will, but I'll provide you a few links here:
Datat Don't Support Postdates Pregnancies Guidelines
Quote:
There have been two randomized controlled trials comparing the effects of monitoring, fetal testing, and induction on perinatal mortality and morbidity in postdate pregnancies. Both have found no significant difference in adverse outcomes or cesarean section rate, Dr. Parer commented.
snip
For many years, obstetricians have believed the truism that the best way to decrease perinatal mortality is to terminate the pregnancy before adverse events occur. Yet whether induction at 41 weeks increases the risk of an operative delivery without preventing perinatal death is still not clear.
There is also no evidence in the literature that testing between 40 and 42 weeks' gestation improves outcomes, though many obstetricians believe it does, he said. The 1999 American College of Obstetricians and Gynecologists guidelines, based on expert opinion, support twice weekly testing by 42 weeks.
(I am forced to note here that the article on the second page mentions inducing with misoprostol, more commonly known as Cytotec. This drug is commonly used in inductions where women do not have a "favorable" cervix, despite repeated warnings by the drug manufacturer and the FDA that it is dangerous & should not be done.)
Postdates Pregnancies~Midwifery Today
Quote:
Large studies have shown that monitoring pregnancy while waiting for spontaneous labor results in fewer cesareans without any rise in the stillbirth rate. One retrospective study of almost 1800 postterm (past 42 weeks) pregnancies with reliable dates compared this group with a matched group delivering "on time" (between 37 and 41 weeks). The perinatal mortality was similar in both groups (0.56/1000 in the postterm and 0.75/1000 in the on-time group). The rates of meconium, shoulder dystocia and cesarean were almost identical. The rates of fetal distress, instrumental delivery and low Apgar were actually lower in the postdate group than in the on-time group.(3)
When a group of researchers conducted a case-matched review of nearly 300 postdate pregnancies, they concluded that the increased rate of obstetric and neonatal interventions "does not appear to be a result of underlying pathology associated with postterm pregnancy." They suggest that "a lower threshold for clinical intervention in pregnancies perceived to be 'at risk' may be a significant contributing factor." In other words, the perceived risk is greater than the actual risk and can become a self-fulfilling prophecy!(4)
Post-term Pregnancy
Quote:
# Management: Antenatal Monitoring
1. Weekly Biophysical Profile
2. Amniotic Fluid Index
1. Demonstrate single 3 cm vertical fluid pocket
2. Lack of pocket associated with fetal asphyxia
3. Lack of pocket associated with perinatal mortality
3. Fetal heart monitoring
1. Biweekly Nonstress Test or
2. Weekly Contraction Stress Test
# Management: Induction at 42 weeks
1. Induction at 41 weeks no recommended
1. No benefit to infant
2. Higher risk of labor complications
2. References
1. Alexander (2000) Obstet Gynecol 96:291-4
For the insurance companies' take on the issue:
Minimizing Obstetrical Risk: Postdating
Quote:
Expectant management may be appropriate if the cervix is unfavorable and the pregnancy is otherwise uncomplicated. Alternatively, cervical ripening with prostaglandin may be a consideration. Although there is no perfect strategy for fetal surveillance that will prevent all fetal deaths, twice weekly non-stress testing with amniotic fluid determinations is the strategy recommended by most clinicians. If expectant management is pursued, an endpoint for delivery should be established. A review of perinatal mortality associated with postdates concluded that induction of labor at 41 weeks’ gestation would minimize the incidence of stillbirth, as well as neonatal and infant mortality, without significant increases in cesarean delivery rate.
What worries me about your story is this: Your doctor is telling you she wants to induce you
in spite of the fact that your cervix is not favorable for an induction (there is a scale used to determine favorability; Google "bishop scale" for more info). She is NOT following what seems to be the standard protocol for a woman in your position--the biophysical profiles mentioned in the quote immediately above.
It would be worth your while, IMO, to ask her exactly what her c-section rate is. (The World Health Organization says that a c-section rate of 10% is ideal, but in the US the rate is more like 29%...if she's on the high end of the 10% to 29% range, I'd worry.) Please remember that you have a legal right to refuse any medical intervention, and if she cannot or will not answer specific questions regarding her standards of care (and especially what she wants to induce you with), that should send up red flags.
FWIW, my third child was born at 41 weeks, spontaneously, without one single problem "commonly associated" with a postdates pregnancy.
ETA: I am not trying to scare you. If your cervix was favorable (& her saying "not in optimal condition" means it isn't) for induction, I would not say a word. But I have talked to too many women who've had bad things happen to them because of a poorly managed pregnancy.
and I never quite get all the information I want from her.
