I am pregnant with my first, and my due date was yesterday (the 8th).
I saw the doctor today, and she said my cervix was "shut up tight," but it was about 50% effaced. She scheduled me for induction next Friday (the 18th). But because my cervix is "not in optimal condition" I have to go in in the middle of the night on Thursday to have it prepared for the induction.
All of which confuses me. I thought the thinning of the cervix was a precursor to dilation. Which to me means that I'm on my way already, or not?
I have not, however, had any contractions - even practice ones, that I know of. Everyone tells me I would know if I had - I hope that's true.
My doctor is not the best communicator and I never quite get all the information I want from her.
She also said that the best chances for me to have a vaginal birth are if I go into labor on my own. Why is that? Because the induction makes things go too quickly? Frankly, while I'm scared of vaginal birth, I'm really scared of a C-section at my size (about 100 overweight when I got pregnant), due to potential problems with healing.
Sorry if these questions overlap others already on the board - I haven't had much time to look around this board.
I would call and talk to your dr for as long as it took for you to understand. I'm sure there are reasons for him recomendinng the induction, but YOU need to know what they are so you can determine if that's what you want to do. I'd recommend getting someone else to come along too, maybe they can understand the dr.
Giving birth is scary enough without induction (my 4th was induced and I was a wreck as we were driving to the hospital, my DH really helped calm my nerves tho, bless his heart) And if you don't know why you are having the induction, then it's harder to accept and go with it.
I'll all about information, can you tell? LOL
Hope you are able to get the answers you need and have a good labor! (And congrats to you, your new little one & the whole family!!!)
also wanted to add that being 10 days late usually isn't a cause for induction, especially if he thinks your cervix isn't ready...maybe he thinks if you go into labor before your cervix is "prepared" then there will be complications? That's something to ask. Although, I'd think your body would be able to prepare itself. However, I am not a dr at all!!!
I dunno. I was induced with both of mine because I wasn't dialating enough. My son was induced at only 10 days late. I was told that he would wait til I was 2 weeks late. So when he scheduled it at 10 days, I asked why. It was because of the hospital bed availability.
With my first, I went to the doctor on about my due date and he told me I was no where near ready to deliver (no dilation, no effacing) and that he'd see me back in the office the following week.
I went to lunch with my Mom.
I went home and made a big salad for dinner.
I sat down to watch the news.
I got up to fold some towels and WOWZO! something made me double over in pain. What on earth?!?!?!?
I sat down and finished watching the news.
My mom realized that I was getting "uncomfortable" from time to time.
My husband came home.
We had dinner.
I called the doctor.
I went to the hospital and 5 hours later (thank you epidural!!!) my DD was born.
No two people are the same, though.
Maybe you'll be lucky and not have to be induced.
Good luck!!!
For some women, an induction means an early trial of labor. It might help to soften and efface the cervix more. I would try to get more info. from your physician. I have seen many women come in to be induced. They had the pitocin hanging all day and it didn't change anything. They were then sent home and rescheduled to be induced at a later date. It is not that unusual to try to do an induction on someone that is 10 days to 2 weeks past their due dates. There is a lady on here that goes by "midwife" she might be able to answer your questions better. Good luck on the upcoming birth and the addition of the new bundle of joy. Just wanted to mention that I am not a physician.
With my first, I went to the doctor on about my due date and he told me I was no where near ready to deliver (no dilation, no effacing) and that he'd see me back in the office the following week.
I went to lunch with my Mom.
I went home and made a big salad for dinner.
I sat down to watch the news.
I got up to fold some towels and WOWZO! something made me double over in pain. What on earth?!?!?!?
I sat down and finished watching the news.
My mom realized that I was getting "uncomfortable" from time to time.
My husband came home.
We had dinner.
I called the doctor.
I went to the hospital and 5 hours later (thank you epidural!!!) my DD was born.
No two people are the same, though.
Maybe you'll be lucky and not have to be induced.
Good luck!!!
Yup. Had a friend pregnant at the same time I was. Her baby was due on Wed. Tues. before, she wasn't even dialating, so the doc scheduled her for induction for the following week. That night, she dialated and went into labor and had the baby in the middle of the night...on the exact due date. Which only happens like 5% of the time.
I'm sure there are reasons for him recomendinng the induction, but YOU need to know what they are so you can determine if that's what you want to do.
Oh, I did get that part - the WHY of the induction, I think. She said that there is an increased chance of stillbirth after about 42 weeks due to the placenta just getting plain too old, and the national protocol for induction is usually about 42 weeks. She likes to schedule between 41 and 42, so that is why next Friday.
I was just more confused about what the 50% effaced thing meant. I thought that was the very beginning of things happening, but she seemed to imply that there wasn't anything going on. And, like I said, no contractions (that I know of)...?
OK, being 10 days late is absolutely a case for induction!!! In fact, 10 days is the latest my doctor(and she is an on campus doc at the top woman's hospital in the Houston Medical Center). The placenta is not designed to work past 41 weeks. I was 10 days late. My child could have died from waiting that late. He was born with thick meconium and had a team of neonatologists on hand because if you aspirate thick meconium you can have brain damange, develop blood poisoning, and die. I am really not tryin to scare you, but I am speaking from personal experience. You do not want your child to end up in NICU over being post-term. I still feel bad that I couldn't have in my room until it was almost time to go home and I still feel bad that he had to lay there in a sterile NICU. Do not go past 41 weeks. Advocate for yourself and your baby. My baby went into deep distress when I asked to lay on my right side. I had developed a feeling that he was having problems (even at home) when I laid on my right side, but after a day of labor and being hooked to monitors I figured "what the harm?" His heartrate plummeted to 70. I shutter to think what had happened if I had laid on my right side to sleep at home without having nurses and monitors. I was given a shot of breathine to stop my labor immediately and had him by c-section less than an hour later. I wish I would have been more educated during my son's birth, so please take some advice from me. No matter how well you maintain your pregnancy, the placenta will start degrading past 40 weeks. A post-term baby who goes 10 days late has a much higher mortality rate than a baby who is 10 days pre-term.
Ask them to strip your membranes to try to help start your labor.
She mentioned doing that today, but said she couldn't do it because my cervix wasn't dilated at all, just effaced.
And what you posted about being late (not the specifics, but the general outcome) is pretty much what she told me today. Mainly increased chance of stillbirth or other problems due to the placenta getting too old. She seemed to feel that the 18th, which would be 10 days past my due date, was an ok time to wait to induce.
Trust your instincts if you feel something is "not right." The last two weeks I felt it was dangerous to lay on my right side, even though it was the most comfortable side (there are no real comfortable sides that far into a pregnancy though). Anyway, I just had a very bad feeling mentally about it, and sure enough when I was strapped to the monitors DS went into distress on that side, they think because his cord was laying over there. You will have a healthy child like mine I am sure, but I would never go that late again. It led to some complications that could have been avoided. Just thinking about my poor baby potentially aspirating that stuff or literally sitting in his own meconium for God only knows how long makes me sad. I don't mean to be an alarmist, because I do think things will be just fine. I just feel very strongly about my negative experience and would hate for any mom to feel the things I felt or have to see their 8 lb baby in the NICU. Thinking about that day makes my blood pressure rise every single time, and a birth should be HAPPY. I hope you will have a much happier experience!
If you are already at your due date and don't want to wait or have an induction (which, like I said, leads to more painful contractions than natural ones) you could try things like nipple massage (with an electric breast pump) to try to get things started. I was too much of a wimp to do that, though.
I just wanted to add that maybe by next Friday when you go to be induced that your cervix will have further effaced on it's own, before you get there .Or you may go into labor before the scheduled induction and have the baby without being induced.
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:
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.)
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)
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
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.
Last edited by GreatBigMonsterMomma; 08-10-2006 at 07:28 AM.
Hi guys,
First off, Congrats Rabbitt on being so close to giving birth! You will find that most providers induce labor at or before 42 weeks. There are many factors though, including mother's health, baby's health, criteria used for dating, cervical ripeness, and others (including, what does the mother want?).
Dairy is correct that some placentas seem to give up sooner than others. Biophysical profiles (a type of ultrasound that measures amniotic fluid and fetal movement, breathing, tone) can be very useful for determining the health of the placenta. Meconium can be caused by being past the due date or also possibly from fetal distress. I have seen some gnarly mec (can I still use gnarly?) in a 38 week baby. Postdates testing (Biophysical profiles) can be reassuring or show a need for an induction.
Have sex. A lot. Seriously, the prostaglandins in semen ripen the cervix. The fact that your cervix is 50% effaced is a GOOD sign. A lot of thinning out happens before a lot of dilation in first time moms. Sex will help to continue to soften and ripen your cervix.
Ask questions and get answers. My bias is to induce about 10 days late unless the woman really wants to avoid induction or we have cruddy dating (ie due date established by a late ultrasound).
Labor happens. It really does. Think about what you want (inductions in first time moms do increase the risk of c/section....but what is the c/section rate of your doc? 15% <my practice's rate>, 29% <nationwide>, 40% <misogynist cretins> edited to add that some practices have sky high rates due to specializing in triplets and other such high risk situations)
ASK ALL OF YOUR QUESTIONS AND GET ANSWERS THAT YOU UNDERSTAND!
Make sure you feel that baby move. Did I mention you should be having sex?
First timer questions
and I never quite get all the information I want from her.
