What’s the standard protocol regarding inductions for AMA these days?

[Anonymous]

Second baby, will be 37 at delivery. I’m with Reiter Johnson Hill and they mentioned due to AMA I can opt for induction after 39 weeks. I’m tempted because I have a toddler at home and predictability would be nice for lining up childcare, work logistics etc.

However doing some research on inductions and seems like the protocol has moved toward earlier inductions. Both on this forum and elsewhere online, 10-15 years ago inductions were mostly offered after 41 weeks, but now there are more mentions of inductions at 39 weeks. I had a very smooth and quick labor with my first a couple of years ago, 5 days before his due date, and so far this pregnancy has been smooth. So I’m wondering why they are offering the induction as early as 39 weeks. I do plan to ask more in detail as I get closer but so far the answer seems to be “AMA.”

What are your experiences with this if you are over 35? Is there some variation depending on which practice you go to ?

[Anonymous]

I have birth at 32 weeks and 38 weeks. My 38 weeker was considered full term. So 39 seems fine to me

[Anonymous]

gave, not have

[Anonymous]

I had induction for AMA and IVF. It failed and I had C-sec complications. On the other hand, my 41wk 3d vaginal birth was very scary with blue baby who did not even get full points for pulse in his apgar score.

I was not given the best chance. Did not get prostaglandin gel or foley catheter. If you've had a vaginal birth inductions are not supposed to fail but don't let them short change you.

[Anonymous]

39 weeks is the point at which the risks are lower for those that induce than those that do not.

This is recommended for healthy first-time mothers of any age. It's also helpful for women who are developing pre-eclampsia or other complications of pregnancy.
https://www.acog.org/womens-health/faqs/induction-of-labor-at-39-weeks

It's been shown to be true for multiparous women as well. "Elective induction of labor in low-risk
multiparous women in the 39th week of gestation was
associated with decreased perinatal morbidity and
a lower frequency of cesarean delivery compared with
expectant management."
https://www.acog.org/education-and-events/creog/curriculum-resources/-/media/7091e63307bc46f38388b6f6b273f14c.ashx

So this really isn't about AMA necessarily. It's true that it decreases risks foremost women.

[Anonymous]

^^"for most"

[Anonymous]

i gave birth to my first at 38 and there was no mention of induction ( in fact i asked repeatedly if i should get induced due to GD and every dr at GW said not until 41 weeks...). i gave birth naturally at 38 weeks so was a moot point in the end

i'm now 40 and my dr says i should get induced at 39 weeks due to risk of still birth increasing starting at 40. none of the doctors realized considered 38 AMA at GW and said big risks start at 40

[Anonymous]

Based on your first pregnancy I’d at least wait til 40 weeks (or 39w6d) and hope you get another quick, smooth delivery again. Induction is fine, but if I had the choice I’d put it off until it’s absolutely needed.

[Anonymous]

pp- my dr recommended it as risk of still birth is higher at 40... so not sure "putting it off until absolutely necessary" would address that as it would be too late but at 37 i don't think the risk is as high

[Anonymous]

Anonymous wrote:pp- my dr recommended it as risk of still birth is higher at 40... so not sure "putting it off until absolutely necessary" would address that as it would be too late but at 37 i don't think the risk is as high

For perspective, I was 37 when I gave birth in 2021 and had a couple risk factors, and my mfm at sibley still said I could go to 40 weeks no problem. She also told me that OB-gyns often rush to get the baby out but MFMs are better at judging risk. Obviously only do what you’re comfortable with, in the end it is a matter of a few days and it is your baby not mine. Just sharing for comparison.

[Anonymous]

33 for first birth, used midwives, not OB-GYN, and went 43 weeks at which point I had to be induced. Had a non-stress test once per week starting at 40 weeks. All fine all the way through vaginal birth. Baby was 100% fine. 2nd baby at 36, born at 39 weeks + 4 days. Also fine, also vaginal.

[Anonymous]

I had my second in 2017 at age 36, and was recommended to induce at 39 weeks. Which I did. I definitely would have gone longer - no contractions at all and I’d gone to 42 weeks with my first. I was told that for AMA or high risk pregnancies, induction at 39 weeks was standard. So I don’t think this is a new thing.

[Anonymous]

I had 3 scheduled c-sections at 39 weeks many years ago (I’m 50; was AMA for the last 2).

[Anonymous]

OP here. Thanks all for sharing. If you opt for induction due to general AMA as opposed to a specific risk/identified issue, is the protocol to get epidural before all else? There was an earlier thread on here about elective inductions, and some responses mentioned epidural before Cervadil/Pitocin, others seemed like they had to start the induction and only get epidural after cervix was dilated enough. One of pros of induction would be minimizing pain - I'd want the epidural first thing before anything is jammed up there.

If anyone had a similar induction recently at Sibley I'd love to hear your experience of how it went!

[Anonymous]

You can definitely request the epidural before the Foley bulb or cervical ripening drug is placed. I had this done at my 39 week induction for my first. However, I’d caution against it because it means being immobile for the early stages of labor. My labor took a long time, and I was very uncomfortable, and I think not being able to walk or change positions or use gravity slowed labor. Next time I will wait as long as possible to get the epidural so I’m not stuck on a bed for 14 hours.