Dr wants to induce early because "no reason to go full 40 weeks"??

[Anonymous]

Wasn't there a new study just out about 39 weeks being the safest time to deliver in terms of the lowest risk of still birth?

[Anonymous]

10:45 is the same PP as first 10:43, btw

[Anonymous]

Is the doctor just doing a membrane sweep and letting you go home to see what happens? Is there a timeframe at which the doctor would want you to go to the hospital for a formal induction, or would you just wait it out until 40 weeks?

I've had two membrane sweeps where I just went back to work to see what happened. With one, I ended up going into labor the next day - normal vaginal delivery, no pitocin. With the second, I went into labor the same day - another normal vaginal delivery.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Generally, I would say that's BS. However, my answer might change based on your actual risk profile. You are high risk and on medication, mayb you should ask for more specifics about why she recommends 39 weeks instead of 40?

I have a heart condition that I was born with, one of things I have dealt with my entire life is hypertension. So far (knock on wood) my readings remain close to 120/80 or below due to medication. When I asked for why the need for induction at the appointment, she said babies are considered full term at 39 weeks and everything is developed safely so she saw no reason to wait until 40 weeks. There was no mention of risk or danger to me or the baby. I am a FTM so I tend to let my Dr obviously take the lead but alarm bells are going off.

Hmm, sounds like an abundance of caution situation because of your heart condition. The Dr. doesn't want to take the chance that it could suddenly go south. I have no idea how likely that would be, of course. Do you have a trusted Dr. for your heart that you can ask if there is any risk to going longer?

[Anonymous]

OP,

Despite your heart condition, as long as your hyper tension is under control, I really don't see WHY you need to be induced at 39 weeks.

I suggest you seek a second opinion.

While it's true that anything after 38 weeks is considered full-term, there is research out there showing that babies benefit from coming out *when they want to come out*, instead of being induced before they're ready. Pregnancy is NOT a one size fits all kind of thing! Some babies need that extra time in the womb.

It is true that the risk of still birth dramatically increases AFTER 41 weeks. 40 weeks is fine. 41 weeks is fine. 42 weeks is very dangerous.

I would ask to be induced after the end of the full 40 weeks. Meanwhile, you can try all the old-wives methods to trigger your labour - the most efficient of which are intercourse and nipple stimulation.

[Anonymous]

Anonymous wrote:What is a "gentle induction"? I can't imagine that you wouldn't need pitocin, and that stuff is a bitch. I wouldn't do it. Just say no.

what's wrong with pitocin?

[Anonymous]

Anonymous wrote:

Anonymous wrote:What is a "gentle induction"? I can't imagine that you wouldn't need pitocin, and that stuff is a bitch. I wouldn't do it. Just say no.

what's wrong with pitocin?

If used inappropriately, it can trigger fetal distress, i.e., "pit to distress," as some physicians will order, which then leads to a C-section that could likely have been avoided if the pit had been used more judiciously. In many women, it makes contractions horrifically painful. That wasn't my experience of it, but it's more common than not.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is a "gentle induction"? I can't imagine that you wouldn't need pitocin, and that stuff is a bitch. I wouldn't do it. Just say no.

what's wrong with pitocin?

If used inappropriately, it can trigger fetal distress, i.e., "pit to distress," as some physicians will order, which then leads to a C-section that could likely have been avoided if the pit had been used more judiciously. In many women, it makes contractions horrifically painful. That wasn't my experience of it, but it's more common than not.

My experience with it was horrific contractions and almost ended up with a c-section. However I ended up getting an epidural to manage the contractions, and was able to get the baby out at the last moment before the doctor was going to move us to c-section. In my case, baby came early due to PPROM.

[Anonymous]

ACOG just released a new study saying it's safest for mom and baby to be induced at 39 weeks. There was a DCUM thread on this a few weeks ago. I too was going to push back against inductions, but after ACOG's recommendation, I'm going to let my OB decide.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Generally, I would say that's BS. However, my answer might change based on your actual risk profile. You are high risk and on medication, mayb you should ask for more specifics about why she recommends 39 weeks instead of 40?

I have a heart condition that I was born with, one of things I have dealt with my entire life is hypertension. So far (knock on wood) my readings remain close to 120/80 or below due to medication. When I asked for why the need for induction at the appointment, she said babies are considered full term at 39 weeks and everything is developed safely so she saw no reason to wait until 40 weeks. There was no mention of risk or danger to me or the baby. I am a FTM so I tend to let my Dr obviously take the lead but alarm bells are going off.

I want to put this to you gently, but you are high risk. That means the "alarm bells" are already going off. Your OB is an experience doctor who has the best interests of you and your child at heart. That is why she wants to deliver you sooner rather than later. So much can go wrong as you get later in the pregnancy; the safest thing in a high risk situation is often to get the baby out. That's your doctor's line of thinking. Your doctor cannot exactly predict what is going to happen if you go past 40 weeks, but she's recommending a risk-reduction path for you. Even though your doctor did not mention risk to you or the baby, that's exactly what she's thinking about: the risk of continuing the pregnancy and waiting for something bad to happen justifies induction as soon as it's safe for the baby. You should sit down with her and ask her exactly why she recommends this path and what she sees as the risks and benefits.

Now for the facts. Induction is the safest course for your baby. In the case of chronic hypertension, there is research supporting that "Among women with otherwise uncomplicated pre-existing hypertension, delivery at 38 or 39 weeks appears to provide the optimal trade-off between the risk of adverse fetal and adverse neonatal outcomes. "http://www.ncbi.nlm.nih.gov/pubmed/21054760.

You should also be comforted by the fact that recent research shows that induction DOES NOT increase c section rates. In fact, it might reduce it: http://blogs.scientificamerican.com/absolutely-maybe/induced-labor-decreases-rate-of-cesareans-study-finds/

There is also increasing evidence that delivering at 39 weeks is safest for *everyone.* http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/why-not-induce-everyone-39-weeks.

Certainly, for a high-risk situation, it's not a suggestion that should raise any alarm bells.

Please, sit down and have an in-depth discussion with your doctor about this. Her number one priority is to keep you and your baby healthy and alive.

[Anonymous]

Anonymous wrote:That sounds like an extreme point of view, unless you're significantly older (mid-40s) or very high risk. I'd be particularly concerned because, although pitocin can be effective when used appropriately, I personally would be leery that someone so pro-induction would use it appropriately.

That said, a membrane sweep isn't likely to do much if your body isn't already on its way. I had mine swept with my first and third, and it did bupkis (first arrived on her own at 40w5d, induced my third at 40w1d, but electively for various reasons; second came at 41w2d). I *totally* get your concern, and I would be upset, too, particularly with a first child. Induction doesn't have to be horrendous, but again, you have to trust your provider to manage it well. In my case, I had cervidil overnight and then pitocin the next day; neither did much. Eventually I had my midwife break my water and we were off to the races--but this child was my third, and that's a good option, not so much for FTM.

I'd push her on what a "gentle induction" means, what your options are, and try to hold off at least until 40 weeks. Hang in there, though, that sounds so stressful.

OP is very high risk. She has a heart condition and chronic hypertension. Her doctor is "pro-induction" because she wants to keep OP and her baby alive.

[Anonymous]

It is standard of care to deliver someone with hypertension on medication at 39 weeks even if well controlled. That is the ACOG guideline. Your doc is following standard of care.

[Anonymous]

Anonymous wrote:^^ Just read your follow up answers--is there another doctor in the practice with whom you can consult? Her reasoning sounds very extreme given your age and what the high risk is. I'm 39 and had higher BP readings than that towards the end; we were monitored a little more closely, but no one pushed me into anything. There's really no evidence base for doing so, not that early.

You have no idea what you are talking about. OP has a heart condition and *pre existing* hypertension. That is very different from your blood pressure becoming slightly elevated towards the end of pregnancy. There absolutely is an evidence base for inducing at 39 weeks for high-risk patients like OP.

[Anonymous]

Anonymous wrote:
OP,

Despite your heart condition, as long as your hyper tension is under control, I really don't see WHY you need to be induced at 39 weeks.

I suggest you seek a second opinion.

While it's true that anything after 38 weeks is considered full-term, there is research out there showing that babies benefit from coming out *when they want to come out*, instead of being induced before they're ready. Pregnancy is NOT a one size fits all kind of thing! Some babies need that extra time in the womb.

It is true that the risk of still birth dramatically increases AFTER 41 weeks. 40 weeks is fine. 41 weeks is fine. 42 weeks is very dangerous.

I would ask to be induced after the end of the full 40 weeks. Meanwhile, you can try all the old-wives methods to trigger your labour - the most efficient of which are intercourse and nipple stimulation.

PLEASE stop giving medical advice out over the internet! OP has a heart condition and pre-existing hypertension. Her doctor is recommending induction because she wants to keep this high-risk mother and her baby alive.

[Anonymous]

Anonymous wrote:It is standard of care to deliver someone with hypertension on medication at 39 weeks even if well controlled. That is the ACOG guideline. Your doc is following standard of care.

+1

My bp rose during pregnancy, PIH, and was induced at 37 weeks. With chronic controlled hypertension, delivery is at 39 weeks.