Kaiser will only let you go ONE week past due date??

[Anonymous]

My sister is pregnant and has health insurance through Kaiser. Her doctor's office has told her that they will only let her go one week past her due date (i.e., they will schedule the induction for no later than 7 days past her due date).

I'm really surprised by this, and a bit worried for her, as the women in our family have a history of routinely going 10-12 days past the due date.

Are there any other Kaiser patients out there? Is this what you are hearing in your practices also? Has anyone had any luck in pushing back on this? Have your doctor's been able to articulate a good reason for this practice?

It seems inconsistent with other practices I hear about who seem to let women go up to two weeks late before inducing...

[Anonymous]

I have Kaiser as well and was told 41 weeks is their standard protocol for induction. I am curious whether others have been able to push back as well. I am definitely aiming for a no to limited intervention birth and this is a concern for me. I haven't pushed back yet, and will save the battle for closer to my due date. It seems crazy that they could force an induction on you so hopefully it's something they tell you and then you're able to negotiate with your doctor.

[Anonymous]

They can't force you.

[Anonymous]

Anonymous wrote:They can't force you.

Understood. But doctors offices have varying degrees of pressure that they are willing to apply to get clients to adhere to their recommendations. Short of saying "I flat out refuse" (at which point what, can they drop you as a client and say you're on your own?), what are the likely options here?

[Anonymous]

Can you lie about your conception date? Too late for the OP, but wondering if this would work for others. How can they really be sure about your due date in most cases anyway?

[Anonymous]

Anonymous wrote:

Anonymous wrote:They can't force you.

Understood. But doctors offices have varying degrees of pressure that they are willing to apply to get clients to adhere to their recommendations. Short of saying "I flat out refuse" (at which point what, can they drop you as a client and say you're on your own?), what are the likely options here?

I would say, "I agree to come in once a day, if necessary, for a non-stress test. But I am not interested in being induced at 41 weeks if my Bishop score is still low when my family naturally goes past 41 weeks, especially with first babies."

Be calm and reasonable, knowing that it is your decision. They don't want to fight and will appreciate an informed respectful approach.

[Anonymous]

Anonymous wrote:Can you lie about your conception date? Too late for the OP, but wondering if this would work for others. How can they really be sure about your due date in most cases anyway?

I don't like because my midwife (in an OB practice) accepts my due date based on my ovulation day, not my LMP. If I were in a practice that demanded to go by the LMP, I would lie.

[Anonymous]

Anonymous wrote:Can you lie about your conception date? Too late for the OP, but wondering if this would work for others. How can they really be sure about your due date in most cases anyway?

They can tell by the size of the baby. My baby measured 7 weeks 2 days today and I am 7 weeks 1 day based on my last menstrual period. So it is pretty accurate.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Can you lie about your conception date? Too late for the OP, but wondering if this would work for others. How can they really be sure about your due date in most cases anyway?

They can tell by the size of the baby. My baby measured 7 weeks 2 days today and I am 7 weeks 1 day based on my last menstrual period. So it is pretty accurate.

They can only tell if they do an early sonogram, around 7 weeks. After that the baby measures bigger or smaller but they don't change the due date because it is too inaccurate. Lots of people don't have the early sonogram.

[Anonymous]

I was with Kaiser last year and discussed this with my OB. She indicated that it was her preference to have patients go no later than 41 weeks, but would be open to going to 42 weeks with monitoring. I also asked her about whether being part of a managed care organization constrained/dictated her practice and she said no, that each doc retains a lot of discretion. (Except she did tell me they do not do breeches, a Kaiser policy).

Most OBs these days have a strong preference for 41 weeks being the endpoint to prevent stillbirth and meconium aspiration syndrome. The most recent literature indicates that allowing women to go past 41 weeks before inducing does not reduce the C-section rate (there is a lot to parse in that simple statement, but that's how the studies have come out). Therefore, they see no benefit to going past 41 weeks, just additional risks to them and to the baby. I think that OBs honestly see pregnancies that go past the due date as pathological because statistically the best outcomes are in the 39 week range. This is just part of their training -- they see things in terms of risk of *this* baby dying and that is really all they care about. A woman's future reproductive life is just not on their radar screen.

Having said all that, with a family history of longer pregnancies and being a FTM, I think your sister would be well served to push back and ensure that she is at least allowed to go to 42 weeks, particularly if she plans on more than one child. If she is monitored every day and the baby starts to decline, they will catch it. (More common would be a false positive where they find a reason to induce on the ultrasound that really wasn't anything of concern). Because Kaiser is both provider and insurer, they cannot drop her, so she should feel secure in making her preference known. My sense is that it is not unheard of to go to 42 weeks even though it is not OBs' preference so hopefully they will work with her.

[Anonymous]

+1 to PP. We also have Kaiser and their standard is no inductions before 39 weeks and they prefer to induce at 41 weeks for late arrivals, but your doctor absolutely gets the final call on those decisions. If the OB you currently have is not open to a conversation around it, switch.

[Anonymous]

Most OBs now induce at 41 weeks, there is a risk of no or little amniotic fluid

[Anonymous]

Anonymous wrote:Most OBs now induce at 41 weeks, there is a risk of no or little amniotic fluid

It's easy to check amniotic fluid. No need to guess. The OB only induces at 41 weeks if you let them.

[Anonymous]

Anonymous wrote:Most OBs now induce at 41 weeks, there is a risk of no or little amniotic fluid

That's ridiculous. Yes, there is a very small risk of all kinds of pathological things developing at any point during pregnancy. The medical model focuses on those potential problems, and views the womb as a suspect place to be once the baby has reached "full term." However, the vast VAST majority of babies do just fine and the womb/placenta nourishes them perfectly until nature determines that they and mom are ready for birth. Since the average length of a first time pregnancy is 41 weeks and a few days, a predetermined 41-week induction is going to mean a TON of inductions for first time moms, which leads to a drastically increased c/s rate.

We have some evidence that there is a very slight increase in risk to pregnancies which continue beyond 42 weeks. This already small risk can be substantially mitigated by using modern technology to monitor mom and baby during the last week or two of gestation. In other words, using a NST and/or BPP beyond 41 weeks will most certainly alert us to even the smallest trouble which might be brewing inside. In fact, these tests are considered quite "conservative" and produce lots of false positives; so chances are it will detect something yet everything will still be just fine. Even still, a concerned OB or mom can use these tests and induce if there is any cause for concern. Otherwise, allowing the pregnancy to continue to its full gestation is safest for both the baby and the mother, particularly if the mother is planning on future children.

OP -- you should know that by law, an OB cannot drop you within 30 days of delivery. Additionally, if you arrive at your hospital in labor, they are required BY LAW to treat you. You have options here. You can let your OB know that you refuse to be induced at 41 weeks, and schedule your induction for 42 weeks instead. (Often when the realize that you will not negotiate on this, they will relent and say it's fine.) You could also refuse to schedule any induction at all, and simply show up at the hospital when you (spontaneously) go into labor. Or you could refuse to schedule an induction, and if you at any point get nervous waiting, show up at the hospital and ask to be induced; if you are near or beyond 42 weeks they will admit you.

In the past five years, the OB model has shifted from an automatic 42-week induction to that of an automatic 41-week induction. This has become the standard of care without any evidence that the outcomes are better for mom or baby. Since so many OBs have adopted this practice, most feel they need to follow suit because it becomes a liability issue if they aren't doing what everyone else is. However, it is still YOUR body and you have the power to consent to their protocols. Of course, you need to be sure of what you want because they are very powerful and coercive.

[Anonymous]

My SIL delivered at Kaiser. From the beginning, they told her that unless there was some problem, they wouldn't induce until 14 days past the due date. (As it turns out, the doctor had some concerns 8 days past her due date and then ended up inducing then.)