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

[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?

Pitocin was absolutely horrible when i was in labor. They started it as a routine (I should have studied up on it and stopped them). They just do it to hurry everything up. Babies often don't respond well to it. Mine certainly did not. His heart rate went down every time they started the drip. I ended up with a c-section in no small part due to pitocin.

Things just need to happen naturally unless there is an immediate risk to the baby or the mom. This assembly line approach we have in this country is really F-ed up.

[Anonymous]

OP, this is directly relevant to you. Print it out and go discuss it with your OB.

"Delivery at 38-39 Weeks May Be Best for Moms With Chronic HTN

After 39 weeks, women with chronic hypertension who received expectant management showed a significant increase in severe preeclampsia versus women with planned deliveries, 10.3% versus 0% (P=0.001).

"The findings of this study do suggest that the nadir of morbidity for babies born to women with chronic hypertension occurs after 38 weeks and before 40 weeks," Harper told MedPage Today via email. "These results are consistent with [the American College of Obstetricians and Gynecologists'] recommendations for delivery [of these women] by 40 weeks."

http://www.medpagetoday.com/obgyn/pregnancy/57864

[Anonymous]

Anonymous wrote:

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.

OP, I am as granola as they come, and I tend to side with this poster in your case. That said, ask your cardiologist. Ask your OB more questions. But your medical condition warrants this kind of caution.

[Anonymous]

Anonymous wrote:

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.

Then why is her doctor only JUST NOW mentioning it? Why has this plan not been discussed from day one? Did her doctor just now figure it out?

Her doctor may well be following established protocols, but if OP is so high risk, she should be consulting with a good MFM. Even if that person concurs, she'll have that information and feel more confident in the decision. She also has every right to ask about induction protocols, given that inappropriate use of pitocin is not exactly rare.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Then why is her doctor only JUST NOW mentioning it? Why has this plan not been discussed from day one? Did her doctor just now figure it out?

Her doctor may well be following established protocols, but if OP is so high risk, she should be consulting with a good MFM. Even if that person concurs, she'll have that information and feel more confident in the decision. She also has every right to ask about induction protocols, given that inappropriate use of pitocin is not exactly rare.

Are you an OB? How do you know what is "inappropropriate use of pitocin"? Are you going to tell OP exactly the amount she should be administered and when? Of course she should talk to her doctor, but not on the basis of "someone on the internet told me that is too much pitocin."

[Anonymous]

Anonymous wrote:My Dr wants to do a gentle induction at 39 weeks because she says there's no real reason to wait until 40 weeks and there's a risk of still born after 41 weeks. I am high risk but everything has been controlled with medication so far and I have had no complications. I did not want pitocin or epidural and was trying to avoid csection unless it was an emergency. I feel like membrane sweeping is just going to lead to pitocin which will just lead to csection. I tried to express concern about not wanting to push anything until my body was ready and was told "this is what was best and recommended."

I feel like I've lost complete control over my labor and delivery and am surprised because the entire pregnancy, my ob was on board with my wishes. It's too late to get another dr at this point and I know if she is not in agreement of my birth wishes, there's no way the hospital will be. Has anyone dealt with this before? If it were emergency, I would do anything for the baby. But why suggest the early induction if nothing is wrong? Did membrane sweeping work for you? Or is this just a csection waiting to happen?

I was induced at 39 weeks, I also had a controlled high risk pregnancy. My labor took almost 40 hours, it sucked. I wished I had waited for my son to come when it was the right time. The "gentle" part was that they first stretched my cervix, I think that is what it was. It HURT and nothing happened, so then they broke my water, and nothing happened. Then they had not choice but to give me pitocin, it sucked.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My Dr wants to do a gentle induction at 39 weeks because she says there's no real reason to wait until 40 weeks and there's a risk of still born after 41 weeks. I am high risk but everything has been controlled with medication so far and I have had no complications. I did not want pitocin or epidural and was trying to avoid csection unless it was an emergency. I feel like membrane sweeping is just going to lead to pitocin which will just lead to csection. I tried to express concern about not wanting to push anything until my body was ready and was told "this is what was best and recommended."

I feel like I've lost complete control over my labor and delivery and am surprised because the entire pregnancy, my ob was on board with my wishes. It's too late to get another dr at this point and I know if she is not in agreement of my birth wishes, there's no way the hospital will be. Has anyone dealt with this before? If it were emergency, I would do anything for the baby. But why suggest the early induction if nothing is wrong? Did membrane sweeping work for you? Or is this just a csection waiting to happen?

I was induced at 39 weeks, I also had a controlled high risk pregnancy. My labor took almost 40 hours, it sucked. I wished I had waited for my son to come when it was the right time. The "gentle" part was that they first stretched my cervix, I think that is what it was. It HURT and nothing happened, so then they broke my water, and nothing happened. Then they had not choice but to give me pitocin, it sucked.

I'm the PP, it was called maybe stretching the membranes? I don't know, the doctor did it in his office, it was really painful.

[Anonymous]

A doctor that threatens you with a still birth does not have your interest at heart.
Only 5 % of babies come on due date, it is just an estimate.

Tell the doctor you will go to the hospital when the labor starts

end of story
your doctor is planning his/her vacation and wants to go and play golf

[Anonymous]

Anonymous wrote:

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.

Amen! This is a high risk pregnancy where the mother has been medicated from the beginning. The OP may need to talk to her OB more to better understand why her OB is recommending this specific course of action but some of the advice being given by non medical professionals with no knowledge of Op's condition is misguided and reckless.

[Anonymous]

Anonymous wrote:

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.

+1 It sounds like the OB could have been more proactive in preparing OB for a 39 week induction but it doesn't sound like a convenience induction. FWIW, my sister is a nurse specializing in cardiac ICU and outside of geriatric patients (who are the great majority), the most common type of patient she sees is women who had a heart problem due to pg/labor. I wouldn't mess around with this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Then why is her doctor only JUST NOW mentioning it? Why has this plan not been discussed from day one? Did her doctor just now figure it out?

Her doctor may well be following established protocols, but if OP is so high risk, she should be consulting with a good MFM. Even if that person concurs, she'll have that information and feel more confident in the decision. She also has every right to ask about induction protocols, given that inappropriate use of pitocin is not exactly rare.

Are you an OB? How do you know what is "inappropropriate use of pitocin"? Are you going to tell OP exactly the amount she should be administered and when? Of course she should talk to her doctor, but not on the basis of "someone on the internet told me that is too much pitocin."

Are YOU going to tell her any of those things? No?

Neither I, nor anyone else on this thread, is telling her exactly what appropriate pitocin dosing is. And my guess is the OP is too smart to listen to us anyway. But when a physician provides no rationale other than, "trust me, I'm a doctor," it's worth asking more questions. I've worked with far too many doctors to automatically trust what they say. Moreover, the good ones proactively provide explanations and rationale for what they do because they know their shit and don't patronize their patients. They also communicate plans with them along the way, rather than springing something on patients at the eleventh hour. Finally, it's incredibly naive to assume that doctors only act with their patients' best interests in mind, that their biases or preferences never enter into the picture. I'm not saying all or even most doctors do this, or are that selfish, but there are plenty who bring their unexamined biases to the table and act accordingly.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Then why is her doctor only JUST NOW mentioning it? Why has this plan not been discussed from day one? Did her doctor just now figure it out?

Her doctor may well be following established protocols, but if OP is so high risk, she should be consulting with a good MFM. Even if that person concurs, she'll have that information and feel more confident in the decision. She also has every right to ask about induction protocols, given that inappropriate use of pitocin is not exactly rare.

I've had two pregnancies with complications including hbp, medication, and induction. In my experience, doctors act like everything is going just great up until it's not. The doctors do the worrying for you, up until it's time to start really worrying.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Then why is her doctor only JUST NOW mentioning it? Why has this plan not been discussed from day one? Did her doctor just now figure it out?

Her doctor may well be following established protocols, but if OP is so high risk, she should be consulting with a good MFM. Even if that person concurs, she'll have that information and feel more confident in the decision. She also has every right to ask about induction protocols, given that inappropriate use of pitocin is not exactly rare.

I've had two pregnancies with complications including hbp, medication, and induction. In my experience, doctors act like everything is going just great up until it's not. The doctors do the worrying for you, up until it's time to start really worrying.

That makes sense. But then, at the very least, they should tell high risk patients up front that things may change quickly, and if they do, here's what may happen. It's not clear from the OP that things are no longer going great, or if it's just time in the doctor's mind to do things differently. Either of those (or any other scenario) should be communicated clearly, and the best doctors do just that. There's a difference between a true emergency situation that crops up unexpectedly, and something long-standing that isn't adequately discussed.

[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?

What's wrong with pitocin? OWWWWWWWWWWWW!!! Take labor pain and ramp it the eff up. I needed it (PROM), but lord.

[Anonymous]

I'll stay out of the induction discussion except to say that most likely your doctor has your interests at heart, but for peace of mind speak to him or her again to understand her reasoning.
I needed pitocin for both my deliveries because I wasn't progressing the way I should have after my water broke. The first time, there was meconium in my waters and the second time my waters had been broken too long without much progression. With my first, they had to turn it off after an hour or two because my uterus overreacted to it and caused a bit of distress for the baby. But it was enough to get things going and I had a normal vaginal delivery. The second time the baby and I tolerated it well (but omg the pain before I got my epidural!) and had a normal vaginal delivery again.