When to schedule induction?

[Anonymous]

Anonymous wrote:I’ve never heard of induction just for ama alone.

The first OB I saw looked at me at my 8 week confirmation appointment--and I was 35 years old--and said "We induce all geriatric mothers at 39 weeks." And when I pushed back, oh boy. Quickly found a different practice.

This was not in the DC area, fwiw.

[Anonymous]

OP, since there's nothing you can do about the platelets, I would focus on minimizing the risk of having a c-section. Nothing going on now is raising your risk of a c-section - not even a large baby which it sounds like yours isn't anyway. The biggest risk of c-section for you right now is if you were to be induced before your body is ready. Look up the research on that. It's pretty conclusive that induction leads to c-sections more frequently when your cervix is not dilated or effaced enough. Research what the optimal dilation/effacement measures are. Try to get yourself primed for labor by walking a ton, relaxing in your down time, drinking red raspberry leaf tea, having sex, ask for a membrane strip if you're eligible, etc. Try to let labor start on its own and don't go to the hospital until you're in active labor. 

I agree with the PP who advised to talk to the anesthesiologist beforehand. That is a good idea. I would honestly research it and if you find conflicting studies, bring them the printout and ask questions.

FWIW, I think it's crappy that they're pushing you to schedule an induction at all. My practice (GW OBs) wouldn't even entertain the notion until the 40 week appointment and I was just under 35 at the time (they told me the risk profile doesn't change until 40). That's how it should be if you're low-risk, because it reserves beds for the people who truly need the medical intervention.

[Anonymous]

FTM, normal-sized baby, 35, with one complication. And if you're set to be induced on Saturday, that means you're between 39 and 40 weeks right now, right?

Based on my experience, I don't think there's any urgent reason why you should be induced now and generally, yeah, I'd try to keep baby cooking till 41 weeks.

That being said, considering the particularities of your risk, there's nothing magical about keeping the baby in for longer. Not having an epidural with an induction sounds like an absolute nightmare to me, as does having a c section under general. So, given the risk/tradeoffs here, I'd go with a 40 week induction as being nice and in the middle.

I had two inductions -- one at 41 weeks (kinda), and one at 39 weeks. Whatever you do, be prepared for it to take a while.

[Anonymous]

OP here. Went to dr this am and should have updated platelet counts tomorrow. My cervix is soft, but not yet dilated- the dr I saw today gave me a Bishop score of 3. She said she anticipates my platelets are probably stable- so somewhere around 120. She wants to stick with the induction date of this Saturday (my due date), giving me the reason of AMA. I pushed back on that because I'm on the lower range of AMA, have had a low risk pregnancy so far, and my fetal monitoring has been going well- amniotic fluid level is good, baby movement and heart rate consistent, etc. Their scheduling is booked for inductions next week but she said if I wasn't comfortable with Saturday and platelets are stable, she could ask for an exception (whatever that means) to schedule me instead early next week to give me a couple extra days, which I think I would feel ok with.

I just don't like the idea of going into an induction when I'm not even dilated solely because of my age, assuming platelets are stable. I don't feel like my body is ready yet. It's the very last stretch of an otherwise physically uneventful and fit pregnancy, and since the weekend I've had symptoms of symphisis pubic dysfunction, which is impeding my mobility and frankly also demoralizing me on top of this induction back and forth. They didn't really prep me for this- nobody told me until last week that they have essentially a cattle line of inductions scheduled and I might have trouble getting in, or that AMA would be an issue at 35 and 6 months old. I'm having trouble getting into a good mental place which is hard in the last week when I think I'm supposed to be excited and ideally feeling more ready and confident.

[Anonymous]

To be frank- you don’t sound low risk (AMA, low platelets, weekly NSTs....) . Get the induction.

[Anonymous]

Anonymous wrote:OP here. Went to dr this am and should have updated platelet counts tomorrow. My cervix is soft, but not yet dilated- the dr I saw today gave me a Bishop score of 3. She said she anticipates my platelets are probably stable- so somewhere around 120. She wants to stick with the induction date of this Saturday (my due date), giving me the reason of AMA. I pushed back on that because I'm on the lower range of AMA, have had a low risk pregnancy so far, and my fetal monitoring has been going well- amniotic fluid level is good, baby movement and heart rate consistent, etc. Their scheduling is booked for inductions next week but she said if I wasn't comfortable with Saturday and platelets are stable, she could ask for an exception (whatever that means) to schedule me instead early next week to give me a couple extra days, which I think I would feel ok with.

I just don't like the idea of going into an induction when I'm not even dilated solely because of my age, assuming platelets are stable. I don't feel like my body is ready yet. It's the very last stretch of an otherwise physically uneventful and fit pregnancy, and since the weekend I've had symptoms of symphisis pubic dysfunction, which is impeding my mobility and frankly also demoralizing me on top of this induction back and forth. They didn't really prep me for this- nobody told me until last week that they have essentially a cattle line of inductions scheduled and I might have trouble getting in, or that AMA would be an issue at 35 and 6 months old. I'm having trouble getting into a good mental place which is hard in the last week when I think I'm supposed to be excited and ideally feeling more ready and confident.

Look- no one feels “ready and confident” and “in a good mental place” when they are 39 weeks pregnant. Don’t buy into the myth that this needs to be a magical time for you. Your delivery is probably not going to go the way you plan. I say that without even knowing what kind of delivery you want. You’re going to struggle with the let down of a non- perfect labor, non - perfect breastfeeding try, a non perfect recovery, etc- just try to let go and know that late pregnancy/ birth/ postpartum is HARD and typically NOT FUN. And almost never as you planned it.

[Anonymous]

Anonymous wrote:OP here. Went to dr this am and should have updated platelet counts tomorrow. My cervix is soft, but not yet dilated- the dr I saw today gave me a Bishop score of 3. She said she anticipates my platelets are probably stable- so somewhere around 120. She wants to stick with the induction date of this Saturday (my due date), giving me the reason of AMA. I pushed back on that because I'm on the lower range of AMA, have had a low risk pregnancy so far, and my fetal monitoring has been going well- amniotic fluid level is good, baby movement and heart rate consistent, etc. Their scheduling is booked for inductions next week but she said if I wasn't comfortable with Saturday and platelets are stable, she could ask for an exception (whatever that means) to schedule me instead early next week to give me a couple extra days, which I think I would feel ok with.

I just don't like the idea of going into an induction when I'm not even dilated solely because of my age, assuming platelets are stable. I don't feel like my body is ready yet. It's the very last stretch of an otherwise physically uneventful and fit pregnancy, and since the weekend I've had symptoms of symphisis pubic dysfunction, which is impeding my mobility and frankly also demoralizing me on top of this induction back and forth. They didn't really prep me for this- nobody told me until last week that they have essentially a cattle line of inductions scheduled and I might have trouble getting in, or that AMA would be an issue at 35 and 6 months old. I'm having trouble getting into a good mental place which is hard in the last week when I think I'm supposed to be excited and ideally feeling more ready and confident.

PP here from a couple days ago: this is great news! It sounds like the platelets are a non-issue, and you are already a little effaced. Now you can try to focus on the fact that everything looks good for you either to go into labor on your own, or for your body to respond favorably to induction drugs because you will be more dilated/effaced with the extra days. There are many reasons not to go past 41 weeks but the evidence that induction helps isn't as clear between 39-40 weeks for low-risk, healthy people (and your age - 35 and a half - doesn't make you high risk if you're healthy).

I'm sorry to hear your practice is so rigid and trying to pressure you into inducing on their preferred date. They should have listened to you and discussed the pros and cons of inducing/waiting rather than acted like you were asking them to bend the rules. This is good practice for when you need to stand up for your child in the future. It's hard to stick to your guns especially with doctors who are supposed to know everything and do things in our best interests. I always tell myself no one is looking out for my child more than I am. The evidence backs your choice to wait a few extra days, and it's important for you to be comfortable with any treatment or procedure.

If you do get the induction next week, you can ask to go in at night and get the cervical ripening drugs placed, then go home and sleep and return the next day (or earlier if regular contractions start). Hospitals just aren't restful and early labor is about resting and letting your body do its thing. Keep in mind that once they admit you, or if your water breaks, then you're on the clock and there's no turning back from delivering the baby. If you have an appointment between now and then you can ask them to strip your membranes - but I think you have to be dilated a certain amount first for that. Sometimes it works and sometimes it doesn't.

If you feel well, walk a lot and rest/relax as much as possible the rest of the time. Try to enjoy the final exciting days. Good luck!

[Anonymous]

Anonymous wrote:To be frank- you don’t sound low risk (AMA, low platelets, weekly NSTs....) . Get the induction.

I agree. Get the show on the road!

[Anonymous]

Anonymous wrote:To be frank- you don’t sound low risk (AMA, low platelets, weekly NSTs....) . Get the induction.

Decreasing platelets is a natural occurrence in labor due to the excess blood. Her platelets are on the low end of normal, that's all. The fact that they tested her repeatedly for it, are doing weekly NSTs and are now pressuring her to induce on their preferred date don't mean she's high risk - it only indicates they are a very rigid practice without an evidence-based approach to pregnancy.

[Anonymous]

Yeah, I'm very confused as to why an otherwise healthy 35 year old is being sent for weekly NSTs before 40 weeks. I know lots of practices do this because every woman over 35 is a ticking time bomb in their minds, but the evidence of their value seems sketchy, at best.

[Anonymous]

OP here. To PP at 13:36- thank you for your thoughtful encouragement. It made me feel better. I am trying to look at the soft cervix as a good sign, as opposed to "why am I not dilated yet" which was my initial reaction. I am going to try to rest and keep walking, even though it's not the most comfortable.

Correct, my practice sends any woman 35 or older for weekly NSTs starting at 36 weeks. I am technically classified as high risk because of my age but the other doctors I have seen at the practice have either never mentioned it or commented I am on the lower end of AMA and otherwise healthy so not a concern. The dr I saw today was the first one who mentioned inducing based solely on AMA, so I was a bit caught off guard. The dr I saw last week, when all this talk of scheduling inductions started, said they usually recommend induction between 39 and 40 weeks for AMA, but in my case given my health, etc., she was fine letting me go to 41 weeks but no later. The possible complication of the platelets and the scheduling intervened, and they ended up putting me on the schedule for my due date and now it's a negotiation.

I wish they had been more straightforward at like week 36 (instead of 2 days before I hit week 39) with their recommendation for AMA to give me time to consider. I probably would have scheduled something for middle or later next week, between 40 and 41 weeks, which hopefully I won't end up too far off from assuming platelets are ok tomorrow. I guess this is also good prep for all the things that can happen during the delivery/birth process and learning to balance going with the flow and advocating for myself under pressure when physically compromised.

[Anonymous]

Anonymous wrote:OP here. To PP at 13:36- thank you for your thoughtful encouragement. It made me feel better. I am trying to look at the soft cervix as a good sign, as opposed to "why am I not dilated yet" which was my initial reaction. I am going to try to rest and keep walking, even though it's not the most comfortable.

Correct, my practice sends any woman 35 or older for weekly NSTs starting at 36 weeks. I am technically classified as high risk because of my age but the other doctors I have seen at the practice have either never mentioned it or commented I am on the lower end of AMA and otherwise healthy so not a concern. The dr I saw today was the first one who mentioned inducing based solely on AMA, so I was a bit caught off guard. The dr I saw last week, when all this talk of scheduling inductions started, said they usually recommend induction between 39 and 40 weeks for AMA, but in my case given my health, etc., she was fine letting me go to 41 weeks but no later. The possible complication of the platelets and the scheduling intervened, and they ended up putting me on the schedule for my due date and now it's a negotiation.

I wish they had been more straightforward at like week 36 (instead of 2 days before I hit week 39) with their recommendation for AMA to give me time to consider. I probably would have scheduled something for middle or later next week, between 40 and 41 weeks, which hopefully I won't end up too far off from assuming platelets are ok tomorrow. I guess this is also good prep for all the things that can happen during the delivery/birth process and learning to balance going with the flow and advocating for myself under pressure when physically compromised.

If their policy is a hard stop at 41 weeks then they'll find a spot for you on the schedule! They won't want to risk a stillbirth (not that the rate is high, but it does start to climb statistically at 41 weeks).

[Anonymous]

^^also, effacement is more important for starting labor than dilation. I was dilated 2 cm for WEEKS but once I was mostly effaced (what they mean when they say "soft") labor started within a couple days. Your cervix can dilate quickly once you're fully effaced.

[Anonymous]

Hi OP, this is the PP whose platelets are at 78.

To be honest it sounds like you have good news: your platelets have stabilized, your cervix is softened. I would suggest that you start walking a lot and have sex - this should help you get dilated. Then at your next appoint ask them to strip your membranes. Those are all good things that can help you jump start labor on your own.

As or me, my baby is measuring larger than my previous full-term deliveries and I still have 6 weeks so this is going to be a big kid. They are counseling for a csection but not necessarily an induction. At this point there is a high likelihood that I will not get an epidural. I'll start steroids next week but the only other option if my platelets drop even further would be an IVIG infusion which is essentially a blood transfusion but with the nationwide plasma shortage that may not be feasible. I'm going to shoot for vaginal (epidural or not) and if that doesn't work - the full team is prepared that I am a patient who may need a csection so all of the doctors are aware.

However it happens, I wish us both boring uneventful deliveries and healthy babies.

[Anonymous]

This is OP- hi there. Thanks for checking back in. Sorry to hear about your platelets, but hopefully the steroids will help keep them stable and you can have the delivery you want. It's good you have enough time on the front end to prepare for a couple of different possible scenarios. That mental prep time is gold. Best of luck with everything and thanks for all your helpful advice.

As for me, my count is stable as of today so I've convinced them to push induction to early next week- still waiting to hear what day. It's only a difference of 2 or 3 days, but I feel better and more confident about it. Gives me a more time to try to bring on labor naturally and if not, to hopefully be better ripened for the induction.