When to schedule induction?
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Anonymous
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I'm due next week, delivering at WHC. I'm 35, and have to date had an uncomplicated pregnancy (FTM). My OB told me today that generally they recommend induction between 39 weeks and 40 weeks for women 35+, but because I don't have other risk factors and am on the lower end of that range, they will let me go to 41 weeks if that is my preference. I've been going for NST fetal monitoring once a week in addition to the OB every week and everything looks normal/good/etc at this point. I'd be fine waiting to schedule the induction until the 41 week mark because it's preferable to me to go into labor naturally if possible, though I do worry about creating some c section risk due to the baby having more time to cook in there and get bigger (I haven't had a scan in awhile, but baby was in 60th percentile for weight about 6/8 weeks ago).
The main wrinkle is my platelets are trending low. They tested them again today and I should know the number tomorrow. The dr said generally at 100 or under they will not give an epidural, and if there ends up being a c section, it would have to be general anesthesia. My platelet number in early August was 135 so I am thinking if it has dropped to 125 or below, I should schedule the induction sooner (maybe on my due date?) to mitigate the risk that platelets continue to drop while I wait to go into labor and then I potentially have a more stressful delivery/c section, etc. Wondering if anyone has had experience with this. It seems the doctor is giving me the judgment call right now up to 41 weeks unless my platelets have dropped drastically. I am trying to inform my decision making in a scenario where they continue low, but not so dangerously as to where the doctor would order me to get induced by a certain date. |
Anonymous
2 things - the risk of the baby getting bigger leading to a C and the risk of induction rather than naturally-occuring labor leading to a C is probably a wash. But if there is any chance that you might have to have a C under general anesthesia, avoid that. I almost had to have a C-section under general and the risks are awful - they have to get the baby out in under 2 minutes so the risks to you and the baby are greater, the baby will come out limp because the anesthesia hits them too and they have to go to the NICU so you don't get Apgar and other signs of a healthy baby right away, you are unconscious so there's no skin-to-skin/"golden hour," and your recovery is harder because they can't give you pain meds through the epidural so they have to do a "nerve block" on your torso so you don't feel the incision right when you wake up. I was terrified and honestly the doctors and nurses seemed very uneasy with the possibility as well. I ended up with a C-section with an epidural and it was not my preference but we knew the baby was perfect immediately, she was snuggled up on my chest as I was stitched together, and I am very grateful I got to meet her when she was born. |
Anonymous
| 16:45 here - one other thing, if you have a regular C-section your partner can be right there by your head. If you're under general they can't be in the room so neither of you sees the baby when it's born. I was prepped for a C under general and when they unexpectedly got the epi in so I could have a regular C, someone had to run and get my husband. This isn't the most important consideration but considering how scary the situation was I was glad not to be alone. |
Anonymous
| I would schedule an induction as close to 39 weeks as possible. |
Anonymous
Can you expand on why? Is that due to the scenario I laid out, or just as a general matter? |
Anonymous
| Did they say where your cervix is at? I have to have an induction because of a complication but the OB mentioned that something about my cervix was "favorable" for it. |
Anonymous
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He wants to induce you before week 40 because you are 35+
Your doctor either dumb or just wants the birth to be convenient for him and his practice |
Anonymous
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For DS, I was induced at 41 + 6 days at 33 and then for DD2, I was induced at 39 + 0 days at age 40 because of AMA. I would not stress too much either way. Pretty similar experience.
I was reluctant for the first induction just because of induction but it was totally fine and better than DD1 who came slowly on her own at 41 weeks. For DD2, I felt like it was early but it was also fine - it probably took a little longer to really get labor going but then she was a perfect size and easiest labor and recovery. I’m grateful to have listened to the doctors as I believe they were honestly counseling to avoid a potential bad outcome even if chances were slight. All same practice FWIW. |
Anonymous
| Op, let us know your updated platelet numbers when you get them! I think that may help you decide. |
Anonymous
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OP, baby's size is not a risk factor for a c-section unless you have certain conditions or complications (like GD).
You may want to read about the real risk factors - provider/hospital preference and induction before the body is primed for labor - being the big ones. It sounds like your practice are already treating you as a high-risk case (testing your blood for platelets, giving you NST tests), despite you actually being very low risk. That indicates they are more likely to recommend a c-section for you earlier in your labor than they would for someone they view as low-risk, even if your labor is progressing normally. Some sources of info that might help you make a decision: http://www.childbirthconnection.org/ https://evidencebasedbirth.com/ |
Anonymous
| I would ask your OBGYN for their honest opinion on what they would do if they were you. I would go with an induction at 39 or 40 weeks. My understanding is that the risk of waiting until the 41st or 42nd week is higher for women above 35. |
Anonymous
The website, "Evidence Based Birth" is not really evidence based. |
Anonymous
Never mind OP I reread your post and saw that you are 35 which is on the younger end  I would still ask your OB on the best course of action but looks like the risk is pretty low for you
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Anonymous
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I would schedule right at 40w. You avoid the risks (however small) that come with being AMA past 40w as well as the stress over platelets.
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Anonymous
The site has hundreds of detailed articles and podcast episodes that explain the latest and best research on childbirth topics, with full citations. ev·i·dence-based adjective denoting an approach to medicine, education, and other disciplines that emphasizes the practical application of the findings of the best available current research. But I'm not going to argue....anyone can access the site and form their own opinions. |