Anonymous
Post 06/12/2021 21:55     Subject: Kaiser will only let you go ONE week past due date??
For some 10+ years now Kaiser has been the provider for indignant /low income women having babies who often do not seek prenatal treatment at all. That may be the negative "evidence" that some posters are referring to.

i got out of Kaiser when they became the Medicaid provider for the state of Maryland and many places around the country.
Anonymous
Post 06/12/2021 20:19     Subject: Kaiser will only let you go ONE week past due date??
Anonymous wrote:
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.


This is absolutely true, and women should do what they feel they need and want to do. it is also worth remembering that a given practice can decline to take you on for any later pregnancies, for any reason (other than protected class --a nd this is a not a protected class issue). That will be irrelevant in many cases, but it may be relevant to some women.

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.


Do you really mean to say "without any evidence," or do you mean to say there is not any evidence for a difference that is meaningful to you, even if there is good evidence for a difference in outcomes? Just checking before I post further.
Anonymous
Post 06/12/2021 19:07     Subject: Kaiser will only let you go ONE week past due date??
Anonymous wrote:Kaiser wouldn’t let me go past 41 weeks with any of my babies and I’m pregnant now and they still won’t. Kind of sucks because I just gestate long. I had very long inductions because I don’t think my kids were ready.


This is your particular OB at Kaiser. While it is standard for them to recommend 41 weeks for an induction date (as it is for most obs) I just want to second the other posters who said their Kaiser OB was still flexible. my OB said that was their standard protocol but if I wanted to go longer that was certainly fine, they would just monitor me. She was comfortable up until 41 and 5. We scheduled for that day and she really left it to my discretion. My OB happens to be the medical director for Obgyn for Kaiser mid-Atlantic (I was her patient before she took on this role and have stayed on even though she doesn’t see as many patients anymore) soI feel confident that there is this flexibility at Kaiser.
Anonymous
Post 06/12/2021 18:48     Subject: Kaiser will only let you go ONE week past due date??
Not enough information.
Age of your sister?
Bmi?
Diabetes?
IVf?


The doctor can not force her and if she wants to wait, then wait. They will say, “Here is my rec, if you don’t agree, then you assume the liability.”

You have to assume liability anyways. It is your kid.
Then they say, “Ok, if you change your mind let me know.”

She will likely need testing after 41 weeks.

Anonymous
Post 06/12/2021 17:45     Subject: Kaiser will only let you go ONE week past due date??
Anonymous wrote:
Anonymous wrote:I was told at Kaiser that I would not be allowed to go past 1 day of my due date. No problems with pregnancy just told that's the policy. With Kaiser if you do not comply in the slightest they will mark it down in their notes. You will be sorry afterwords when they try to say you were "defiant". They really don't like any standing up for oneself.


Troll post


I mean yeah since they brought up a 9 year old thread.
Anonymous
Post 06/12/2021 17:18     Subject: Kaiser will only let you go ONE week past due date??
Kaiser wouldn’t let me go past 41 weeks with any of my babies and I’m pregnant now and they still won’t. Kind of sucks because I just gestate long. I had very long inductions because I don’t think my kids were ready.
Anonymous
Post 06/12/2021 17:07     Subject: Kaiser will only let you go ONE week past due date??
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Ugh. The guidance exists because of adverse outcomes. Why are people lying to increase their own risk of catastrophic adverse outcomes. You guys deserve what you get I guess.


Because the guidance differs with the standard of care elsewhere. Unless you’re saying every other DC hospital and practice is increasing their risk of catastrophic adverse outcomes, then this is a decision that should be made by a patient with her doctor, the managed care practice her doctor is a part of.



Yes if you doctor-shop you can find all kinds of practices. Doesn’t make them safest.


The best practices in the area are typically not Kaiser. I wouldn’t call that “doctor shopping”.

I also think calling it doctor shopping diminishes the importance of having a good OB team you’re happy with— like you said there are plenty of practices. It is in patients benefit to get to see the best, not the most “managed”
Anonymous
Post 06/12/2021 16:29     Subject: Kaiser will only let you go ONE week past due date??
I went to 41 and 2 days and went into labor naturally and ya know what there was meconium I got an infection and fever and ended up with c section. I’m so glad I’ll have my scheduled csection at 39 weeks who wants to go that far in.
Anonymous
Post 06/12/2021 15:33     Subject: Kaiser will only let you go ONE week past due date??
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.


Lol ok you are an expert.
Anonymous
Post 06/12/2021 15:31     Subject: Kaiser will only let you go ONE week past due date??
Anonymous wrote:
Anonymous wrote:Ugh. The guidance exists because of adverse outcomes. Why are people lying to increase their own risk of catastrophic adverse outcomes. You guys deserve what you get I guess.


Because the guidance differs with the standard of care elsewhere. Unless you’re saying every other DC hospital and practice is increasing their risk of catastrophic adverse outcomes, then this is a decision that should be made by a patient with her doctor, the managed care practice her doctor is a part of.



Yes if you doctor-shop you can find all kinds of practices. Doesn’t make them safest.
Anonymous
Post 06/12/2021 15:23     Subject: Re:Kaiser will only let you go ONE week past due date??
Anonymous wrote:
Anonymous wrote:You guys do know that the baby can die if past the due date, right? You really want to take responsibility with your date counting/great experience as doctors and take a chance on, not yours, but some else's baby's life.


And if you'd done your homework, you'd know that it's not until after two weeks post dates that infant mortality goes up. And babies can die anytime in utero. Hustling to have an induction whether or not one is warranted because of some policy is not good science; in fact, it's very bad science.

Plus, this thread is a year old. OP's sister is coming up on her DC's first birthday.


You’re just wrong. Fetal morality goes up sooner than 42+0.
Anonymous
Post 06/12/2021 15:21     Subject: Re:Kaiser will only let you go ONE week past due date??
I don’t get why people don’t trust their doctors to advise on what the best medical protocol is for delivery
Anonymous
Post 06/12/2021 14:52     Subject: Kaiser will only let you go ONE week past due date??
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Ugh. The guidance exists because of adverse outcomes. Why are people lying to increase their own risk of catastrophic adverse outcomes. You guys deserve what you get I guess.


Because the guidance differs with the standard of care elsewhere. Unless you’re saying every other DC hospital and practice is increasing their risk of catastrophic adverse outcomes, then this is a decision that should be made by a patient with her doctor, the managed care practice her doctor is a part of.



The American college of obstetricians and gynecologists recommends 41 weeks. Say what you will of Kaiser, but they are evidence based


+1. They can't force you to do anything so it's not a question of "allow" but I don't understand people who want a doctor there, but won't listen to the doctor's advice. Outcomes in the 39-40 week period are good. Not going past 41 weeks is the expert, evidence based recommendation. If you want to play the expert then why are you roping the doctor into it at all?
Anonymous
Post 06/12/2021 14:36     Subject: Kaiser will only let you go ONE week past due date??
My sister (1 child) and I (3 kids) all went to 42 weeks. 4 healthy kids. Sister had hospital birth and I had 2 birth center births and 1 home birth (all midwives, of course.) No hard and fast "let you/not let you" stuff. Your body, your choices. We made intelligent, well-informed ones.
Anonymous
Post 06/12/2021 13:41     Subject: Kaiser will only let you go ONE week past due date??
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Ugh. The guidance exists because of adverse outcomes. Why are people lying to increase their own risk of catastrophic adverse outcomes. You guys deserve what you get I guess.


Because the guidance differs with the standard of care elsewhere. Unless you’re saying every other DC hospital and practice is increasing their risk of catastrophic adverse outcomes, then this is a decision that should be made by a patient with her doctor, the managed care practice her doctor is a part of.



The American college of obstetricians and gynecologists recommends 41 weeks. Say what you will of Kaiser, but they are evidence based


ACOG website says 42 0/1, unless the dates are uncertain at which point they recommend 41. Given that every other practitioner in the region has at least some flexibility on the dates— and that other Kaiser patients were told they can go over 41 earlier in the thread— an actual policy on 41 weeks for healthy baby and mother would not reflect evidence based care.