Anonymous wrote:I'm almost 37yo, with a 3.5yo dd (who was born 5 days late). Currently 40w4d pregnant with no labor signs. I'm not physically miserable or anything, but I'm a little unnerved by my doctor's willingness to have me return for my next appt a full week from today, and not sooner, assuming I don't go into labor before then. Is that standard?

Yes, standard. And they will let you go 2 full weeks.

Anonymous wrote:At 39, the midwives at GW at the time let me go to 41 weeks, 6 days. They would have induced the next day.

They are not exactly known for their conservative approach to delivery in this town, or anywhere for that matter. My new OB commented to me that they are known for being “extreme” in the obstetric community. How else do you think they have achieved a 94 percent vaginal delivery rate.

Anonymous wrote:"Mother Nature is not infallible, she’s the reason birth used to be the leading cause of death for women and babies."

mother nature or poor sanitation, lack of antibiotics and malnutrition? Most of those deaths were from infection and hemorrhage which are now preventable. Maternal deaths in the US have risen sharply in the last 20 years.. along with both the c-section and induction rates. Hmm.

Infection and hemorrhage are not always preventable. Part of the rise in maternal deaths is due to reporting—it’s not as clear cut that the rise is as sharp as everyone is saying—there are so many issues with how maternal deaths are collected and reported on by states that the US refuses to publish the national rate due to all the inaccuracies. A lot of it is due to reporting inaccuracies on cause of death certificates and the wording of the questions, ie was the deceased pregnant in the last year. C section and induction rates are rising because you have older mothers delivering babies for the first time, with more assisted reproduction, at higher ages, with more chronic conditions, high rates of obesity, and lack of full access to health care for many women. Let’s focus on the needs of patients, and giving all women and babies the best care possible, not birth ideology or health care quality measures that all come with their own drawbacks.

"Mother Nature is not infallible, she’s the reason birth used to be the leading cause of death for women and babies."

mother nature or poor sanitation, lack of antibiotics and malnutrition? Most of those deaths were from infection and hemorrhage which are now preventable. Maternal deaths in the US have risen sharply in the last 20 years.. along with both the c-section and induction rates. Hmm.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op here again, I just spoke to my doc office and they are urging me to wait for my body to do this on its own, so I'll try to sit tight until my next appointment with them on Monday. Or go into labor on my own! At the end of the day I think I need to trust the person who's seen me through this pregnancy and my previous one.

You’re well within your right as a patient to discuss your concerns with your OB, OP. Did you speak to your doctor, or just a nurse? Are you at a practice that is more conservative, or one known to try and minimize interventions? Personally I find it a bit odd that at AMA they are not encouraging you to at least schedule an induction at 40 weeks.

If you are comfortable with the risks of waiting to induce, fine. But you are well within your right to discuss the risks and benefits of inducing or waiting at this point. Plenty of conservative practices would have already induced you by this point. Sometimes our bodies don’t do the right thing and interventions can avoid a bad outcome. Mother Nature is not infallible, she’s the reason birth used to be the leading cause of death for women and babies.

Thanks, I do appreciate this reminder/reinforcement. My OB is in surgery today so I couldn't speak to her, unfortunately. When I met with her earlier yesterday she suggested I'd be induced by next Thursday (so, 41+4). She's at a big hospital (Cornell - I'm in NYC) and I would say they fall somewhere in the middle. They have a birthing center with midwives but I'm not a patient there, just been seen as part of their mainstream practice. With my dd I appreciated a slightly less interventional approach as they allowed me to deliver vaginally despite my water having broken about 30 hours prior to her birth (I.e. no "24 hour rule" if things seem to be progressing).

New York has abysmal maternal mortality and c-section rates (neighboring NJ has a special placenta accreta center because of all the c-sections area hospitals do) so they're probably backing away from intervening in low-risk, healthy pregnancies such as yours with both of your babies. Good luck to you, the end is stressful and unfortunately if you're on the internet, full of negativity and misinformation. Hopefully you can relax and enjoy these last days!

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The biggest risk in going past 40 weeks is that the placenta can calcify and stop providing nutrients to your baby. You might not know this has happened until it's too late. I'm sorry, I'm not trying to freak you out - it was a long road for DW and me to have our two and we unfortunately weighed risks like this constantly until the babies were both here.

This is a load of rubbish. Where did you get this pseudo science?? There is zero evidence to support this theory.

OP, the risk of stillbirth for you being under 40 and assuming your pregnancy is healthy and you yourself are in good health with no conditions is incredibly low.

PP here. I didn't pull this out of my ass.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090024/


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121913/

^ This shows a link between hypertension and calcification (not sure if OP has indicated her blood pressure)


https://www.sciencedirect.com/science/article/abs/pii/S0143400415300084

^ "....the risk of stillbirth was much higher when PPC was present."


Is there a large percentage of women affected by this? No. Is it mostly linked to hypertension? Seemingly. Will OP probably be fine if she waits? Probably. But this is a thing, it does happen, and it can result in stillbirth.

I didn't claim this was common - I did claim to know people this has happened to, people who are in a high risk community of folks. This was a real conversation my wife had with her MFM and a big part of the reason why she chose to be induced at 39 weeks.=Luckily OP seems to be very low risk for this happening - but it happens.

Nice try but PPC is PRE-TERM placental calcification (<32 weeks), which is typically caused by smoking, maternal hypertension, or a problem with the placenta that is usually identified by early and consistent prenatal care. Calcification at full term is perfectly normal and expected.

It also hasn't even come close to a consensus on causing stillbirth.

My first kid was so big in comparison to my small size, they opted to schedule me for repeat c-section between 39 and 40wks, not to go past due date. I'm down with it. I am going to try for a VBAC if this one comes earlier, but otherwise I'm good with this plan.

At 39, the midwives at GW at the time let me go to 41 weeks, 6 days. They would have induced the next day.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op here again, I just spoke to my doc office and they are urging me to wait for my body to do this on its own, so I'll try to sit tight until my next appointment with them on Monday. Or go into labor on my own! At the end of the day I think I need to trust the person who's seen me through this pregnancy and my previous one.

You’re well within your right as a patient to discuss your concerns with your OB, OP. Did you speak to your doctor, or just a nurse? Are you at a practice that is more conservative, or one known to try and minimize interventions? Personally I find it a bit odd that at AMA they are not encouraging you to at least schedule an induction at 40 weeks.

If you are comfortable with the risks of waiting to induce, fine. But you are well within your right to discuss the risks and benefits of inducing or waiting at this point. Plenty of conservative practices would have already induced you by this point. Sometimes our bodies don’t do the right thing and interventions can avoid a bad outcome. Mother Nature is not infallible, she’s the reason birth used to be the leading cause of death for women and babies.

Thanks, I do appreciate this reminder/reinforcement. My OB is in surgery today so I couldn't speak to her, unfortunately. When I met with her earlier yesterday she suggested I'd be induced by next Thursday (so, 41+4). She's at a big hospital (Cornell - I'm in NYC) and I would say they fall somewhere in the middle. They have a birthing center with midwives but I'm not a patient there, just been seen as part of their mainstream practice. With my dd I appreciated a slightly less interventional approach as they allowed me to deliver vaginally despite my water having broken about 30 hours prior to her birth (I.e. no "24 hour rule" if things seem to be progressing).

Wow, I’m surprised they let you go past 24 hours. The reason for that is increased risk of infection. I am glad it worked out for you, but that is not the standard of care as I know it. Increasingly it seems that academic medical centers with a midwifery groups are being heavily influenced by them to reduce C sections, avoid interventions, and promote normal, physiologic birth. The problem with that, is that that philosophy is not improving outcomes, as that new CDC report just out showed. It’s actually lack of access to care and the right interventions being pushed at the right time that is causing problems.

I delivered my first at 41 weeks and I wish I had pushed for an earlier induction. I ended up with preeclampsia, a deteriorating placenta, a huge baby who needed help to be delivered, and a whole host of other problems. In hindsight, I could see my belly swelling daily and felt anxious every day I went past my due date, but I kept being told to let nature do it’s thing, and that my body knew what to do. That philosophy, for me, turned out to be wrong and harmful.

If you feel concerned at all, don’t hesitate to talk to your OB directly. I personally wish I had listened to my gut when I felt that waiting was riskier than inducing.

PP here who posted about calcified placenta and got told it was pseudo science. Thank you for sharing your experience.

I went to 42 weeks with my first, when I was 36. (Was scheduled for an induction @ 42 weeks. Labor started the day before, but I didn't deliver until the next day.) My water broke at 41w2d with my second, when I was 39. My CNM practice would have let me go to 42 weeks with lots of monitoring. I'd read the studies, understood the risks, and discussed options with both the midwives and the MFMs.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op here again, I just spoke to my doc office and they are urging me to wait for my body to do this on its own, so I'll try to sit tight until my next appointment with them on Monday. Or go into labor on my own! At the end of the day I think I need to trust the person who's seen me through this pregnancy and my previous one.

You’re well within your right as a patient to discuss your concerns with your OB, OP. Did you speak to your doctor, or just a nurse? Are you at a practice that is more conservative, or one known to try and minimize interventions? Personally I find it a bit odd that at AMA they are not encouraging you to at least schedule an induction at 40 weeks.

If you are comfortable with the risks of waiting to induce, fine. But you are well within your right to discuss the risks and benefits of inducing or waiting at this point. Plenty of conservative practices would have already induced you by this point. Sometimes our bodies don’t do the right thing and interventions can avoid a bad outcome. Mother Nature is not infallible, she’s the reason birth used to be the leading cause of death for women and babies.

Thanks, I do appreciate this reminder/reinforcement. My OB is in surgery today so I couldn't speak to her, unfortunately. When I met with her earlier yesterday she suggested I'd be induced by next Thursday (so, 41+4). She's at a big hospital (Cornell - I'm in NYC) and I would say they fall somewhere in the middle. They have a birthing center with midwives but I'm not a patient there, just been seen as part of their mainstream practice. With my dd I appreciated a slightly less interventional approach as they allowed me to deliver vaginally despite my water having broken about 30 hours prior to her birth (I.e. no "24 hour rule" if things seem to be progressing).

Wow, I’m surprised they let you go past 24 hours. The reason for that is increased risk of infection. I am glad it worked out for you, but that is not the standard of care as I know it. Increasingly it seems that academic medical centers with a midwifery groups are being heavily influenced by them to reduce C sections, avoid interventions, and promote normal, physiologic birth. The problem with that, is that that philosophy is not improving outcomes, as that new CDC report just out showed. It’s actually lack of access to care and the right interventions being pushed at the right time that is causing problems.

I delivered my first at 41 weeks and I wish I had pushed for an earlier induction. I ended up with preeclampsia, a deteriorating placenta, a huge baby who needed help to be delivered, and a whole host of other problems. In hindsight, I could see my belly swelling daily and felt anxious every day I went past my due date, but I kept being told to let nature do it’s thing, and that my body knew what to do. That philosophy, for me, turned out to be wrong and harmful.

If you feel concerned at all, don’t hesitate to talk to your OB directly. I personally wish I had listened to my gut when I felt that waiting was riskier than inducing.

Anonymous wrote:Went 1 week 6 days past my DD with the first
1 week past with the second (and that was by far my worst labor & delivery)
10 days past with my third

There may be reasons for concern with waiting, but size isn't one of them. The fetus does put on weight after 36 weeks, but it's fat, not skeleton, and fat is easy to deliver.

According to who, exactly? This sounds like some nonsense.

Anonymous wrote:

Anonymous wrote:The biggest risk in going past 40 weeks is that the placenta can calcify and stop providing nutrients to your baby. You might not know this has happened until it's too late. I'm sorry, I'm not trying to freak you out - it was a long road for DW and me to have our two and we unfortunately weighed risks like this constantly until the babies were both here.

This is a load of rubbish. Where did you get this pseudo science?? There is zero evidence to support this theory.

OP, the risk of stillbirth for you being under 40 and assuming your pregnancy is healthy and you yourself are in good health with no conditions is incredibly low.

PP here. I didn't pull this out of my ass.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090024/


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121913/

^ This shows a link between hypertension and calcification (not sure if OP has indicated her blood pressure)


https://www.sciencedirect.com/science/article/abs/pii/S0143400415300084

^ "....the risk of stillbirth was much higher when PPC was present."


Is there a large percentage of women affected by this? No. Is it mostly linked to hypertension? Seemingly. Will OP probably be fine if she waits? Probably. But this is a thing, it does happen, and it can result in stillbirth.

I didn't claim this was common - I did claim to know people this has happened to, people who are in a high risk community of folks. This was a real conversation my wife had with her MFM and a big part of the reason why she chose to be induced at 39 weeks.=Luckily OP seems to be very low risk for this happening - but it happens.

Anonymous wrote:

Anonymous wrote:Op here again, I just spoke to my doc office and they are urging me to wait for my body to do this on its own, so I'll try to sit tight until my next appointment with them on Monday. Or go into labor on my own! At the end of the day I think I need to trust the person who's seen me through this pregnancy and my previous one.

You’re well within your right as a patient to discuss your concerns with your OB, OP. Did you speak to your doctor, or just a nurse? Are you at a practice that is more conservative, or one known to try and minimize interventions? Personally I find it a bit odd that at AMA they are not encouraging you to at least schedule an induction at 40 weeks.

If you are comfortable with the risks of waiting to induce, fine. But you are well within your right to discuss the risks and benefits of inducing or waiting at this point. Plenty of conservative practices would have already induced you by this point. Sometimes our bodies don’t do the right thing and interventions can avoid a bad outcome. Mother Nature is not infallible, she’s the reason birth used to be the leading cause of death for women and babies.

Thanks, I do appreciate this reminder/reinforcement. My OB is in surgery today so I couldn't speak to her, unfortunately. When I met with her earlier yesterday she suggested I'd be induced by next Thursday (so, 41+4). She's at a big hospital (Cornell - I'm in NYC) and I would say they fall somewhere in the middle. They have a birthing center with midwives but I'm not a patient there, just been seen as part of their mainstream practice. With my dd I appreciated a slightly less interventional approach as they allowed me to deliver vaginally despite my water having broken about 30 hours prior to her birth (I.e. no "24 hour rule" if things seem to be progressing).

Anonymous wrote:I think There are a lot Of unrecognized brain injuries among babies who cooked too long. The same way there are problems for babies who stew too little. 200 years ago, too long or too short would have just died or delivered as still birth.

If we have access to medicine and care that can prevent too early or too late, why not take advantage of them? The result in both cases is a healthy baby.

What?? I have two 42 week children. I do agree that I needed induced. I was 0 on the bishops scale both times at 41+5 when I was induced (delivered at exactly 42 weeks). My babies hated me obviously.