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how overdue can I go without induction?
Last Post 09 Oct 2005 12:22 PM by Archived User. 2 Replies.
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09 Oct 2005 12:22 PM QuoteQuote ReplyReply
I live in London and am planning a home birth - I've been scouring the net
for information on being post-term. I am currently about 42 weeks pregnant
(baby conceived on or after New Year's day). The hospital is pressurising me
to be induced. So far I've only agreed to having a scan to check placental
function, plus being hooked up to a fetal heart monitor.
However I believe neither approach seems totally reliable. So is there any
point in doing it? Could results give unnecessary reason to induce?
I'm also concerned that scans may have adverse effects e.g. on cell
structure (according to research by Doreen Liebeskind). So far I've managed
a scan-free pregnancy. What if the scan itself compromised placental
function?
Do you have any opinions on how long I can hold off all interventions
without being irreponsible?
This is my second baby - my first baby was 4-6 days overdue.
(I am still breastfeeding my first child, now just 3. I wonder if breastfeeding in pregnancy may have contributed to a prolonged gestational period this time round.) By: eileentracy
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10 Oct 2005 05:48 AM QuoteQuote ReplyReply
Let me start with the easiest question first: You need not worry about the Liebeskind studies. Directly irradiating cells growing in culture medium with who-knows-what dose of ultrasound in no way relates to a modern-day scan of a full-term baby several layers deep within your body.

As to whether breastfeeding your toddler could affect the onset of labor, I apologize, but this isn't something I know about. I just went to the La Leche League site to see if they have a section where they answer breastfeeding questions, and it turns out they do. You might try there. The URL is www.lalecheleague.org/helpform.html.

Finally, you are the only one who can decide what is best to do. There isn't a black-and-white issue. There are potential risks with continuing to have tests to evaluate the baby's well-being and waiting it out and with inducing labor.

I have a couple of suggestions, though. First off, in order to make an informed decision you need to know the potential benefits and harms of inducing labor vs. the potential benefits and harms of awaiting labor, including how likely the harms are to occur. Second, if you are considering induction, I can also tell you some ways to minimize the potential problems. You are fortunate that this is not your first baby. If your cervix is ripe and ready to go, unlike the first-time mother, you don't face increased risk of c-section. (On the other hand, if your cervix is ready for labor, you will probably start labor on your own very shortly.) Still, if you decide on induction, and you don't permit membranes to be ruptured as part of getting started, then you can back out and go home if the induction doesn't "take." Once membranes are ruptured, you are committed to delivery.

Also, once you have a good contraction pattern and are starting to dilate, they can turn off the oxytocin drip (they leave a plain IV running) and see if the contractions continue on their own. Often they will, which can make for a more comfortable labor. Oxytocin is pretty short acting, so you will know fairly quickly if contractions die away. If they do, they can just restart the oxytocin drip.

I recommend arranging for these options ahead of time. You don't want to be trying to convince people to do something that may not be their usual procedure on the spot.

Finally, I don't know if inducing labor with misoprostol (Cytotec) is an issue in the U.K. It certainly is here. Cytotec is a small tablet actually approved only for treating ulcers, but in the U.S. it is used to induce labor by cutting it in quarters and inserting a bit of it usually vaginally but sometimes by giving it orally. Here is what our Federal Drug Administration says about it:

FDA ALERT: – Risks of Use in Labor and Delivery
This Patient Information Sheet is for pregnant women who may receive misoprostol to soften their cervix or induce contractions to begin labor. Misoprostol is sometimes used to decrease blood loss after delivery of a baby. These uses are not approved by the FDA. No company has sent the FDA scientific proof that misoprostol is safe and effective for these uses.
There can be rare but serious side effects, including a torn uterus (womb), when misoprostol is used for labor and delivery. A torn uterus may result in severe bleeding, having the uterus removed (hysterectomy), and death of the mother or baby. These side effects are more likely in women who have had previous uterine surgery, a previous Cesarean delivery (C-section), or several previous births.

Cytotec is no more effective than an FDA approved alternative, prostaglandin E2 to ripen the cervix in combination with oxytocin. It's only advantages are that it is dirt cheap--pennies per dose--and it tends to work more quickly.

I hope that by the time you read this, the issue is moot, and you have had an easy birth and are enjoying your new baby.

-- Henci
By: Henci Goer
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16 Mar 2006 09:48 PM QuoteQuote ReplyReply
Hi Henci

I'm a midwifery student and am trying to put together a information sheet for women who either want to have an induction or have been told by dr/midwives that an induction is on the cards. I need to have evidence based information, yet recently when i was reading your book on obstetric myths, i realised how hard it is to provide information so that a woman can make an informed consent.

Have you got any ideas on where i should start? Is effective care in childbirth Enkin et al. really the bible that our lecturers believe it to be?

Thanks,

Samantha
By: sam


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