I am delighted for you! I'm sorry, though, that it was so hard to obtain something that should have been so simple. All best to you and your little one.

-- Henci

Ultrasound scans do not reliably establish a due date. Even when done in the first trimester, when they are most accurate, the date they give is plus or minus five days (or a 10-day window). For this reason, it is not recommended that the estimated due date be changed unless there is at least a 2-week discrepancy between the clinically-based due date and the date estimated by the sonogram. I hope by this time you have gone into labor on your own, but if not, it's your body and your baby. You have the right to informed refusal.

If you agree to be induced, I suggest that you refuse rupture of membranes until you are established in progressive labor--if you agree to it at all. Breaking the bag of waters is often done as part of the induction procedure, but it commits you to delivery one way or the other. If membranes are intact and the induction doesn't take, you can stop it and go home and try again another day.

Also, refuse to be induced with Cytotec (also known as "misoprostol" or "miso"). Its only FDA approved purpose is to treat ulcers, however, it is commonly used in the United States to induce labor. If offers no advantages compared with prostaglandin E2 (which is FDA approved) for the same purpose other than that it is much cheaper, and it tends to work faster--neither of which are benefits for you or your baby. Here is what the FDA has to say about it:

"Cytotec can induce or augment uterine contractions. Vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor . . . . A major adverse effect of the obstetrical use of Cytotec is hyperstimulation of the uterus which may progress to uterine tetany [uterus contracts and doesn't let go] with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism [maternal and infant mortality rate is very high from this]. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia [profound slowing of the baby's heart], and fetal and maternal death have been reported.

"There may be an increased risk of uterine tachysystole [contractions coming too fast], uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec; including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity [usually defined as more than four births] also appears to be a risk factor for uterine rupture.

"The effect of Cytotec on the later growth, development, and functional maturation of the child when Cytotec is used for cervical ripening or induction of labor have not been established. Information on Cytotec’s effect on the need for forceps delivery or other intervention is unknown."

-- Henci  

Well, I'm still here... 41 weeks pregnant. No baby yet.  My daughter keeps asking when's she going to come... boy oh boy do I get that question a lot these days.  I started researching my LMP vs. first ultrasound due dates, which are different.  I wasn't sure how they could be different (LMP due date Sept. 26th and my first US due date showed Oct. 2nd).  After researching, I now know that Oct. 2nd was probably my real due date, but my dr. never asked me about my cycles.  They just gave me the sept. 26th due date.  I have 34 day cycles so I know that Sept. 26 wouldn't have made sense for me.  Oct. 2nd was what I came up with too (after using the computer calculator) - which is what my first US showed.  Whew... hope I didn't confuse anyone.  I had never heard of this before until two days ago when I looked back at my first US and saw it said Oct. 2nd.  Anyway, my dr. won't change my due date which puts me in a panic just a bit.  They are saying I'm 41 weeks today and I am thinking I'm only 40 weeks one day today.  This means at the end of next week they are saying I will be 42 weeks and have to be induced when I think I will only be 41 weeks one day next Friday.  Any suggestions....  how can I get through to my dr. that I don't want to be induced yet if their policy is at 42 weeks we induce? 

As for the nipple stimulation - yes.... it brings on contractions, but as I was reading your posts; I'm not doing it long enough.  I did it on one breast and got a contraction within 5 min. stopped then did it on the other breast and same senario.  I repeated it on each breast and then quit (time for bed).  I woke up in the middle of the night cramping real bad.  I felt like a contraction just wouldn't let up for about two to three hours.  Then this morning I am still having contractions but just every 20 min. like I have been for two or three months now.  So... I guess it's time for me to try nipple stimulation for several hours. 

Hoping for a baby soon...

You are certainly within your rights to give informed refusal to induction at 41 weeks. The main study used to support induction at 41 wks is highly flawed. I have a critique of this study under "When Research Is Flawed" elsewhere on the Lamaze website.

You can try breast stimulation if you like. A common recommendation is to stimulate one breast and see if you get a contraction. If you do, cease the stimulation until the contraction is over. If stimulating one breast is not sufficient, then move to stimulating both at the same time. Again, if that triggers a contraction, wait until it is over to resume stimulation. The studies of nipple stimulation showed that women were doing this for three 1-hour sessions a day, which doesn't seem very practical to me, but do what you can.

Don't, by the way, agree to membrane stripping. It doesn't have any substantive benefits and a recent study, summarized in this quarter's Lamaze Research Summaries report by Amy Romano, reported an association with prelabor rupture of membranes. In fact, I would recommend specifically telling your OB that you don't want membranes stripped. Some doctors think that this is so trivial that they don't ask permission and just go ahead and do it during a routine prenatal vaginal exam.

-- Henci

I'm certainly no medical expert, but it doesn't sound like there's any reason to induce at this point.  The measure of the baby may be off significantly.  You don't mention having any medical conditions such as pre-eclampsia etc... that would make induction necessary, and all the tests are fine.  What's the rush?  We all want to hold our little babies of course, but life doesn't exactly get any easier once the baby comes, so I would just relax and wait for the baby to come when it comes.  (I have two currently and I certainly understand feeling uncomfortable and not wanting to be pregnant any more, but even so, you are getting more sleep now than you will once the baby comes, believe me.)

Otherwise, if you want to try to induce "naturally", i.e. without synthetic hormones and chemicals, you can try nipple stimulation as some suggested.  My midwife suggested a breastpump for inducing, if it comes to that.  Henci is more familiar with the medical literature and evidence than I am, but as I understand it, there isn't any reason not to wait until 42 weeks or just before given the circumstances that you describe, and even ACOG says that a prediction of a "big" baby is not a reason to induce.  Just my two cents, good luck with whatever you decide!

Hi,

I am 40.5 weeks pregnant and as of today only dilated to one cm (not effaced and baby hasn't dropped).  By the way, this is our second pregnancy.  I delivered our first daughter two days past due date on my own.   I do NOT want to be induced.  My dr. is suggesting waiting it out too.  Do you have any insight or ideas to make this baby drop or bring on labor??    I've tried walking and sex (I walk a little each day and have tried sex three times in the past week and a half).  Nothing seems to be working.  I've had contractions for the past two months everyday, but nothing hard enough or close enough to dilate me, obviously.  Help??  My dr. wants me to be induced at 41.5weeks.  This baby is already measuring 8 pounds with a small (two weeks behind) head.  My first daughter was 8lbs 14 oz.  Hmmm...  other techniques or advice would be appreciated.  Everyone keeps telling me to just go be induced...  I feel like waiting this out until 42 weeks or a day before.  I'm just worried about the weight and her health.  All non stress tests and ultrasounds have come back fine.