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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Mar 11
    2010

    Induction at 41 weeks and 1 day(s)

    Archived User

     I am a first time mom-to-be and have a scheduled induction this Sunday March 14th at 6:30pm; I will be exactly 41 weeks and 1 day. I have had a flawless pregnancy, my weight gain has been average, 29lbs to date, good fetal movement, baby has always had a strong/clear heartbeat, and I have remained active throughout my entire pregnancy, exercising at least 4 days a week (in fact I walked 3 miles the day after my “due date” which was March 6th). As of this past Monday (March 8th) I was checked for dilation/effacement and my OB informed me that my cervix was completely closed, and then proceeded to schedule my induction at the hospital for this Sunday with little else to say. I have been doing much reading/research on the internet concerning inductions etc., and am not sure if I should go through with this scheduled induction on Sunday. I called my OB and made an appointment for tomorrow morning at 9am at which time I will ask him to check me for dilation again. At this point I am leaning heavily towards cancelling the induction if I have still made no progress. My intent and desire for this pregnancy has always been to have her naturally without an epidural. My question is: should I go forward with the induction or wait a few more days, perhaps ask them to schedule my induction closer to my 42 week? Also, how do you feel about inducing a woman, who is not dilated or effaced, especially a first timer? Thank you in advance for your response!

    Henci Goer

    (FYI: myerstab07 e-mailed me on the side. I responded to her e-mail because she was so short of time and asked that she post her query to the Forum so that others who might be interested could read my response. Having done that, I didn't feel the need to rush to respond online.) 

    I cannot tell you what to do, of course, but I can tell you what the research says: as a first-time mom with a cervix not ready for labor, your chances of labor ending in a cesarean are at least double what they would be if labor started on its own. Cervical ripening agents do not change this fact. As for the rationale for inducing at 41 weeks, this largely comes from an extremely flawed study. You may wish to read my critique of it.

    Even if you refuse the induction, though, you are not out of the woods. Insisting on going into labor in your own time may result in your being subjected to scare tactics to get you to change your mind, and that if you persist, once labor begins, you may be depending on the judgment of a doctor who thinks continuing the pregnancy beyond 41 weeks is risky and who therefore will be overly anxious and who also thinks that you are a difficult patient who cannot be trusted to do what is best. The best I can tell you here is to see how your dr reacts. If the dr takes this tack, the best advice I can give is to make sure that, barring an emergency, any consent you give to medical intervention or cesarean is based on factual information about its benefits, potential harms, and the benefits and harms of your alternatives, including doing nothing. Enlist your labor support companion or companions to help you do this because once in labor, you will be both vulnerable and preoccupied.
     
    -- Henci   
    Archived User

    I wanted to thank you for the advice, and for the warning of my doctor using “scare tactics” to get me to keep the scheduled induction date for this Sunday. They absolutely tried to scare me into having this baby on Sunday, if they told me once, they said it 50 times, that I am running the risk of having a dead baby…YES, they actually used those exact words! I was so insulted, frustrated and ALMOST speechless.

     What is most interesting to me is that they confirmed what I had read, that inducing, especially in a first time mom; with little to no dilation/effacement does in fact double my odds of a c-section and other medical interventions. However, they followed up with “what would you rather have, a c-section with a live health baby, or a dead baby, because it would be awful to come this far and have your baby not survive”. At first they tried to tell me that they would not push back my scheduled induction, however I explained that I was adamant on rescheduling it for late next week, when I am 42 weeks, and was willing to sign a release form if needed. Once they could tell I was not backing down and their scare tactics would not work on me, they acquiesced and rescheduled my induction for late next week, but not before saying “fine the decision is yours but be prepared for a dead baby”. I am OUTRAGED with the treatment I have received, and will absolutely begin looking for another practice as soon as I safely deliver my healthy LIVE baby girl.

    My baby is thriving; she is active and has a strong heartbeat. I am going for an ultrasound tomorrow morning to ensure that everything is going well, which I am confident will be the case. I do understand that my doctor has to look out for his practice and for the well being of my baby, but I do not believe that threatening me with a “dead baby” so that I will follow through with being induced when they want, not when my body and baby are ready, shows no regard for my body or my desires for the birth of my child.  

    Thankfully I have a very strong labor support group, consisting of my husband, my mother and mother-in-law who will be with me every step of this journey. They all know what I want from my birth experience, and will do what is necessary to make sure it happens. In hindsight I wish I would have chosen a birth center or another practice that is more in line with my pregnancy/birth wants and needs. Fortunately we plan to have more children, and I will get to make the necessary change for my next child!

    Archived User

    As an OB nurse for 10 years and then a Home Birth midwife for 10 years I will warn you about your ultrasound tomorrow.  It's another strong-arm technique to get you to have the induction and then the doctor wins the power struggle.  A common finding at this gestation is low amniotic fluid.  Drink a lot of water tonight to help. The doctor will tell you it's a sign of a poorly functioning placenta and a sign the baby has to be born.  I don't know for sure why this is a common finding at this point in a healthy pregnancy (but in 10 years I saw a lot of healthy babies born with lots of amniotic fluid after induction for low amniotic fluid).  My guess is that the baby is so big that the ultrasound is unable to find all the amniotic fluid (behind the baby) to measure and it erroneously tells you it is low.  Henci has some good information about that on this site.   Another part of the ultrasound that gives you false results is the biophysical profile.  Something that measures the baby's well-being.  Many women have been induced for not having the required 8 out of 8 score.  This is just not a reliable test.   Do some homework tonight and have some information with you to discuss these issues with your doctor.  P.S.  It is so heartwarming for me to see a strong woman standing up for her helpless baby.  When I worked in the hospital I just rarely saw this. Stay strong!   Also, meditate on love & kindness for your baby's sake.  It's sad that a woman has to gear up as if she is fighting a war in the days before her baby's birth.

    Henci Goer

    I'm sorry that you are in this difficult position. It looks like you are doing a great job at protecting yourself the best you can. I have one additional suggestion: when you arrive on L&D , ask to be assigned the nurse who is most comfortable with and supportive of women who want to avoid medical intervention whenever possible and who want their nurse to help them make informed decisions about their care by explaining their options, answering questions, and helping them advocate for themselves if necessary. Repeat the request at each shift change.

    I would add too that the irony of their pushing you to risk an unnecessary cesarean for the baby's sake in this pregnancy exposes the babies of any future pregnancies and you as well to threats that are equally, if not more, potent

    Please let me know how everything turns out. And if you do end up agreeing to an induction at some point, search the Forum for posts on induction. Many of them have advice on how to maximize safety and likelihood of vaginal birth.

    -- Henci

    martha mccoy

    what ever happened in this situation, my curiousity is peaked.

    Henci Goer

    If she never wrote back, and it seems that she didn't, I have no way of knowing what happened.

    ~ Henci


    All Times America/New_York

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