Monday, November 26, 2012

Healthy babies are worth the wait

When I was 36 weeks pregnant, I was just done. My feet hurt, I was waking up every hour to pee, and my back was killing me. I didn't want to be pregnant for a second longer.

During my OB appointment, I told my doctor how miserable I was feeling. "Next week I'll be full term," I pointed out. "Can you induce me then just so I can get this pregnancy over with?"

"Absolutely!" she said. "I'll put you down to be induced at 37 weeks, so you'll be full term."

She put me down on the calendar and I went in to be induced at the hospital at 37 weeks. My baby was a little on the small side, but she was fine.

Or........ none of that actually happened.

What really happened? At 39 weeks, I felt like my baby was never coming out. I asked my OB if she'd consider inducing if I made it to 41 weeks so I wouldn't spend my entire maternity leave pregnant. She reluctantly said she'd consider it, but my cervix didn't look favorable so we'd talk about it then. (Fortunately, my water broke two days later.)

I'm honestly baffled by the March of Dimes campaign that says "healthy babies are worth the wait" that strives to eliminate non-medically indicated (elective) deliveries before 39 weeks. I just saw a commercial for it on TV where they were trying to convince pregnant women to wait till 40 weeks. Who are all these women who are being induced prior to 40 weeks??? I don't know one woman who was induced before 40 weeks. I had to BEG for an induction at 41 weeks!

I've asked a couple of OBs and they seem equally baffled by this campaign. Who is it aimed at anyway? It's not like you can just go the mall and get an induction. The OB has to be on board with it too, and from what I've seen, most OBs wouldn't want to induce too early for no medical reason and risk a complication.

Can someone please explain this to me?

33 comments:

  1. I would wager that you know more responsible OBs, because it doesn't seem terribly uncommon in my area. There was one doc who was pretty notorious about inducing everyone 2 weeks early, and I knew people pressured to induce also at a separate practice. This is all heard from the mom side, I don't personally know the OBs.

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  2. Around a quarter of my friends were induced prior to 40 weeks. Often just because they were miserable or wanted to schedule. On this parenting site I used to frequent, we had 'due date clubs' - all women due in the same month. Women asking to be induced, or having it offered because the baby 'was ready' at 37/38 weeks was very common.

    I think it is more common in certain areas than others. Where I live, I do not know anyone who was induced prior to 39w, but many of my friends back where I used to live were, often at their own request.

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  3. My cousin was induced at 38/39 weeks. Luckily she didn't ask my opinion about it...

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  4. I can only imagine the big fat lecture I would have gotten from my Ob had I requested this! Hahaha!!! Maybe it's different outside of big academic centers?

    I do wonder about scheduled c-sections for first pregnancies. I have two friends who had them (and knew they would have one when they got pregnant). I wonder how commonly those are offered as well. I don't really see a huge problem with it... but I can't imagine having the balls to request one at the practice I went to.

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  5. I don't know where you are Fizzy but I have lived places where induction between 37-39 weeks was rampant. Consumer request is a huge driver of this trend but (I suspect) the MOD campaign is just as aimed at non-academic OBs who have the attitude that 37 weeks and 39.5 weeks are the same diff for a fetus.

    Now I live in a smallish west coast city where all the hospitals have agreed to a universal hard stop on non-medically indicated inductions prior to 39 weeks. A declaration they did in part b/c they wanted to present a united front against consumers who were asking for it, "No one in town does it, it isn't safe" If it weren't a thing that happened, then making an agreement between >6 hospitals to not to it wouldn't have been a big deal. But it was, there was a huge effort behind it by the state health department, the hospitals themselves and MOD was involved too. When it was announced there were press releases, newspaper articles and blog posts. It was a Big Deal(tm).

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  6. Wow... where I live, I do not hear a whole lot from MOD or early inductions. I figured the MOD campaign was against scheduled C-sections.

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  7. Nope. Never heard about it. My first pregnancy went to 43 weeks. Doc said would induce if not in labor by next weekly visit (cervix was starting to open). I did go before that visit, but, ...

    To say Mom was miserable was an understatement. Worse, I had nothing left for "natural" childbirth, so here came the Blessed Epi!

    Second baby went 41 weeks, but I was showing signs of pre-eclampsia and the daily ultrasounds showed the placenta was deteriorating. He was induced.

    Both babies are healthy adults now, so I guess waiting was worth it.

    Maybe ...

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  8. I am an OB nurse and trust me, there a lot of women who go in and complain of being pregnant at 36-38 weeks and beg for an induction. This is why there is a rise in c-sections because the women may be tired of being pregnant but the body is not ready.

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  9. I am seriously shocked to hear this. I do not personally know of one woman either online or irl who has been induced for non-medical reasons prior to like 41 weeks. I had no clue this was so rampant.

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    1. I'm so glad that the c-section rates are still relatively low in Germany, where I live, but it seems that they're on the rise as well. It's shocking how many people would easily take an induction for non medical reasons, and it's shocking that there are OBs who go along with it. But then, these OBs probably always preferred the surgery part to the "boring" catching. :-(

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    2. And it's a vicious cycle - moms who aren't physically ready are induced too harshly, prolonged labour, stalling, section. I think many of those c-sections after doubtful inductions could have been normal vaginal births with or without epis etc. if the baby had just been allowed to cook longer.
      "Failure to wait" has become a strongly suspected reason for many sections and /or NICU stays.

      And I'm by no means against medically indicated procedures, sections and all! But this is getting scary, and I feel lucky that I had a wonderful midwife. Reading about that stuff before my birth would have scared the shit out of me.

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  10. Sadly, early inductions are quite common where I work (I am an MFM fellow), but we are making huge strides to eliminate them. Unfortunately...we get a lot of multips who come in 3-4cm at 38 weeks and demand and IOL because "they might deliver on the way to the hospital." True, they might, but they have also probably been 3-4 cm for weeks.

    On the subject of elective C-sections...I see that too. There was even an article in the NY times titled "are new york women too posh to push?". I actually had an elective c-section for suspected macrosomia at 39w4d because I had a crazy unfavorable cervix, huge baby and floating vertex. I figured...my maternity leave has already started...time to have a baby and better an elective C-section than a chorio failed induction c-section.

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  11. You know, I was just ranting on FB about doctors who do stupid things because of some fear that their patients will run away to another doctor.

    I was talking about doctors who add "alternative medicine" and other pseudoscience woo, but this would apply as well.

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  12. In my state Medicaid stopped paying for elective inductions and c-sections and as a result most private insurers stopped paying as well. One of the obs at a large hospital was interviewed and said they now have to get permission to induce so the rate of elective inductions went down to about 1%. If pts have to pay for it themselves they won't do it.

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  13. I had to BEG to be induced at 39 weeks for PUPPPs, GD and 3 weeks of prodromal labor. Even with the begging, they almost made me wait until 40 weeks. That said, a mutual online friend of ours was induced with 3/4 of her kids prior to 39 weeks, but that was with a very ripe cervix and tons and tons of prodromal labor.

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  14. I can't count the number of people I personally know that had scheduled inductions or c-sections between 37 and 39 weeks just because. My midwife offered to break my water at 39 weeks since I was 37 weeks and baby was at a +2 station. I declined.

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  15. I always thought that the early inductions were an exaggeration and nobody really did that. Now I feel downright crunchy because all I got was an epidural.

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  16. I used an OB with #1t and CNM with #2. I had to argue against being induced at my 37 and 38 week appt with my OB. She also stripped my membranes at both of those appts to try and bring on labor. Was induced at 39.

    With CNM, begged to be induced and was at 40w3d.

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  17. This is not at all uncommon, depending on where you live. My daughter was offered induction at 37-38 weeks because her husband WAS DUE TO START CLASSES for the fall quarter. They asked me about it and I told them a medical procedure should have a medical reason. They opted to wait and did induce at 41 weeks (when there WAS a medical reason) and it was an easy smooth delivery. Dad had to go back to class the next Monday but survived.

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  18. I was electively induced at 39w3d with #1. I didn't ask but at 37 weeks I was 2-3 cm and my OB offered to "get an induction date on the calender" if I made it that far. She even offered me a couple of options. I made it and had a good experience overall. My baby was over 9 pounds and caused some good tearing so for #2 my OB said I could be induced a few days earlier (provided I was favorable.) Guess what? I was favorable! Went in at 38w5d and had another healthy baby that weighed over 9 pounds! I'm really not interested in carrying a baby to 41-42 weeks.

    Most of my fellow residents had elective inductions or, in one case, an elective c-section. Usually it was within the first few days of starting maternity leave.

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  19. I am learning a lot from these comments, seriously.

    I asked The Skeptical OB about it when I first heard about the campaign and she didn't understand it either. I think she even wrote a post about how the campaign was insane because all inductions are medically indicated.

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    1. And that's where things break down.... I see no medical indication to induce for "tired of being pregnant" @ 37-39 weeks or maternity leave started. We do need to differentiate indications because a social indication =/= medical indication. Perhaps I'm biased as a Military doc my patients are a captive audience so the need to "please" is not as present. The MOD campaign is against convenience and social inductions as not all 37 weekers are ready to be born and many 37week cervixes are ready to open hence increased c/s rate --which from both medical and fiscal standpoints I humbly think we ought to be concerned about.

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  20. I never heard of anyone being electively induced before 40 weeks either! The only person I knew induced before 40 weeks had all sorts of complications going on so it was necessary. At 38 week appointment my doctor asked if I wanted my membranes stripped since I'd gone from a 1 cm, 10% the previous week to a 4 cm, 60% (if I'm remembering right). I said no, she said, "Don't worry, you're not making next week's appointment anyway." I went into labor 2 days later on my own.

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  21. I know several moms who begged for and got inductions for BS reasons. Back aches, want baby to have grandaddys birthday... Know several others who were pressured into inductions or csections by their OBs for vague but non medical reasons. I was miserable. Pre-e, couldn't feel my feet from the swelling, had fought to stay pregnant and got 14 more weeks than my OB thought I would. Still had to deliver at 35.6. All hands on deck- nicu and adult ICU. I still cried, wishing I'd been able to give kiddo another 2 weeks to cook. (She's fine, after a scary start!). I just don't get it. It's an education issue- the fact that most 37 weekers do fine does NOT mean they all will. Healthcare is not Burger King- sometimes it won't be your way.

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  23. It seriously happens all the time where I live. Very few people here go into labor naturally. I had a friend who was induced at 37 weeks with all 4 of hers. Her 4th needed NICU for a week or so. Basically, most OBs here have an attitude that if your cervix is favorable at 37 weeks, why not induce?

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  24. I am from the "tough crap/suck it up" naturalistic camp but then again I am a male in a specialty that generally only deals with babies in the waiting area. This is on purpose :)

    (hell, I even refer curbside questions to OBs or other babyologists)

    We were not given the option of a trial of natural birth due to a condition that could identify me if I reveal it. But her OB picked the date and we just showed up and the kids came out ready to go.

    Having said that, we were living in the world's capital of "convenience" deliveries, or so we heard ad nauseum at the time, so it came up a lot.

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  25. A friend of mine was just induced at 38 weeks. What baffles me is she claimed her OB said it was necessary because the baby was "so big" - yet she barely weighed 6 lbs. Very unfortunate. It's definitely a problem IMO.

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  26. This does not happen in my area. However, once 41 weeks hits, then they rarely, if ever, let the pregnancy progress beyond that due to worries about placental insufficiency.

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  27. It absolutely happens, and non-medically indicated inductions are rampant, depending on the practice patterns of that particular OB.

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  28. According to the horror stories I keep finding at http://myobsaidwhat.com/, it seems that some practises are just worse than others.

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  29. I've lived in MS, GA, AZ, S. Korea, CA and FL so far (We're military) and I would say 50% of the mothers I know - all in real life had 37-39 week inductions for no medical reason. My cousin had her baby 2 weeks early because they said he 'might' get to big. She did not have GB, or any other risks. Just that her husband was tall. No joke.

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  30. I had to fight to NOT be induced on my due date. Like, I had an appointment that happened to be on my due date and they were all "Oh, well, you're already here so why don't you just head on upstairs and we'll get this baby out." They offered to induce me at 38 weeks, as well, because I was having a lot of mental health issues. And then, to top it off, I finally caved to be induced at 41w 5d, and then I WENT INTO LABOR THAT NIGHT/MORNING. I called the hospital to say I was in labor, and that I'd be in when my contractions got closer together and they said "If you don't come in right now and just get the pitocin, it will be AMA and your insurance won't pay for it."

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