Thinking of Getting Induced? Know the Odds

39 weeks pregnant can be a tough time. You’re so close and yet, you’re not in labor. Perhaps you don’t even have any signs of labor, or worse — you’ve thought you were in labor three separate times now. Forget the physical discomfort and exhaustion — the difficulty now is all mental. Your spouse, your mother, your best friend are all checking in on you, watching you, waiting for you to report any sign, any contractions… anything at all! And as if that isn’t enough, a friend, your sister, even your doctor starts talking about getting induced. You are, after all, at 39 weeks. Why wouldn’t you?

The thought of getting induced near the end of your pregnancy can sound alluring. You get to plan around your baby’s birth day, you can stop wondering if you’ll know when you’re in labor, and you’ll finally be done with being pregnant! But before you jump so quickly on the “getting induced because I can” train, let’s take a look at the odds.

Getting induced nearly DOUBLES your chance of having a cesarean. (Source)

Cesarean surgery (or c-section) significantly raises your and your baby’s risk of complications. See this complete list. Beyond cesarean, different methods and medications used to induce carry additional risks. Unless you are considering induction for a true medical reason, take some time to think about the implications that induction could have for you and your baby. If your care provider is recommending induction, ask about your Bishop score. If you are a first-time mom and your Bishop score is less than 6, your risk of cesarean is the highest at 50%.

Waiting can be really, really hard. And uncomfortable. And long. But waiting until your baby initiates labor has so many benefits (see here, it’s worth 5 minutes of your time). Think of the trade offs. Putting in the hard time now can really pay off in the end.

 

 

 

Your Due Date May Not Be Your Baby’s Birthday

The following resource is reposted with permission from the Lamaze for Parents website.

By Marilyn Starr Curl, CNM, LCCE, FACCE

From the time that you learn you are pregnant, the countdown to your due date begins. But the seemingly simple question “When are you due?” can really be answered by only one person: Your baby.

For earlier generations of women, the concept of a due date was “around Thanksgiving” or “late fall.” As birth moved from home to hospital, women were given the approximate date when they should expect to be confined to a hospital bed, called the “estimated date of confinement.” Eventually, this term evolved into “expected date of delivery,” now called “due date.”

Unfortunately, a specified due date has made women (and their family and friends) place too much emphasis on a precise day – to the point that they plan their life around it. Your baby doesn’t have a calendar, however, so it is no surprise that less than 10 percent of babies actually arrive on the date they are due. For the other 90 percent of pregnant women, what does your due date really mean?

The Numbers Game

Many health-care providers use a sonogram to pinpoint your due date, but don’t be swayed by technology: A date based on an ultrasound can be off by a week or more depending on the skill of the technician, the timing of the sonogram and the size of the baby. Until 13 weeks of gestation, most babies grow at the same rate, but as pregnancy progresses, fetal size corresponds less and less to the amount of time that the baby is in the womb. So while many health-care providers keep giving ultrasounds to reassess a woman’s due date throughout her pregnancy, the date is actually becoming less accurate as time goes by. In fact, there’s really no need for a sonogram to determine a due date unless you don’t know the date of your last period.

If you do know the date of your last period, try the following calculation, called Naegele’s Rule. Babies have a gestational period of about 280 days, so count back 3 months from the first day of your last period and add 7 more days. Your approximate due date is that day within the next year. Take note of the word “approximate:” Your baby will grow and mature on his own schedule. The only thing you’ll know for sure is that you should give birth within two weeks before or after that day.

Wait It Out

Many women (and their health-care providers) become so attached to their due date that when the baby doesn’t come on that day, they schedule an induction. But because the due date is unreliable in the first place, inducing the baby may cause him to be born too soon. These “near-term” infants (as they are known) can have trouble breathing, staying warm and breastfeeding, and they often need special hospital care after birth.

Induction isn’t without risks for you, either: Research has shown that a first-time mother whose labor is induced is twice as likely to have a cesarean as one whose labor starts on its own. When you let your baby choose his own birthday, it means he’s really ready to begin life outside the womb.

Remember: Your due date is an estimate of when you will give birth, not a guarantee. If you are “over due,” just count it as more time to establish a bond with your baby, to prepare mentally for motherhood, to discuss your partner’s role during the birth and to ready your home for your baby’s arrival. Consider telling family and friends that you are due “sometime in May” rather than on a specific day in order to prevent a daily barrage of phone calls near the end of your pregnancy. Trust that your baby will know when the time is right for his big debut. It will be worth the wait for everyone.

For More Information:

Which due date should I use?

Babies are worth the wait

 

(Due date calculator screen shot from TheBump.com)

Are You Due on Christmas? Don’t Be Pressured into an Induction!

In the rush of the holiday season, most people worry about on-time delivery of important gifts and packages for friends and loved ones.  But if you’re a pregnant woman due around the holidays, there’s an added worry about when your baby will arrive.

Around the holidays, many pregnant women experience pressure from family or their healthcare providers to “schedule” their baby’s birthday around festivities and travel plans.  Be aware, however, that scheduling a baby’s delivery without a compelling medical reason can put your baby at risk.

“Few doctors want to be pacing the halls on Thanksgiving or Christmas, waiting for a mother to deliver,” said Marilyn Curl, CNM, MSN, LCCE, FACCE and president of Lamaze International.  “So it’s not uncommon to see a surge of women with normal pregnancies being told that there might be an issue and that they should consider scheduling the delivery, coincidentally, right before a holiday.”

It’s not just your healthcare professional who may try to rush your baby’s arrival.  Families often can feel stressed about the uncertainty of the baby’s arrival and feel it may compromise the celebration of holidays.  Some women also fear that their preferred healthcare provider won’t be available and will agree to a scheduled early delivery to guarantee that their provider will be available for the birth.

“I really understand that pressure.  You build a relationship with your care provider over the course of a pregnancy.  Plus, you build up expectations about your holiday celebration.  So it seems like ‘no big deal’ just to get the birth over with,” said Sue Galyen, RN, MSN, HCHI, LCCE, FACCE, a Lamaze childbirth educator from Brownsburg, IN.  “But it’s so hard to think that a scheduled delivery, whether through induction or cesarean, was worth it when either the mother or baby experiences a complication as a result.”

One complication of scheduling your baby’s birthday is that often, baby is delivered just a little too early.  A growing body of research shows that giving a baby those last few weeks or days inside the uterus can be crucial to the baby’s health.  Babies born even a “little” early face risks including breastfeeding difficulties, learning and behavioral problems, breathing problems, increased chance of time in the neonatal intensive care unit (NICU) and risk of death.

You can play a key part in driving down avoidable prematurity.  “Red flags” that might signal being pressured into an unnecessarily early delivery include:
• The care provider suggests that the baby is too big and will be easier to deliver “a little early”
• The suggestion is made that the care provider won’t be available for a holiday delivery or will be “booked up”
• The timing of the delivery is centered on travel and celebration schedules
• Holiday stress is driving feelings of wanting to get the pregnancy “over with”

Here are some things you can do if you feel you are being pressured into an early delivery:

  • Ask your provider if you need to make a decision right now.  If not, ask why not?  Few decisions need to be made on the spot unless the mother or baby are clearly doing poorly.
  • Research your options.  Use credible sources of information, like LamazeChildbirth ConnectionMothering Magazine’s online forum or your doula to see what the research says and talk to other moms about their experiences.
  • Make a pro/con list.  Label your pros and cons with “medical” vs. “personal” and weigh the “medical” pros and cons more heavily.  If you are talking about a major medical intervention like cesarean or induction and you don’t have a good list of cons, it’s a good sign that you need to do more research.
  • Trust your gut.  Your instincts are geared to protect you and your baby from risk.  Listen to what your gut is saying in the context of the research.
  • Find support.  It’s hard to disagree with your health care provider, so be sure that you go into your appointments with someone who can help you have an informed, evidence-based conversation about your best options.

Inducing labor without a compelling medical reason is one of many routine interventions that has not proven a medical benefit to mothers and babies and can impose harm.  Other common routine interventions include continuous fetal monitoring, coached pushing, being positioned on your back during labor, requiring repeat cesarean surgeries for women with a prior cesarean and separating mothers and babies after birth.

You can learn more about the Lamaze Six Healthy Birth Practices by enrolling in a Lamaze childbirth education class and visiting www.lamaze.org/healthybirthpractices.

Finding Your Most Accurate Due Date

Calculating your due date can be tricky. Unfortunately, it’s not as simple as knowing the date of your last menstrual period (LMP), a tool used by most online due date calculators and care providers. Even the high-tech ultrasound, which can be helpful in detecting some things, is not the best at figuring out your due date.

Knowing your most accurate due date is important as you near the time of birth. Many care providers impose limits for how long a woman can go past 40 weeks before scheduling an induction (despite guidelines from the American Congress of Obstetricians and Gynecologists stating that a full-term pregnancy is 42 weeks). If your due date is calculated for July 1, but your actual due date is July 10, you may receive unwarranted pressure to induce when in reality, your baby has not even reached 40 weeks gestation. Inductions carry a host of risks and interventions and should be scheduled only if medically necessary for the health of you and your baby.

So how do you calculate your most accurate due date? Childbirth Connection has created a simple worksheet to answer questions and use in conjunction with your care provider to determine your due date. The form is below, and it can also be downloaded on the Childbirth Connection website.