Thursday, December 06, 2012

Inductions

Unorganized post ahead.

When I was interviewing midwives, one of the most important things I was looking for was someone who wasn't afraid of pregnancies going past 42 weeks. Margaret was thoroughly past 42 weeks and Isaac was pushing 42 weeks. I needed someone who wasn't going to drop care with me if 41 weeks came and went.

Almost immediately upon me asking about their "overdue" policy (you know how books are 10 cents each day overdue at the library!) most midwives started reciting off various natural induction methods they recommend. I didn't get any midwife saying that she'd recommend a mother to go get pitocin or anything like that- it was just, "Oh, when a woman gets to 41 weeks I start suggesting chiropractic/castor oil/acupressure/acupuncture/such and such herb/etc." What I wanted to hear was, "Oh 42 weeks- no big deal, especially with your history."

Maybe I'm the only pregnant mom in the world that doesn't want to try any induction method at all, even if it's "natural." It seems to be common consensus that the "natural" options aren't going to work anyway if your body isn't ready for it. So the point of trying them at all is...?

Some options, like castor oil, can run havoc on your system (diarrhea!)- why would I do that and then discover, "Oh, well, it didn't work so your body/baby must not be ready?"

So birthy friends- what's your opinion on natural inductions? Why is it such a big thing in the midwifery world? I interviewed 4 homebirth midwives this time and each one had some sort of favorite induction method. Is 42 weeks really that scary? 43? Personally, I'd want someone who wouldn't be suggesting that I induce, even naturally. It would be telling me my body couldn't do it- or that they themselves are afraid of a "big" baby. Why would I want a midwife afraid of big babies?

Do you think "natural" inductions work? Did you try it? Did it work? Was it worth it? Am I the only one who wonders, "So what's the point...?" I promise it's not that I want to draw out my pregnancies as long as possible- I get really uncomfortable at the end. I've already been struggling for months with getting my body up out of bed (followed by about 20 feet of waddling due to sciatica pain). It's not pleasant, to say the least. But is it really worth it to cut those last few days/weeks off if nothing else is indicating that there's a problem?

For the record, my midwife hasn't been suggesting that I do anything (yet) since I'm not at my "time to have a baby." She does tend to think I'll have this baby sooner than I expect, but I think she just doesn't get that I gestate long. She's looking at a 3rd time mom and thinking, "Oh, this will be faster and sooner than these other births I'm attending!" HAHAHAHA. Sure, maybe I will, but I'm not going to get my hopes up. I already did the "I'm going to have a baby any day!" thing with Margaret for over a month and that's not fun.

I look forward to your comments.

21 comments:

  1. I can't vouch for your state or the midwives you interviewed, but here in FL midwives are not allowed to care for you after 42 weeks. According to state law, once you hit 42 weeks, your midwife is supposed to accompany you to the hospital for an induction (YIKES). I don't expect a midwife to lose her ability to earn a living because my baby isn't born within 42 weeks, but it was quite the gun to be under. Fortunately my baby came exactly at 42 weeks (and we probably could have fudged some numbers in my chart somewhere to buy a few more days, but not much more than that). I did try the "natural" induction methods but I didn't believe in them and don't think they mattered in the end. My baby came when she wanted to. I'm just glad she came when she did.

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    1. That's exactly why I was glad we went UC with Margaret- we would have been dropped by a midwife and had an induction. And if my body responded to that the same way it did to my normal birth hormones (44 hours labor) I probably would have been failure to progress and sectioned. I know a lot of people are against UC, but sometimes it's the only option if you want to avoid interventions. I understand why states would have a lower limit for midwives attending births (like 37 weeks) because too early and you've got a NICU baby. But maybe we need less restrictions on "overdue" ness.

      California is like Florida- we have a 42 week limit. Some of the midwives I talked to were more comfortable about going all the way to 42 than others. Some would start induction options earlier than others because of that worry.

      I'm also curious if the 42 week limit in CA includes things like 42 + 4. That's still "42 weeks" and not yet 43...

      And I imagine due date fudging can be really easily- after all, doctors change due dates due to ultrasounds all the time.

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  2. I am with you on the induction thing. But I know as a doula that it seems like moms all really start to get really tired of being pregnant around their due date and they usually ask for something to do, anything they can do, to make them feel like they are doing something. I think that it is so easy to get a date stuck in your head and tell yourself you can endure till then, then once it passes it is hard to wait. I have never gone past my due date and so I can't really say, but it seems to me that the lessons that "waiting" teaches you is almost more important than having your baby come sooner. There is a lot to learn from waiting for the baby to be ready-- physically and spiritually to come.

    Best wishes by the way! I can't wait to meet your little one.

    Oh, and by the way I've never had castor oil not work on a client who was past her date! Though I am not really sure it is worth it in the long run... I'd rather just wait it out than have the side effects of castor oil!

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    1. I think the waiting is amplified by everyone around you wanting to meet the baby, too. "When are you having that baby?!" I wonder if we need a new term for "due date" because it gives the impression that the baby should be born by that date instead of around that date. There's also a bit of shame like, "Why isn't my body working- it's supposed to have a baby by now." I know when I went over with Margaret some of the "Weren't you due last week?" comments felt like, "You can't even have a baby when you're supposed to! Failure! Stupid young mom," especially if they came from older women. And when your friends who are due around the same time are having babies and everyone is happy for them and you're still pregnant and feeling like a whale... That sucks.

      And re-reading that paragraph... yeah, I had some issues. This is why we do "due seasons."

      And then there are extra issues involved that aren't even related to the health of the baby or mom... like maternity leave. If you took time off before your baby arrives and then the baby is 2 weeks "late," in many cases you lose 2 weeks on the other end of your maternity leave. So I understand that sort of impatience- you'd want as much time with your baby before having to go back to work.

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    2. Also, I couldn't imagine someone saying "Weren't you due a week ago?" with the intent of "your body can't do this, you're a failure." If they seem surprised when they say it, I'd think it's more a testament to our culture's high induction rates and the fear doctors instill in their patients that they don't even need to get to their due date. I'd be surprised to hear of someone making it to 41 weeks without a doctor trying to talk her into inducing...Not because 41 weeks is bad, but because doctors usually try to push as many interventions as possible. For me, that "surprise" would not reflect negatively on the woman though - rather, it would reflect a positive opinion that the doctor wasn't being so darn pushy. :-p

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  3. I accidentally induced via relations with my husband. It was the exact due date that I calculated myself, but a few days early compared to ultrasound/midwife calculation.

    I also induced contractions the same way several times before, so I didn't really believe I was in labor until I hit transition... I had the same problem with baby #2 (not being convinced I was really in labor, that is) without any induction-y things.

    My mom induced me with a whole bottle of castor oil and we somewhat suspect that may have lead to my rather blue pallor at birth--that's a LOT of castor oil!

    My sister did castor oil because her husband asked her to but she doesn't think that's what did it--she only took two tablespoons over a several hour period, and according to her doctor it couldn't have made a difference. I'm unsure.

    I don't really have to worry about the 42 weeks thing, as I have not yet met my due date with either of my babies. I gestate on the shorter side, I guess. Good luck!

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    1. Ah yes... the sex induction! I think we'll keep that up as per our regular sex life, but I'm not going to start increasing frequency just for the induction factor. :) I'm not sure how we're increase frequency anyway... we're pretty dependent on when the kids are sleeping and we're not both tired out from the day already!

      Ooh... whole bottle of castor oil. Funny thing- about 3 days after Margaret's birth, I found a whole bottle of castor oil in our first aid kit. Could have used it... except I wouldn't have. You actually have to drink a lot of castor oil, from what I've read, though- like 3-4 ounces. I think our bottle is somewhere between 6-8 ounces. I should check.

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  4. I don't really have anything to add to your discussion of overdue-ness, other than that it seems I've heard people get scared of 42/43 weeks because then "problems" happen. (I don't remember any specifics though...Can't the placenta stop working and the baby die or something?? I don't go that long so I haven't exactly researched it much. You seem to have a positive history with it though!)

    I did want to ask though....Have you had any issues with using your "due season"? Seasons are so long, it seems people would bug you even more? I don't remember roughly when you're due this time, but I'd imagine your due season is Winter? Wouldn't people be saying, "It's winter, so you're due now, right? Are you overdue yet? Are you overdue....now? .....now? ......nnnnnow?" :-p I think if I were in your position, I'd just tell people "The baby will probably be born ___" and then give a rough date about 2 weeks after your official "due date." I.e. If you're due the middle of a month, say the beginning of the next or some such thing?

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    1. Some people will say that the placenta will start showing signs of "aging" after a certain point and placentas of babies that are later show more signs of that. I've also heard a counter argument that the fact that these labors are happening at that point shows that the body knows when it can't sustain the baby any long and goes into labor and that those "aging" placentas are evidence of the body working correctly. And I've also heard that the infant mortality rate doesn't increase significantly until after 43 weeks- meaning that 42 weeks and some days is still in the realm of normal and not a worry. I did a lot of reading on it with Margaret, but that was almost 5 years ago. I wonder if there is more information out there now.

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    2. Oh, about the "winter" thing, I remind people that "winter" is between Dec. 21 and March 21 and not to start worrying until Easter. :)

      I did a due season with Isaac. I said "summer" and most people assumed late July or August, so I there wasn't any upset when he came in the middle of July. No one was bugging me yet! Well, except for the fact that I was huge by the time May came around. :)

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  5. I am hesitant about inductions as well. I have had friends say, "I don't think I ever would have gone into labor--I went four days passed my due date and had to be induced!" I try to tactfully remind them that two weeks before or after the due date is all "normal" but people do get antsy once the date arrives (and I personally have never gone "over" so I can't speak for that). My aversion to inductions is that I want my baby to have as much time to grow as it needs. My first came 12 days "early" and my third was 1 day early, but had a 40 minute labor, start to finish. I am honestly worried what I would do if I had a fourth child--I am afraid the labor would be even shorter than 40 minutes and I wouldn't make it to the hospital in time or the midwife wouldn't make it to my house in time. My midwife said they could "manage" my labor by breaking my water next time, so I wouldn't risk a rapid unattended birth, but I really don't like the induction idea--what if the baby needed 10 more days to grow and wasn't ready to come at 39 weeks or whatever?
    It's probably a safety regulation to induce at 42 weeks for your midwives, but I agree that it's hard to consent to a "one size fits all" rule for your individual circumstances. Maybe you could sign some type of waiver acknowledging the risks of going past 42 weeks and assuring them you won't hold them responsible, etc if you go past 42 weeks and complications arise.

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  6. It's been a long time since I've commented, because I usually just read in my Google Reader now. But I wanted to chime in on this topic, because I was induced with my first. And through the whole experience, I felt like little bits of my autonomy where peeled away....with the very last bits totally washed away with the breaking on my water bag! I was only 38 weeks, and the doc had used a pretty good scare tactic to get me to "consent". I am often overwhelmed when I think of how incredibly horrible that birth could have been if my body had not already been preparing for birth. Luckily, breaking my water put my into labor. I don't think I realized then how dangerous the whole situation was.

    I've never gone past 40 weeks, my second came on his own at 39 weeks. So I can't say how I would feel if I was waiting. But I definitely feel that induction, at any time, is a loss of what should be. And I think that the pressure from everyone else is a huge factor in how a mother handles her due date. I felt a lot of pressure from people to have my baby even before I hit term!!! ("Wow, you haven't had that baby yet?" "You look like you're about to pop!" "Are you having twins?" All of those felt, to me, like I was being pregnant too long, or looking too big.)

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  7. I read about your 'due season' and therefore refused to tell anyone my baby's due date. When people asked, I said, "Oh, probably by Memorial Day," even though that would have been 43 weeks. One person (a NURSE!) even said that I'd just better induce before that weekend - and this was when I was only about 16 weeks!

    The first time the doctor measured her after IVF and told me a due date, I said, "Babies come when they want! Babies don't have calendars!" Yeah, she came at exactly 40 weeks, the exact date he said. :)

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  8. My induction was a terrible experience. Even though I was already in early labor at 41 wks 4 days on the day of my scheduled induction (everyone in that practice was scheduled for an induction when they hit that day) I would not do it again. I might try natural methods if i reached 42 since going over 42 weeks would immediately disqualify me from a homebirth here in PA. Any chance you just ovulate a lot later? When I started charting I discovered that I regularly ovulate on between day. 18-21. I know other women who don't ovulate until day 30 or later. I imagine that "delayed " ovulation also probably affects due dates significantly. When I went in for my first prenatal the nurses didn't even know how to calculate due date from ovulation date! I just had to tell them a made up first day of cycle so it would adjust.

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    1. With Margaret- my 43 weeker- I knew my ovulation day- the chart was very clear- and it was actually before the expected day 14. In fact, we found out I was pregnant on June 30 (actually a couple of days before my missed period because I was anxious) and had her on March 29, and with February having a leap year that year, we knew I was pregnant for a full 9 months! I also knew Isaac's ovulation day, too, and because I was breastfeeding, it was actually later in the month. This time I wasn't charting as regularly, but from the partial chart, I think I ovulated about 3 days later than the normal day 14. That puts me 3 days later than what my midwife is using as my EDD. I probably should have told her a different LMP date. She keeps asking me if it really was a regular period (maybe she suspects I'm counting implantation bleeding?) but it really was a regular period. I've never had any implantation bleeding or any bleeding at all in any of my pregnancies until bloody show when I'm in labor. I've been lucky like that.

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  9. Sex jump started my labor with Peanut, but after that it was long and difficult because she was posterior. I almost wonder if it would have been better if it were not jump started. With Twig, I definitely felt done, but I tried more to focus on getting my body ready rather than getting her out. I got adjusted regularly by the chiropractor for the last few weeks, spent a lot of time sleeping and relaxing, and stuff like that. I also spent a lot of time walking, but that was in large part because it gave me something to do and made me feel better.

    My friend, who had the same midwife as me, went something around 42 weeks and 5 days. The midwife was in no rush to get the baby out. She told me at one of my appointments (where I had a slightly elevated BP, so was asking what would happen if I developed other signs of preeclampsia) that if she really needs to get a baby out, she has the mom go on a juice fast. That's only for emergency situations though. Otherwise, just let the baby come when it comes.

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  10. The only "natural induction" techniques we tried were walking, sex, and the "Come OUT, Baby" track from Hypnobabies. You're right that induction stuff won't work if your body's not ready. At 41 weeks with Charlotte, a friend brought me a sausage casserole and we'd walked 28 blocks. That night my birthing time began. I was induced with Cervadil with Stephen, but I think he would have been a 41+ baby instead of a 40 (I was induced due to high blood pressure issues).

    I think a lot of women just need to gestate longer. And that's OK. At least you know your track record, and can plan accordingly.

    And I would NEVER, EVER try castor oil. The sausage/birthing time cleaning out was enough for me---I wouldn't want some of the violent reactions I've heard of to it.

    I am pretty sure that in most states 42 weeks is the max for home birth midwives. I guess if it got to that point, you could always UC again. :)

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  11. KaralynZ8:48 AM

    I was charting my cycles precisely with my pregnancy so I knew the date of conception - my son was born ON his due date, at exactly 40 weeks, so it wasn't an issue for me.

    If I had gone over and the midwives had wavered I would have lied about my dates.

    I would never try castor oil or anything that had yucky side effects but by the end I was trying the pineapple and walking as much as I could. I was DONE.

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  12. I tried a bunch of stuff, but nothing worked. 38 or 39 weeks was the end of a dry spell and the beginning of operation sex induction. 40 weeks I started pumping daily-ish. It was the weirdest thing EVER when colostrum started coming out a few days later. 41 weeks, 2 cervical sweeps and I began black cohosh. 41 weeks 5 days was castor oil. That was pretty gross. The worst part was trying to consume more of it after the first dose. Operation S.I. continued as I continually reminded my poor, exhausted hubby that he HAD to get this baby out of me, lol. I was delivering at the birthing center at Sutter Davis (run by midwives) and the first I heard the word induction was at the 41 weeks 4 days NST. They had to schedule me for one at 42 weeks, but it was just a formality, and they were sure the baby would come by then. The absence of pressure was refreshing. My plan was to just go in for another NST at 42 weeks and decline the induction. Our appt was for 8 or 9am. I lost my mucous plug and felt my first contraction at 4:30am. Fifty hours of labor later, I was FINALLY pregnant no longer! Your henna is so beautiful btw!!!

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  13. Great to find another friendly face in the crowd! My short story (without having read all these great comments...). Induced with #1 at 41wk (naive), natural w/#2 at 41wks, induced w/#3 at 38ish? high blood pressure (still a little naive), let it ride w/#4 to 42weeks, natural. Gestate long...and super quick labors. I finally found my voice with #4, and was able to stand strong, as long as there was no distress, midwives, and all were happy enough to let me go. Doesn't quite answer you question, but I wanted to sympathize!

    Second to this. I had never heard of prenatal depression. I feel like you just gave me a label for some of my experiences! Makes more sense. Ah-ha. Thanks.

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  14. Fabulous post! Just had my first homebirth a few weeks ago with babe #4! I appreciated all you said about natural induction. I couldn't agree more. Babies will come when ready. And I have in my inexperience and lack of support really become too anxious and exhausted myself emotionally unnecessarily in previous pregnancies. Next time around I won't share my due date....novel idea!

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