My first client's due date is today. She called me after her OB appointment today to let me know that at 40 weeks, she is 90% effaced and 1 cm dilated. This is progress since last week, when she was 80% and not dilated. Despite this progress, the OB has scheduled an induction for a week from today. My client will be 41 weeks on scheduled induction date.

I had a prenatal today with my second client. She has gestational diabetes, consistently measuring 2-3 weeks large for dates. LMP date is exact, so it's not a problem with dating. She will more than likely be induced by 40 weeks.

Both of these ladies are going to be first time mommies.

I feel really bummed that my first 2 clients have strong possibilities of being induced.

Are there any studies or info on the percentage of women that successfully are medically induced and still labor and deliver without pain medication?

Any other words of encouragement or advice? I'm feeling totally bummed.

I would honestly take this experience and learn from it :)

I am curious, but how much do you go into detail with mamas during their prenatals about inductions and the risks and benefits of that? Do you go over the Bishop's score with them?

When I was taking private clients I would discuss this with them at a prenatal which was held way before they got close to their due dates. We would talk about the risks and benefits, and I would bring them a copy of the Bishops score and explain how it works and how if they score rather low then they are risking leaning more towards an unsuccessful induction and then a cesarean birth. I also discussed how inductions could influence pain management, how inductions mean continuous fetal monitoring and less mobility. In fact, I even do an exercise with moms (not specifically geared towards inductions, but more to show them how unmobile they can be with continuous fetal monitoring). I took ace bandages - two large ones and put velcro on them with a string attached to simulate the two monitoring belts. I take another smaller one and use that as a blood pressure cuff, and then I tape a cord to their hand for the i.v. Each of the strings has a clip on the end and so we clip those accordingly to close furniture and then mom gets to try to move and change positions with these in place. Doing this exercise can really open a mama's eyes and so later when we discuss the inductions and I mention how she will be continuously monitored she remembers what that felt like to be that tied down.

Honestly I have found that at this point you might not have success changing their minds, but instead can support their decision. I know I found myself in the same position with a few of my first clients and it was so frustrating and that is when I decided I would hit them early with the information and empower them with questions they can ask if their doctor brings it up. I also do go very thoroughly into making sure there is a good fit between mama and healthcare provider and suggest that mama know a lot of these things well before she gets close to her due date.

Sending big hugs, and not sure if I really helped.

At my very first prenatal visit with a client I ask how her due date was established. Even if they know the exact date of LMP does she know if she has a 28 day cycle or a 35 day cycle? Does she know that if left to nature that NORMAL human gestation for first time moms is 41 weeks 3 days? But yea, induction without pain meds is totally possible. I did it. It depends on how commited they are to not having them for the most part. Good luck.

I would honestly take this experience and learn from it :)

I am curious, but how much do you go into detail with mamas during their prenatals about inductions and the risks and benefits of that? Do you go over the Bishop's score with them?

When I was taking private clients I would discuss this with them at a prenatal which was held way before they got close to their due dates. We would talk about the risks and benefits, and I would bring them a copy of the Bishops score and explain how it works and how if they score rather low then they are risking leaning more towards an unsuccessful induction and then a cesarean birth. I also discussed how inductions could influence pain management, how inductions mean continuous fetal monitoring and less mobility. In fact, I even do an exercise with moms (not specifically geared towards inductions, but more to show them how unmobile they can be with continuous fetal monitoring). I took ace bandages - two large ones and put velcro on them with a string attached to simulate the two monitoring belts. I take another smaller one and use that as a blood pressure cuff, and then I tape a cord to their hand for the i.v. Each of the strings has a clip on the end and so we clip those accordingly to close furniture and then mom gets to try to move and change positions with these in place. Doing this exercise can really open a mama's eyes and so later when we discuss the inductions and I mention how she will be continuously monitored she remembers what that felt like to be that tied down.

Honestly I have found that at this point you might not have success changing their minds, but instead can support their decision. I know I found myself in the same position with a few of my first clients and it was so frustrating and that is when I decided I would hit them early with the information and empower them with questions they can ask if their doctor brings it up. I also do go very thoroughly into making sure there is a good fit between mama and healthcare provider and suggest that mama know a lot of these things well before she gets close to her due date.

Sending big hugs, and not sure if I really helped.

We spent LOTS of time discussing the issues that can come up and the risks involved.

Both mommas don't WANT to be induced, but one having GD, has been advised by her doctor since they found out about it that she will probably be induced. She has had such a troublesome pregnancy (almost losing the baby at one point) that she would rather just do as the doctor says and not risk a large baby or any medical issues with him.

The other momma, induction scheduled at 41 weeks, doesn't want it and totally understands the risks and we have talked in depth about the pain management issues that it brings up. I have another appointment with her tomorrow and am trying to collect the most helpful information that I can offer her, on top of what we have already discussed. She is really tired of being pregnant and so part of me thinks that she might agree to the induction at 41 weeks just to get the pregnancy over with. I don't want to try and persuade her of anything or talk her into or out of anything. I just want to be sure to provide her with all the info I can so she can make her own choice.

that always kills me. if you dont want to be induced, just dont freaking get induced....

I dont know what studies show but I have had all 3 births induced with pitocin (two I had to have cervidil) and I never gotten an epidural.. I did however get stadol with my first..

It is possible!! I think it will depend on who her OB is too whether or not they will allow positions or whatnot.. I had a midwife (she is apart of the OB practice I go to) for all 3 of my births and I were able to sit in a rocking chair and with my last I even stood for awhile and used a birthing ball while being induced..


Good luck to them both! :squeeze

that always kills me. if you dont want to be induced, just dont freaking get induced....
Ditto. They can say NO or not show up (unless it was completely medically necessary, of course).
Supposedly I had GD (was with an OB) and when I spoke to 2 midwives about it afterwards I discovered that my OB was EXTREMELY conservative with the numbers. By the standards of the midwives I would not have been considered gestional diabetic.
I'm not so sure I believe in the whole GD thing anymore anyway...

Ditto. They can say NO or not show up (unless it was completely medically necessary, of course).
Supposedly I had GD (was with an OB) and when I spoke to 2 midwives about it afterwards I discovered that my OB was EXTREMELY conservative with the numbers. By the standards of the midwives I would not have been considered gestional diabetic.
I'm not so sure I believe in the whole GD thing anymore anyway...

With the first client who is just being induced because she maybe "overdue" I would have her hold her ground with her OB. Or at least work on things to get it all moving before she is induced.

With your GD client, I'd be careful with that. I had a midwife for my first who said I didn't have GD and my child was almost 10lbs at birth and had Shoulder Dystocia. Plus my father has diabetes and I was over weight, and that puts me at higher risk for it. Gestational Diabetes is serious and should be treated as such. Perhaps you can Google it and see what the American Diabetes association or the Canadian Diabetes Association recommend. I'm sure there is information out there, it is just a matter of finding it. And have your client talk to their Endocrinologist about what they think about not getting induced.

Sorry, I'm rambling I know, I have kids clamouring all over me. Gotta go.

K. :dust

that always kills me. if you dont want to be induced, just dont freaking get induced....
I am right there with you. If they truly don't want it then they just don't need to show up :) Unfortunately sometimes I think mamas say they don't want to be induced, but they are so sick of being pregnant and then add to that doctor pressure and they easily cave.

I have a question about "not showing up" for an induction..

Say if they were 42 weeks and didnt show up, is it true eventually everyone goes into labor? And if not what if the OB refuses to induce next time because you didnt show up before?

I've always wondered this cause I go to 42 weeks and they don't mention inductions until 42 unless something is wrong. I'm sure if I didnt show up someone would be upset.. I regret getting induced but I'm extremely thankful cause I had a great expierence.. Can they tell if your placenta is ageing by a u/s? I know they constantly check with NST's and u/s for the fluid.

yes, eventually EVERYONE goes into labor. in fact i have a friend who was just pregnant for over a year had her baby last night, healthy, small little girl!!! check outt he ten month momma page on birthlove.com theres no reason to induce for post dates alone. if theres something wrong with momma or baby thats one thing. no they cant tell crap about your placenta and the fluid thing is largely a myth. as for gestational diabetes, i have mixed feelings about it. i dont think its as big a deal as they make it out to be, but it does tend to lead to a much larger baby than your body might normally make. one of the few times where it may be possible to build a baby just too big for your body. my last momma had GD tho, baby was 9lb 9oz and if she hadnt been so tired i think she would've gottenh er out fine with nary a tear.

do you care if they get upset that you dont show up for thier induction?? most of the moms i've met who got scheduled didnt even get to pick the date, it was usualyl just convenient to the doctor. no offense but f*** that, IMO.
also check out "induction and circular logic" you should be able to find it ont he midwifery today site, if you cant i'll email it to you. they did a study showing that rate of stillbirth actually doesnt increase till 43 weeks, and even then its very marginal. the 42 week date was set from a poorly performed study done in the 50's.

I think the whole GD thing is blown way out of proportion. I think it's silly to test people that have absolutely no risk factors by giving them a ginormous amount of sugar. I've met several moms, like myself, that have no history of diabetes in the family, are not overweight and eat a healthy diet that have failed the GTT.
I like Henci Goer's article on GD http://www.gentlebirth.org/archives/gdhgoer.html.

As far as not showing up.... If the client doesn't feel comfortable saying that she doesn't want to have an induction she can always say that she is sick. No one wants to have a baby when they are sick, right?

Of course, these are only suggestions and your client has to be the one to decide what she wants to do.

i've had quite a few of my moms heavily resaerch GD and decide not to test for it cuz they feel the test is jsut as dangerous as the ailment. i have had a couple test anyway since they've had gd or similar issues before. it definitely helps to be informed.

Good thread Ladies! In my opinion GD is overblown. Yes, it's helpful to know your "numbers" so that you can control GD through DIET. Hello, diet? Yes most type 2 diabetics control their insulin levels with diet.

As for not showing up, what can the Dr do? Flog you with a wet noodle? Yes, they might refuse care because the patient is "uncooperative" but if they're uncomfortable with their provider then that isn't such a bad thing. Now if the parents really like the Dr or midwife they should have open lines of communication so induction dates shouldn't be an issue. Right?

I agree that dates are often off. There is just no sure way to date a pregnancy. Does mom have a long cycle or a short one? When does she ovulate? When was the sperm introduced? My aunt ovulated at the end of her cycle, like on day 5! So her dates were always off.

I look forward to hearing what happens with these two mommas.

:ghug

It's not that I would care who I pissed off, but what if they refused to induce later.. I guess thats my issue with my body, since I went to 42 weeks I feel like maybe I'm one of these people that just can't get labor started on her own.. I did get to pick my date so I got to choose my induction with my midwife.. The obgyn practice I went to has a midwife and 4 OB's, I just felt more connected to her and she was the one that delivered my last 2 children, but I've had a midwife induce with all 3 of mine..

I just worry about this cause we know we want a 4th, and my dream is to maybe have a homebirth or at least a birth in a birthing center in water. I know they won't allow inductions there though, so I dont really know what to do.

As far as dating the pregnancy, I didn't know when I got pregnant with my first two but with #3 we were trying, we had actually had to get help to get pregnant and ttc for 3 1/2 yrs, so I could tell you the day I got pregnant and still went over that much.. But that said none of my babies were big, my first was 8lbs 8oz and my other two were 7lbs 12oz.. Great sizes IMO for being 42 weeks.

Oh raspberry, I cant find that article on midwifery today, could you PM it to me or email it? ksmith1154@triad.rr.com..

Thanks! :sgrin

there's no such thing as someone who can't get labor started on their own, at least that i've ever heard of. as for them refusing to induce later on, if there is a medical emergency i beleive they're bound by law to treat you (anyone know if that's untrue?).
I will definitely send you that article. with your babies being such smell/normal sizes i think its definitely possible they just need a little longer to cook. imagine if they induced you at 38 weeks like some doctors are starting to do? you would very likely have a preemie on your hands. i am glad to hear tho that you got the care provider you wanted and that it all went well.
i think you could still for sure home birth. in this area if you go over 42 weeks you can still home birth you just need to check in weekly with a doctor to make sure the heart beat is still normal, baby is growing, and your BP is ok, that sort of thing.

here is a little motivation for you :http://www.birthlove.com/free/ten_month_mama.html

btw, your avatar is hypnotic LOL

LOL I know isn't it? Thats one reason why I liked it so much.. Plus I love daisies.. :happy

Oh I know! If I would have been induced at 38 weeks I would have had a 5lber I'm sure! I wouldnt have allowed that though, I do give it until 42 weeks before I a allow them to do anything, I just wonder what would they say if I had refused.. It's amazing how OB's have such power over you thinking you have to get induced at 42 weeks, I'm actually a little afraid to go over 42 weeks cause of the "placenta breaking down" or the stillbirth thing.. Yet I see all those momma's on that website you posted about going to 46 weeks!! :omy

the placenta breakdown is largely a myth, it happens in less than 1% of cases, and generally not till after 43-44 weeks. (which who knows, maybe your bake time is 42 w 1 d?). and if baby does show signs of distress, then induce, no reason to do it before. induction is meant to be a lifesaving technique, not elective. actually, crap i dont know if i cant ifnd it but there was a study done in canada recently that showed induction only made a difference for one in 1000 births. so they would have to induce 1000 women, to save one baby. seems a little extreme considering the risks of induciton itself?

Lynn...are you a member of the birthlove site? Is it as good a resource as it claims? It sounds as if it would be a great place to get info.

i used to be i need to renew, it is TOTALLY worth any fee to belong there.

Lynn...are you a member of the birthlove site? Is it as good a resource as it claims? It sounds as if it would be a great place to get info.

I like birthlove too, but as with many things, take it with a grain of salt.

Looks like induction #1 is going down as scheduled. I had met with her on Friday and talked with her again about what an induction would mean for her birth plan (less mobility, probably much stronger contractions, an IV, EFM, no shower/tub, etc) I also left her with a copy of Ina May's Guide to Childbirth and Henci Goer's Thinking Women's Guide to a Better Birth...so she could do some more reading and research on her own and weigh her options.

She was bummed and said that she just wasn't sure, but had an appointment with her doctor on Monday (today). The induction was offered by the doctor last Wednesday, but doctor said it wasn't necessary, it was simply offered because my client for convenience and 'peace of mind' I guess you could call it.

My client went in to her Monday appointment today to talk more about induction. Her blood pressure was good. She called me this morning complaining of racing heart and trouble breathing. I had her place a call to her doctor, who thought it was an anxiety attack, maybe caused by a dream. Her belly measured 44 cm today at 40.5 weeks so the doctor told her that the induction would probably be best.

She will call L&D Wednesday at 6am to see if they can take her. I will meet her at the hospital. I'm nervous and a little sad.

Does anyone have specific tips for helping with an induced labor? She will have lots of help- her husband, her mother, her mother's girlfriend and me will all be present to support her.

What about trying diferent ways of bringing on labor?

She's tried doing acupressure, walking, nipple stimulation. She did not want to try castor oil or other homeopathy/herbs though she has been drinking raspberry leaf tea throughout her pregnancy. Her husband won't have sex with her either. =( It freaks him out for whatever reason.

jsut do the same pain releif techniques you normally would. make sure she is able to move around, it will help. expect your arms to be sore the next day!

I am having the same problem the doctor told my client she going have a induction on monday... her due date is saturday. Here the thing she was explaining to the doctor why she did not what to get a induction because she wanted to have mobility..so she could deliver natural. Well I guess he ask her why she wanted a natural birth it was not like, "she was going to get award for it". :jaw Can you believe some doctors. :cursing She worried because he says she will not have any type of mobilty. Oh..and another thing he already told her he going to break her water at 12 p.m. Can you believe that. Well :crossed that her baby comes before monday.

Susan

I'm not sure what kind of induction she will have but for my last two inductions they did an amniotomy so I was not hooked up to anything and had complete mobility. And I'm not sure I even needed the epidural but was so used to them I got it anyway.

Good luck to your client.

K.

to me this would be a red flag to CHANGE DOCTORS!!!! you have the right to change up till the baby is crowning and even then its probably negotiable.

I'm not sure what kind of induction she will have but for my last two inductions they did an amniotomy so I was not hooked up to anything and had complete mobility. And I'm not sure I even needed the epidural but was so used to them I got it anyway.

Good luck to your client.

K.


Well I did explained to her she did not have to be stuck in bed that she could move. ..not sure about this doctor....not sure why he told her she had to be stuck in bed.


Susan

to me this would be a red flag to CHANGE DOCTORS!!!! you have the right to change up till the baby is crowning and even then its probably negotiable.



yeah,,,...don't think she will do though.

Susan

well thats certainly her choice as well. i just cant imagine staying put with someone who obviously didnt respect me, kwim?

...She worried because he says she will not have any type of mobilty.

Susan


I had a client once who was augmented with Pitocin. She really wanted to labor in the Jacuzzi (you can labor in Jacuzzi even after membranes have broken at this hospital). They told her that she had to be on the monitor for 45 min. at a time because of the Pitocin; so after every 45 min, we unhooked her and she sat in the Jacuzzi for 15 min. at a time! We just rolled her IV pole (for Pitocin drip) over to the tub with her and covered her IV hand. No, it wasn't the best and ideal situation, but it allowed her to have at least some mobility. There's usually more room for mobility than some Dr's will allow you to believe! Of course, my client did have a CNM, which made all the difference, I think! ;)

Just wanted to let you girls know I am heading to the hosptial...the baby is coming. I am soooo excited.


Susan

Just wanted to let you girls know I am heading to the hosptial...the baby is coming. I am soooo excited.


Susan

:woohoo Good luck to you and momma!!!!! Let us know how everything went when you can!! I'm so glad that she isn't being induced. :clappy

YAY!!!!

You can have mobility with pitocin.. Or at least I did.. I got to stand, sit in a rocker, go use the bathroom and use the birthing ball all while on pitocin.. Only thing I had to do was to get internal monitering but I thought it was worth it just to get out of the bed..


Oh, how was the birth???? We want DETAILS! :rofl