Dear Dr. David:
Thanks for providing such a great service. I'd like to give you a quick run-down on my birth experience, in the hopes that you can give a second opinion.
I went to a midwife in a birthcenter (there were also two OB's on staff)because I wanted as natural a birth as possible. It was my first pregnancy (31 years old) and I was in very good physical condition. I told my caregivers early on that I knew when I conceived. Going by my LMP, my midwife informed me at 37 weeks that she didn't feel comfortable delivering us in a birthcenter because she believed my baby would be large, 8-9 pounds. At 42 weeks, w/ only 1-2 cm dilation and some effacement but no serious contractions, my midwife conferred w/ the OB and they agreed that I should be induced that day.
After 6 hours w/ the PG gel, and lots of walking without any real "change", they put me on a pitocin drip. It was brutal, and I could not move about freely. The labor lasted more than 24 hours; I only dilated to 8 cm and stayed there for 5 hours. When midwife broke my water, it was stained with meconium. She called in OB, who felt that C-section was the safest route. So it was done.
My questions are: according to my records (keep in mind I know beyond a shadow of a doubt when I conceived) my baby was only 39 weeks, not 42 as they said; so, was I really overdue? My son was over 9 pounds, but again, would it have been any worse if I we had been allowed to wait until he and my body went into labor on their own instead of forcing it? I give credit to my midwife/doctor; I believe they did what they felt was best. Having said that, I cannot shake the firm belief that had we not been forced into such an artificial labor, my son and I might have been able to have a very different birth. What do you think, given the above info. Also, can I responsibly refuse to be induced if my next pregnancy goes "late"?
Thank you for your time.
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Dr David
Moderator posted 02 January 2001 11:15 AM
Dorothy
A reasonable summary of some of the issues surrounding post-term pregnancy can be seen at the Canadian Society of O&G's website. Obstetric "dates", or number of weeks pregnant are traditionally measured from the last period, not conception. "Due date" is 266 days (38 weeks) from date of conception, or 280 days (40 weeks) from the first day of the last menstrual period. Up to a quarter of women may normally go past 41 weeks, or be "overdue". This doesn't mean induction must occur, but it probably does mean that a discussion of this as a treatment option should take place. http://www.sogc.medical.org/SOGCnet/sogc_docs/common/guide/pdfs/co15.pdf
The Cochrane database of randomised trials also has a summary of their meta-analysis available on-line. http://www.cochrane.de/cochrane/revabstr/ab000170.htm
Part of the full report reads as follows:
"In health systems in which induction of labour is a safe and acceptable option, the question of induction of labour should be discussed with women after 41 weeks' gestation. They should be informed that about 500 inductions of labour may be necessary to prevent one perinatal death, and that there is no evidence that induction either increases or reduces the likelihood of delivery by Caesarean section. If the woman opts for induction of labour, the choice of method of induction should be based on evidence from randomized trials comparing the available methods. Women or obstetricians who opt for conservative management should be aware of the lack of evidence to support the effectiveness of any particular method of antenatal fetal surveillance."
The evidence suggests that induction for macrosomia alone in the non-diabetic does not improve perinatal or obstetric outcomes. http://www.cochrane.de/cochrane/revabstr/ab000938.htm
"Can I responsibly refuse to be induced if my next pregnancy goes "late"?"
You need to make your own decision on this taking into account the risks of induction (which probably include a slightly higher risk of uterine rupture with VBAC &endash; see refs below) versus the possible (very small) increased risk of stillbirth with conservative management after 41 weeks. You would also need to consider how you FEEL about the interventions involved in induction.
Refs: Zelop CM et al. Uterine rupture during induced or augmented labor in gravid women with one prior caesarean delivery. Am J Obstet Gynecol 1999; 181: 882-6.
Molloy BG et al. Delivery after caesarean section: review of 2176 consecutive cases. BMJ 1987; 294: 1645-7.
Dr.David
DISCLAIMER:
This advice is of a general nature to help in decision-making. It
does not constitute recommended treatment for an individual. You must
consult your health care provider for individual
advice.