Induced - to be or not to be...?

[Picketty]

I don't post on here very often, I'm much more of a reader, but I think I need some advice. At my Ob appt a couple of days ago (36w+3), my Ob said baby is measuring a bit large, currently about 38 weeks, and that it's current weight was estimated at 3.3kg (although he did say the machine estimates about 10% more than irl). He says that if we left it to term it could well be over 4kg. I also have preg-related low platelet count (currently at 71), so he wants to induce me in 2 weeks. I've done some reading over the last couple of days and I'm not entirely sure his reasons for inducing me are valid, but also that inductions can very quickly lead to c/s. I'm not against a c/s if it is medically necessary, but I don't want to be forced to have one just because he thought I couldn't vb my baby.

My DS was brought on via a SnS and arrived at 38+5 weighing 3.57kg, and ended up being a forceps delivery. I had a lot of drugs during his birth and didn't remember much of it, so I was really hoping for a much more active birth with less drugs this time around. Ob thinks that this baby will almost certainly be bigger than my DS.

I don't find my Ob very easy to talk to, and he whizzes through things at a million miles an hour so I struggle to take it all in. He wants to do an internal in just under 2 weeks, and then induce the next day.

What are your thoughts on his reasons/my options please?

[onthefly]

It doesn't sound like you're comfortable with the idea. It's really important to see eye to eye and have full confidence with your health carer - do you feel you have that?
Personally, I would ignore warnings about big babies. 4kg is not that big - both of mine were over 4kg. I was induced first time, against my better judgement without any real medical indication and it did not go well, so this is where I'm coming from.
Of course you would do what was necessary to care for your child,but you have to have the confidence that what your health carer is telling you is right. When they are dismissive or untrusting of the mother, it's pretty hard to have confidence.
I suggest reading up on internals and the risks of early rupture of membranes, infection, etc. If he feels these things are necessary, then it's up to him to make a solid case to convince you, not the other way round.
Good luck.

[HotI]

my first was 3.7kg, augmented labour and a vac assisted birth. my next two were close to 5kg, and 4.5 kg and were natural births without any assistance. They were ready to be born, and i was free to move around, and both these contributed to the easier births.

i would not induce for a 'larger baby' prediction, nor for post dates, without serious indicators that baby or i needed the pregnancy to be hurried up.

Have you found any techniques that work in getting yourself heard, and getting the Ob to explain clearly? I would find that really difficult working with someone who wasn't able to answer my questions. You might find it easier to write your questions and concerns and send them to the Ob prior to your appt, asking for a written response or let him know that is what you would like to discuss at the appointment.

I would want to know risks and benefits of inducing at that time (39 weeks?), and of waiting. What effect will induction have on the blood condition? How may the blood condition affect vaginal birth/assisted birth/c section?

What is the point of the internal in 2 weeks?

I would have come away with a lot of questions, and disappointed that the Ob didn't explain better so that i could make informed decisions.

[MrsFabuloso]

IMO, unless your health, or your baby's health are in danger some way from a natural birth, being induced is unnecessary.

If you need more information from your OB, make a longer appointment with him before he wants to see you next, write down all of your questions, and concerns and talk to him, possibly talk along a support person who might know about things, like a midwife or doula, or just a freind/hubby for some strength and support. If you're still not comfortable with his reasoning, don't do it. Just remember that you don't have to.

Good luck.

[Ginger]

What is the actual reason for the induction? Is it to do with your platelet count? Or is it because they think the baby might be big?

[BellyBelly]

Some great advice - but its unclear here the reason why he's inducing. Its not cool if he's making you feel fearful of a 'big' baby. As already pointed out, its not huge, my third was a 4kg bubba and as a doula I have seen 4kg bubbas being born without any issues (without drugs or forceps/vacuum).

Some doctors will mention shoulder dystocia but its a positional thing and seen in babies of all sizes, even 7lbers.

Good luck and good on you for doing your research. Follow your gut, I find it to be very accurate. And from what you describe about your Ob whizzing things around and not taking time to explain things to you and reassure you, imagine how labour might be for you with someone like that. You'll always remember how you felt during birth, you dont get a second shot - make sure you're happy with your carer and you trust them to do right by you x

[Ca Plane Pour Moi]

I plan to tell health "care" providers to expletive off.

Check out the NICE guidelines 2007 for antenatal and labour care for the lapses of professional standards your Ob is showing.

[Picketty]

Thanks ladies. I'm not entirely sure why he wants to induce me, a combination of the potential size (although I dont think it seems massive), and my platelet count. The low platelet count means the blood has trouble clotting, and I could potentially bleed out. I am aware of that risk. He says the internal is to see how ripe the cervix is, but with my DS he said he was going to do an internal, and without asking did a SnS. When I was pregnant the second time I went with a different Ob because I didn't like/trust my original Ob, but sadly that pregnancy ended early, so I went back to my original Ob for superstitious reasons. I regret that decision now.

We've had a student midwife following us, and she was at the appt the other day, so I'm going to ask for her take on what he said - perhaps his reasons are clearer than I remembered.

I had actually got to the stage where I was sort of looking forward to labour and felt confident in my abilities, but my confidence has all been swept away in one short appt.

[Bumperstump Cummerbund]

My post is going to be more about induction than anything, mainly because I see you're in Perth as well and you might be going to the same hospital my sister went to.

She was induced at 35+6 for GD and a full sized bub. They told us several times that she would be able to walk around, get moving, and in all likelihood once they got her dilated and broke her waters she'd do the rest herself, so she said yes. What ACTUALLY happened was they got her dilated to 4cm, broke her waters, and she wasn't allowed to get up because she needed continuous monitoring for the syntocinon. They had told us she would be able to use wireless monitoring, but the midwife said they aren't equipped with it. So she spent the next 40 hours sitting in bed trying to have a baby before getting a caesar because of 'failure to progress'. And she also wasn't allowed the waterbirth she'd been promised because of the drip. All of which they could've told us before she said yes to the induction, but they chose to lie about.

Whether or not you induce is obviously up to you, but I wanted to give you her experience.

[onthefly]

Ugh! That doctor sounds terrible! That is absolutely not the way you should be treated. SnS without consent is assault.
I know you're at the pointy end of things, but I urge you to think about seeking alternative care. I assume you're private? Would you consider hiring a private midwife instead and birthing in a public hospital, for instance? Or just go public. I had a much better experience at our local public - Swans - than I did with a private OB at Mercy.
You and your baby both deserve much, much better care than this.

[Picketty]

Thanks for sharing your sister's experience BC. I'm due to go to Murdoch - is that where she went? The trainee midwife said all the same things - mobile, able to get in bath etc, but as most inductions seem to also have an epi then I would end up immobile, making the process harder.

I think I've worked out what the Ob's train of thought is, and that is that if I have a large baby I would probably want an epi, but I cant have an epi if my platelet count drops too low. So his idea seems to be to bring the baby on while my platelet count is still reasonable, so I can have an epi if I want. But I've never said to him I def want one, just that I'm open to pain relief options. I'm still not sure it's a viable enough reason.

I do like the hospital and the midwives there were all fantastic, so I'm loathe to change hospitals so late on, but it's safe to say I wouldn't recommend my current Ob.

[Bumperstump Cummerbund]

No, not Murdoch. I don't think I can say where it was on an open forum, but it's the high risk one

Not all inductions require an epi - my other sister (I have 3) was induced with her first one because her waters had already broken, and she went on to do the rest naturally. The sister above did eventually need an epi, but we both honestly believe that if they'd just let her get up and move, she would've been fine.

I've only heard good things about Murdoch though!

[HotI]

Even with a syntoc drip and continuous monitoring, it is possible to get off the bed and sit on a birth ball or walk around as far as the leads can reach. They may not like it, but there s usually no medical reason to stay on the be d.

This can make continuous monitoring a little less 'accurate', but continuous monitoring has its own issues, and the evidence doesn't really support its use.

[Mummato2]

I've had both an induction and a natural drug free birth.

I won't lie, the induction was rough. The natural birth was nowhere near as painful and bub was a bigger baby.

That said, a few points above stand out. Firstly, you HAVE TO trust your care giver. It might be worth a second opinion from the midwives? Are you seeing a private or public OB? At the very least, I'd be getting a second opinion. If you're private, maybe book in with the public midwives and see how they'd manage you. See which way 'sits' better. Kelly is right, gut instincts are generally very spot on.

Secondly, the platelet issue can potentially be a big issue. Once bub is out and you deliver the placenta, you are going to bleed (everyone is different as to the rate of bleeding, but you will bleed). If your platlet count is really low you could potentially bleed at a rate that is problematic. Since no one on this site is a medical doctor - I would be asking your OB before the appointment in 2 weeks, what options will you have if you decide to go full term and go into labour on your own. You might actually find that low platelets mean very little whether you are induced or go to term. You might find it makes a substantial difference and upon learning this - induction is a no brainer.

Thrombocytopenia is the term I think - perhaps check out google and look for general info. That'll help you create a list of questions to prepare for the next visit.

No matter which way you go, you MUST have full information to make a sound decision. If your OB races through things I'd be wary of this while in labour. You need to get all the information - seek out a midwife, GP, OB or community nurse appointment within the next couple of weeks and be armed with confident info before your next OB appointment.

Good luck xx