Sunday, December 25, 2011

Induction, why, how, when

I have been getting a lot of questions about inducing labor. It seems that providers are offering thirty-nine week inductions at the same time that the March of Dimes is strongly campaigning against it. I hear why questions and how questions and especially when questions. As always, if you have trusted your providers to manage this pregnancy, I think you must trust them to manage the labor and delivery. However, I also believe in empowering yourself with the facts to understand their rationales and question whether you do have choices. Or not.

A pregnancy is forty weeks, give or take about two. Postterm is defined as forty-two weeks. You may be more likely to be postterm if this is your first pregnancy, dates of last menstrual period are vague or you've had overdue pregnancies before. It may be that this is a familial trait; you are at risk for postterm pregnancy if you are obese. Once again, the "Y" gene can be blamed; it seems that there are more boys who are postterm.

Sometimes it is a medical issue with the placenta or the baby. That's why you are monitored so closely when your pregnancy goes beyond about forty weeks. Whatever the cause for your lingering pregnancy, it will end. But everyday can feel like an eternity when your back aches and your feet swell. You are "over" the heartburn and the hemorrhoids, anxiety, nightmares and insomnia. The nursery is getting dusty and every well-meaning relative calls hourly for an update. Don't forget all the strangers in the mall who insist that you must be having twins. You'd know by now.

Prenatal care for postterm pregnancies may be taken up a notch. You might be seen two times a week, a perinatalogist my see you one time and your provider the next. You will have ultrasounds to determine baby's well-being and fluid levels. You'll be watched for signs of preeclampsia. Kick counts are important and so is fetal heart monitoring. Although it's not a great indicator of when you'll deliver, your cervix will be checked for effacement and dilatation.

Your team will determine, if weighing the benefits against the risks, that inducing the labor is best for the outcome of your pregnancy. Baby's size might be a time to consider induction. Perhaps fluid levels are too low or the placenta is aging. Meconium becomes more prevalent, with inherent complications. Ask your provider why the induction is preferred.

With first pregnancies, you may be looking at a two day induction. The cervix is checked and if it is determined that it needs some softening -up, then cervidil may be utilized to get that cervix ready the night before pitocin ( synthetic contraction hormone ) is ordered. Sometimes the cervix just gets a nudge, if it is open enough for an amniotomy ( breaking the bag of water ). That may be all it takes.

You and your provider will determine together what the best course is for this pregnancy. It is possible that this pregnancy will be overdue. It's okay to be disappointed and frustrated. Stay busy, keep working and enjoying a social life. Plans can be broken, so don't hesitate to make them. Change your voicemail greeting and update facebook so that everyone knows your status without the bother of all those inquiries.

Be proactive and monitor kick counts, notify your provider if you might be leaking fluid. Know the signs of labor but don't be afraid to call as much as you need to. I am fond of reminding patients that you are not issued a coupon book for phone calls or office visits. Err on the side of caution. And run any home remedies by your doctor or midwife before you decide to take this labor into your own hands. Many home remedies don't work and some may even be detrimental especially if your body isn't ready for labor.

Rest assured, you will not be the first woman in history to never deliver her baby. One way or another, this pregnancy will end. It's a terminal condition.