Induction methods most favorable to a natural birth?

[Proserpina]

Been shooting for a natural birth in the hospital (this is my birth plan). I'll be 41 weeks tomorrow and consented to my first third trimester cervical check this morning, only to have confirmed what I suspected for myself from checking at home: cervix is completely closed. My doctor (whom I like, who is a 3rd year family practice resident, whom I have a good relationship with) wanted to induce me on Saturday (I'd be 41 + 1), but I flat-out said "no." I asked to be allowed to go to 42 weeks before being induced. He spoke with the "most liberal" attending physician about my request and she said the latest she'd be willing to let me go before inducing would be Tuesday, when I'll be 41 + 4.

I asked what methods they'd be looking at trying for induction. They said Pitocin and/or a mechanical method (like a Foley's catheter or something?). I know for certain that I want to stay off of a constant Pitocin drip.

I'm still hoping and praying that my body goes into labor on its own so that this becomes a moot point. I can dig my heels in more on being induced at 41 + 4, if I have to. But if it comes to taking an induction, what kind of induction would be most likely to allow the rest of my labor and delivery to progress naturally? Any ideas?

I'm going in on Saturday morning at the crack of dawn for a NST and an u/s to check baby's amniotic fluid levels. Doula is coming with me as she's concerned they'll try and foist the induction on me then.

 

[Amygdala]

Would they offer you a stretch and sweep? That's a fairly "natural" method, in that it just kicks things off (increases prostaglandin levels around the cervix, but these are produced by your own body) but doesn't involve continuing intervention. The downside is that you have to be at least a cm or so dilated to be done.

I personally wouldn't consent to waters being broken, as it puts you on a clock. If it doesn't cause contractions, you have no alternative but to consent to pitocin or even a section at some point, as the risk of infection increases quickly.

Have you tried nipple stimulation (with a breast pump). It has about a 1/3 chance of working if you're far enough along but you've got nothing to lose there. Methods vary from 15 mins each side once to a lot longer, so I'll opt to just go on the pump whenever I have nothing better to do, eg while watching tv.

I don't know much about gels and pessaries but think they're considered more gentle than pitocin, if they're available to you?

If you have to go on pitocin, you can ask to be given an initial dose and for it to be turned off, once labour gets going. Often things progress by themselves.

If you do go that way, try not to worry about it too much. My MIL had two drip-induced births and still managed without other drugs with both of them.

What exactly do they mean when they say they won't "let" you go any longer though. It's not like they can force you? Or are they saying they'll only deliver you if you consent to induction by 40+11? What happens if you say no, can you get monitoring on a daily basis to make sure baby is still well?


Just a side note as well, as I'm in a similar situation (40+7 today): I've looked at the research for birth outcomes compared between induction and expectant management (monitoring and waiting) and it's not at all black-and-white. A few studies suggest that the c-section rate is lower for induced post-term births than for expectant management. I've not made my mind up about when I'll consent to induction if it comes to that but have a read around yourself, it seems that at some point, induction might actually give you a better chance of a natural birth!

Oh and a second side note, as I'm in a rambling mood: I'd ask which of the induction methods are going to be least restrictive to you once labour starts, ie can you still use a shower/pool, can you move, do you need to be monitored continuously etc.

 

[Proserpina]

Thanks, Amygdala. Good information.

I haven't tried nipple stimulation with a breast pump because my insurance won't put out for the breast pump until after baby is here. I guess I could look into getting a cheap hand pump and try it.

My cervix is completely closed, so I don't think a sweep is an option. I'm sure my doctor will offer another cervical check tomorrow; maybe I will allow it if a sweep is an option if I've dilated at all. Otherwise I don't see the point.

I'm going to be pretty resistant to the idea of breaking my waters for exactly the reason you said. I did think about asking if we could try an initial dose of pitocin, then see if my body takes it from there.

I don't like the language of "letting" me go so far, either. When my doctor said that yesterday, I blurted out, "Says who?" I have no idea what they would do if I dug my heels in and played the "I refuse treatment" card; I don't think they're used to patients who are this outspoken about their treatment. I hate to be in conflict with them like that, but I feel like they need to do a better job of explaining why it's so darned important to them that I be induced before 42 weeks. (I'm worried that I'm falling prey to defensive medicine bullcrap.) As I see it the worst they could possibly do is drop me from the practice. I doubt they would do that prior to the delivery (that's ethically questionable), but they could do it afterwards. (There's court orders, but I've never heard of a court-ordered induction, only court-ordered c-sections.)

If you can point me in the direction of this research on going post-due naturally vs. induced, I'd like to see it. I'll try to look into it myself. It isn't just a c-section that I fear though. I had my labor augmented with Pitocin + breaking my waters last time. DD didn't tolerate it well, I wound up with an episiotomy + forceps delivery to hurry up and get her out, and I was the rare person who had an extremely negative outcome from the episiotomy (3 years of dyspareunia). So I'm really wanting to avoid instrumental delivery/episiotomy as well.

And I'm so sick and tired of people telling me, "It doesn't matter, so long as you have a healthy baby." Well, yeah, obviously that's goal #1, but I'd kind of like us to have a healthy mother, too.

Anyways, gonna be at the hospital tomorrow @ 7 AM for monitoring, and I'm sure they'll try to push me to induce again when I come in. Wish me luck!

 

[seaweed eater]

FWIW, my doula said she likes Foley catheter best and tries to push for that when possible, and that she would advise consenting to a sweep if an induction is looming. I couldn't have either of those done, though, because I was completely closed, so I don't have any experiences to report.

Cervidil is better than Pitocin IMO. In any case Pitocin is not indicated if you are closed. Cervidil is just prostaglandins...kind of like EPO (or so I told myself)! Cytotec is also used to ripen the cervix sometimes, but what I heard and read led me to believe that it is kind of scary and should be avoided. I did have Cervidil (no Pitocin) and, while I don't have anything to compare my experience to, I doubt that the Cervidil made the pain much worse. I did get an epidural late in the game because I had an uncontrollable urge to push (and I would do that differently next time, knowing what I know now) but the pain itself wasn't unbearably bad for me.

AROM is risky because it puts you on the clock and of course makes you and baby more susceptible to infection. But I might take that over Pitocin depending on how things were going.

So if I were you, I would ask for a sweep tomorrow if possible, and then, should you end up being induced, insist on Cervidil (not Cytotec) if you haven't progressed and Foley if you have. And go from there.

Good luck. I hope things happen naturally for you

 

[Kitteh_Kat]

I second the Cervidil. I refused to be induced with Pitocin at first, so we all agreed to do Cervidil. They insert it up into your cervix, and it releases prostaglandins to help dilate it. They left it in for 12 hours, and when they checked me after it was removed I had went from 2 CM with no signs of progressing on my own to 5 CM and in active labor, and then progressed a CM each hour.

Hope your delivery goes well!

 

[Amygdala]

Sorry, I didn't take notes of references but just had a quick search for you again. I think this paper probably sums up what I've found: There's conflicting evidence (WENNERHOLM, U.-B., HAGBERG, H., BRORSSON, B. and BERGH, C. (2009), Induction of labor versus expectant management for post-date pregnancy: Is there sufficient evidence for a change in clinical practice?. Acta Obstetricia et Gynecologica Scandinavica, 88: 6–17. doi: 10.1080/00016340802555948). Sorry I couldn't post a link. There's plenty of references in this paper to have a closer look as well. Hope that helps to get you started.

For a quicker option, try putting "induction expectant management post date pregnancy" in google scholar or an academic search engine.

Fingers crossed for you. I completely agree that while a healthy baby is obviously top priority, the way in which they arrive and the psychological and physical impact on both mother and baby are very important as well. So stand your ground (not that you need telling ) and I really hope you get the kind of birth you want!

 

[Proserpina]

Well, here's how things turned out.

To make things very short: came in on Saturday for the NST, etc. and was only a 1. The doctors still wanted to induce then, but gave me the option of having a sweep and going home for one more day, so I took it.

Came in at 7 AM on Sunday, September 29th, and was found to be a 2 that could be stretched to a 3 and 50% effaced, so they decided to skip the mechanical induction and just try a low dose of Pitocin. I stopped asking for more time because I was edging pre-eclampsia.

Was on a Pitocin drip of 1 ml/hr for 3 hours, then they bumped it up to 2 ml/hr for 2 more hours. Then they took me off the drip and my labor was progressing on its own. I delivered after 8 hours of induced labor. The only other intervention used was a vacuum extractor (baby was 9 lbs 5 oz, direct occiput posterior). No pain meds.

Thanks for the advice and feedback. I'm glad things worked out okay in spite of having to take the induction.

 

[seaweed eater]

Sounds like you and your little boy did wonderfully! Congrats!!

 

[Joyfulsahm]

This thread encouraged me a lot. I'm past my due date so this has been on my mind as I'll be facing induction if nothing happens.