Sorry if there is a thread about this somewhere else, but I didn't see one.
It looks like I'm going to have to have the induction talk and scheduling on Monday. Unfortunately I'm not seeing my normal doc (I love him but he is out of town) and I'm not very comfortable with the partner I'll be seeing. I've been really hopeful that things wouldn't get this far so I have very little knowledge on the subject other than I want to put it off as long as possible as long as everything else is looking good. I want to be as prepared as possible with regards to knowing my options and deciding what is right for me. Anyone have any good resources regarding various induction methods?
I personally wouldn't talk induction until at least 2 weeks post date. If your baby and your body is tolerating things well, there is no need to rush things, IMO.
Also, have you tried some minimal, interventions yet (like membrane stripping)? I'd start there if you absolutely must move things along.
Dylan 4/22/04, Devon 6/24/06,Dorothy 9/13/07, Derek 12/19/09, Daniel 12/18/10, Daphne 2/24/12
Mindie and Mark, 5/16/09
Just found this and thought it was interesting. It doesn't have much info about other options, but it's a good overview of the true statistics behind inductions.
Friday, January 28, 2011
“Except When Medically Necessary” : Making informed choices about induction of labor
by Amy Romano, CNM
This post was originally published on Science and Sensibility for Lamaze International.It’s not hard for women to find advice and recommendations to avoid induction of labor “except when medically necessary.” But what do those words mean and who decides when an induction is medically necessary?
Lamaze’s Healthy Birth Practice Paper cites ACOG Guidelines that define medical induction of labor as necessary in the following circumstances:
Yet a systematic review of the highest quality research found evidence only to support the first three. Even in these three cases, differences in important health outcomes were small, study methodologies have been criticized, and some important questions remain unanswered.
- your water has broken and labor has not begun.
- your pregnancy is postterm (more than 42 weeks).
- you have high blood pressure caused by your pregnancy.
- you have health problems, such as diabetes, that could affect your baby.
- you have an infection in the uterus.
- your baby is growing too slowly.
For the rest of this list and other so-called “medical” reasons for induction, we simply lack scientific evidence that induction offers any clear health benefits, and for other conditions the available evidence suggests induction is more likely to harm than help.
When trade-offs are uncertain for a proposed course of treatment, that treatment is known as “preference-sensitive care.” According to the Dartmouth Atlas of Health Care, a leader in studying practice variation, “Decisions about these interventions — whether to have them or not, and which ones to have — should thus reflect patients’ personal values and preferences, and should be made only after patients have enough information to make an informed choice, in partnership with the physician.”
As the Dartmouth Atlas has demonstrated for many types of medical and surgical interventions, however, decisions are more likely to reflect local practice patterns and the preferences of individual providers than the preferences of patients themselves. While the Dartmouth Atlas does not track induction rates, a 2004 study in New York State found that risk factors (at least those documented in birth certificate records) explained just 12.6% of the four-fold variation in induction rates across hospitals.
But what of the variation in the use of interventions when clear evidence suggests is harmful? Shouldn’t rates of those interventions be stable at or near 0%? Take, for example, the rate of elective (non-medically indicated) deliveries before 39 weeks. In a landscape where clinical consensus is hard to come by, all of the major players from ACOG and ACNM to the March of Dimes, the National Quality Forum, and the Joint Commission, have gotten on the no elective deliveries before 39 weeks bandwagon. Yet this week a major hospital watchdog group, The Leapfrog Group, partnering with Childbirth Connection and the March of Dimes, released for the first time hospital rates of elective deliveries before 39 weeks and the results are all over the map (pun intended). Some hospitals are in the low single digits, rates we know are possible when quality improvement efforts are taken seriously, while others report up to half or more of allbirths between 37 and 39 weeks are electively delivered.
Women need individualized, evidence-based information about the likely benefits and harms when considering induction of labor in the face of complications or significant risk factors. Childbirth Connection has launched a new web resource dedicated to Induction of Labor to help fill this need. But evidence is just one piece of the puzzle. Women also need information about maternity care practice patterns in their communities, since this factor seems to affect their likelihood of induction more than any other. Leapfrog’s voluntary database of elective early delivery rates stands to drive significant quality improvement. Let’s hope it’s just the first step toward full transparency of maternity care quality.
I just barely got beaten to posting the article
If it comes to medical induction, my advice is start with the least invasive methods possible--cervadil/prepadil and foley catheter before moving on to pitocin.
Remember that having an induction scheduled doesn't mean you have to show up for it.