Another update... Advice Needed.

14 posts / 0 new
Last post
SoniaNoemi138's picture
Joined: 01/24/11
Posts: 569
Another update... Advice Needed.

35 weeks today!!

I've been here for 12 days now. Bloodwork still looking good. Bp has been good to borderline high as well. We just finished another 24-hour urine collection today, hope to get those results tomorrow. A sonogram last Thursday showed that bloodflow from both my arteries on both sides of my ovaries (around there) is not optimal but the main source, the umbilical artery is good. They will most likely do another sono this Thursday (hopefully to check for growth)

My question: the plan is basically to induce at 37 weeks (in 2 weeks!) the dr stated they have to do an amnio to check on her lung maturity. I already told her I wasn't going to do that, that I had previously declined an amnio and she went on trying to convince me that the chance of miscarriage is really low blah blah blah and steroid shots are not advised after 34 weeks. Is this true? Do I absolutely have to do an amnio now that we are so far along? There have to be other options. Right? I would have to have to do this now when I was so adamant about not having it done previously. Is my other option to watch Thalia struggle to breathe if she were to be born now with under developed lungs?

Thanks again ladies!!

Joined: 03/16/15
Posts: 53852

thats a tough decision. Personally, I would probably deny the amnio, because a baby at 37 weeks is considered full term, and can probably breath on its own. But that is just me. Whatever you decide, just listen to your gut feeling, and talk with the docs some more to way the pros and cons and discuss your concerns more with them. Sorry you are having to go through all of this. Sad

Disneykat's picture
Joined: 01/02/07
Posts: 486

I'm with Melissa on this one. I would deny the amnio myself as well.

BloomingRose's picture
Joined: 12/03/08
Posts: 992

First, I'm glad that so far all is looking well! Hope all your results continue to come back good!

Next, I don't know anything about amnio, so I hope I don't sound stupid or silly, however, I'm not sure I totally understand WHY they want to do an amnio to check her lungs?? By 37 weeks their lungs are good to go. Hailey was born at 37 weeks, 2 days and had no troubles. Is it because she was measuring a bit on the small side that they want to check? Would a regular u/s not be good enough to check?

Also, I went and looked up about the steriod shots and the one site I read said usually between 24-34 weeks. You're just now getting to 35, therefore, if you're really concerned, I would ask what the risks are doing it at 35 weeks. The lungs are generally the last to do all the final things to get ready. I'm sure someone else with more knowledge though can give better advice lol.

As a patient though, you have the right to take all the pros and cons of things and make the best decisions based on what you know. Unless you're wanting to do something really stupid, I can't understand why a Dr would argue and try andmake you do something else, kwim.

Hang in there, and good luck. KUP on what goes on etc.

Roobear's picture
Joined: 03/26/08
Posts: 343

Here's the nurse side of me:

Even at 37 weeks some babies are not ready from a lung maturity point of view. This could mean something as small as needing a little help with oxygen or pressure to keep the air sacks open, to full on needing a ventilator and administration of a substance called surfactant into the lungs to help them open up. An amnio to check for lung maturity basically looks for certain cells and substances in the amniotic fluid that come from the lungs that show whether or not the baby is making enough surfactant on their own. The risk of miscarraige they talk about when doing an amnio doesn't really apply so late in the thrid trimester, that is more of a 16-20 week concern. Any time you insert a needle into a person though there are risks, so of course you have to take the into consideration.

My bigger question would be, if baby looks ok, and you bp is ok, and your labs and urine are ok, why induce at 37 weeks? Why not give baby as much time as possible to give a better chance of the lungs being ready?

The mum side of me now....

I would decline the amnio, and probably push to not be induced at 37 weeks if there was no clear indication as to why. Bottom line is if at any time you need to be delivered, whether it be today, tomorrow or at 37 weeks, for your health or the baby's health, they won't even do the amnio cause it doesn't matter. If it is safer for baby to be out, then baby needs out. I would say, if they want to do an amnio to check lung maturity, and if the results come back that the lungs aren't ready, then they won't induce, you don't really need to be induced at the point. KWIM?

Prudence's picture
Joined: 05/02/05
Posts: 256

Yeah, it's a myth to say that AT 37 weeks- their lungs are perfectly fine. My DD ended up in the NICU after being induced at 37 weeks, plus a few days. It was a short stay- 5 days- but definitely not ideal. She just could not get the whole breathing thing down.

Now, I think Roobear has the most sensible advice. JMHO.

zoe08's picture
Joined: 09/09/08
Posts: 665

Personally I would deny the amnio.

If they feel that inducing at 37 weeks is necessary, than really it shouldn't matter what the amnio says. My friend had her boys at 35 and 36 weeks due to pre-e and she had steroid shots with both...neither of her boys ended up in NICU and her littlest one was born at 4lb 13oz.

So I would either ask to go ahead and get the steroid shots as a precaution for having to deliever early, or just wait it out and most likely at 37 weeks baby will not need the NICU, though there is still a possibility she will, but there is always that possibility even at 38,39, 40+ weeks.

Danifo's picture
Joined: 09/07/10
Posts: 1377

Babies who come on their own early (36-37 weeks) are more likely to be ready than babies who are induced at that stage.

To say that all babies born after 37 weeks are fine because that is term is BS. I'd say a third of the babies in the step down NICU were delivered after 37 weeks. On average they seem to have short stays (5-8 days). There are a variety of reasons besides lung maturity...

Will they still induce you at 37 weeks if you decline the amnio? That is a guideline so they may be reluctant to do so.

mandi04's picture
Joined: 08/10/03
Posts: 2272

I agree that babies at 37 weeks aren't necessarily ready as far as lung maturity. You just never know. My 34 week 5 day daughter did better than my 35 week daughter. My son was a few days shy of 37 weeks and did fine but there are other babies that don't.
I don't think the risk is miscarriage at this point, I would imagine the risk would be infection or labor. If an infection started I'm sure the results wouldn't matter and they'd get the baby out ASAP.
I do agree with denying the induction, if she really needs to come out than the amnio shouldn't matter because she'd be deemed safer outside than in.

nori_garsi's picture
Joined: 10/31/06
Posts: 2069

I think the medical community has gotten a lot of flack for early inductions/c-sections recently and are changing their policies. Technically 37 weeks is full-term but that doesn't guarantee that the baby will be fully developed. I think it's one thing for the baby to come on its own at 37 weeks, but from what I've seen, in order to induce that early I think doctors want to make sure the baby is strong enough to be outside the womb. I know that my doctors won't induce or perform a c-section before 39 weeks unless it is absolutely medically necessary. I've also heard that they don't do the steroid shots after 34 weeks. I know there's some risks associated with them so I don't know if that's why...

I'm the oddball out here, I would probably have the amnio if you want to go ahead with the induction at 37 weeks. The risk at this point is minimal and it would let you know how baby is doing. Having said that, it doesn't seem like the induction is 100% medically necessary (at this point) because if it were they wouldn't be worried about the amnio. If you were going to refuse anything I would refuse the induction so that baby could bake longer.

At the end of the day you need to make the right decision for you and your baby, whatever that is. You never know what will happen between now and then though. Things can change in an instant, for worse or better. Good luck making a decision.

heatherliz2002's picture
Joined: 02/02/08
Posts: 2273

I agree 100% with Meghan... if everything is looking okay for the time being, I would not only decline the amnio, but I'd decline the induction as well. I wouldn't induce that early unless it was absolutely unavoidable, and right now it doesn't sound like it is. If the situation changes, then that's a different story. But for now, I'd wait.

Starflyr's picture
Joined: 10/20/07
Posts: 428

In terms of pediatrics/neonatology, there are risks with being born late preterm (35-36 weeks). 37 weekers still have a significantly higher risk of having late preterm problems than 38+ weekers - not just with breathing, but with ability to coordinate the suck/swallow/breathe needed for eating, etc.

THAT is why ACOG recommends against non-medically indicated induction prior to 39 weeks now. The risks of amnio at this point are labor/infection, NOT miscarriage. The reasons for it are also different. Amnio in early pregnancy is to look for gender, and chromosomal/genetic defects that might lead to elective pregnancy termination - somethign that is COMPLETELY optional, basically. Amnio at this point is NOT being done for the same reasons.

personally, I'd allow an amnio if you are OK with the idea that a "good lung maturity test" will likely give the green light for induction at 37 weeks. If it's not good, they will likely wait a few days and do another amnio and so on until it comes back good, THEN induce unless your condition worsens, in which case, they'll make baby come regardless.

Will support you in whatever decision you make!

Star

Danifo's picture
Joined: 09/07/10
Posts: 1377

I just wanted to add that I felt very uncomfortable when they wanted to induce me at 34 weeks. I was hoping that they would let me go as long as possible and was upset they wouldn't. They did explain the risks and my situation. After that, I understood the risks and accepted that was what they were doing and that they really thought they were doing the necessary thing but I wasn't happy about it. I ended up going into labout on my own so it wasn't an issue.

When they told me after that I had a placental abruption I was relieved that they would have induced me a few days later.

Even though many of us would like as little intervention as possible, these guidlines are there for a reason. If the amnio shows the baby's lungs are mature, then the doctor's think it is worth the risk to induce. If the baby is not mature enough, then they would rather wait. Without knowing everything about your situation, I don't know what I would do but I would want their reasons clarified. I would probably go for the amnio because i would want the information and don't feel the risk at this stage is that great.

ekcanada's picture
Joined: 05/06/09
Posts: 1707

I love the fact that we have so many members of the medical profession on our board!

Just wanted to send hugs. I think I would decline boyhood the amnio and induction!