questions about pre/birth plan

[neeleymartin]

have several questions about ds due on april 10. not sure what has made me wonder these things but:

is there a need for an internal exam at 36 weeks? had one last preg. with diff. doctor. but i think that i prefer to wait it out, don't want to stir the waters. he said it's a way to find out what direction the baby's head is facing. is it the ONLY way?

also, this new doc induces at 41 weeks. last pregnancy, my doc waited until i was 42 weeks. reason was that babies delivered after 41 weeks have a 7-10% death rate. i really value his education and he is very well read and intelligent. has taught at harvard medical and practiced in boston for many years before coming to cape cod. his reputation is excellent.

love to agree with him but i just can't. we had to leave our last ob b/c he switched to just gyn. poopoo.

opinions needed. tia

[shawnandangel]

is there a need for an internal exam at 36 weeks? had one last preg. with diff. doctor. but i think that i prefer to wait it out, don't want to stir the waters. he said it's a way to find out what direction the baby's head is facing. is it the ONLY way?

I thought they could tell by Ultrasound, but that's an expensive route if your health insurance company won't cover it.

If I were you I would do my own research on that 7-10% death rate. See if there is research to back it up or just your doctors experience. Then I would present my findings to the doctor if they contradicted. Not in a confrontational way, just casually. "I respect your opinion but I researched babies born after 42 weeks and found x, is there a compromise we can reach that will make both of us happy?

[o_mom]

have several questions about ds due on april 10. not sure what has made me wonder these things but:

is there a need for an internal exam at 36 weeks? had one last preg. with diff. doctor. but i think that i prefer to wait it out, don't want to stir the waters. he said it's a way to find out what direction the baby's head is facing. is it the ONLY way?

also, this new doc induces at 41 weeks. last pregnancy, my doc waited until i was 42 weeks. reason was that babies delivered after 41 weeks have a 7-10% death rate. i really value his education and he is very well read and intelligent. has taught at harvard medical and practiced in boston for many years before coming to cape cod. his reputation is excellent.

love to agree with him but i just can't. we had to leave our last ob b/c he switched to just gyn. poopoo.

opinions needed. tia

On the internal - no need for it. An experienced OB should be able to tell from feeling (leopold's?) which way the baby is. Combine it with the location of the heart rate and you can get a really good idea without ultrasound or internals. Mine could tell at 30 weeks or so from feeling my belly.

On the 41 weeks - ask for studies that back this up. My guess is that he is grouping ALL babies after 41 weeks, so 41, 42, 43, 44, 45, not babies from 41 to 42 weeks.

[egoldber]

41 weeks have a 7-10% death rate.

I can not believe this is correct. Perhaps he meant a 7-10% increase in the death rate? Meaning it goes (for example) from 1% to 1.07-1.1 %

[o_mom]

I can not believe this is correct. Perhaps he meant a 7-10% increase in the death rate? Meaning it goes (for example) from 1% to 1.07-1.1 %

Good catch - that is probably it. I think I would want to find out the source and look at the meaning myself.

[SnuggleBuggles]

No internals *at all* in pregnancy OR labor are necessary. They can certainly tell the direction and position of the baby by where the heart tones are and palpating. No u/s needed, no internal needed. Also, as we all know the state of our cervix does not indicate when the baby will come or even how long labor will be. You can be 4cm at 37 weeks but not go into labor till 41 weeks. Or you can be high and closed at 37 weeks and go into labor that night. Your cervix is only part of the equation. It doesn't change anything really unless they need to induce for medical reasons and need to know which drug or method to use since it would vary by cervical readiness. In birth they can figure out when it is time to push when you feel that pressure...or the baby is right there. :)

There was a study that compared outcomes of inducing at 41 weeks vs 42 weeks. This is one that I always remembered but it is from 2001. I'll see if I can find more up to date info:
"The authors conclude that although complications of labor appeared to increase with extended gestation, infant outcomes were similar. They also emphasize that routine induction of labor at 41 weeks of gestation increases complications of labor with little or no benefit to the infant."
http://www.aafp.org/afp/20010215/tips/10.html

This is a review of why the research that cited the benefit of inducing at 41w vs 42 may be flawed from Henci Goer:
http://www.lamaze.org/Research/WhenResearchisFlawed/PosttermPregnancyCochrane/tabid/173/Default.aspx

This is probably the study he is thinking about from 2005:
http://www.journals.elsevierhealth.com/periodicals/euro/article/PIIS0301211504004865/abstract

I know there are better sources out there for the studies but my kids are pestering me to get off. Hopefully someone else will chime in with the correct, up to date info but if not I will search more later when the kids are not bugging me. :)

Beth

[brittone2]

Yep, internals aren't necessary at all for a normal pregnancy, and I agree... I have my doubts about how legit that 7-10% number is (to say the least).

My midwives are at a freestanding birth center but w/ emergencies, inductions, etc. they deliver at a large university hospital. We discussed plan of action if I went past my EDD...they still don't even "require" induction at 42 weeks. They use biophysical profile and I think a non-stress test periodically and as long as everything looks okay, they are fine w/ mom continuing the pregnancy provided she isn't high risk for some other reason.

[AnnieW625]

At 36 weeks my doctor just did a feel for the head and that was it; not sure if that the same internal exam you are talking about. It was pretty painless though.

After having DD at 37/1/2 half weeks, at the time at which my labor had stalled and had a nurse break my water I wish not to have pitocin ever again. I would be more freaked out about that than my baby being late. If you don't have your baby by 41 weeks and think you can wait another week or so let your doctor know, and be firm about it.

In my neck of the woods (suburban southern LA County) it seems very common that they schedule you to be induced if you are more than 40 weeks pregnant and that kind of bugs me too. My mom went almost 42 weeks with my sister 21 (almost 22 years ago) and everything was fine.

[SnuggleBuggles]

I wanted to say add that if you want to go to 42 weeks instead of 41 weeks get them to book you a non-stress test and biophysical profile to happen right around 41 weeks. If all looks good then you can feel more comfortable with your choice to wait. I went 10 days past my edd with ds2 and 14 days past with ds1. I had all the tests and things looked fine. With ds1 they tried to play the scary card and say, "well, things look perfect now but that can change drastically quickly." Inductions and being postdate carry risks so it really is a personal choice where you need to see how you and baby are doing and go from there- not just what the calendar says, imo.

GL!
Beth