Induction imminent

Things that have happened since my last post…

Did the non-stress test at the hospital on Monday night. Baby passed with flying colors.

Went to my post-due-date check-up on Thursday morning, where my one and only hot doctor had returned. I consented to a cervical check for the first time this trimester, but told him I was pretty certain my cervix was closed (I’d checked myself the night before). He expressed amazement that I check my own cervix and did the check. Yup, cervix was closed for business. He said they’d like to schedule an induction for this Saturday (9/28); I flat-out said “no” and said I did not want to induce until I was 42 weeks. He went and checked with their “most liberal” attending physician, and she said the latest she’d “let” me go was Tuesday (10/1), when I’d be 41 + 4. I asked what kind of induction they were talking about, and he said probably mechanical later augmented by Pitocin. The mention of Pitocin really, really did not thrill me.

He asked me to come into the hospital at 7 AM on Saturday morning, said that was his day to be working in the OB unit. He wanted me to do another non-stress test and an AFI ultrasound to check on the baby’s amniotic fluid. My doula said:

IT'S A TRAP!

She figured that, since that was the day that was originally proposed for induction, they’d heavily push induction that day.

Came in this morning with my husband and daughter, and my doula met us there. We started with a non-stress test, which my baby passed again. Then my doctor tried to do his own AFI, but concluded that my amniotic fluid was somewhat low and wanted to get a second opinion, so he arranged for me to go to radiology & imaging so that a real tech with better equipment could evaluate me. Before we did that though, he wanted to do another cervical check and get urine and blood to test for pre-eclampsia. We had done three blood pressure checks by that point, and they had all been high. I was resistant to doing another cervical check, but finally consented. Cervix was at a 1 and he could just barely get a fingertip in. Still, improvement from Thursday.

(At one point, hot doctor had the ultrasound over something that was rapidly flickering on the screen, and he said, “Look at that, you know what that is, right?” I can’t read those things to save my life, they make so little sense to me, so I said, “Please don’t say a tentacle.” And he said, “It’s a tentacle!” What popped into my head but I didn’t say: please tell me that’s not the penis waving around…)

I gave them blood and piss and then headed off to imaging. The u/s tech there was fantastic. She put the amniotic fluid levels at 6.3, and said 4 and above was normal, so we were fine there. She also took a good look at baby as much as possible and showed that s/he is head down, the placenta looks good, and the umbilical cord is nowhere near his/her neck. This lifted my spirits, so we headed off to the cafeteria and got breakfast.

Came back to our room in L&D to await the results of our tests. Hot doctor eventually came in to break down all of the pieces. He took my blood pressure one more time, and this time it was quite normal. However, he said I had +2 protein in my urine. So I didn’t have pre-eclampsia yet, but because of my history with it, the three earlier high readings, and the protein in my urine, was at severe risk for it, and because of that, they’d like to induce today using the methods we discussed earlier: mechanical augmented by Pitocin. He said he’d spoken with both the family practice attending physician and the obstetric attending physician, and that was the recommendation all around. However, since the baby had pretty good results on the NST, the AFI had not been terrible, and because I was so informed and in tune with my body, they’d be okay with giving me a sweep and letting me go home for one more day, so long as I promised to watch baby’s movements and watch out for signs of pre-eclampsia. He admitted to me that because my cervix was not ripe for induction, inducing today did significantly increase my odds of a c-section or at least an instrumental delivery, which he knew I did not want, but said they were erring on the side of caution in favor of the baby. He said that he personally was in favor of me staying and inducing, but did not think going home for another day was a bad option or necessarily the wrong choice.

[POST-BIRTH UPDATE: At one point, when he was trying to stress the dangers of low amniotic fluid (he kept saying my amniotic fluid was “low,” I would say, “I thought my results were normal,” and he would say, “low end of normal”), he said low amniotic fluid could cause “intrauterine problems.” I asked, “What kind of intrauterine problems?” and he replied, “Well, there’s fetal demise. That’s a possible outcome.” My doula (who was seated behind him) actually made a face. Not that she had to. I could not believe he had just played the “dead baby card.” I also wanted to laugh and say, “Well, I guess a dead baby is an ‘intrauterine problem’ of sorts!” because he hadn’t really answered the question, but I refrained. Anyways, it was a low point in the care I received at the hands of a doctor whom I otherwise liked a lot, who otherwise did a good job. Looking back, I am convinced that the staff was prepared to use “low amniotic fluid” to argue me into induction that day regardless of what my actual AFI results were, because they weren’t comfortable letting me go past 41 weeks.]

It was my turn to talk, so I told him that I understood that healthy baby is job 1 in this trade. Of course it was what I wanted, too. However, I’d felt considerably traumatized by the interventions I’d had at the birth of my daughter, and I felt like, when I tried to complain about that outcome, people had sneered at me, “You have a healthy baby! (Or, at least, the problems with her health had nothing to do with obstetrics.) You should just be happy with that.” Well, yes, I was happy with that. But I’ve spent the last seven years wondering whether or not we couldn’t have had both a healthy baby and a healthy mother. As far as the current induction proposal went, I was concerned that:

  • I’d wind up with a c-section, either because of failure to progress or fetal distress
  • I’d wind up with an instrumental delivery and episiotomy due to fetal distress, just like I did with my daughter
  • I’d be unable to cope with the pain of a Pitocin-fueled labor

He didn’t downplay anything. He admitted that induction was going to increase the risk of all three of those and my concerns were valid ones, especially since my cervix was not really ripe for induction. He then left me alone for a while to confer with my husband and doula on what to do.

I talked for a while with both of them, and they were both in favor of waiting another day. I was, strangely enough, leaning towards just doing it today, out of fear that both Pitocin and magnesium would become inevitable if I came back tomorrow and my cervix was not any more favorable for induction. My doula left and my husband and I talked about it for a bit. My doctor eventually came back in, and my husband left and we talked alone for a bit. He was now pretty encouraging of me giving things one more day. What I’d said about wanting both a healthy baby and a healthy mother seemed to have sunk in. [POST-BIRTH UPDATE: I still showed some reluctance about practically agreeing to induce in one day, and I think this may have annoyed him a little bit, because he began talking about how they wouldn’t even be giving me the option of one more day had this not been a family practice, that if this had been an obstetrics practice, they would certainly be telling me to stay and induce. Considering that I was fine waiting one more day, and I had some cervical change that may have been critical to the induction working, I think this says a lot about obstetrics. Anyways, he clearly felt that one more day was generous, while I had wanted one more week.]

So, we made the decision to go home for one more day. Hot doctor did a sweep first to try and get things moving. I didn’t think it was very painful, and he commented at one point, “You seem to have a pretty good pain threshold.” I sure hope so, because it sounds like I’m going to need it. Tomorrow at 7 AM, I go back in for another NST, blood test and urine test, but unless my blood pressure looks great and all of those results come back very normal, it seems unlikely I’ll get any more time without an induction. Yes, I’m stubborn, and I really wanted a completely natural childbirth, but even I know that full-fledged pre-eclampsia is something I don’t want.

I’m at peace with this. I feel like my wishes have been heard and respected, and that my doctor has really tried to make them a reality given the circumstances.

Guess we’ll see how things go tomorrow.

[POST-BIRTH UPDATE: To see how things turned out, see Constantine’s birth story.)

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Categories: Labor & Delivery, Prenatal Care | 1 Comment

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One thought on “Induction imminent

  1. Cheri

    I recently went through your blog from the very beginning months and skimmed through everything up to the present date. You’ve come a long way! 🙂

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