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Induction at 39 weeks for big abdominal circumference?


13 replies to this topic

#1 Bellefin

Posted 07 December 2012 - 08:53 PM

Hi, I got good advice last time so back again to see what you all think of this situation? I have searched through the boards and read all the old posts.

DD1 - Ob (different to this time) never estimated her size, or did any measurements that I can remember. 40+6 waters broke on their own but I had to have syntocinin to bring on contractions. She was born with episiotomy that night, 8lbs 12oz/54cms with 15 mins of pushing so a good size but not causing any problems.

This baby - single umbilical artery which is meant to make baby smaller than average but she has been measuring average all the way through. A few weeks ago (36 weeks) ob said head was 50th %ile, body was 75th %ile and he was worried about shoulder dystocia so how did I feel about induction? This was just after I said I didn't want to be induced because baby is due Xmas Eve.

Last week (37 weeks) I told him I didn't want to be induced and he "measured" baby and said it was 3kgs so even if it went to 41 weeks at 200g weight gain per week plus +15% machine error, it wouldn't be above 4.3kgs so he was happy to leave me be. This week he says it is measuring 3.6kgs and I said how can it have put on 600g in one week and he agreed, the machines are not accurate so he is sending me for yet another growth scan at the ultrasound place and talking about inducing again.

I really really don't want to be induced and looking online most things say inducing early doesn't decrease the risk of SD anyway, and your pelvis opens better if all the hormones are right from going into labour yourself. Plus I would be able to have an active labour and birth, not flat on my back with monitors from induction so gravity can help me get the baby out. My sister is a homebirther and says it's all BS and the Dr just wants to arrange me around his Xmas plans, however her baby was just over 7lbs so she never had this issue. My DH is 6 foot 4 and was a big baby which is why I am having big babies. I don't have GD but I do have the upper end of average amniotic fluid.

The other complication is when to induce, right around my EDD is Xmas so I can't be induced (nor do I want to be) on 24/25/26th.

I have very low fertility and this baby was very hard to conceive and so will likely be my last and I wanted to have a natural labour and I am worried about ending up with an emergency CS.

So much stuff online says it's all crap and you shouldn't induce for suspected big babies or larger than average abdomens, but then I think I just want the baby out safely. I really want the baby to choose her own birthday and to experience the excitement of not knowing when I'll go into labour, but then I don't want to risk any damage to baby either.

I had been lying awake at night losing sleep and having nightmares about this, then he said it was OK last week and I felt fine, but now he's started on the induction thing again.

FWIW my mum had 4 babies, the last being over 10lbs and got him out OK. I don't think my pelvis is any smaller than her. Also they measure me at 37+3 today whereas I was tracking ovulation and we had essentially given up TTC and only DTD once so I think I am 37+6 which I know is splitting hairs but when they are plotting me on their charts I measure bigger because they think I am half a week behind what I actually am. I have told them this but the MW starts about leaps years changing the EDD (which I can't see how is possible because I got pregnant after February so how could that have any effect?)

Sorry this is really long but it is stressing me out, do I let them induce me at 39 weeks or just refuse induction against Obs advice? I feel like baby is going to go overdue again and because of Xmas I have to decide whether to get induced at 39 weeks or go to 41 weeks. Or start on the castor oil?? Part of me thinks I should just get over it and get induced but I have a yukky feeling about it and just want to let my body do it's thing. I guess I'll have to wait and see what the sonographer says next week.

TIA

#2 TillyTake2

Posted 07 December 2012 - 09:01 PM

What about agreeing to induction on the 27th (so 3 days over by their dates but 6 days by yours)?

#3 Madnesscraves

Posted 07 December 2012 - 09:18 PM

Well...

Sorry to say this but they are drs for a reason. I think what's happening now is your hormones are rampant. You're only seeing possibly 1 side without considering all that factors.

If you're not happy with your OBs advice, you are more than entitled to get a second opinion from another OB. I don't know your OB so I can't say. But all I can  suggest is discuss with with your OB. Tell him how you feel. What you want. Make him explain in detail what has to happen why it needs to happen. Give you figures  graphics etc


Talk to him. I am sure he will be more than happy to explain his reasons.

#4 MrsLexiK

Posted 07 December 2012 - 09:28 PM

I know a relative who was induced based on the baby's measurements. She was induced at 38 weeks, she wanted natural as possible so the OB said ok we will induce the lease invasive way as there is les chance of ending up with a csection. He also said though the drugs should be kept away as it would up the changes of a csection. She ended up giving birth to a 10.5 lb baby (again at 38 weeks) drug free, birth.

Yes sometimes they get the measurements wrong, othettimes they get them correct. I don't have this dream in my head about having a natural perfect birth. So for me it wouldn't matter I would just go with the OB.

#5 becstar101

Posted 07 December 2012 - 09:39 PM

Personally, I would wait until you've had a proper ultrasound done and then think more on the results. Get another opinion if necessary.

You've birthed a decent sized baby before, your body should be pretty good at getting things going, so unless there is a large discrepancy in head/body size, you should be ok.


#6 Soontobegrinch

Posted 07 December 2012 - 09:52 PM

OP if you have polyhydramnios there are possible complications of this and this may be factoring into the decision to induce you.
Ignore your sister, obstetricians do not have a day off on Christmas Day unless they are on holidays and this you would have been told. Maternity hospitals are usually a buzz with work on Christmas Day too. It is so offensive to suggest that his primary concern would be his Christmas lunch. sad.gif
I would suggest that at your next visit you go with a list of questions and if you are still not happy about the answers then ask for a second opinion.
Good luck.

#7 Bellefin

Posted 07 December 2012 - 10:54 PM

I don't have polyhydramnios, they have said I have a lot of amniotic fluid which makes my tummy look bigger and can also distort the ultrasound. It was something like 19 by ob and 18 by sonographer and the upper range of normal is 22 I think?

My last ob wanted to induce me because she was going on holidays, which is why I never went back to her. Sorry but I think obs are notorious for inducing to suit their own schedule. It was funny that he asked me first if I wanted to be induced to avoid an Xmas Day delivery and when I said no, then he brought up the big baby thing.

QUOTE
I think what's happening now is your hormones are rampant. You're only seeing possibly 1 side without considering all that factors.

I don't feel hormonal at all and I think I am considering all the factors. I have done a lot of reading and talked to a lot of people and it's a very polarising topic. Some people are very pro natural birth (like the pro-breastfeeders) and some people just think who cares, get it out, like the people that think who cares, just formula feed, they all survive.

QUOTE
I don't have this dream in my head about having a natural perfect birth. So for me it wouldn't matter I would just go with the OB.

It's not all about this. The pro natural birthers say you are way better off to let a big baby go into labour naturally because of the hormones released to be able to open your pelvis better and let the baby descend slower. They reckon shoulder problems are caused more by the baby's position than size, and that if I birth upright the baby will get out better, than flat on my back with an induction.

QUOTE
You've birthed a decent sized baby before, your body should be pretty good at getting things going, so unless there is a large discrepancy in head/body size, you should be ok.

This is my gut feeling.

#8 Bazinga

Posted 07 December 2012 - 11:08 PM

I went through a birth centre and not once were they worried about my size and I was huge! I went into natural labour at 41+6 but after 27 hours he was still to high. I was transferred to the hospital given syntocinon but it did nothing. I didn't dialate past 9cm and after his heart rate dropping on the monitor I was given a csection. He was 10lbs 2oz. Anything can happen. Go with your gut instinct. You can always change your mind.

#9 Soontobegrinch

Posted 07 December 2012 - 11:10 PM

QUOTE (Bellefin @ 07/12/2012, 11:54 PM) <{POST_SNAPBACK}>
My last ob wanted to induce me because she was going on holidays, which is why I never went back to her. Sorry but I think obs are notorious for inducing to suit their own schedule. It was funny that he asked me first if I wanted to be induced to avoid an Xmas Day delivery and when I said no, then he brought up the big baby thing. .


This is my gut feeling.



It may surprise you to know that many women ask to be induced if their doctor is going away on holidays as they do not want to see anyone else so the question your Obstetrician asked you was just a standard question.

It may also surprise you to know there are many women who ask to be induced before Christmas and many obstetricians who will say no and some who will say yes so therefore the induction question is also not such an odd one.

As a midwife who worked more Christmas Days than I had off I can assure you that the obstetricians do not have the day off unless they are on pre arranged holidays and despite your protestations if a woman is induced before Christmas Day it is because she has a medical reason for it or the doctor and the patient have agreed to do so.
It is offensive to suggest that inductions are to fit in with the obstetricians life and ridiculous too because inducing someone does not necessarily mean the women will deliver in the daylight hours or at anytime different to if she had come into labour spontaneously.

If you are unhappy with your care then ask for a second opinion, you say you have a gut feeling all will be well then follow this feeling...you are probably right.

#10 Honey Pot

Posted 07 December 2012 - 11:16 PM

I've been talking induction today with my hospital due to large baby + posterior position. I was induced with my DS and hated being hooked up to a drip and monitors. They said this time, because I've birthed before, doing an ARM should be enough to induce labour and avoid the drip. No guarantees of course but better odds being baby #2. Any chance your obs could offer gels / breaking waters and then leaving you to birth as naturally as possible? It might be a reasonable compromise.

#11 Bellefin

Posted 07 December 2012 - 11:32 PM

Yes actually that's a good point, we didn't talk about how he would induce me, I was assuming it's the whole drip thing but I would be more open to a stretch and sweep or the gels etc to get things started since I would be 39 weeks and have already been having prelabour cramp type feelings so may be already dilating quietly. I go back next week after the growth scan so I will have a list of questions for him including how he would plan to try an induction.

#12 I'mBeachedAs

Posted 07 December 2012 - 11:57 PM

If you're already having pre labour cramps you may end up going into labour naturally in the next week or so anyway. Fingers crossed for that outcome for you!

#13 Duck-o-lah

Posted 15 December 2012 - 04:56 PM

Just found this thread Bellefin, hope you're donig ok. Not being an OB myself or knowing your full story I honestly couldn't comment on whether an induction was really necessary, but I would be asking lots of questions! I would go with your gut as much as you can, good luck! Can't wait for baby news biggrin.gif

#14 monkeys mum

Posted 17 December 2012 - 01:04 AM

My experience with ds1 was a bit different to your current situation. I had insulin dependant gd, a growth scan at 36wks and to check placenta position. My next visit was a few days later and an induction was indicated as being wise due to ds abdominal size, his thigh bone was big too but their main concern was his tummy. I was induced at 37 +5, the night before i had gels then arm in the morning, no drip and only gas. No issues in delivery other then it was very quick and over in one push. Ds had a visit to scn due to possible gd complications, which it turned out there were none, his size issues were due to being super long and hunched over lol

Id previously had a bigger baby that had got distressed and needed a ventouse to help her out before her hb dropped too low, was at 8bpm when they turned the monitor away from me. She was 8pound 12.5ounces, ds was 50g or so lighter.

So to answer your question yes i have been induced due to tummy size but for me it was seen as a possible gd side effect, same thing my nephew had who crashed after birth. I would get induced for medical issues if i felt it was needed, and as i have big babies i would try for an active labour. My last was over 9pounds and my easiest labour, only time i wasnt upright was for arm, and he was delivered with me kneeling on the bed in one push.

Good luck with your decision.



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