Re: Postdates,Neonatal Death
From: Anna Meenan, MD (annam@uic.edu)
Wed Aug 3 11:01:56 2005
I agree, and I wonder every day how these women (and girls) who can't
handle another few days to weeks of pregnancy will handle raising
teenagers.
Interestingly enough, one of the banner ads that came up alongside Dr.
Kaplan's post was for "Excessive pitocin birth injury" and linked to the
website of a lawyer in Texas who claims the biggest birth injury award
in Texas (11 mil.)
--
Anna Meenan, MD
At Wed, 3 Aug 2005, Richard D. Kaplan wrote:
>
> My understanding of the recent literature and my personal experience is that induction increases the rate of cesarean delivery. I do not feel it is appropriate to double a women's risk of cesarean only to appease them. I would rather educate them about the increase risks of induction and hope that they can find the emotional strenght to wait for labor.
> This in my mind relates to another thread about the difference between how we grew up compared to our children. Our son's due date turned out to be 3.5 weeks earlier than his actual delivery. His Ob was the chief at Univ. Of Penn. where I was a medical student. My wife had severe back pain and I had four residency interviews scheduled. It never occurred to us to demand an induction. We were frustrated and upset but felt that the only determining factor was the natural onset of labor, or the recommendation from our obstetrician to intervene. Yesterday, I had three patients at 37 weeks asking me when I was going to end their misery! Go figure.
>
>Richard Kaplan
>Greensboro, NC
>
>>>----- Original Message -----
> From: Len2976@aol.com
> To: Multiple recipients of list OB-GYN-L
> Sent: Wednesday, August 03, 2005 7:26 AM
> Subject: Re: Postdates,Neonatal Death
>
> As a general rule, we induce at 41 weeks. We usually will do an NST at 40 1/2. Only very rarely do we have a patient that goes over 41 weeks--and that's because she refused an IOL. In that instance we would have the patient doing BPP 2x per week after a lot of counseling.
>
> We usually have the opposite problem--getting the patients to wait till term to deliver. I'm in a 3 CNM, 1 MD private practice in a semi-rural area of Florida. Many of our patients start asking for an IOL at 35 weeks because they "can't take it any more" or "the baby is big enoungh." If the cervix is favorable (especially in a multip) we will do an IOL at 39 weeks. I'm very careful at 38 weeks that there is an indication. Last year one of the obstetricians at our hospital induced his own wife at 38 weeks (she couldn't stand being pregnant a day longer). She had good dates--an U/S at 5 weeks. The baby ended up in the NICU with RDS for 9 days.
>
> Lenora McCall, CNM
