PREGNANCY-BIRTH Messages for March, 1999: Re: labor induction at 41.5 wks vs expectant management

Re: labor induction at 41.5 wks vs expectant management

From: Anne

anonymous@obgyn.net

Mon, 22 Mar 1999 20:43:18 -0600 (CST)

With all due respect To Dr. McIntosh: Although the oxytocin and pitocin are chemically identical they are worlds apart in the type of contractions they induce. Pitocin delivers "transition" type contractions, ALL the time; as opposed to the slower build-up of contractions found normally. I was induced with my first baby-- IT WAS A NIGHTMARE!. TRANSITION CONTRACTIONS SUCK! Not to mention you are not allowed as much freedom to walk and get comfortable, because they need to monitor you and more closely and because you have and IV in. You're thrown into labor with no gradual build-up and it is hell. You could not pay me enough money to do that again- and I didnt for my second kid! Ask any lamaze intstructor what the worst kind of contractions are and they will say transition.

So basically pick your poison, either wait and chance a c-section or induce and have a rough labor. Hope your choice is easier than mine was--I got induced and then had a c-section on top of it all! Hope I didnt step on your toes Dr. Mc :)

-- Anne N.

At Thu, 18 Mar 1999, William D. McIntosh, MD wrote: > >At Tue, 16 Mar 1999, benito wrote: >> >>At Sun, 28 Feb 1999, bj wrote: >>> >>>Hello, thankyou in advance for your time. >>>My wife is at 41.5 wks pregnancy. She is scheduled for induction in a >>>few days. The baby was evaluated by u.s. 3 days ago and is fine, and >>>my wife's cervix is 'unfavorable' at this time. This is our second >>>child, our first was delivered by scheduled C section due to breech >>>presentation, transverse incision. We're having second thoughts about >>>the induction, we feel that maybe given a little more time things could >>>progress naturally on their own. We are trying to educate ourselves >>>about the options, our doctor is much too busy it seems to discuss with >>>us what these options might be. From our reading, we are thinking >>>perhaps waiting an additional week might be possible, with twice weekly >>>checkups and daily at-home prostoglandin gel application on or near her >>>cervix. We are having difficulty deciding if this is a wise or a poor >>>decision. In addition, if we were to wait an additional week and labor >>>did not progress, would it then be less risky(at 43.5 wks) to go >>>straight to a C section? We are concerned that the extra week could have >>>a deleterious effect on the placenta, especially if under the influence >>>of exogenous oxytocin during induction. We would greatly appreciate any >>>insight you might be able to offer. >>> Thankyou, B.J. and Margo > >The rate of fetal complications begins to rise dramatically between 41 >and 42 weeks. This does not mean that you will have problems, just like >if you drive without a seat belt you will not necessarily die in a >wreck, it just makes it more likely. Expectant management with close >monitoring is one option, though it is not my favorite. Home use of >prostaglandin gel is not approved, and can lead to severe consequences. >There are really very few indications for primary C/S without labor, and >this is certainly not one. The question is what are you trying to >accomplish? If your goal is a healthy mother and a healthy baby born >vaginally, I would lean strongly towards induction now. The extra week >WILL have a deleterious effect on the placenta, but oxytocin is >oxytocin, whether it comes from an IV or from the mother. They are >chemically identical, and no one has ever proven any difference. > >-- >William D. McIntosh, MD >Clarksville, TN > >This is for educational purposes only. It is not intended > to replace consultation and examination by your physician > or other health care provider. >

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