To Induce or Not Induce – That Is The Question

Two weeks ago during my first internal exam I was thrown a bit of a curve ball. Taped against the office versus patient glass divider hung a photo and brief biography of a new doctor about to join the Fair Ridge OBGYN practice. I automatically started to envision the worst case scenario: new doctor, on-call, the day I decide to go into labor. “No, no, no,” I told myself as I tried to halt my imagination and force yoga breaths in-and-out through my nose. I tried to remain calm until the nurse called my name.

Urine sample, weight and blood pressure check, pushing and painful prodding against my cervix – I waited until the end of the visit to find out the most important jeopardy question of the day, “New doctor joins practice”. I hoped for the response, “What is May 1st 2011?” WRONG! How about, “What is April 11th with on-call, hospital rounds starting April 14th”. I wanted to cry…hysterically. All I could think is why me?   To make matters worse, during the week of my due date, this new, unknown-to-me, doctor-I-already-don’t-like would be on-call almost the whole.entire.week.

So let me back up and preface this story a bit in case you have not been keeping up with my blog. Just weeks into my pregnancy I switched OBGYN practices (you can read about why clicking here). I was quite upset that I had to spend a substantial amount of time researching local doctors, un-confident in my ability to pick the best one for baby and me. I found Fair Ridge OBGYN online. I utilized medical rating tools like ratemds.com and message boards where current and former patients wrote about and provided feedback on their experiences with this practice. I read nothing negative with almost all the commentary providing glowing, over-the-top positive feedback. The worst comments I found were related to their nursing staff – who cares I thought, the nurse won’t be delivering my baby! So we went in for our meeting and we left signed up as new patients. My husband and I were elated that we found this practice and finally relished each and every appointment to meet and learn more from and about, the two doctors at this practice.

Fast forward to week 36 of pregnancy.  The week of realness, the week an official countdown can start, the week where we find out when this baby girl might truly arrive. The worry of delivery and motherhood set-in on this exact morning. My stressful, anxiety-free pregnancy was over and now, to make matters worse I had to hear that a doctor I never meant might very likely be the one to deliver my child. There was no way around it. There was nothing we could do to change these circumstances, so my husband and I uttered words we dare spoke before: induction.

Let’s back up again and discuss my birthing plan so I can explain why to me, induction has been a dirty word! I never in a million years thought I would be a hippie-ish type pregnant woman when it came to my labor and delivery. But then again, I knew nothing about labor and delivery and it wasn’t until I became educated that I realized there are a lot of choices a woman can make regarding this experience. I guess it didn’t help either that I have been attending a FABULOUS pre-natal yoga class where the instructor is also a doula! So although not typed up and printed out, I had some high-level bullets I had planned to share with my doctor:

–Prefer to go into labor naturally with no chemical/medical assistance

–Prefer to labor at home as long as possible

–No discussion of induction unless medically needed or past 41 weeks pregnant

–Ability to shower during labor and use birthing ball (hippie, I know!)

–Must authorize and discuss use of pitocin, only as last resort

You get the point.

So for me to utter the word induction was a big step, in the wrong direction. However, it has felt like the only way I could ensure having one of the two doctors I have grown to know, like, trust and feel confident with the day of my delivery.

Fast forward to today – my 38 week check-up. I had to get it out! I told my doctor, the most kind, caring, doctor whom it is difficult to say anything harsh to, how displeased I am with their scheduling of the new doctor. My husband told him that full-term patients should be guaranteed one of the two original doctors. I told the doctor that I am annoyed that my anxiety and worry has centered on this issue instead of the million other things I should be thinking about. I also explained that I put a lot of intention, thought, and research behind picking this practice and that now I could labor and deliver with a woman who may not be as like-minded as me in terms of my wants and needs. And I added that I researched this new doctor and found little information and what I did come across was well, rather negative.

I put our doctor in a difficult place and I felt bad. But I too was put in a position I wasn’t too pleased about. I have felt forced to make an already critical decision 1. Get induced to ensure I have a doctor I know and trust during labor and delivery (and increase my chances of a c-section as a result) or 2. Let labor occur naturally almost guaranteeing that a “stranger” will direct and guide me during labor and delivery. One option doesn’t feel better than the other.

Our semi-resolution. My doctor was clear that he prefers not to induce labor unless it is medically needed or if the woman is 42 weeks pregnant with little signs of labor approaching naturally. He explained the risks of induction – how some woman don’t respond to pitocin and how many result in a c-section. Again, more reasons why I love these doctors and their ability to respect a woman’s body and not force-feed planned medically and chemically induced deliveries. But he also respected my need for him or the other doctor I know to be present during my birth. He laughed when I pulled out the doctors two week on-call schedule, but he then used it to pick the day he would induce me (20 April 2011 – one day after my due date)…with a couple of disclaimers.

1. I still can very well go into labor on my own. Although only 1 centimeter dilated, I am 90% effaced, and my water can break at any time regardless of my dilation and effacement progression. The rule is you have 24 hours to deliver your baby once your water breaks or else the baby is at risk for infection. PLUS I am walking, bouncing on my birthing ball, eating spicy food – you name it. I’m doing anything natural that can help get this show on the road!

2. I will meet the new doctor next week during my 39 week visit and I will be open-minded (requested per my doctor). I can ask her whatever I would like. If she makes some amazing impression on me in this short visit I can cancel my induction and wait it out knowing that there is a high probability she will be the doctor on-call when I go into labor.

3. If still pregnant, I will see my main doctor on 18 April 2011. He will not approve my induction on the 20th unless my body produces signs that it would favorably respond to the induction. If he feels confident in moving forward he will then strip my membranes (ouch) and I will check in to be induced on the 20th of April.

I never in a million years thought that I would have to think, consider, and worry about such a variable 2 weeks out from my due date. I feel like motherhood has already begun, forcing me to make several big decisions prior to our daughter’s arrival by trying to determine what is best for me, my baby, and her daddy. The positive outcome is that my husband and I are united. We’ve supported each other, understood each other and have really listened to each others concerns and suggestions about how to handle this situation. This unfortunate circumstance has given me a positive preview of how we will tackle parenthood.

I would love to get the opinions of other mom’s and mom’s-to-be about whether or not I should get induced!  Please click the poll or share your feedback in the comment section below!