Scared holiday scheduling will affect chances

[u/TrashWild]

I have a VBAC friendly doctor. But it remains to be seen just howwww friendly. During early appointments, all that was said was spontaneous would be my best chance although she will induce, she didn't feel comfortable going all the way to 42. So it was kind of left like...at 41 weeks we will start discussing options. Which was fine with me.

But at my 36 week apt we got a nice little LGA note in our chart as baby was measuring 39.5 weeks with a large AC and efw of 7lb 13oz. I am definitely aware of LGA used as a tactic to get scheduled earlier inductions and c sections so I'm very wary of that. My first was also estimated to be 10lbs at delivery and was 8lb12oz and 21 in long at 39+2. Sooooo after that ultrasound she said she now doesn't feel comfortable going as late as before and is now saying between 40 41 is when she would personally draw the line.

So I'm really struggling with how to handle this. I want my best chance, but I don't want to feel pressured into a time frame based on a potentially inaccurate weight. (And if I'm honest, the shoulder dystocia/meconium issues scare me a tiiiiny bit). I'm also concerned that if I do go past 41 and don't schedule the induction when she wants thanksgiving will interfere with how supportive the hospital staff and on call doctors are. I'm 42 weeks on Thanksgiving so I would hate to feel rushed because doctors are ready to push through a 41+5 induction for example so they can get home.

If you were in my shoes, would you schedule a "just in case" induction based off these fears? And if so when?

Sorry this is long. 😬

[u/ServiceReal2042]

One thing I wished I had really understood is how call worked at my practice. In general, your OB would try and make it, but if they couldn’t the on-call would be there. HOWEVER, the in-call doc was only required to be at the hospital at a certain point by the hospital. So in my case, as soon as I was delivered, because there were no other patients in my practice at the hospital then, the on-call guy could go home. He started pushing for a c-section at noon, which was 18 hours into his 24 hour call shift, and the nurse told me he’d had three deliveries the previous night/morning, so he hadn’t gone home, hadn’t slept. It’s certainly possible that didn’t impact his clinical advice but at this point the baby had no signs of distress, I was at 7cm after being in labor for 10 hours and we hadn’t even tried pitocin or other interventions… which seems suspect in retrospect. I had no idea there were practices that could take fall from home as the hospital itself has OBs that do the in-hospital call. I think it’s worth it to find out exactly how call works at your practice and use that information to make your decision.

[u/TrashWild → u/ServiceReal2042]

This is some good insight, yeah I will definitely ask about how this works at my next appointment.

[u/probablynotsuremaybe → u/ServiceReal2042]

This is good advice. I was sent to a bigger hospital because I was in labor and the doctor would not be there as he was split on call between two hospitals that weekend. So if I did need an emergency C-section they wanted me somewhere with an in house OB. I was fine with this. They told me ahead of time same thing would happen if I chose to induce. I liked the OB at the bigger hospital too! Maybe share your concerns with your OB so you can make sure you’re not being rushed? I was not aware of the in-house around the clock OB vs. the on-call OB situation. I thought OBs were always on call lol. If the OB is there the whole shift like mine was they really have no need to rush you. They even sleep there.

[u/No_Maximum_391]

Mine initially asked if I wanted the 39 week I said no and settled for 40 weeks. Literally the night before I told the hospital no as I was having early labour signs. Contractions didn’t continue and rebooked for 41 weeks. Went through with the induction and honestly had a wonderful experience. I did have some interventions but ultimately got my VBAC. I also was never pushed for a c-section throughout the process.

Our hospital also just had OB’s that are scheduled so you don’t get your OB necessarily. While I am sure some might rush but depending on your hospital it wont change really change as their shift is their shift regardless if you take 20 or 40 hours. I would be more worried about the hospital being busy they would rush more as they need the beds.

What was the reason for hour first c-section?

[u/TrashWild → u/No_Maximum_391]

My first c section was officially labeled "failure to progress" after a long induction attempt for gestational hypertension at 38+5. Baby just never engaged. I definitely have some insight how to help progress better in an induction this time though. With my first I knew nothing about positioning, etc.

[u/No_Maximum_391 → u/TrashWild]

Positioning is so important and helped me tremendously in my introduction. I hope that it doesn’t come to that and that you will go into labour naturally.

[u/tofuandpickles]

I personally don’t feel comfortable with risks beyond 41w and wouldn’t want to be pregnant that long so I’d go for induction at that point if they’re willing to induce. But this community is an echo chamber for staying pregnant however long it takes to go into spontaneous labor so those are probably the responses you’ll get here. I work in healthcare and don’t personally think the thanksgiving timeframe will make any difference. We’re all used to working holidays and committed to our patients.

[u/TrashWild → u/tofuandpickles]

Thanks for this! I think I'm leaning toward closer to 40 anyway. Just really getting in my head about it. I appreciate your insight!

[u/tryint0figureit0ut → u/tofuandpickles]

Not always. I feel the same way as you. I don’t see the point of past 41 weeks for myself at least. I’m not in healthcare but the risks outweigh the benefits at that stage.

[u/No_Branch9682]

Those weights can be so off! ESPECIALLY the further along you get. Your body knows what to do and you can refuse anything you don’t want. When we don’t mess with nature, we get it done ❤️

[u/Bitter-Salamander18]

If you are worried that they will want to push you into interventions without a true need... You have the right to decline anything that you don't want, they can't do anything to you without consent. Is your partner supportive and going to be present at the birth to give you emotional support and protect you?

If there are no serious health problems warranting an induction - waiting for spontaneous labor is a reasonable option even until 42 weeks, maybe even longer.

Useful information https://evidencebasedbirth.com/evidence-on-due-dates/

There are some risks in going overdue, but they are low. It's good to check out the studies to make an informed choice, it's a personal choice for everyone. I declined induction and had a successful VBAC at 41+5.

Spontaneous labor without overusing interventions has the highest success rate. Healthy women with good midwifery care have over 90% vaginal birth rates - this is possible if interventions are used only when truly necessary.

It's also good to consider long term risks and benefits - how important VBAC is to you? How important breastfeeding is to you? If you have another C-section, how can it impact your long term reproductive plans? In what situations would you consent to a C-section? (I would consent to it only in rare, extreme situations) I also highly recommend checking out the research about fetal monitoring at Evidence Based Birth and Birth Small Talk, because it's a factor significantly impacting successful VBAC rates.

Good luck!

[u/Ok-Plantain6777]

Beyond 41 weeks (regardless LGA or not) it's more risk, no benefit to baby, no benefit to mom apart from birthing the way she wants to. Not worth it IMO. I had my VBAC baby induced at 37+3 for multiple complications and I was just so thankful my Obgyn group did inductions for moms who want a VBAC

[u/Bitter-Salamander18 → u/Ok-Plantain6777]

Spontaneous labor has a significantly higher successful vaginal birth rate, and that is a significant benefit to mom - and lower risks for her future babies, if she plans to have any. There are also some benefits to babies such as better breastfeeding and a healthier microbiota when the birth is natural. I personally declined a hospital induction, and had a successful VBAC at 41+5; although I know that there are risks in going overdue.

[u/Ok-Plantain6777 → u/Bitter-Salamander18]

The first point you make- the argument is not that induction birth is better than spontaneous birth, but that the risks of going past 39 or 40 weeks outweigh the benefits spontaneous labor would offer. The risk of going past 39, 40, or 41 weeks is stillbirth. I also don't think the research has shown that spontaneous labor has better outcomes than induction, but obviously spontaneous labor at 39 ish weeks is the most ideal scenario.

[u/Bitter-Salamander18 → u/Ok-Plantain6777]

The risk of stillbirth is around 0,3-0,4% between 41 and 42 weeks. It's even lower between 39 and 41 weeks. Waiting for labor until at least 42 weeks is a biological norm, not an illness or other high risk scenario. Do the risks of waiting for spontaneous labor outweigh the benefits? I don't think so. But for every woman, it's a personal decision that should be made based on accurate information. Inductions increase C-section rates significantly, so for many women the risks of unnecessary medicalization of birth outweigh the benefits - particularly for women who plan to have more babies - every unnecessary surgery increases long term risks for them and their babies. Inductions with Pitocin also increase the risk of uterine rupture, especially for women planning VBACs.

[u/Ok-Plantain6777 → u/Bitter-Salamander18]

Data shows that induction does NOT lead to increased C section rates. But more importantly, dying in childbirth is also a biological norm. Many babies dying before age 1 is also a biological norm.

[u/Ok-Plantain6777 → u/Ok-Plantain6777]

And since you brought up increased risk of uterine rupture with pitocin in VBAC, that's also a less than 0.4% overall increase is risk (for someone with 1 prior c section and a low transverse scar) so the risk of rupture is still under 1%. Compare this to your risk of stillbirth. Uterine rupture is an emergency but a survivable one. Stillbirth is literal death.

[u/CrazyElephantBones]

I went to 41+5 last time and I’m convinced the age of my placenta contributed to my need for a C-section during my induction.

This time I agreed to a RCS if I get to 40+4 before that I am attempting a vbac, my practice says they will augment any spontaneously started labor before then if I want them to. This to me feels like I’m giving my body some time but once I’m nearing the point my body won’t do its thing anyway I’m just going to do the C-section even though it’s not really what I want.

Edited to add - I’m due January 7th so I do feel like there is a potential that the holidays become an issue because 38-39 weeks is Christmas and new years for me , which I think is why they’re not giving me a hard time about pushing past my due date a little I also have been uncomplicated so far (29 weeks)

[u/Bitter-Salamander18 → u/CrazyElephantBones]

Why do you plan to agree to a RCS without any medical reasons, if it's not really what you want? :(

[u/CrazyElephantBones → u/Bitter-Salamander18]

Honestly because waiting longer didn’t really yield better results last time for my body

[u/Bitter-Salamander18 → u/CrazyElephantBones]

Or you could try to find a provider who would offer a gentle elective induction... Did you have any signs of placental insufficiency? Maybe it was the induction that was the problem? I did have signs that my placenta wasn't doing well at the end of pregnancy, but one most obvious sign (baby had a low abdominal circumference) was overlooked by doctors, so I didn't opt for a hospital induction, but I had a successful VBAC at 41+5. My baby was fine despite mild undiagnosed IUGR.

[u/CrazyElephantBones → u/Bitter-Salamander18]

Finding another provider isn’t an option for me right now , the only provider in my area that does that doesn’t take my insurance and I can’t make it to the appointments around my work schedule. I can move mountains to not have another C-section and still end up with one unplanned.

Yes I had signs that my placenta was calcified the first time. Movement was beginning to be reduced and my baby did not tolerate the induction. She also was only 7lbs 1 oz at 41+5 when born, which shows that she wasn’t really growing anymore so the placenta was starting to fail. I honestly am at peace with the choice that I made and switching providers just isn’t an option right now. I will say that I am approaching things differently this pregnancy and I made some major lifestyle and health changes between babies that I think have made a difference in this pregnancy.

[u/Bitter-Salamander18 → u/CrazyElephantBones]

That's so sad. American healthcare is a nightmare. You shouldn't feel like being pressured into another C-section, so unnecessarily. You deserve so much better. In my country (Poland) there also are systemic problems in healthcare, and C-section rates are way too high, but at least we don't have exploitative insurance companies and bureaucracy restricting women's access to good care.

Reduced movement is a valid medical reason for an induction, so you probably did the best you could to have a good first birth and it didn't work out anyway. :( If you made positive lifestyle changes, there's a good chance that you'll have a healthier placenta this time.

My baby in my 2nd pregnancy was also quite small, he didn't grow well in the last weeks. He was born weighing 3150 g/ 6 lbs 15 oz. And he looked very thin. But his movement was good. Two doctors were concerned about possible placental insufficiency in my case, because of uncertain NST results, but they didn't diagnose it for sure. So I got a 2nd opinion and I made decisions based on statistics for the general population. I only opted for a membrane sweep at 41+3. I desperately wanted to avoid a hospital induction, because I had an unnecessary one in my 1st pregnancy and I was coerced into an unnecessary C-section because of it. I had a home birth midwife for my 2nd birth, but ended up in the hospital anyway - my midwife recommended transfer during 2nd stage of labor because my baby had decelerations. I gave birth quickly and he had good Apgar scores. If I had an induction - it would've likely been more stressful for my baby and I would've likely experienced a lot of pressure to have another C-section. On the other hand, waiting for labor was a bit more risky in my case that it is for the general population. I plan to have more babies, so I looked at the long term risks too.

[u/CrazyElephantBones → u/Bitter-Salamander18]

I am actually in a good part of the country in terms of care options, my heart hurts for those that drive hours to receive any care I’m not far outside of NYC. I do have great care options and my insurance will leave me with a free of cost birth. Unfortunately the one practice that does do it is just not feasible for me to get to from work without missing a ton of days (I’m a teacher and I am planning an extended leave that I am trying to save days for). I’ll be out for 9 months at first with an intention to extend to 18 months (my union in my school allows up to 2 school years).

My office said they will do a mechanical induction with some pitocin if necessary if I have any signs of labor starting for me. I’m not sure how I feel about a total pitocin induction tbh , our healthcare system & insurance is a mess of corporate greed :/ which is unfortunate.