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You are wrong. At my 40 week appointment my midwife said, "You're feeling done being pregnant aren't you? (insert puppy dog eyes) I will go ahead and schedule you for an induction next week". And that was that. No medical reason!!!!
The reason for the induction listed on my hospital records was >42 weeks which was very obviously not true. I was induced exactly 6 days after my due date (confirmed via early ultrasound, I had 2 in fact). I was low risk the whole way through. I had a very healthy pregnancy, no complications, no risks and no concerns.
The risk of perinatal death decreases with advancing gestational age until some point between 38 and 41 weeks, when it begins to increase again.
Mehl-Madrona and Madrona (1997) reviewed self-reported data from midwives in the western United States between 1970 and 1985. A total of 4,361 midwife-attended home births were compared with 4,107 family-practitioner-attended home births performed in California and Wisconsin during the same time period. Sampling frames and response rates were variable, as were the data collection instruments. Deliveries were matched by maternal age, insurance status, parity, and presence of risk factors. Midwives were significantly more likely to deliver postdate pregnancies, defined as gestational age greater than 42 weeks, than were family practitioners (midwives also were more likely to deliver breech and twin pregnancies). Mortality rates were significantly higher for midwives compared to family practitioners, a difference that was attributable entirely to more postdate, twin, and breech deliveries in the midwife group.
Both of these studies are limited by issues concerning accuracy of dating, completeness of reporting, confirmation of causes of death, and in the case of the Mehl-Madrona paper, a rather complicated sampling scheme and questions about the true comparability of groups. There also are concerns about generalizability in terms of current midwifery practice in the United States. However, patients who select home birth are, by definition, low-risk patients. They also are unlikely to have undergone antepartum testing. The excess mortality seen in women with prolonged pregnancy delivering at home in these two studies is consistent with an independent effect of increasing gestational age on perinatal mortality.
Surveillance with tests that include fetal heart rate monitoring and assessment of amniotic fluid volume or elective induction both appear to be reasonable strategies beyond 41 weeks. Patients and providers should be informed that the best current evidence strongly suggests that there is a significant increase in the risk of perinatal mortality in women managed with antepartum testing compared with women who are electively induced at 41 weeks. Because this risk is small in absolute terms, and patients may have different preferences for both the outcomes and processes of labor and delivery, both options should be discussed.
Now, your contention is that it was "unnecessary" to induce at 40 weeks and 6 days. Perhaps we can agree not to quibble over the 24 hour difference between 40 weeks and 6 days and 41 weeks.
I contend that being at 41 weeks is a sufficient medical reason to offer induction. Certainly, it is also reasonable to offer to wait another week and do antepartum testing. But to call an induction at 41 weeks "unnecessary" is not true. And there is increased risk of stillbirth in that 41 to 42 week time frame.
Recent studies have shown that the risks to the fetus14,15,16,17,18,19,20,21,22,23,24,25,26 and to the mother23,27,28,29,30,31,32,33 of continuing the pregnancy beyond the estimated date of delivery is greater than originally appreciated.
"The management of postterm pregnancies is complicated and fraught with complex issues. The decision of whether to induce labor or to proceed with expectant management with or without antepartum fetal surveillance is not taken lightly. Data support inducing labor at 41 weeks' gestation in an accurately dated, low-risk pregnancy, regardless of cervical examination findings. This strategy, although not without its critics, averts the need for antepartum fetal surveillance and does not increase the cesarean delivery rate; in fact, it may decrease the cesarean delivery rate."
Ultrasonography in pregnancy should be performed only when there is a valid medical indication. ACOG (2009) stated, "The use of either two-dimensional or three-dimensional ultrasonography only to view the fetus, obtain a picture of the fetus, or determine the fetal sex without a medical indication is inappropriate and contrary to responsible medical practice."
Has nothing to do with whether or not ultrasound is routine in prenatal care. They are referring to people who get ultasounds for fun, to see pictures of their baby and to find out the gender. There are non-medical pay for service 3-d ultrasound places that expectant Mom's go to for this purpose. A dating ultrasound, an anatomy scan, or any other medically indicated ultrasound is not what they are talking about here.
An ultrasound is generally performed for all pregnant women around 20 weeks gestation. During this ultrasound, the doctor will confirm that the placenta is healthy and attached normally and that your baby is growing properly in the uterus.
Suzy also posted a link from American College of Obstetricians and Gynecologists that says ultrasound is recommended. Medical doctors do recommend ultrasound as part of prenatal care. I suspect most CNM's would agree since they work with medical doctors. Your midwife is not a CNM and apparently does not follow this belief. Your body, your baby, your choice.
The risk of perinatal death decreases with advancing gestational age until some point between 38 and 41 weeks, when it begins to increase again.
Mehl-Madrona and Madrona (1997) reviewed self-reported data from midwives in the western United States between 1970 and 1985. A total of 4,361 midwife-attended home births were compared with 4,107 family-practitioner-attended home births performed in California and Wisconsin during the same time period. Sampling frames and response rates were variable, as were the data collection instruments. Deliveries were matched by maternal age, insurance status, parity, and presence of risk factors. Midwives were significantly more likely to deliver postdate pregnancies, defined as gestational age greater than 42 weeks, than were family practitioners (midwives also were more likely to deliver breech and twin pregnancies). Mortality rates were significantly higher for midwives compared to family practitioners, a difference that was attributable entirely to more postdate, twin, and breech deliveries in the midwife group.
Both of these studies are limited by issues concerning accuracy of dating, completeness of reporting, confirmation of causes of death, and in the case of the Mehl-Madrona paper, a rather complicated sampling scheme and questions about the true comparability of groups. There also are concerns about generalizability in terms of current midwifery practice in the United States. However, patients who select home birth are, by definition, low-risk patients. They also are unlikely to have undergone antepartum testing. The excess mortality seen in women with prolonged pregnancy delivering at home in these two studies is consistent with an independent effect of increasing gestational age on perinatal mortality.
Surveillance with tests that include fetal heart rate monitoring and assessment of amniotic fluid volume or elective induction both appear to be reasonable strategies beyond 41 weeks. Patients and providers should be informed that the best current evidence strongly suggests that there is a significant increase in the risk of perinatal mortality in women managed with antepartum testing compared with women who are electively induced at 41 weeks. Because this risk is small in absolute terms, and patients may have different preferences for both the outcomes and processes of labor and delivery, both options should be discussed.
Now, your contention is that it was "unnecessary" to induce at 40 weeks and 6 days. Perhaps we can agree not to quibble over the 24 hour difference between 40 weeks and 6 days and 41 weeks.
I contend that being at 41 weeks is a sufficient medical reason to offer induction. Certainly, it is also reasonable to offer to wait another week and do antepartum testing. But to call an induction at 41 weeks "unnecessary" is not true. And there is increased risk of stillbirth in that 41 to 42 week time frame.
Recent studies have shown that the risks to the fetus14,15,16,17,18,19,20,21,22,23,24,25,26 and to the mother23,27,28,29,30,31,32,33 of continuing the pregnancy beyond the estimated date of delivery is greater than originally appreciated.
"The management of postterm pregnancies is complicated and fraught with complex issues. The decision of whether to induce labor or to proceed with expectant management with or without antepartum fetal surveillance is not taken lightly. Data support inducing labor at 41 weeks' gestation in an accurately dated, low-risk pregnancy, regardless of cervical examination findings. This strategy, although not without its critics, averts the need for antepartum fetal surveillance and does not increase the cesarean delivery rate; in fact, it may decrease the cesarean delivery rate."
Suzy, can you please use the quote function when quoting text from articles and links. I have no idea what you part of your post you wrote and what part is quoted from the articles or links. Thank you.
I don't see anything in your link saying that routine use of ultrasound screening should be standard practice in prenatal care for all pregnant women in the US. Your link talks about the potential benefits which I'm fully aware of. You don't need to keep on trying over and over to convince me of them. I'm very much aware and educated on this topic. If you can find a link showing me that the routine use of ultrasound is the standard reccomendation in prenatal care for all pregnant women in the US then by all means, prove me wrong. Otherwise you're wasting your breath.
The quote from that link is not what the 2009 ACOG recommendation says. It says it is reasonable to offer it to everyone. Anyone, low or high risk, can decline it of course. And ultrasound has, de facto, become a part of low risk prenatal care to the extent that insurance covers it.
Hmm, this refers to ultrasound solely to tell the parents whether it is a boy or a girl. I do not believe any insurance companies cover that (or 3D or 4D scans).
"Although some controversy still exists regarding whether routine ultrasound screening of all obstetric patients
improves pregnancy outcomes, one ultrasound examination per pregnancy is considered the standard of care."
I would disagree with Cigna in that I think two scans: one first trimester (to establish due date and rule out multiple pregnancy) and one second trimester (to evaluate anatomy and look for anomalies) should be standard.
Quote:
You said homebirth is unrealistic.That is puzzling to me considering the fact that women and babies are just as likely to die in the hospital as they are at home.
Honestly, we're going in circles. You will never convince me and I will never convince you. I'm not sure this is even worth discussing anymore.
You say that women and babies are just as likely to die in the hospital as at home. All I am saying is that preventable deaths are more likely to happen at home.
Suzy, can you please use the quote function when quoting text from articles and links. I have no idea what you part of your post you wrote and what part is quoted from the articles or links. Thank you.
Sorry. I am flattered you thought I could have written this. I will try to do better. My comments in red --- seems the easiest thing to do since I cannot edit the original:
The risk of perinatal death decreases with advancing gestational age until some point between 38 and 41 weeks, when it begins to increase again.
Mehl-Madrona and Madrona (1997) reviewed self-reported data from midwives in the western United States between 1970 and 1985. A total of 4,361 midwife-attended home births were compared with 4,107 family-practitioner-attended home births performed in California and Wisconsin during the same time period. Sampling frames and response rates were variable, as were the data collection instruments. Deliveries were matched by maternal age, insurance status, parity, and presence of risk factors. Midwives were significantly more likely to deliver postdate pregnancies, defined as gestational age greater than 42 weeks, than were family practitioners (midwives also were more likely to deliver breech and twin pregnancies). Mortality rates were significantly higher for midwives compared to family practitioners, a difference that was attributable entirely to more postdate, twin, and breech deliveries in the midwife group.
Both of these studies are limited by issues concerning accuracy of dating, completeness of reporting, confirmation of causes of death, and in the case of the Mehl-Madrona paper, a rather complicated sampling scheme and questions about the true comparability of groups. There also are concerns about generalizability in terms of current midwifery practice in the United States. However, patients who select home birth are, by definition, low-risk patients. They also are unlikely to have undergone antepartum testing. The excess mortality seen in women with prolonged pregnancy delivering at home in these two studies is consistent with an independent effect of increasing gestational age on perinatal mortality.
Surveillance with tests that include fetal heart rate monitoring and assessment of amniotic fluid volume or elective induction both appear to be reasonable strategies beyond 41 weeks. Patients and providers should be informed that the best current evidence strongly suggests that there is a significant increase in the risk of perinatal mortality in women managed with antepartum testing compared with women who are electively induced at 41 weeks. Because this risk is small in absolute terms, and patients may have different preferences for both the outcomes and processes of labor and delivery, both options should be discussed.
Now, your contention is that it was "unnecessary" to induce at 40 weeks and 6 days. Perhaps we can agree not to quibble over the 24 hour difference between 40 weeks and 6 days and 41 weeks.
I contend that being at 41 weeks is a sufficient medical reason to offer induction. Certainly, it is also reasonable to offer to wait another week and do antepartum testing. But to call an induction at 41 weeks "unnecessary" is not true. And there is increased risk of stillbirth in that 41 to 42 week time frame.
Recent studies have shown that the risks to the fetus14,15,16,17,18,19,20,21,22,23,24,25,26 and to the mother23,27,28,29,30,31,32,33 of continuing the pregnancy beyond the estimated date of delivery is greater than originally appreciated.
"The management of postterm pregnancies is complicated and fraught with complex issues. The decision of whether to induce labor or to proceed with expectant management with or without antepartum fetal surveillance is not taken lightly. Data support inducing labor at 41 weeks' gestation in an accurately dated, low-risk pregnancy, regardless of cervical examination findings. This strategy, although not without its critics, averts the need for antepartum fetal surveillance and does not increase the cesarean delivery rate; in fact, it may decrease the cesarean delivery rate."
Has nothing to do with whether or not ultrasound is routine in prenatal care or not. They are referring to people who get ultasounds for fun, to see pictures of their baby and to find out the gender. There are non-medical pay for service 3-d ultrasound places that expectant Mom's go to for this purpose. A dating ultrasound, an anatomy scan, or any other medically indicated ultrasound is not what they are talking about here.
If you're having a low-risk pregnancy, however, you might not be offered an ultrasound at all. In fact, the American College of Obstetricians and Gynecologists recommends ultrasounds only when there's a specific medical reason.
Quote:
Originally Posted by sbd78
Suzy also posted a link from American College of Obstetricians and Gynecologists that says ultrasound is recommended. Medical doctors do recommend ultrasound as part of prenatal care.
In Suzy's link, ACOG discusses the benefits of ultrasound and reccomends discussing the benefits and risk with all patients but they do not recommend the routine use of ultrasound testing as a standard part of care for low risk pregnancies. If you read it differently then quote exactly where they say in the article that they recommend ultrasound screening for all pregnant women. Otherwise you're wasting your breath and arguing about something that's a non-issue.
Quote:
Originally Posted by sbd78
I suspect most CNM's would agree since they work with medical doctors. Your midwife is not a CNM and apparently does not follow this belief. Your body, your baby, your choice.
This is not about what "most" medical doctors, CNM's or CPM's say or do in regards to ultrasound. The reccomendation is that they all discuss the benefits and risks of ultrasound. That is the reccomendation and all of those people are supposed to follow the reccomendation. I also wish you would stop making so many assumptions. My midwife offers ultrasound testing and discussed the benefits of testing with me just like my CNM did in my last pregnancy. You have jumped to some majorly false conclusions in this thread and I really don't appreciate some of the things that you have openly assumed about me and my prenatal care.
Sorry. I am flattered you thought I could have written this. I will try to do better. My comments in red --- seems the easiest thing to do since I cannot edit the original:
The risk of perinatal death decreases with advancing gestational age until some point between 38 and 41 weeks, when it begins to increase again.
Mehl-Madrona and Madrona (1997) reviewed self-reported data from midwives in the western United States between 1970 and 1985. A total of 4,361 midwife-attended home births were compared with 4,107 family-practitioner-attended home births performed in California and Wisconsin during the same time period. Sampling frames and response rates were variable, as were the data collection instruments. Deliveries were matched by maternal age, insurance status, parity, and presence of risk factors. Midwives were significantly more likely to deliver postdate pregnancies, defined as gestational age greater than 42 weeks, than were family practitioners (midwives also were more likely to deliver breech and twin pregnancies). Mortality rates were significantly higher for midwives compared to family practitioners, a difference that was attributable entirely to more postdate, twin, and breech deliveries in the midwife group.
Both of these studies are limited by issues concerning accuracy of dating, completeness of reporting, confirmation of causes of death, and in the case of the Mehl-Madrona paper, a rather complicated sampling scheme and questions about the true comparability of groups. There also are concerns about generalizability in terms of current midwifery practice in the United States. However, patients who select home birth are, by definition, low-risk patients. They also are unlikely to have undergone antepartum testing. The excess mortality seen in women with prolonged pregnancy delivering at home in these two studies is consistent with an independent effect of increasing gestational age on perinatal mortality.
Surveillance with tests that include fetal heart rate monitoring and assessment of amniotic fluid volume or elective induction both appear to be reasonable strategies beyond 41 weeks. Patients and providers should be informed that the best current evidence strongly suggests that there is a significant increase in the risk of perinatal mortality in women managed with antepartum testing compared with women who are electively induced at 41 weeks. Because this risk is small in absolute terms, and patients may have different preferences for both the outcomes and processes of labor and delivery, both options should be discussed.
Now, your contention is that it was "unnecessary" to induce at 40 weeks and 6 days. Perhaps we can agree not to quibble over the 24 hour difference between 40 weeks and 6 days and 41 weeks.
I contend that being at 41 weeks is a sufficient medical reason to offer induction. Certainly, it is also reasonable to offer to wait another week and do antepartum testing. But to call an induction at 41 weeks "unnecessary" is not true. And there is increased risk of stillbirth in that 41 to 42 week time frame.
Recent studies have shown that the risks to the fetus14,15,16,17,18,19,20,21,22,23,24,25,26 and to the mother23,27,28,29,30,31,32,33 of continuing the pregnancy beyond the estimated date of delivery is greater than originally appreciated.
"The management of postterm pregnancies is complicated and fraught with complex issues. The decision of whether to induce labor or to proceed with expectant management with or without antepartum fetal surveillance is not taken lightly. Data support inducing labor at 41 weeks' gestation in an accurately dated, low-risk pregnancy, regardless of cervical examination findings. This strategy, although not without its critics, averts the need for antepartum fetal surveillance and does not increase the cesarean delivery rate; in fact, it may decrease the cesarean delivery rate."
So do you think that all women should be induced at 41 weeks?
The quote from that link is not what the 2009 ACOG recommendation says. It says it is reasonable to offer it to everyone. Anyone, low or high risk, can decline it of course. And ultrasound has, de facto, become a part of low risk prenatal care to the extent that insurance covers it.
Hmm, this refers to ultrasound solely to tell the parents whether it is a boy or a girl. I do not believe any insurance companies cover that (or 3D or 4D scans).
"Although some controversy still exists regarding whether routine ultrasound screening of all obstetric patients
improves pregnancy outcomes, one ultrasound examination per pregnancy is considered the standard of care."
I would disagree with Cigna in that I think two scans: one first trimester (to establish due date and rule out multiple pregnancy) and one second trimester (to evaluate anatomy and look for anomalies) should be standard.
You say that women and babies are just as likely to die in the hospital as at home. All I am saying is that preventable deaths are more likely to happen at home.
CIGNA is an insurance company who's priority is about profit and concerns are about liability, not health. Can you show me exactly where ACOG says that the routine use of ultrasound screening is recommended for all pregnant women, including those who are low risk and should be used as a standard part of prenatal care.
If a low risk women planning a homebirth lives 40 miles from the nearest hospital then yes, I could see that being more risky to deliver at home but if a low risk woman planning a homebirth lives close to a hospital then I disagree that planned homebirth for low risk women is any riskier then planned hospital birth is for low risk women.
OT: My DH is planning to trim the tree in our yard this weekend. he'll be using a ladder and a chainsaw (gasp!) Should we have an ambulance waiting in the driveway in case something happens?
So do you think that all women should be induced at 41 weeks?
It should be discussed. If someone wants to wait another week and do the testing, that is an alternative, but waiting is still associated with some increase in risk to the baby.
In the past, the concern about induction has been that some women are hard to induce.
That could lead to more Cesareans. With the medical options now available for "ripening" the cervix, a "failed induction" is less likely to happen.
Keep in mind that the whole idea of delivery before 42 weeks is to prevent an otherwise unexplained stillbirth of a healthy full term infant.
So, yes, based on the references I gave you, I think 41 weeks is better than 42 weeks.
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