6) I bet the doctor got the husband’s work number from the woman’s emergency contact list. And an elective induction is not an emergency.

Whoops they unplugged the Pitocin again…..

The woman next door to me in the hospital after I had my first baby brought five kids with her, and NO ONE was watching them. They were running the halls, screaming, banging things, slamming doors — what a nightmare! I have no idea what the circumstances were that led to those kids being there, but the other adults with her weren’t doing anything to keep them quiet. Eventually the nurses asked the family members to take the kids out of the maternity unit.

Ah, but what do you do if mom is being induced, is strapped to monitors, and on one can take them home? I guess you let the kids demolish the hospital.

THe mom has the right to informed refusal, regardless.

And bullying tactics by the doctor aren’t justified even with the slight increase in stillbirth after 42 weeks. The doctor needed to present facts, not make an end run around the mother’s right of informed refusal.

Actualy the stillbirth rate begins to increase at 38 weeks (when it is at its lowest, statisticaly). If that was the ONLY consideration, we would be inducing all women at, or around, 38 weeks (and geting lots of preterm babies as a result). The ACOG does NOT state that 42 weeks is some sort of “cut off”; in fact a woman at 42 weeks has some options: inducing is an option (it is most likely to work in a multip with a favorable cervix), proceding straight to c-section is an option, and watchful waiting is an option (with NSTs and/or biophysical profiles conducted twice weekly to monitor baby’s condition). All are considered “acceptable” choices according to the ACOG. For a woman with an unfavorable cervix, who would like to avoid unneeded surgery (like, say, she has two kids at home and doesn’t want to deal with taking care of two kids and a newborn while recovering from a primary section (usually the ahrdest to recover from), watchful waiting may be the best choice. And let’s not forget that two times a very small number is still a very small number (think 1/1000 vs 2/1000). And the studies that showed “double the risk of still birth after 42 weeks” included data from the 1960′s. Monitoring has improved greatly since then.

So, you’re right, Larry, there is an increased risk of still birth after 42 weeks. But the absolute risk is still very small and since inductions put the mother and baby at increased risk, it should be entirely up to the patient to decide which course of action she is most comfortable with. Assuming there are no other complications at play, waiting is perfectly valid.

“Labor would likely not last more than 6 hours after AROM.” ? Seriously? You must be in the crystal ball business- there is no way you can predict this. “That doesn’t seem a high “price” to pay for a healthy livebirth at 42 weeks.” Because 1 day after 42 weeks, the placenta expires and baby dies. Come off it, plenty of healthy babies are born after 42 weeks. How do you know docs even got mom’s dates right? I’m betting if we checked statistics, more babies die from prematurity (much if which is iatrogenic) or complications of than are stillborn. Take your dead baby card, Larry, and keep it to yourself. Unless the doc has some solid proof that the baby is in danger by remaining in the womb, there is no reason to induce.

Why can’t we ever just say, “And there’s an equally good chance you’ll go into labor on your own and everything will be just fine!” Why does it always have to be painted as the worst case scenario? We spend way more time thinking about all the stuff that could go wrong – and planning for a disaster that might never happen – than we spending coaching women on how to have a normal pregnancy and treat things IF they come up.

We know the EXACT conception date of our daughter, and she was born 3 weeks late–unfortunately by induction, but by that point it was MY CHOICE to do so. My OBGYN was very supportive of my continuing the pregnancy, as he does NOT like inductions since he does not like c-sections. After my due date passed he started fetal monitoring twice a week for the first week late….every other day as of the 2nd week late, and daily after that point. My baby was not showing any signs of distress, so he left it up to me, but discouraged induction. As of nearly 3 weeks late we were noticing SLIGHT signs that the placenta may be getting old, so I went ahead and scheduled the induction. (This was AFTER trying every natural way possible to bring on labor.) I was VERY PLEASED with how my doc handled things. He did NOT take to fear mongering or pushing me. It helped keep me calm and in controle.

Larry, once again you seem to miss the point of posting these quotes from medical professionals to patients: they are inappropriate. In all kinds of ways.

We can assume that the woman, the patient, here was not incapacitated since she could bring her kids – so the husband was not the one to make the choice to induce or not. Talking to him and not the patient is another example that when it comes to maternity care the mother is often not considered a real person. If we want more healthy babies and more healthy mothers that has to change.

Again, if the OB had talked to the actual patient and present some of the facts (opinions) that you did then this wouldn’t be a MOSW quote – it would be an example of treating the patient and being a good medical professional (we might even see it on Thursday).

Yes, but the stillbirth rate also increases for a whole host of other reasons that no one seems to give a crap about, so…

And the increase is so small that for many mothers (for whom their unborn child is their first priority, even ahead of their own lives), the risk you note is not worth the risks of induction.

You would make a different choice than this woman. That’s your right. And her right is to make the choice that is best for HER.

I bet my mother would have liked 6 hour labours. Out of 5 births she only ever got one that was under 10 hours.

Yup, I know I would!

But again, you’re assuming she was already at 4cm and would *immediately* begin having regular contractions the minute the induction began.

I was a multipara when induced (necessary) and I had 12 hours of completely nonproductive contractions. I was still 1/2 cm dilated at that point.

So yes, once the woman begins active labor, she might dilate 1cm per hour from 4 to 10cm if conditions are right, but how long does it take to get to 4cm, and how long will she push afterward?

Also, are you taking into account that pitocin contractions are typically harder to cope with than oxytocin contractions? And therefore the mom might resort to pain medication? And that with an epidural, her pushing will likely be less effective?

Are you taking into account that because the mom’s not ready to give birth, the baby might not be in a good position to descend, nor in a good position to push?

I hope that if you’re an OB, you’re not selling induction to your multiparas by telling them it’ll be a six-hour trip.

How often are women already 4cm dilated before they start labor? Serious question, because I only know my own experience, which is that I am never more than 1cm before labor starts. So if you wanted to induce me, and told me it’d probably only be six hours, but you were thinking “once you get to 4cm,” — well, then add another eight hours on before that.

Hey Larry, mind telling us where you work? Because if you’re so sure of yourself you should be confident in disclosing that information.
Meanwhile, I’d like to know so I can be sure to run the opposite direction if I ever come near you. Now I’m going to have to ask the first name of every medical professional I know. You just made a lot of innocent Larrys lose business. Shame on you.
“In my experience that I’m waving around to quiet all your women, birth goes exactly like this or I’ll make it do so.” You people wonder and gawk when I say I don’t want to have kids? I wouldn’t let you give aid to my cat.

I was 4-5 cms dilated with my first before going into active labor. I was in labor for 22 hours. With my second I had no VEs but have no reason to believe that I wasn’t already dilated as well before active labor and I had a 14 hour labor. I do not know many women who have had 6 hour labors. I don’t know what kind of experience you are talking about, but I wouldn’t want to be a part of it.

I believe somebody here had proof that breaking the bag of waters only sped things up by 20 minutes. Since it increases the risk of infection and risk of prolapsed cord I think I’ll pass. 20 extra mintues of labor is “a small price to pay” especially for the doctor. I would be more interested to know what her Bishop score was at that point, but I suspect that even the doctor didn’t know that. I suspect that the woman didn’t show up to her office appointment or induction BECAUSE she didn’t have a sitter. I also suspect the doctor called the husband at work BECAUSE the woman didn’t show up. I am a lot more interested in her BPP and her Bishop score than the length of her labor. Then again I am a woman of science and pay attention to those annoying little details that trip up people who put it on autopilot and doen’t ask the right questions. Larry, You are a fool! I feel very sorry for your patients. But you let me know if your c-sction rate is less than 10%. mkay?

Larry, I have five children. My first labor was induced with cervadil for 12 hours at which point I was 2 cm, and then pitocin for 6 hours. I went from 4 cm to complete in 15 minutes.
2nd was also induced, but without cervidil. I went from 4 to complete in about 30 minutes.
My 3rd was 15 hours, went from 4 to complete in about 9 hours.
My 4th was 9 hours. I went from 4 to complete in about 6 hours.
My last labor was 40 hours, with 9 hours from 4 to complete.
Notice the pattern? It’s pitocin that makes them go so quick, not the amount of babies.
I would venture that you induce or augment most of your patients.
What is your induction/augmentation rate? I’d love to know.

Larry, as the person who submitted this, I go from about 4-complete in anywhere from an hour to a few hours. This was my fourth child and I know exactly how my transition starts. There was no reason to rush this and no reason to rush to the hospital even if I had been laboring for a while. Baby would have been fine if it had been born at home or on the way as I had prepared myself for a UC just in case. There is NO typical for any class of woman when it comes to progression of labor. NONE. It is exactly that mentality that leads to too many unnecessary interventions and c-sections and as a woman, I take offense to the know-it-all mentality. Each of my labors has gotten longer by a couple of hours – now which mold does that fit into? NONE because by your OB rules, they should be getting shorter. HA, no such chance.

Well doc, this multipara with a favourable cervix needed Pit, Gel, Atards and AROM to even get to 3cm, and it took 7 hours to get to 4cm, and another 8 to get to 9cm!

Yes! Calling the husband is the thing that bothers me the most about this quote. For all sorts of reasons mostly having to do with respect and professionalism.

Yeah, I just couldn’t get past the calling the husband part. This completely ludicrous, as if the mother wasn’t an adult who is capable of making her own decisions.

All I could think is that if my OB tried that with my DH (she NEVER would), he would laugh hysterically, tell her to call me for an answer and then promptly hang up the phone. He knows better than to make decisions on my behalf, especially when it comes to childbirth. LOL!

What gets me about OBs posting here is that they are very selective about what they comment on. Remember that HORRIBLE post some months back where the OB said, “Pit her to distress, I’m tired of her” clearly being unethical and unsafe. The other guys (Fogerty? Can’t recall) was silent on that one, just like he was on the one where the OB said something to the effect of “I’m cutting you (episiotomy) to punish you” to a young mother. Yet they jump in freely on other issues, often where ‘informed consent’ is involved (i.e. an educated mom trying to make a good decision, and a doctor using scare tactics) to support the OB. I don’t like that lack of balance. It’s like they ignore the horrible stuff, but pull out their ‘expertise’ when it’s mom’s instincts/education coming into play. Docs, you can’t have it both ways.