Nov 042012

“We have to do an induction at 42 weeks, but we don’t schedule inductions on the exact day you are 42 weeks; it has to be the day before. But, the day before is Labor Day and the weekend, so we’ll see you this Friday.” – Nurse Practioner said to woman who was 40 weeks and 6 days pregnant.

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 November 4, 2012  Due Date, induction  Add comments

  43 Responses to ““We Have To Do An Induction At 42 Weeks, But We Don’t Schedule Inductions On The Exact Day You Are 42 Weeks…”

  1. “Because it’s no big deal to the nursing staff what day we write on this piece of paper. It’s all the same to us, but our lawyers throw an absolute FIT if we ‘let’ a woman go to 42 weeks, and no one ever sued because their baby was born at 41 weeks or 40 weeks, so we’ll make sure your birth is convenient to us and the lawyers based on the magical date determined by the Wheel Of When and the measurements of any ultrasounds you may possibly have had early on, even if they disagreed with one another. Because once I write it down on this sheet of paper, all dates are absolutes. Any questions?”

  2. “…and we can’t do it the day AFTER, of course, or your baby will explode.”

  3. And what other day would be more perfect for a baby to be born than Labor Day?

    • I had arranged to watch the kids of a girlfriend of mine when she went into labor. She called me early on Labor Day and said, guess what day it is – and I said Labor Day and she said no LABOR DAY. I was at her house in minutes – those kind of stories are fun!

    • My sister was a Labor Day baby and I was a 4th of July baby!

  4. Oooooh, sciencey!

  5. A client once called me in a tizzy because her doctor said her water levels were low, and that she had to induce right away. I called my midwife to check the numbers with her, and she said, “Of course her levels are low – it’s a holiday weekend!” Meaning, they wanted to induce to make sure she wouldn’t ruin their holiday…
    Client refused, but I don’t remember which day she ended up giving birth.
    For the record, I get the whole ‘docs/nurses/midwives have families that need them, too’ thing. But if you choose this job, the hours come with it, and you have to deal with it. I’m a doula, and not every birth has come at an ideal time for me. When I stop being OK with that, I’ll stop being a doula.

    • “Doctors have families that need them too” does NOT mean “I get to lie to my patients so I can have my family time at their expense.”

      If the doctor honestly believes his/her needs are so important, then the doctor should just outline his or her personal needs to the patient and trust that as a reasonable human being, the pregnant mother will understand that the risks of induction and possibly unnecessary surgery are of course less important than the doctor being home on a holiday weekend. If the doctor can’t do that with a straight face, then the doctor needs to understand that lying or greatly exaggerating the risks of remaining pregnant for three more days doesn’t improve his or her moral standing.

      I’m glad to hear your client refused the induction.

    • So what are OB’s supposed to do? Should the requirements for being an OB be that you must live in the hospital and swear to never marry or have children? What kind of lives are OB’s/nurses (who all carry waaayyy more patients at one time then any midwife/doula and who also *have* to be available 24/7 for critical care patients unlike midwives/doulas.) allowed to lead? Work/life balance is a must for all people.

      • Yes a work/life balance must exist but NOT at the expense of patient safety. Inducing because of holiday interference is NOT a good reason!

        • How about scheduling things when you have the maximal amount of staff and are less likely to have delays due to staffing limitations. Is that a good reason to schedule an induction for a particular day, since she wasn’t being induced because of the holiday she was being induced because she was well over 40 weeks and not in labor.

          • …which is not a particularly evidence-based reason to induce, and if you’re going to have a rule, like “41w3d is okay, but the risk rises at 42 weeks so blah blah blah,” then don’t induce at 41w3d because of a holiday weekend! Especially when the vast, VAST majority of women will go into labor naturally before 42w, but there is a significant minority that won’t go into labor by 41w3d (yet will, if given a couple more days)… and because induction has many risks.

          • 6 dyas is not well over 40 weeks. How did you ever pass high school math? Go look up the term “standard deviation.”

          • We aren’t talking about 40 weeks 6 days are we? We are talking about 41 weeks 3 days, that is well over 40 weeks. that is a standard deviation away.

          • The only “good” reason to schedule an induction is because Mom or baby is at risk for complications. Holiday weekends don’t fall under that category.

        • I think we are taking more issue that the doctor was trying to perform a potentially dangerous medical procedure that could lead to major surgery and the only reason was so he could go HOME.

          If there is NOT a medical indication for a medical procedure: DON’T DO IT.

          That should be a massive DUH.

          • The induction was not so the doctor could go home, yes the scheduling was for the convenience of hospital staff, they wanted her to have the baby when the staffing would be peaking and not at a nadir, but the induction was because she was at 40+ weeks and not in labor.

          • But doesn’t it make more sense to push the induction back one day rather than forward four days?

      • Goldilocks..

        They should just be honest or work to avoid that by making more clear demands, with evidence for why, of their employers (for instance: do outcomes go awry when docs/nurses are not given enough mental health breaks? Probably!).

        If they want to induce a woman to avoid a holiday labor that they’re on call for.. They need to be honest about their motivation. They also need to be honest and stop being so cavalier about the risks involved with an unnecessary induction! The risks are very real. Pretending they’re not real to “not live in a hospital” doesn’t mean that the doctor and nurses are not actually pretending.. meaning lying.. meaning doing something against someone else’s best interests without their consent.. meaning literally VIOLATING another person.

        If you think that violating someone else is happening because doctors/nurses “need lives too”, then you/we/they need to advocate much stronger labor regulation in this field… meaning, more days off, less hours in a row, days off that are guaranteed unless there is some type of emergency, unpenalized “mental health” vacations, etc. Absolutely NOT NOT NOT advocate docs and nurses being excused or shrugged off for literally violating other people (in manners that could risk their lives no less) so that their lives are not as socially difficult.

        And if you really needed me to explain that to you, I hope to goodness you aren’t in the health-care field… :-

        • Really well-said, A different E. A lot of people work on holiday weekends, and work long hours – and get paid far less than docs. I respect my doctors (thankfully, I’ve had mostly great ones) but if one tried to pull this on me – manipulating me into a medically unnecessary procedure using misinformation – I would change doctors. If you are on call, you’re on call. If you don’t want to be, take it up with your employer, not out on your patients at the expense of their care!

        • Dang, you worded that beautifully!

      • If hospitals and OBs are going to insist on inducing at 42 weeks without medical indication, then they need to staff the hospital appropriately to accommodate their own regulations.

        If hospitals and OBs are going to insist that hospitals are the only safe place to have a baby, then they should not create unnecessary risks by forcing medically unnecesary inductions.

        Also, midwives do have to be available for their patients who are in labor. Moreso than the OBs, because OBs do not remain with their patients for the entire duration of labor whereas midwives do. OBs rely on the nursing staff and the monitors to let them know when to show up, whereas midwives are by the woman’s side the whole time.

      • It’s true that the hours come with the job, just like someone who hates bodily fluids and personal interaction should not become a doctor or nurse.

        However, doctors don’t have 24 hr duties every day, so unless they’re taking extra shifts, they will not be absent from their families all the time (I know some doctors who love to take extra even on christmas, so they don’t have to spend time at home. Makes me wonder why they wanted a family in the first place. :/ )

        There are plenty of specialties a dr. can chose when they want to avoid 24 hour shifts at all costs. Anesthesiology and ob/gyn are none of them.

      • I’m in the military. When I enlisted I knew that it meant I might spend holidays, birthdays, and anniversaries away from my family. I missed my son’s first Christmas, spent my 6th anniversary in tech school, and spent the first 5 months of my marriage away from my husband.

        It sucks, but if I wasn’t willing to make those sacrifices, I would never have joined in the first place. I don’t see why that should be the case for cops, EMTs, ER staff, military members, and firefighters, but OBs are some kind of special.

        • Exactly. My husband was in the military and this was just par for the course. You NEVER knew when they would be unexpectedly called up for some kind of duty or exercise or be deployed or whatever. Good commanding officers and units would do as much as they could to make sure soldiers got time with their families, etc. but there is only so much they can do. And guess what? Someone still has to be on duty on holidays, so you have to work around it!

          Same thing with OBs and nurses and a lot of other professions.

      • They deal with it. That’s what you sign up for, but it seems like a lot of medical professionals don’t understand it.

        I’m sure my OB didn’t want to come back to the hospital at 1am so she could help me with delivering my baby, but I’m glad she didn’t tell me to get a section at 6pm the day before so she could go home to have dinner.

      • Actually, I personally think that, for low-risk women (75%+ of all women in the US), midwives should be the primary care providers. And yes, they understand that those hours are part of the job. Then there would be “hospitalist” OBs (but a lot fewer than the current number of OBs) that are basically “on-call” for those MW clients that do end up needing emergency C/S or other surgical procedures (shouldn’t be many of them).

        • I don’t know about you, but my insurance company DOES cover a midwife, but you are TOTALLY on your own if you want one. They refuse to help you find a midwife as they are not the “safe” option. Same thing with birth centers. I believe a birth center is covered under my plan, but they will not help me find one that takes my insurance.

          I have to do all the searching and legwork myself.
          Because “standard of care” really means “conform to what we are used to so we don’t have to think,” at least as far as insurance goes.

          Sometimes I really wish I lived outside the US so getting a midwife wouldn’t be such a problem. I do realize there are vast online resources for finding a midwife and birth center, but if my insurance covers them, they should include them in the “search for medical providers” section online.

          • Are they even allowed to do that?! Now that I think of it, when I decided to switch to home birth, they made me call a bunch of midwives in my area to find out if they did home births (they didn’t). But they didn’t have any home birth midwives in network.

          • My insurance was like that too, until I was advised by a local midwife to file an exemption claim so I could be under her care. My insurance magically found a midwife they covered right away, even though the week prior they claimed to have no knowledge of any in network.

          • My insurance has a clause in it that specifically excludes home births and any care by a midwife. I’m 12 weeks right now, and we’re paying everything out of pocket…

      • Goldilocks – My mother worked in a hospital lab for 30+ years. It’s not quite the same as it is for an OB, since her schedule was fairly stable. However, for my entire childhood, there were ALWAYS holidays that she worked. Some years she was working on Thanksgiving, some years she was gone on Christmas Day. We kids (I have 4 siblings.) learned early on that if you work in the medical field in any capacity, your time may not always be your own. It’s part and parcel of the job and you know that going in.

  6. Oh, such a pity that I will unexpectedly feel unwell and forget to show up.

    If there is *one* thing that shouldn’t be planned around holidays, it’s labour and birth. That’s what the 24hr background is for (and anyway, hospitals don’t close on weekends, so what.)

    • If a woman goes into labor on a weekend, of course she can show up at the hospital and they will admit her. But most hospitals refuse to *schedule* c-sections/inductions on the weekends or holidays, which isn’t a bad thing, imo. If the doctor wants to schedule something in advance he does have to work with the hospital scheduling rules and availability.

      • Maybe I didn’t make myself clear, but I’m agreeing with you that surgery that isn’t emergent should not be scheduled on a weekend or any other time with reduced staff (like nights). In this case, if the induction was wanted and necessary, I think they should have scheduled her for a day later/after the holiday.

  7. There is so much about this that doesn’t even make sense to me. You have to schedule the induction the day before 42 weeks? It absolutely CAN’T be on the day OF 42 weeks? Uh- whyfor? And I’d like to see the medical necessity for inducing at exactly 42 weeks, not a day later.

    Oh, and you won’t see me this Friday, because I’m not showing up. I’ll either go into labor before that day or after that day on my own, OR we’ll discuss induction when you can give me a reason for it that doesn’t include your convenience. Thanks.

    • I’m betting there’s some legal thing where the hospital has written guidelines to eliminate women going past 42 weeks for legal reasons.

      This (of course) presumes the EDD is correct, but not “permitting” a woman to go to 42 weeks sounds an awful lot like defensive medicine.

    • This.

      How does a uterus and woman suddenly become toxic at 42 weeks, but 41 weeks + 6days, she’s fine? These are babies, not expiration dates!

  8. So, this is how they manage “emergencies” eh?

  9. 11:59 pm on 41 weeks, six days… everything’s fine.

    12:00 am on 42 weeks… uterus explodes, killing everyone in a 20 mile radius. Pets, too. I can’t speak for any of you but I’d hate to be the cause of little Timmy’s dog dying.

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