Yesterday I had my 34-week OB appointment. Everything went well, the non-stress test looked good, and we talked about the upcoming Group B Strep test. Then she said, “So we’re thinking we’ll plan your induction for Tuesday, August 2nd, when you’re 39 weeks. Is that a good day for you?”
Woah. We’d had some conversations about when I might deliver, but we had never discussed a planned induction!
She went on to explain that she was recommending induction at 39 weeks due to my gestational diabetes. Though I hadn’t really planned for that, it seemed reasonable. Frankly, I felt relieved to have a firm expiration date for this pregnancy on my calendar, and excited to know we’ll get to meet our little girl a little earlier than her due date. Obviously I didn’t have anything major on my calendar for my 39th week of pregnancy so I gave her the go-ahead to get it scheduled.
My husband couldn’t make it to the appointment yesterday, so I called him from the parking lot on my way out to give him the update. I was excited; he was hesitant. I’ve mentioned before that he’s the kind of guy who doesn’t take things at face value – he wants to do his own research before he’s convinced. So as soon as he got home from work he jumped on PubMed.
From everything I had read, a planned induction is typically only problematic for the baby prior to 39 weeks. Of course, if an induction is needed for medical reasons, then it’s because it’s safer for the baby to be delivered than it would be for he or she to stay put until labor starts naturally. Regardless of the reason, though, induction at 39+ weeks seemed to be pretty safe, albeit with more discomfort for mom (yay epidural!) and a slightly increased risk of cesarean birth. I don’t love that, but I can live with it.
However, my husband found some studies on PubMed that showed that babies born later (at 40 and 41 weeks) tended to have slightly better cognitive functioning – an effect that lasted well past birth and at least into grade school. The differences were greatest for babies born prior to 39 weeks, but there were still small benefits to an additional week or two in the womb beyond that. It’s not huge, but it’s something. Furthermore, the more we talked about it, the more unsure we felt that my GD was really negatively affecting the baby. My sugars have been very well controlled, even without insulin, and her growth scans have consistently shown her in the 50th percentile, so size isn’t an issue. Is an induction really necessary?
We ended up deciding to send an email to our doctor asking what she thought about waiting until 40 weeks to induce, with the caveat that we could move things up if the baby started showing distress.
This morning she gave us a call to discuss. I really love how responsive she is. She explained a bit more of her reasoning for a 39-week induction, which was really helpful. Basically, it’s not just about the baby’s size. Studies done on women who wear continuous glucose monitors show that even women with well-controlled GD have frequent highs and lows that aren’t always caught by the 4x daily finger sticks. This increases later in pregnancy as the placenta grows and releases more HPL. These fluctuations stress the baby and make it a safer bet to deliver at 39 weeks (when she’ll be fully developed anyway) rather than subjecting the baby to an additional week with these stressors. Basically, the OB wasn’t saying no – we could still push the induction date back to later that week or all the way to 40 weeks if we felt strongly about it – but her strong recommendation was to start the process at 39 weeks.
I trust her on this. She’s been in practice for decades and I have no reason to believe she’s not doing what’s best for the baby. So we told her to go ahead and schedule for 39 weeks. Though compromising by pushing the date back by a few days seemed appealing, I’ve found through personal experience (backed up by actual studies) that inpatient care over the weekends tends to be worse than during the week, so I’d rather not risk delivering on a Saturday or Sunday if I don’t have to.
Do I feel a little sad about this (potentially) really changing the birth experience we planned for? Sure. If the induction happens as planned we won’t have the excitement of realizing I’m going into labor, the time spent with our doula laboring at home, then the drive to the hospital when the time is right. My labor on pitocin will be more painful, so I’ll probably get an epidural sooner than I had planned. Hopefully I won’t need a c-section. But honestly, I’ve never been big on the “birth experience” part of becoming a parent. I think of it as a nice bonus if it happens, but our priority is doing the safest thing for our baby. We’re pretty risk-averse and given the complex medical issues we’re dealing with (CF in addition to GD) we’re trusting the experts on this one.
So – that’s the plan! Of course, if I go into labor naturally before then, it’s a moot point. But it’s exciting to know that we are truly only about a month away from having this baby, one way or another.