post-dates/induction question

Jolie, BSN · Dec 9, 2001

Whenever a patient goes over-due, she needs to have some testing to determine fetal well-being. If all appears well, most OB's will set a schedule of non-stress testing every other day. If any of these tests have non-reassuring results, then the mom will need a bio-physical profile, and/or a CST. IF these tests look bad, then she should be induced or scheduled for a section, whichever is most appropriate.

Even when all the tests look good, I have never seen a doc or midwife allow a patient to go beyond 42 weeks without intervening.

The placenta does not have an indefinite life-span. Its functioning begins to decline with time, placing the baby at risk for oxygen deprivation and malnutrition. Babies born post-dates have a greater risk of complications such as fetal wasting, and meconium aspiration.

I agree with you that it is sometimes appropriate to nudge mother nature.

fergus51 · Dec 10, 2001

Our docs do just what Jolie sid, monitoring for problems and inducing once a woman is really overdue. My issue with being "overdue" is that half the time the dates are wrong. A lot of women don't have a perfect 28 day cycle and a lot of ultrasound dates are inacurate as well. I have seen more than a few "overdue" babies come out with vernix.

semstr · Dec 10, 2001

Agree with the other two. Here we wait too and the woman has to be checked every 2-3 days, depending on how she and the baby are doing.

42 weeks plus 2-3 days is the absolute max.

Take care, Renee

KRVRN, BSN, RN · Dec 13, 2001

A friend of mine went to her OB appt at 42 wks plus 1 day and the doctor told her that if she hadn't delivered in a week, THEN he would induce her. I'm sorry, but 43 weeks is just too long for comfort. Her dates were dependable. (This was the same doctor that had her push for 7 hours to the point of exhaustion with NO progression before doing a c-section).

She had to put her foot down and he agreed to induce her later that week, making her about 42 and 3 days. Her baby came out big, vernix-free and peeling. Luckily no meconium. I forbid her to ever have a baby with that OB or at that hospital (it was a little tiny hospital)! Her birth experience was so bad that she says she never wants to have another baby.

Jolie, BSN · Dec 13, 2001

KRVRN,

I'm glad your friend stood her ground and had a healthy baby. After her first experience with that doctor, I'm surprised she went back! 7 hours of pushing???Yikes!!!

**canoehead, BSN, RN** · Dec 13, 2001

Why is it that whenever something bad happens people write "it was a small hospital" as if that explains all. Working at a small hospital I hear lots of clunkers about how the huge impersonal hospital screwed up, or most often about lack of assistance, or pushing patients through their assembly line. Let's back off a little huh?

KRVRN, BSN, RN · Dec 14, 2001

I indicated it was a small hospital because they only had 4 L/D rooms, and 2 or 3 nurses, handling L/D and PP. There was no doctor there, --as best as I can tell, he was on call. He also was seeing pts in his office in the next building until the early evening. Hmmm, and that's when her section was done. My personal opinion was that she was told to push so long because they didn't want to have to take her in for a c-section because that would tie up extra staff from floating to any of the other moms. They even sent her down to x-ray to have pelvic x-rays to see how big her pelvis was. That's a little strange to me. Is that USUALLY done to determine whether to do a c-section or not? After the c-section, they had to send her downstairs to the ICU to recover. She couldn't even see her baby until she came back up.

Being a small hospital doesn't necessarily just explain it all away. But that hospital very obviously didn't have any type of backup readily available and I still believe things would have been different had she been at a bigger place with more backup staff. No offense intended, I should have said that their particular unit had very little staff rather than "it was a small hospital." Enough staff if everything is status quo, but probably not enough if things are out of the ordinary.

Heck I have another story from the same hospital... Another woman I know (2nd baby) went there because she was having contractions. Their L/D was already full, and the nurse there checked her and said she was only 2cm and the EFM wasn't showing contractions. Apparently didn't actually FEEL her abdomen, despite a 2nd time mom telling her "I'm having regular contractions." Sent her back home without ever being seen by a doctor. She was home MAYBE 5 minutes when she told her husband to call 911 because the baby was coming. Idiot that he was, he tried to speed her to the hospital at 100 mph at 4AM. Well, she had her baby in the car halfway there and her birth certificate says "Highway 75, automobile" as her place of birth! My opinion is that a place with enough staff and beds would have at least monitored her awhile and maybe admitted her. And if they really didn't have the staff or beds to take her, they should have arranged a transfer (there's probably 10 other hospitals within 20 miles of there).

**canoehead, BSN, RN** · Dec 17, 2001

OK, but just for the record patients in big hospitals have to wait until after office hours for their docs too, and have inadequate assessments/monitering.

Q. · Dec 22, 2001

I also agree with the above posts.

My main problem with inductions is when they are done at 38-39 weeks and when the woman is not truly post-dates and all fetal assessment tests are reassuring. Half the time inductions done without any real medical reason only lead to MORE complications such as a section, increased recovery time, post-op complications, babies with RDS, etc. Babies are MEANT to pass through the birth canal to help squeeze out that fluid.

L&D.RN · Jan 5, 2002

I agree with Suzy...just sent a lady home yesterday after 2 days of pitocin induction with no results. Reason for induction - postdates...her EDC by LMP was 1/4/02, by US 12/29/01...she was brought in for induction on 1/1/02. What happened to letting nature take its course unless there's a compelling reason to do otherwise.

fergus51 · Jan 5, 2002

I just had a woman who was due a week before be induced and the baby came out with vernix again. I should also mention she was a VBAC and we've all seen that study about VBACs and inductions. She was in labor for a total of three hours and tore so badly! Her rectum was torn worse than anything I have seen in my nursing career. I hate inductions!!!