Three weeks ago at my 36-week appointment, the nurse educator at my OB office gave me a handout put out by the March of Dimes regarding this initiative. I think it was the office's way of saying, "Unless you have a clear medical reason to be induced, we're not going to do it before 39 weeks, so don't even ask." As much as I've griped and moaned to my coworkers and family about being 'ready RIGHT NOW' since 37 weeks (right now am 39), I have to applaud them for taking part in this.
I have seen way too many social inductions/deliveries starting at 37 weeks, as I'm sure most of you have too. The hospital where I work as well as the upscale hospital down the street both have private docs that will do them, which is pretty scary. It's one thing if there is a legitimate medical need, or if the baby comes on his/her own; those are totally different scenarios. But to go inducing and delivering 'just because', that is downright scary. I realize the social delivery trend isn't a new one; I am glad that someone finally took notice, said enough is enough, and put some numbers with it.
No inductions before 39 weeks unless medically indicated, has been the standard of care at the hopital i'm at for the past 2-3years. The MOD information was part of the training we received when we took ALSO. As the mom of a preemie I'm so glad to see this information being distributed and put into practice!
whenever i talk to people about the risks of non-medially needed inductions/sections before 39 weeks I almost always get the same reply "but my doctor would not do it at 37 weeks if it was not safe" and i just want to bang my head. 39 weeks should be the standard - Even the NEJM article, the most common ref for the timing of repeat sections says that 39 weeks is best.
a few more days of discomfort are well worth the greatly reduced risk of having a baby in the NICU.
Glad this info is getting out there
I also do think something needs to be said to docs though who let women go too long...working in a large referal center NICU I've seen too many "post date" disasters end in severe disability, even death, even with the new cooling protocol being used.
I also do think something needs to be said to docs though who let women go too long...working in a large referral center NICU I've seen too many "post date" disasters end in severe disability, even death, even with the new cooling protocol being used.
it seems like in my area of the country you hit 39.5 and 40.0 they start pushing inductions for 40.1 IMHO/E as long as the AFI is good and the placenta look good (i.e. no calcification) than induction talk should be held off/ nut then again i know someone that usually carries her babies to ~43.0 as do all the women in her family and as she says "we slow cook our babies so that they are sweeter!"
it seems like in my area of the country you hit 39.5 and 40.0 they start pushing inductions for 40.1 IMHO/E as long as the AFI is good and the placenta look good (i.e. no calcification) than induction talk should be held off/ nut then again i know someone that usually carries her babies to ~43.0 as do all the women in her family and as she says "we slow cook our babies so that they are sweeter!"
I guess I'm not terribly experienced, but working in a large NICU I guess I've only seen the bad cases...but enough to scare me away from 40wks + 2 days...
I'm pleased with the recommendations but doctors can get really creative when it comes to inventing indications. It troubles me that community-based doctors really don't have have much oversight and don't have to answer to colleagues/peers.
I'm pleased with the recommendations but doctors can get really creative when it comes to inventing indications. It troubles me that community-based doctors really don't have have much oversight and don't have to answer to colleagues/peers.
I find this to be anecdotally true as well. I almost never see this among residents/attendings in the teaching hospital where I work. The private docs, on the other hand....it just depends on who's on. One of my RN friends who works in a community hospital has written docs up for blatantly fudging reasons to section/induce.
I will have to say, though, I give my OB full marks on this one, and he's based at a community hospital. (I work at a different facility than where I'll deliver.) He is not into fudging reasons to induce (or section) and I am glad. I saw him yesterday at 39 weeks, still just 1cm dilated, and after all was said and done, he told me, "Okay, I'll see you next week if you're still pregnant." I'll be just over 40wks at the next appt, and he said we could talk about induction at that point, but didn't act like it was done deal by a long shot. This is not a 'rush to intervene' kind of doc and that's one of the things I like about him. (He is one of the ones that, if he sections you, it's because you need a section, not because he's getting impatient with you.)
That was a lot of rambling to say: I have seen docs fudging medical necessity too, Hushi. But there are those who don't and I am grateful every day that they're out there.
Our facility does not allow elective inductions until 39 weeks, and then only with a favorable Bishop's score (no cervical ripening agents are allowed for elective inductions). If the score is not favorable, elective inductions are not allowed until 40 weeks 5 days.
I think this policy change is great, but we have definitely seen an increase in "medically necessary" inductions - current favorites being resolved IUGR (???), "IUGR" (with baby measuring at 20%), and of course, the all time favorite - "preeclampsia," with a BP of 115/50 and absolutely normal lab values. Very frustrating, and I think it reinforces the mentality to patients that if they act like a pain in the butt and annoy their providers enough, they will get preferential treatment.
The rationale for not doing these inductions is also very hard to explain to patients who are having their fourth or fifth baby, and were induced around 37 weeks with their other kiddos. If the provider hasn't broached the topic during the pregnancy, having the nurse or midwife tell the patient in triage that we're not going to admit her for an induction just because she is 38 weeks always comes as a surprise. I always try to explain the latest research, and how it is so much better for baby to be inside unless there is a reason to be out, but moms are just sick of being pregnant and don't seem to care. Many have even said to me that they don't think it would be a big deal if the baby had to go to the NICU for a few days. Ugh!!!
Specializes in Nurse Leader specializing in Labor & Delivery.
i have seen bad (for baby esp.) inductions at 40 weeks - overall truly non-medically needed inductions need to be avoided all together!
If I could give this more than one "kudos" I would. The whole thing comes down to this. Non-medical inductions need to be stopped, period.
Where I used to work, we often saw women scheduled for inductions at 38 1/2 to 40 weeks. If she was 40 weeks, she was automatically was scheduled for a "post dates" induction at exactly 40 weeks. I never saw a woman who was greater than 40 4/7 in the entire 4 years I worked there. Where I work now is EXTREMELY progressive and evidence-based (teaching hospital for both physicians and midwives). I can truly say that the ONLY inductions we see prior to 41 weeks are for medical reasons. We regularly see women who are 41 1/2 to 42 weeks, and there have been a handful of times that I've seen women who were 42+ weeks.
I've come to realize that most women truly don't go into labor on their own before 40 weeks.
Specializes in Nurse Leader specializing in Labor & Delivery.
I find this to be anecdotally true as well. I almost never see this among residents/attendings in the teaching hospital where I work. The private docs, on the other hand....it just depends on who's on. One of my RN friends who works in a community hospital has written docs up for blatantly fudging reasons to section/induce.
Yes, I've seen this as well. One particular doc was guilty of this - she'd schedule women for IOLs at 38 weeks and for reason she'd say "PIH". When we'd dig further, we'd find that she had ONE borderline pressure in the office 2 weeks prior. No proteinuria, and NO PIH labs drawn ever. Then when we'd question the mother, we'd learn that she requested it simply because she was "ready to be done."
I guess I'm not terribly experienced, but working in a large NICU I guess I've only seen the bad cases...but enough to scare me away from 40wks + 2 days...
You must have had a run of bad luck... or the results of the stress of unnecesary inductions on babies. The evidence shows that the risks to babies (of stillbirth, what we are inducing to avoid) go up slightly until 42 weeks when they climb a bit more sharply, not 40.
Specializes in Nurse Leader specializing in Labor & Delivery.
I guess I'm not terribly experienced, but working in a large NICU I guess I've only seen the bad cases...but enough to scare me away from 40wks + 2 days...
You're probably seeing them due to stress from the induction process, rather than due to being 40 and 2.
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Sandwitch883RN
165 Posts
No inductions before 39 weeks unless medically indicated, has been the standard of care at the hopital i'm at for the past 2-3years. The MOD information was part of the training we received when we took ALSO. As the mom of a preemie I'm so glad to see this information being distributed and put into practice!