Decisions, decisions

We have been busy the last several days going to medical appointments and trying to make decisions about what we want to do as we approach 42 weeks of pregnancy. We have exhausted the first and most low-risk intervention (at least in our mind) - serial membrane sweeping. We have considered and rejected two other suggestions - evening primrose oil and castor oil induction. For each of these we had to do a bunch of research and try to make an educated assessment of how effective and safe they are. The one reasonable study I found of EPO indicated that it does have an effect, but does not lead to a shorter overall time to birth. It seems to be likely to cause complications like prolonged rupture of membranes. Castor oil does seem to work on average (i.e. for some people), but we ultimately decided that the potential side effects were not acceptable. I don't want to go into labor in a state of dehydration and illness. We concluded that we would prefer a Pitocin induction if we have to go that route.

In the meantime, we continue to accumulate more information about our particular situation from ongoing testing. We've now had two non-stress tests and an ultrasound, in addition to several cervical exams. The ultrasound was a particularly interesting experience. We've been hearing all along from people how amazing it is to see your baby on an ultrasound (i.e. how much we were missing out by declining to have one). This may be true earlier in pregnancy, but we were not impressed. It was hard to see a lot because the baby is all curled up at this point and there is not a lot of room for him/her to move. We could clearly see the spine and the heart beating, but that's about it. Also, we were somewhat shocked at the procedure used to measure the amount of amniotic fluid -- the reason we were having the ultrasound in the first place. This measurement is not based on volume, as we expected, but based on a single linear measurement of the fluid pocket in each of four quadrants. Furthermore, this pocket changes noticeably as the baby moves around, and the technician has to keep moving around until she finds an angle in which there is not any umbilical cord in the way. Needless to say, we don't have much confidence in the final measurement they came up with. It seems like you could detect a severe problem this way, but otherwise it appears to be a poor test. In any case, the level of amniotic fluid appears to be fine based on this measurement. Our non-stress tests (in which they monitor the baby's heartbear for 20 minutes) also seems fine. This is somewhat reassuring, but it doesn't necessarily mean that something can't suddenly go wrong with the baby. I am supposed to monitor the baby's movements to make sure they seem "normal", which is an easy way to become paranoid.

So we are weighing the risks of going up to and/or past 42 weeks of pregnancy (there are increased risks of stillbirth, and some other things - small but increasing) with the risks of inducing. It seems like everything goes better if the baby can come on its own, but clearly inductions are done all the time (probably much too often). It can make for a much more intense labor, and possibly one in which the contractions are strong enough to harm the baby. In this case, they will have to do a C-section. Unfortunately, we'd have to go to the hospital instead of the birth center to have a pitocin induction. After discussing all the implications of this with the midwife, it doesn't sound as bad as we thought -- I would still be under the care of the midwife, not an OB. Still, I'd be hooked up to an IV and continuous fetal monitor the whole time, which will be quite different that what we've been preparing for. After considering all the options, we decided to schedule an induction for Friday. We felt relieved to finally have made this decision. It has been complicated somewhat by the fact that they don't actually have any rooms available for Friday, so we'll have to wait for one to become available sometime later in the day. The midwife's assessment is that my body is likely to respond well to induction at this stage, so we're hoping it will all go smoothly, and hoping even more that labor will begin spontaneously between now and then!