Size discrepancy? Induced with Cervidil?

Hi All!

So I went for my 37 week appointment today and my MD has decided to induce at 38 weeks, next Wednesday the 26th. Baby A is weighting in at 6 lbs 2 oz and baby B is 5 lbs 3 oz. My doctor didn't seem too concerned but said he would like to get them out sooner rather than later. Does anyone have any opinions on their size discrepancy? Baby B has constantly measured smaller and the ultrasound tech seemed to be having a hard time getting measurements on Baby B because of the way she is positioned, so the weights could be off.

He plans to induce with Cervidil and try for a vaginal birth. Baby A is vertex and Baby B is breech. Has anyone had any experience with this Cervidil? How long does it take to work, etc. I am hoping to avoid Pitocin. I'm kind of scared of an induction, particulalrly with Baby B being breech. I was really hoping to go naturally!

I would love to hear any opinions and experiences, positive or negative!

Thanks, Anne.

 

We haven't had much of a size discrepency, but I have seen others post that they have had up to a lb difference in the babies and the Dr's seemed ok with it. I think as long as the babies have both been growing relatively the same proportion at each scan then they are probably fine. The babies position could really throw off measurements, I know they have a hard time getting good measurements from my Baby A b/c she is so low.

I am also a little surprised they are inducing. My peri Dr's said that they would not induce me (and both babies are head down) b/c there are too many risk factors for the uterus, especially rupturing since it is so stretched out. If we don't go into labor on my own we have a schedule c-section on the 26th. I don't want to scare you away from induction, but I know after the mentioned some of the risk factors I would rather have a controlled setting and just do the c-section, although I am a bit nervous for that as well. Good Luck and can't wait to hear your birth story!

Oh, I have never been induced with Cervidil, only pitocin and I hated it!

 

Not that I fully understand what this is, but you might ask for your Bishop's score. That's supposed to predict how well induction will work. And based on those findings, maybe play for a little more time. See this article:

In otherwise uncomplicated twin pregnancy, it's OK to go full term:

http://www.uptodate.com/home/content/topic.do?topicKey=labordel/5122

My girls also had a big size difference. Almost exacly like yours, 6.11 and 5.12 at birth at 39 weeks. My peri and OB weren't worried because both were growing well on their own curve and they were di-di. Now that they are born I can say there's no problem. Both girls were perfect and still are. Perfectly healthy anyway. :FIFblush:

I've heard bad things about cervidil. I'd do a little research and avoid it if you could. I did some successful home induction - 4 mile walk, nipple stimulation, black and blue cohash. None of these seemed to help. But castor oil did. I took an ounce of it at 5AM, and second ounce at 6AM and while taking the second ounce, my body spasm-ed and my water broke. Natural birth 28 hours later. That sounds long, which it was, but it didn't have to be. It's a complicated story.

Just giving castor oil a shout out. Not ideal, but probably preferrable to cervidil and pit.

Good luck!

 

here's some info on inductions from Penny Simkin's book The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions:

"There are several ways labor can be induced or augmented:
1. Self-help methods (nipple stimulation, walking, acupressure & acupuncture, sexual stimulation, bowel stimulation with castor oil, teas, tinctures, herbs, and homeopathic remedies - these last should be used with the guidance of an experienced herbalist or homeopath & the knowledge of your primary caregiver).
2. "Stripping" the membranes to begin labor induction. The caregiver inserts a finger into the cervix and circles around the inside to separate the membranes from the lower segment of the uterus. This is usually painful for the mother - it feels like a very vigorous vaginal exam - and it sometimes results in inadvertent rupture of the membranes. Stripping the membranes usually does not actually start labor, but it may hasten ripening and thinning of the cervix to make it more ready for dilation. The procedure cannot be done if the cervical opening is hard to reach because it is very posterior (pointing towards the mother's back), or if it is tightly closed.
3. Artificial rupture of the membranes (AROM). This sometimes speeds or augments labor, if it is timed correctly.
4. Prostaglandin gels, suppositories, or tablets. Prostaglandins are hormone-like substances produced by the body and also synthesized. Like the prostaglandins that a woman produces herself, prostaglandins in drug form promote the softening, thinning, and, sometimes, dilation of the cervix. They are used when labor must be induced before the cervix has naturally softened or thinned. Prostaglandins come in these forms:
- A water-soluble gel containing prostaglandin (Prepidil). The gel is applied to the inside or the outside of the cervix through a syringe. More may be applied after 6 hours or so.
- A tampon-like device that contains prostaglandin (Cervidil). Placed in the vagina behind the cervix, the device gradually releases prostaglandin over about 12 hours.
- A tiny tablet containing another synthetic prostaglandin, misoprostol (Cytotec). The tablet is either placed in the mother's vagina, behind her cervix, or given to the mother by mouth. Tablets are given by mouth when the mother's membranes have ruptured, since placing anything in her vagina would add to the risk of infection. A second tablet may be administered after 4 to 6 hours. Cytotec in low doses (25 micrograms vaginally or 50 micrograms orally) usually acts gradually, like Prepidil and Cervidil do. Often with higher doses (50 micrograms vaginally or 100 micrograms orally) and sometimes even with the low doses, Cytotec causes sudden, very intense contractions and fetal distress. This is less likely to happen with the other prostaglandin agents.
5. IV administration of a synthetic form of the hormone oxytocin (also called Pitocin). This can start or speed up labor. Pitocin is mixed with IV fluids in a continuous drip. By regulating the dose, the caregiver can usually control the intensity and frequency of the contractions quite well. Electronic fetal monitoring is required, along with a nurse's close observation, to detect and correct excessively strong or long contractions.
Attempts to start labor with Pitocin often fail when the cervix is firm and thick. If prostaglandin is used before Pitocin, this problem is often avoided.
If an induction is done for medical reasons and fails, cesarean delivery is the only remaining option. If an induction is done for convenience and fails, the mother may be sent home to await spontaneous labor, but this rarely happens today. Usually, the baby is delivered by cesarean."

this is a pretty brief overview so let me know if you'd like more info on one of the specific items - i'd be happy to quote some more.

 

I take it back, I think it was Cytotec that I heard bad things about, not cervidil. Sorry, and thanks for the overview, MissBossy!

 

it probably was - Cytotec is pretty nasty stuff. the company that manufactures it actually recommends against its use in labor. it is used less now than it was in the 90s but it's still out there. :headbang: the nice thing about Prepidil & Cervidil is that if you are one of the very few women who does react quite strongly to it (contractions come on long & strong immediately) than both products can be removed (gel washed away with a douche & tampon removed) which will stop (or at least reduce) the intensity of the contractions. Cytotec, especially when taken orally, can't be unadministered once taken so if you have a strong reaction to it, you're looking at a whole host of other interventions and likely a cesarean delivery.

 

They tried cervidil on me (which all it really does is supposed to soften up the cervix so that it starts to dilate) and it did nothing when I was induced at 38wks with my daughter. I ended up needing the pitocin to help my contractions. Pitocin was fine for me. Did make my contractions a little more powerful...but that is the point. I ended up getting the epi a couple hours later so I didn't have to suffer long. I think this time, we are going for the C section at 37wks (after a talk with my OB today). Mostly because Baby B is still Breech and is bigger than A at this point (plus I want my tubes tied). Good luck!

 

I am not sure if it was really cervidil but the name sounds familiar to me (?). Drs tried to induce me by cervidil for 2 nights (singleton pregnancy). Did not work. On the 3rd day, they had to break my water and that's when I finally started dialating.
I wish you good luck. 38 weeks sounds great to me!

 

just to clarify, the prostaglandins (Prepidil & Cervidil) are usually used to prepare your cervix for induction with pitocin - it's not really expected that they'll start contractions on their own, if that makes sense. if you're lucky, they will sometimes jump start labor but that's usually only if you're pretty close to starting on your own anyway.

 

My doctor would not induce me with cervidil; she said it was contraindicated for multiples, so I instead had a c-sectio at 38 weeks and a day or so.

 

I had prostiglandin gel with both pregnancies. My first was a singleton and I needed 2 doses of the gel before they started pitocin, but the induction did work eventhough it was about 20 hrs. With my twins, I was also given the gel and I immediately went into having contractions and never needed the pitocin. My Baby B was actually bigger than A by 3/4 of a lb. She was breech as well. My labor and delivery time with them was only 6 hrs. Baby B did flip to vertex after A was delivered and I had absolutely no complications with my labor/delivery. I did get an epi about 15 mins. before I started pushing (I went from about 5-10 in that time).