Working with my hospital's induction policy

My OB informed me on day 1 of learning I have twins, that it is his policy and a hospital-wide policy to induce for twin births at 38 weeks. As I draw closer to this I am now having reservations, since my entire pregnancy has been so easy and complication free. I went into labor naturally with my first DD, had a 12-14 hour labor, pushed about 20 minutes and went drug free. When I found out it was twins, I immediately took harbor in the modern interventions available, liked the idea of an induction and imagined preterm labor at 24 weeks with nicu babies. Now that I am at 28 weeks and so far so good, I am lessening my conservative, fear-based thinking and swaying back toward my original ideals when I thought this 2nd pregnancy was a singleton. I had planned to work with a midwife and have the next one at a birthing center. I really don't want to nor plan to switch mid-stream with my practitioners. And in fact, that is not even an option. I like my OB overall and plan to stay. I want this hospital b/c it is also where I work and a comfortable environment for me.

So this is where I am at and would like to find out more. Of course I will have this conversation with my OB in time, but want to do some research. Why 38 weeks is my main question. I understand the placenta can erode, but my EDD is based on my LMP, not my ovulation. I am quite certain I ovulated late (had been charting in previous cycles where I usually o'd in CD 19+, with cycles of 31-33 days. So I think my EDD could actually have been moved more to 9/30 (it is 9/24 now, so essentially I would be induced around 9/10--which I also have issues with, considering the date of the next day...).

getting to my question, does anyone have any links/resources where I can learn more about the whole end period for twins. Is it pretty standard that the OB/hospital has such a firm line? I am hoping to negotiate a 38 w 6 day induction type thing if labor does not come naturally. Given my prior experience going into labor at 39 w 3 days, does it seem likely I would go just as long?

 

My OB showed me a chart - cannot remember the source, but medical journal-ish - showing NICU admissions based on gestational age. The line is steady at 100% admission until 35 or 36 weeks - even if the babies are fine, they are admitted as a precaution until they hit the magic GA (they don't stay in the NICU until they hit the magic GA, but they are admitted for observation - even if it's short - if they are not yet 36 weeks). Then the admission rate drops off steadily until 38 weeks, when it rises again as GA increases. His recommendation is 38 weeks for the NICU admissions and placental problems you mentioned. I will be 38 weeks on August 28, but really would like September birthday, so he has scheduled me for September 1. He said he would be comfortable doing my c-section any time between August 28 and September 3.

I felt like the chart is for the twin population in general, not specific to my hospital, but I could be wrong.

 

Huh? I guess they have their reasons, but doesn't really make sense to me.

My DW OB said as long as everything is good, he will keep them up to 40 weeks...he has 2 13 year old twins of his own that were kept to right under 40 weeks...but if at 40 weeks...he will induce

Glad hers doesn't feel the same way, cuz at 38 weeks...I "MIGHT" just be getting back home. I should be home at her 37th week. I just hope she can hold them hostage that long

 

My OB wants to induce at 39 weeks...as much as I want to be DONE with this pregnancy, I have serious reservations about being medically induced (and btw, planned a homebirth with DS, so I have very similar philosphies as you do in regards to birth). Anyway, IF I am still preggers at 39 weeks (which, btw, I think is also incorrect as I have long cycles...31 days vs. the standard 28 days they go by on their little wheel)...I plan on working a compromise with my OB...offer to go in for weekly or even twice weekly or whatever NSTs...if the babes look okay, then we keep going until THEY decide to come. If it appears that they may be under stress, then we can induce. But I just have issues with looking at statistics and bell curves and lumping my babies in with it. I understand that in some twin pregnancies, things start to go haywire at the end...but that is in SOME pregnancies. If mine doesn't fall into that category then I don't want to be treated the same. I have no problem with NECESSARY medical induction...I just have a problem with doing it because it's the "standard" policy.

I'm hoping, however, to have them before 39 weeks anyway! And remember, while no one wants an adversarial relationship with their doctor, they can't MAKE you do anything...I mean, you don't have to consent to an induction...so that's always an option if it comes to that. But talk to your doc, explain your reasons and offer to work with him to alleviate all concerns he might have by going through as many tests as he needs to feel comfortable.

Lastly though, I would suggest holding off on this conversation until the very last minute (37 weeks). You don't need to open up a can of worms if it's not necessary. You may very well go into labor before then and then you've annoyed your doc. It's like the old saying that you should never complain about your waitress BEFORE you get your food...

 

I wish that I could partake in this conversation but I have no idea what my hospital policy is....I havne't seen my OB yet nor will I for a little over a month now!!! I'm very anxious to find out what they will and will not do. However, I'm glad that I can read what everyone is saying because it helps prepare me for what I might want to discuss (at a later date) with my OB.

Robyn
16 weeks

 

My doc goes to around 37 weeks and then he wants to get them out. I think its mostly the risk of the placenta starting to deteriorate and the babies running out of space. I'm not really sure but I think hospital policy typically has to do with the risk of complications and past experience, right? I'm perfectly comfortable with my doc's plan so its not an issue for me. I dont know how you get around hospital policy if its firm though. They may tell you that you have to go somewhere else -- especially if there's any liability issues involved with their insurers(which there may well be). When it comes to OB, I think that almost all policies have to do with the hospital's medical malpractice insurers.

 

I was also told 38 weeks. My high risk OB will not induce twins when it's a VBAC. So either I go into labor on my own before 38 weeks or I have a c-section on that day. The reason I was told for the "38 week cut off" was that the risk for complications rise in twins after 38 weeks. I was told that 38 weeks with twins is compared to 43 weeks with a single pregnancy. It's not safe to go that long b/c the placenta does not function as well and your uterus can only get so big(and of course the bigger the uterus gets the higher the risk for bleeding problems). I'm sure every hospital/Dr. has there reasons but even in Dr.'s Lukes book she says the "ideal" time for twins is between 36-38 weeks.

 

My obstetrician said the same thing. I didn't really ask why though. I was just glad as I am only 20 weeks and super uncomfortable already. I was induced with my son so I am not worried about being induced. The only difference between induced and going normally is that your body goes basically from nothing to hard labour, atleast from what I was told and what it felt like to me, which in my case meant I was only in labour for 7 hours before he came out.Its all been there done that for me. I am just hoping that my water breaks on its own this time. Lol!

 

Thank you for this topic!! I have had 2 induced and 2 come on their own, all in a hospital/birthing center.....we had also discussed a home birth way before finding out it was twins and had already opted for this OB [my old doc quit delivering] instead. I am against inducing again and really believe that in MOST cases the babies will know when to come and will come when ready--especially since this is not a new thing for my body. We were impatient with #1 (10 days "overdue"), #2 came on his own 6 days "over", #3 came on her own "on time" and #4 was induced because of my high blood pressure. I wish I would have discussed that more with my doc--my little guy had problems sucking, even though he was only 5 days "early". I think he would've gone a week over and been healthier for it.......
I'm guessing, like others have said, that if it really is hospital policy, it is a malpractice thing and I'm not sure how much leeway they'll give you, but surely 5-6 days wouldn't hurt? After explaining the cycle and the numbers, with yourself confident and informed, I'm thinking your OB will definitely listen to reason. Instead of waiting, though, because it is already scheduled, you might want to have that discussion now--they can fill that spot with someone else if needed.....and I just pray you go into labor yourself and not even have to deal with that!!

 

Mine is 38 weeks and I am already looking forward to knowing that I have 10 more weeks at the latest. I feel comfortable with that for sure. My last dd was 10 days overdue and even though she was 8 lb 4 oz she ended up in the nicu after pooping during labor and having heart decelerations and a fever after birth for no reason they could find. She had a spinal tap when she was less than a day old and was on antibiotics for 7 days. I blame all that on being overdue, I strongly feel that at least in that case, she would have been better off being induced earlier. I do feel that things deteriorate when you go past a certain point. So that probably influences my feelings towards the 38 week limit my hospital has.

Good luck with your plans, it's always nicer when everything can go how you want it (at least if they don't decide to come on their own earlier LOL )

 

My hospital's policy is 38 weeks as well. However, because of my size (4'11) and the lack of growth I'm experiencing, my doctors (military- so I don't get the same doctor every time, but they all agree on this) really don't think I will make it to 38 weeks. They think I will be lucky to make it to 34 or 35 weeks. They think that my body will just run of out room for the babies and therefore the babies will stop growing. If that becomes the case, then I will have an emergency c-section. My due date is October 16th, so 38 weeks would be October 2nd for me. I guess all I can do is wait and see. I agree though that I believe they reasoning for a 38 weeks policy is there just isn't as much room as a singleton for the babies to grow and because of the deterioration of the placenta.

 

Ditto for me on this. I'm only 5 ft tall and my doc just gives me the side eye when I tell him (with such confidence) that I am going to make it 37 weeks. He says that he will be ecstatic if I go at least 34 so anything approaching 36 or 37 weeks would be a real accomplishment for me. Some really short women go the distance and I'm not sure what's their secret -- I would love to know!!

 

I thought I would be LUCKY to get to 36 weeks...and ANXIOUSLY counted down the days...but here I am at 37w4d and I'm 5'2"!

 

First of all, there is a big difference between feeling great and having no problems at 28 weeks, and how things are at 36-38 weeks. I know there have been a number of people on this board who have gone to 38+ weeks with a normal check up only to loose one or both babies for unknown reasons. And yes, there have been some who have gone to 40 weeks without a problem. The statistic that says not to go beyond 38 weeks is a real one, and looks at total twin births and how the babies and mommies have faired at different gestations.

One more thing about going into labor on your own--I am very glad my OB didn't want me to go beyond 36 weeks, because I would have never labored on my own--it turned out that Marcus' head was wedged in crooked, and he couldn't move any farther down the birth canal--he presented with his temple rather than the soft spot. My point is, you never know what will happen, so be open to all possibilites. The goal is healthy babies, not how they got here.

 

Keep em coming. I lurk all over the place here trying to see who is past their 37 week mark. My DW has to make it that far for me to be home in time.

Of course she might be feeling like they BETTER come out before that, but we are keeping our fingers crossed.