This baby shows no interest in coming out. I had my weekly appointment (38w5d) yesterday. The doctor brought up induction, noting that because of my age (just under 40) and loss history, they would generally not want me going past 40w6d and that we could consider induction starting at 39 weeks. We talked about it a lot, and I said on one hand I was not interested in inducing early unless there was a reason, and on the other hand I remain REALLY nervous about this baby being born healthy, and since he’s clearly alive now I do feel tempted to just pull him out.
She seemed to understand. She suggested just checking my cervix to see if induction was even an option. Spoiler: it’s not.
Apparently they use something called the “Bishop score” to determine whether induction is a good idea/likely to be successful.
Here’s the information from Wikipedia:
Parameter
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Score
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Description
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0
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1
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2
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3
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Position
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Posterior
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Middle
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Anterior
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–
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The position of the cervix changes with menstrual cycles and also tends to become more anterior (nearer the opening of the vagina) as labour becomes closer.
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Cervical Consistency
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Firm
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Medium
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Soft
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–
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In primigravid women the cervix is typically tougher and resistant to stretching, much like a balloon that has not been previously inflated (it feels like the bottom of a chin). With subsequent vaginal deliveries the cervix becomes less rigid and allows for easier dilation at term.
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Effacement
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0-30%
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40-50%
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60-70%
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80+%
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Effacement translates to how 'thin' the cervix is. The cervix is normally approximately three centimetres long, as it prepares for labour and labour continues the cervix will efface till it is 'fully effaced' (paper thin).
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Dilation
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Closed
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1–2 cm
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3–4 cm
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5+cm
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Dilation is a measure of how open the cervical os is (the hole). It is usually the most important indicator of progression through the first stage of labour.
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Fetal station
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−3
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−2
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−1, 0
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+1, +2
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Fetal station describes the position of the fetus' head in relation to the distance from the ischial spines, which are approximately 3-4 centimetres inside the vagina and are not usually felt. Health professionals visualise where these spines are and use them as a reference point. Negative numbers indicate that the head is further inside than the ischial spines and positive numbers show that the head is below the level of the ischial spines.
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Here's another article:
And another one suggesting it’s a poor indicator of labor induction success:
And here’s another one suggesting a “simplified” score (considering fetal station, cervical effacement, and parity) does predict success:
She said they would look for a combined score of 7 or above before seriously considering inducing, at least at this stage. I was a 6. I was 30% effaced (score of 0), dilated about 1cm (score of 1), cervix was medium (score of 1). She told me baby was still pretty high, but did not give me a number, and did not mention position of baby. Presumably to get to my score of 6 baby is in anterior position (score of 2) and fetal station was -1/0 (score of 2). In other words, this baby’s not looking to go anywhere for a while.
If I were a totally healthy young mom with no history of issues, I’d be like “cool!” (I’m sure that’s how I was with my son.) This time, though, I’m nervous. I confessed to a friend that I remain very, very worried about the outcome of this pregnancy, and she was like, “me too! I won’t rest easy until that baby’s in your arms.” That made me feel better (validated) and worse (it’s not just my imagination, I’m still at risk) at the same time.
So we’re going to check again next week (39w5d, although hubs and I think my due date is a few days off/early) and then decide if we want to schedule an induction (if it’s even an option) or try something else to get things going like sweep my membranes.
From what I’ve read/what my doctor has told me, the potential benefits to membrane sweeping are: can reduce the need for other methods of labor induction such as oxytocin or prostaglandins, and can reduce the duration of pregnancy. One medical journal article I read said that “To avoid one formal induction of labour, sweeping of membranes must be performed in eight women.” Another article suggested, “We concluded that sweeping of membranes was ineffective to reduce the need for formal induction of labour.” So it’s either not particularly effective, or just effective rarely.
The risks are: discomfort during the procedure, bleeding, and irregular contractions. There is also a risk that your water is broken, with one article saying 1 in 10 (although my doctor said it’s never happened to her). I’ve also read there could be an increased risk of infection, but the medical journal study doesn’t seem concerned about that. So the big risk is just discomfort.
It’s unclear to me that there’s much benefit, and it sounds like it’s pretty painful. I think I’ll hold off until closer to the date they would induce to consider this option. But if things don’t look like they’re going to start moving, I think I will schedule an induction sometime after 40 weeks, and have my membranes swept a few days ahead of the induction.
I hope your baby decides to arrive soon! Wishing you all the best for the birth. Excited for you to meet your little one :-)
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