Induction vs. c-section

Posted on December 5, 2007 // baby

I talked to my doctor yesterday evening about my options following the distressing ultrasound. She confirmed that she thought the baby might be large (medical term: “macrosomia”) when she had palpated my abdomen. She says she supports my desire to go forward with induction, but I can tell that she probably thinks a c-section is a wiser choice. And when I say “my desire to go forward with induction,” I don’t mean that I actually want to do that. I would prefer to go naturally above all else. But confronted with the potentially large size of this baby, if I wait any longer the hospital will take the induction option off the table and require a c-section. My doctors says that c-sections are mandatory when the baby’s size is estimated at 4,500 grams (about 10 pounds), and my baby’s estimate is 4,300 grams (9 pounds, 10 ounces). In the event I go for induction, I’ll be closely monitored and they will not attempt delivery with the vacuum or forceps if the pushing stage is prolonged due to the risk of “shoulder dystocia,” where the shoulders get stuck in the birth canal. They’d require a c-section at that point.

Tomorrow morning I’ll call my doctor and ask about a second ultrasound – I just want another one for confirmation. The baby was pretty active during it, and I’m wondering if those little snapshots they take for measurements might have been too blurry – perhaps it threw the measurements off. I really don’t know if that’s possible, but it’s worth asking about.

So back to my original problem – no progress as far as station or dilation, I found some information about how obstetricians determine the likelihood of a successful labor induction. Induction is particularly likely to lead to c-sections in nulliparous (never given birth before) women. They use a method called the “Bishop Score”:

Bishop Score

CONDITION 0 1 2 3
Dilation (cm) Closed 2 4 5
Effacement (%) 30 40-50 60–70 80
Station -3 -2 -1,0 +1,+2
Consistency Firm Medium Soft —
Position Posterior Midposition Anterior —

I’ve highlighted my current situation in the table above. A score of less than 5 is considered unfavorable, and my score is a whopping 3. So when I take that into account along with the potential size of the baby, it seems my odds for a c-section are pretty darned high. So I’m juggling the idea of inducing with a small chance of success and a large chance of emergency c-section, or just going for the c-section where at least I know what I’m going into and the recovery will probably be slightly easier than if I’d gone through hours of labor beforehand.

Here I am in the examination room right before yesterday’s doctor’s appointment:

Feeling just a bit uneasy!

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