A New Low

I can’t sleep. My mind keeps spinning horror stories out of my anxiety. Brad and I have reluctantly agreed with our OB that a medical induction is the best thing to do for our son, who is still quite happily and healthily (happy and healthy from all appearances, anyway) hanging out inside of me.

The one medical reason my OB could find for induction (and believe me, she tried hard to find one) is that my amniotic fluid levels have probably dropped since last week, from about an 8 to a 5. 8 is the magic number; they get nervous with anything below 8. (These measurements are in cm, and I believe they correspond to something called the Amniotic Fluid Index (AFI), a measure of amniotic fluid where the largest pockets of amniotic fluid in each quadrant of the uterus are found via ultrasound and their lengths measured.) Even my OB has admitted this is a relatively poor quantitative method for assessing fluid levels, though she didn’t mention this fact yesterday like she had the first time she did the measurement when I was at 40 weeks.

While it is normal for amniotic fluid levels to decrease in later pregnancy, a large enough decrease can supposedly indicate a decrease in placental function, which might indicate the baby isn’t getting enough oxygen, which might lead to problems during labor and/or birth defects. Or, I might have been slightly dehydrated. Might, might, might; threat, threat, threat. All based on this imprecise and possibly inaccurate measurement. The recommendation from my doctor is to induce labor as soon as possible; they like to do this at 42 weeks anyway, and I’m at 42 weeks today. We agreed to Friday (tomorrow), reluctantly, feeling pressured, nervous, and unsure of ourselves.

The recommendation in many of the books I’ve been reading (The Thinking Woman’s Guide to a Better Birth, The Birth Book,) is to be patient and wait, unless there are clear signs of fetal distress. A lowered AFI alone does not seem to be considered one of those clear signs of distress by the authors of these books–but of course I still feel nervous about it. It’s a vague possible sign of fetal distress. And now, of course, I find myself second guessing everything. Did the little guy really move as much today as yesterday? Are his quiet periods usually 90 minutes long, or did it used to be 60 minutes? Is that pain in my left side gas, or the beginnings of a placental abruption?

Frustratingly, the OB didn’t spend any time explaining the risks associated with medical induction to us. I should have pinned her down on this, but I guess I was too upset during the appointment to think straight. If I hadn’t been poking around on my own, I’d have no idea that some of the many side effects of the drugs they use to induce labor are, for the mother: nausea and vomiting, diarrhea, excessive postpartum bleeding, uterine hyperstimulation (contractions that last longer than normal, are stronger than normal, and closer together than normal, all of which can harm baby), early placental abruption, and uterine rupture; for the baby, increased jaundice, increased likelihood of fetal distress (due to lack of oxygen), increased likelihood of many unnecessary medical interventions to deal with perceived fetal distress. (Since many tests of fetal distress actually have a high percentage of false “positives,” meaning they indicate problems when there are none, and since induced labors are monitored much more closely due to all the other risks mentioned above, you end up with more interventions for supposed fetal distress). Sure, these side effects are rare, but so are true fetal postmaturity problems at 42 weeks gestation.

From the reading I’ve done, it appears that there is no clear cut way to go, actually. Induction has risks, waiting has risks.

But everything has risks. Having a baby, getting married, walking down the street, flying in an airplane. I guess what I really need to do is get over the idea that everything in this pregnancy would be smooth and “normal” and accept the fact that I don’t trust my OB as much as I hoped I could. There are way worse things in the world. I feel self-pity and frustration, and that can’t be doing me or my son any good; he’s already had enough exposure to stress hormones during his time with me! It’s also very likely that these feelings could be inhibiting the start of labor.

I have some legitimate complaints for my doctor and for the obstetrics profession in general, but I shouldn’t be letting those things interfere with the love and excitement I could be feeling when thinking about my son. I stood in his room last night and cried and cried, wondering if I’d really ever get to see him. It was just awful. I’m already failing him as a parent.