Today we had our last scheduled appointment with our local OBGYN group, two days before my due date. We got the full workup (ultrasound, NST, exam) and discussed The Plan from here on out.
The results of the full workup are that baby is looking great, positioned in the same optimal birth position he’s been in for a few weeks now (lying with his head square on my cervix, facing my back), and my cervix is starting to change, but is not yet considered “ripe.” (For those who like numbers: 1.5cm dilated, 40% effaced, -3 station.) Of course, cervical info like this is nearly meaningless — it’s entirely possible that left to my own devices I’d stay at the same numbers for weeks, and it’s also entirely possible that I could go into spontaneous labor tomorrow. But it was encouraging to hear that something is happening.
Then came the talk about The Plan. I didn’t really know what to expect, but the doctor just came out and said, “OK, I know you have a preference for Dr. X in our practice. She’s on call next Wednesday, when you’ll be 40w6d. What if we start cervical ripening Tuesday night and plan to induce on Wednesday?” I agreed, they scheduled it, and it’s on the calendar.
It all happened so fast I didn’t really feel like I could think it through in the moment, but now I have some very mixed feelings, probably because I feel like this is a problem that just has no correct answer.
It’s a little earlier than I’d wanted, but only by about two days — I’d been ready to ask for cervical ripening to start at 41w0d, followed by induction, so this is two days earlier. Two days isn’t a lot, but given where I am in pregnancy, it could very well be the difference between spontaneous and induced labor. Or not — the problem is, there’s just no way to know. Since two days is unlikely to make a substantive difference, maybe it’s worth it to have the doctor we prefer… but not if induction winds up leading to an otherwise avoidable C-section (not that there’s any evidence that this would be the case — the best recent studies indicate that induction at 41w does not increase the risk of C-section even with an unripe cervix).
In my ideal world, I’d rather go into labor spontaneously. But there’s no guarantee that that will happen, or even that it’s what’s best for my baby and me. After all, my mom waited, wound up going past 42 weeks, needed an emergency C-section, and I almost died. So it’s not like waiting for spontaneous labor necessarily gives me a get-out-of-jail-free card for poor labor outcomes. Waiting until 41 weeks seems like the best compromise according to the data — so one or two days earlier is probably negligibly different.
Another thing on my mind, of course, is the anxiety. I’ve woken up in the middle of the night three times in the last week in tears with worry about my baby. My nightmare (literally) is that I’ll wake up one day, won’t feel him move, and we’ll go in and he’ll be dead. I know he’s alive and healthy now, and I want him out while he’s still OK. I’m already in the regime where stillbirth risk is rising, and even though it’s still small overall, having had a baby die inside me with no warning once means that I just don’t want to take any unnecessary risk, even a tiny one, of having it happen again.
As I’ve been thinking about it today, I realized there may be a middle ground. I know that the risks of induction leading to C-section are higher with an unripe cervix. Given the slight dilation I have already and the excellent positioning of the baby, I’m hoping I’ll make progress by next week, but I just don’t know at this point. So my slightly revised plan is to ask to go in for a cervical check Monday or Tuesday before they start the cervical ripening, to find out if my cervical status has changed. If it has, I’ll feel much better about going forward with the induction. If it hasn’t, maybe I’ll check on the call schedule and see if one of the other doctors I’ve felt reasonably comfortable with would be on call if I waited a couple of days. There’s one doctor I definitely don’t want, and another that I probably don’t want, but either of the other two would be fine with me. The only problem with this plan is that I think (although I haven’t confirmed) that they will not want to induce me on the weekend, which only gives me a couple of days of wiggle room unless I wanted to wait until Monday (which I’m not sure I do, and which my husband has already said makes him a little nervous). But getting to ask the questions would be reassuring.
At least for now, I’m happy to have a date on the calendar, and to know that there is a plan that everyone is OK with that would involve me holding a baby by late next week (fun fact: if all goes according to The Plan, it’s very likely that my son would share his birthday with his father!). I’m also happy to feel like there’s some flexibility in the plan — the doctors I talked to today emphasized that I can call and ask questions anytime in the next week, and that changes in the plan were possible. So for the moment I’m reasonably content to sit back and wait to see what happens. Who knows… maybe I’ll go into labor in a few days and all of this will be moot anyway! Point is, my son will be here soon, in a matter of days, not weeks. And when I put it that way, it’s a pretty amazing place to be.