# WWYD? AROM vs. Pitocin to induce



## bkbabymomma (May 23, 2007)

So, I'm at 42 weeks. Tried every non-invasive induction method under the sun, no luck. Going into the hospital tonight for cervidil. Tomorrow midwife has given me the choice of breaking my waters or a small dose of Pitocin. Anyone have thoughts on why to do one vs. the other?

I'm falling apart a little for a variety of reasons. Under intense pressure and scrutiny from relatives (doctors) who assure me that at age 40, 42 weeks pregnant, and using a midwife, I have put my baby in mortal peril (really, with an urgency and certainty like they're watching me blowdry my hair in the bathtub). Any insight from a friendly crew would be most welcome. I should mention that this is my second child, I delivered vaginally last time, and I am currently at 4 cm, soft, and effaced. Thanks mommas...


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## sapphire_chan (May 2, 2005)

AROM starts a 24 hour timer.

Theoretically, pitocin could be stopped to let you rest, and turned down once the contractions start up. In practice, they'll probably just crank it higher and higher and want to break your water to place an internal monitor anyway.

Before going either route though, how do *you* feel the baby's doing?


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## bkbabymomma (May 23, 2007)

Thanks for responding so fast. I think she's fine -- gotten a 10 out of 10 on 3 BPPs this week. I am somewhat conflicted about "rushing" to an induction, but the emotional toll on myself and my family has tipped the scales.

One of my girlfriends had an amniotic fluid embolism and perished, along with her child, during labor many years ago. Intellectually I can put this catastrophe into perspective -- part of the great, overarching lesson of pregnancy and parenthood, that control is an illusion. But it has made me susceptible, at moments, to fear. My FIL (whom I care deeply about, and who is entrusted with care of my son while I'm in the hospital -- we've exhausted every other childcare resource while waiting for baby to arrive), is suddenly a stark-raving lunatic, and has decided that he has to save my imperiled baby from my ignorant decisions. Unfortunately, he's in a position to interfere at the hospital in a way I never thought he'd invoke. I picked this particular hospital because they have a reputation for leaving midwives alone (the reason I was "allowed" to have my last child vaginally despite pushing "too long"). Now I fear an OB will be present during every stage of my induction -- invasive, embarrassing, disrespectful to me and my midwife. Do I dare break my waters now, when that will put me on a clock that doctors will be overseeing? I doubt they'll let me walk away if the pitocin doesn't work, given that now they'll be aware of my "overdue" status.

I'm feeling so stressed out, judged, betrayed -- the floodgates of fear have opened. Wow, this is turning into a different post than I intended... sorry. I just want to make the best decisions I can for my family under the circumstances, and I feel like I've lost my bearings.


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## EBeth0000 (Aug 19, 2007)

I just wanted to post and say that I am so impressed at your ability to express your thoughts. It sounds like you are really in touch with what is going on--inside and outside of you, and I really respect that. You seem able to face this decision with information and maturity, and it seems like something you have considered greatly. Great kudos to you.

I went over 42 weeks with my first babe, and I did not have the presence of mind you are expressing here. I think your feelings and fears are normal, given your circumstances. I ended up going "naturally" (ha ha after every 'natural' induction method under the sun) and having DS the day before my hospital induction was scheduled. I honestly don't know what I would have done if he wasn't. I either would have shown up at the hospital (cervadil, pit, an OB I had never met, no doula lined up, a hospital I had never VISITED) and I really don't think I would have had the strength to do this, but I might have played hooky from the hospital, been fired by my midwives, gone UC at home as long as possible and gone into the ER pushing? Who knows. . .

I don't have personal experience with AROM or Pitocin, but I did want to share that my yoga instructor had her first without an epidural with a pitocin induction for dates, as well as several other aquaintances I know--so if that is important to you, it is possible. It does sound as thought you may be "inducable" Can you find out your bishop's score before consenting to a induction? If it's not "good", could you beg for another day to try to increase the induction's chances of success?

I would also look into finding a doula w/experience w/these situations. Maybe it's not something you would have wanted/ needed with a second natural birth with a midwife, but induction changes the game, and might help you deal w/some of that in the hospital. . .?

I honor your strength.


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## lurable (Jul 23, 2006)

First of all







s
I'm sorry that you are dealing with this issue with your FIL.

I chose to have AROM before pit as I felt it gave me a better opportunity to get into my own natural labor. I had pit for my first dd and the labor was very intense and fast--it seemed unnatural. That being said I chose to have AROM first this time and it basically played out the same way--I ended up needing the pit and my water resealed without us knowing, resulting in another intense and fast labor when it was ruptured again. That being said- if I had it to do again I would choose AROM over the pit again since I find the pit to create too strong contrax and the after effects have always been bad for me (blood loss and what the Dr. called a lazy uterus--although I knew it was a result of the pit....but that's another thread







)
Anyway---Best of Luck!!!


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## Mommal (Dec 16, 2007)

I would also choose Pitocin over AROM. From everything I've heard and read, Pit is no fun. The contractions can be a lot harder than normal contractions. But at least Pit can be turned down or off. AROM, once done, cannot be undone. And it can be incredibly hard to resist further interventions when your care providers are telling you that time is running out and your baby could get an infection if you don't get him/her out NOW.

How is your FIL able to interfere in your care? You are an adult, and your care is your business, your right, and your responsibility. If he pushes, push right back. If an OB shows up to your induction, tell him/her that he/she wasn't invited, and can leave.


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## whalemilk (Jul 11, 2008)

I wouldn't do AROM. Can you start with Cervadil? I heard rumors some people who are already a little dilated can get started with that and then not even need the pitocin.


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## hapersmion (Jan 5, 2007)

I'm sorry people are pressuring you.







That is incredibly stressful.

Personally I wouldn't want to be induced for post dates, especially with good BPPs. I think I would end up really seriously resenting the people who had pushed me into it, if I felt I hadn't been allowed to make my own decision. It would damage my relationship with them, I think. But you are the only one who knows your full situation, of course.

Have you ever heard of a Foley catheter? It is something I have heard mentioned as a less-invasive induction method, if you do get induced. They put a balloon in your cervix and it slowly inflates, making you dilate. It might be something to consider - unless at 4 cms already it wouldn't work, hmm...

I guess if I had to choose between AROM and pit, I'd take the small dose of pit - IF I could get assurances from the midwife that it would be turned off immediately once labor started. I wouldn't want the AROM timetable.

Good luck, I hope you find some peace and that everything goes well for you.


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## sweetsadie77 (Jun 13, 2006)

I'm sorry you're under pressure to induce when you and your baby are well.

I would choose AROM over pit....Having had a baby before and a cervix ithat is so ready for labour it will probably be enough to work without anything else at all, and if it doesn't the pit is still there. The AROM won't tie you to IV's and fetal monitors. You'll be able to move freely and labour in water.

In the meantime maybe try lots of forward leaning, hands and knees, stair walking (2 at a time if you can manage) to try to encourage baby to be in the most favourable position for labour when it does begin. You could try stimulating labour today with a breast pump (or after AROM but before Pitocin).

Also with a cervix so favourable there is a good chance that the cervidil alone will bring on labour.

Best of luck...


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## citymomstl (Jun 14, 2008)

First, I want to agree with poster #4. You go, girl, for being so in tune with your needs and desires, and to still have the presence of mind in the midst of all this craziness to express yourself so clearly.

Second, I have induction issues in general in a big with my my last pregnancy (both pit and AROM at 2.5 cm), but AROM without sufficient dialation particularaly scares me because it can cement a malpositioned baby. Given the necessity in this pregnancy, I would go with low dose pit first before AROM. Just my two cents (no medical background here).

Best of luck with your decision!!! I hope that you are in natural labor now as I type.


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## alegna (Jan 14, 2003)

I would do neither.

I had dd about 2 months ago at 43 weeks 5 days. He did not look like an "overdue" baby at all. (yeah, my dates were right...)

If he'd been kicked out 2 weeks earlier I know we would have had problems. If he'd been induced it would have caused problems.

Babies come when ready.

Feel free to pm me









-Angela


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## bkbabymomma (May 23, 2007)

Thank you all you lovely people with your helpful advice and kind words. I actually do think my crying jags this morning may have finally kicked something into gear. Whether I can get myself into full-blown labor by nightfall is another question. Come on breastpump...

Blessings back to all of you.


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## soso-lynn (Dec 11, 2007)

That is good news. If you feel that labour is coming, do not go to the hospital as scheduled tonight. Cancel that right away and then go to hospital (or wherever you intend on giving birth) only when you are in well established labour. They might want to augment your labour or give you the induction treatment package if you show up for your appointment, even if you are in natural labour already.


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## Halfasianmomma (Nov 1, 2007)

Just wanted to chime in as a mama who had her baby at 42 wks + 1 day, because of a scheduled induction. My cervix was 80% effaced, I was dialated to 2 cm, and baby's head was well applied to my cervix. I had had a bunch of labor signs in the month preceding , but for some reason, she wasn't coming out.

Since my cervix was already soft, cervidil wasn't considered. My doc did AROM and it didn't do squat for me, so I agreed to the pitocin, but only for a certain period of time. I had a very wonderful support team with me (my DH and my awesome doula, Jessica Leduc), and they negotiated for me for the lowest dose possible of pit and for a set period. The nurse on duty tried to make me stay in bed supposedly because the fetal monitor might lose the fetal heart, but my DH was wonderful and basically threatened to pull the IV right out of my arm if she didn't let me get up to labor standing (my prefered position throughout the entire birth). It helped that our doctor (not an OB) was totally behind us and willing to let me have the birth experience I wanted. After a 3 hour course of pit, it got turned off, the IV was removed as well as the monitor. By then, my contractions were well under way, and before I knew it, I was in transition. I did the whole 20 hours of labor without pain medication, even through 2 hours of pushing, and only suffered a few 1st degree tears. I won't lie and tell you that pit contractions are easy...but I just dealt with one at a time, had my doula to support me, and I used some Hypnobabies and yoga techniques to get me through.

I totally understand where you're coming from, and to be quite honest, I experienced a bit of guilt for "giving in" to the induction, but in the end, I came out of the experience feeling "in control" and very strong. If you choose to go the induction route (and I'm not saying you should), just make sure you have a team of people who know your rights and are ready to defend you at the drop of a hat.

HTH! Good luck!


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## SublimeBirthGirl (Sep 9, 2005)

I would seriously consider doing neither but if I had to choose I'd use a low dose of Pit and turn it off whan labor started. I hope you're in labor right now!


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## Shilohsmom (Mar 13, 2007)

I just had my beautiful baby girl a week ago via induction for pre-e/PIH. I had antibiotics and had to wait a few hours for the first dose to kick in before doc would consider AROM. He gave me the choice of sitting and waiting for a few hours and then he'd break my water or trying a low dose of pit with the option of turning it off if it became too much to handle. I opted to do the pit first. I started out with 2 mu of pit and was gradually increased to 20mu of pit of the next few hours. I was able to laugh and joke through all of the contractions. I sat on the birthing stool with my doula and friend close by...and the contractions were never that bad. BUT, the nurse (who was a doll BTW) came in and said the ctx were too close together and she turned down the amount of pit.

When doc came back at lunch to check me...I hadn't dilated anymore than before and she hadn't moved down at all. So, I (with slight fear) decided on an AROM. Doc had the nurses disconnect my IV and leave me with a heploc...and told me to "get my butt walking"! He did the AROM at 1245pm and she was born at 714pm. I was able to walk around, soak in the hot bath tub, and keep my birth drug free. FOR ME, the AROM worked...but I know that it doesn't work that way for everyone. I'd try the pit first and if after a while nothing is happening...I'd do an AROM and then get out of bed and start moving! Let gravity do its job!!

Good luck, I hope you are in labor and holding a baby soon!


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## Nan'sMom (May 23, 2005)

If pushed I'd do pit and see how well that started things off since AROM gets you on the clock. But I think I'd be more inclined to tell everyone to leave me alone as they were endangering my health and my baby's health with their fears, turn the ringer off the phone and get a trusting homebirth midwife who doesn't have a 42 week limit.

Best of luck with this!


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## SublimeBirthGirl (Sep 9, 2005)

Quote:


Originally Posted by *Shilohsmom* 
I just had my beautiful baby girl a week ago via induction for pre-e/PIH. I had antibiotics and had to wait a few hours for the first dose to kick in before doc would consider AROM. He gave me the choice of sitting and waiting for a few hours and then he'd break my water or trying a low dose of pit with the option of turning it off if it became too much to handle. I opted to do the pit first. I started out with 2 mu of pit and was gradually increased to 20mu of pit of the next few hours. I was able to laugh and joke through all of the contractions. I sat on the birthing stool with my doula and friend close by...and the contractions were never that bad. BUT, the nurse (who was a doll BTW) came in and said the ctx were too close together and she turned down the amount of pit.

When doc came back at lunch to check me...I hadn't dilated anymore than before and she hadn't moved down at all. So, I (with slight fear) decided on an AROM. Doc had the nurses disconnect my IV and leave me with a heploc...and told me to "get my butt walking"! He did the AROM at 1245pm and she was born at 714pm. I was able to walk around, soak in the hot bath tub, and keep my birth drug free. FOR ME, the AROM worked...but I know that it doesn't work that way for everyone. I'd try the pit first and if after a while nothing is happening...I'd do an AROM and then get out of bed and start moving! Let gravity do its job!!

Good luck, I hope you are in labor and holding a baby soon!

It's such a huge risk though. Even putting aside cord prolapse and malpositioning, if it doesn't kick up labor (and for many women it doesn't-think about the women who have SROM and labor doesn't really kick in for 24+ hours, often leading to interventions) you're locked in. After 8-36 hours, depending on the group, you're going to end up with a c-section (first Pit, of course, so you'd have both anyway). It can go really quickly and smoothly, but it doesn't always. Or even usually, I bet.


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## wannabe (Jul 4, 2005)

I hope it is starting on its own!

But I would choose pit over AROM.


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## bkbabymomma (May 23, 2007)

Thanks again everyone. Luckily I was spared this difficult decision -- took the cervidil and was in labor 4 hours later. 4 hours after that I had a healthy baby girl. I can't tell you the relief and gratitude I feel for being spared a cascade of interventions. My midwife was AMAZING, and her back-up, who had seen me a few times during my prenatal care, showed up at 1:00 A.M. to help, just 'cause. The nurse on duty stayed over her shift 3 hours to help me too (even though she had a second job to go to shortly after). It was absolutely incredible to be attended by these 3 generous women, and such a wonderful antidote to the negativity of my in-laws who wanted me in high-risk care (since the baby was completely healthy and my delivery uncomplicated, my FIL has decided that I "mixed up my dates" and she wasn't late after all -- forget that she weighed almost 10 lbs.). Nuts.


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## ~Megan~ (Nov 7, 2002)

Would you care to list the natural methods you've tried in case you missed one?

I would probably request a ballon dilator first.


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## ShannonT (Dec 6, 2007)

Quote:


Originally Posted by *bkbabymomma* 
Thanks again everyone. Luckily I was spared this difficult decision -- took the cervidil and was in labor 4 hours later. 4 hours after that I had a healthy baby girl. I can't tell you the relief and gratitude I feel for being spared a cascade of interventions. My midwife was AMAZING, and her back-up, who had seen me a few times during my prenatal care, showed up at 1:00 A.M. to help, just 'cause. The nurse on duty stayed over her shift 3 hours to help me too (even though she had a second job to go to shortly after). It was absolutely incredible to be attended by these 3 generous women, and such a wonderful antidote to the negativity of my in-laws who wanted me in high-risk care (since the baby was completely healthy and my delivery uncomplicated, my FIL has decided that I "mixed up my dates" and she wasn't late after all -- forget that she weighed almost 10 lbs.). Nuts.









:

Congratulations!


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