Considering the Bishop Score

On Tuesday my husband and I were invited to attend a mini lecture on the risks of induction.  This was the day after skipping my first induction appointment that was unsolicited and unwanted - at 41 0/7 weeks.  Beyond my strong convictions to have this baby girl au natural, there actually are medical complications to consider.  Complications that may be so commonly occurring, in fact, that they have been adopted as normal to the process of labor and delivery.

One of the most discussed scenarios in the natural birthing camp goes something like this: induction > increased labor pain, increased intensity in contractions > fetal distress > C-section.

This is in no way to say that there isn't a time and place for induction or c-section.  It's just that when we heard about the Bishop Score at this mini lecture, I think our jaws dropped.  The Bishop Score is used...or was used, as it seems...to determine whether or not a woman is a good candidate for induction.  And it is based on the physiological conditions of the cervix and the baby, not a calendar date.  Common sense can be such a beautiful thing.

thanks to BabyMed.com for the borrowed chart

At 41 weeks, by choice, I hadn't had a single pelvic exam because there was no reason.  I could have walked around for weeks several centimeters dilated, and I didn't want to get my hopes up.  I'm not a patient person.  Likewise, I could go from 0-10cm in a very short time frame, but I didn't want to get discouraged in my wait for soon-to-be-baby girl if there wasn't a glimmer of progress being made.  And certainly, no one made mention of a Bishop Score and how a cervical exam might shed some light on the discussion of induction.  The only factors presented by the hospital staff were some skewed data used to make fearful cases for expediting our baby's exit.  First it was meconium aspiration, then it was a reference to nonspecific "risks" and a misquoted ACOG standard for induction, and most recently the deterioration of placenta as well as the explanation that if I haven't made progress beyond 1 cm by 2:20pm today (41 4/7 weeks), as a first time mother, I would not be capable of having this baby without the aid of an induction.  Did that last one just blow your mind?  It did mine.

So when we went in for yesterday's non stress test to check on our perfectly healthy unborn babe, we asked for an exam.  The findings put us at a 3.  The Bishop system suggests between 8 and 13 as favorable scores for successful inductions.  This lack of consideration again blew my mind.  Here I am being harassed on nearly a daily basis to have my body pumped full of cervical ripeners and artificial hormones when it isn't even primed to have a baby, who in my opinion hasn't come because she isn't ready.

So you can imagine how appalling it was last night at 11pm when Labor and Delivery called to ask me to come in right then instead of the Friday morning appointment forced upon me, the second made after politely declining induction altogether.  But the icing on the cake was definitely the provider who called back at 11:15pm to explain the likely failure of my body and it's equally likely need for drugs to produce a baby regardless of the fact that its signs all point to "not ready". 

We have chosen to wait until Monday (42 0/7 weeks) and reassess soon-to-be-baby-girl's place in the world, since it is true that several risks do go up slightly at that point in gestation (meconium aspiration, fetal macrosomia, dysmaturity syndrome, and stillbirth and neonatal mortality risks double from 0.003% to 0.007% after 42 weeks).  But we're keeping in mind that making a baby is also a very individual process.  Some just cook longer than others - period.

She is not estimated to be large, thus making the risk of fetal macrosomia, a baby born weighing 8 pounds 13 ounces or more (mayoclinic.com), and dysmaturity syndrome, "characteristics resembling chronic intrauterine growth restriction from uteroplacental insufficiency" (ACOG: Clinical Management Guidelines for Obstetrician-Gynecologists Number 55, Sept. 2004) pretty much a non-concern of ours.  Her amniotic fluid is good, her heart rate is good, her movement is well within 10 kicks per 2 hours, and all of my vitals are healthy as well.  There appear to be two real causes of friction between the hospital staff and my family: noncompliance with scheduling at a facility with very high birth volume and exaggerated worst case, yet pretty unlikely, scenarios. 

Today we are scheduled to see yet another midwife, who I suspect will insert an inflated version of her postdate risk of choice even though we haven't reached "postdate" yet.  The plan is to get my membranes stripped to naturally coerce labor to begin if for no other reason than to get out of the loop of stressful confrontations with these people.  We absolutely want what is best for our tiny, stubborn offspring, which is why we're waiting a few more days for her to decide that maybe it's time to become a part of this big, wide world.