Reconsidering the considerations

So, we're about 57 hours or so from our induction appointment, and, as I tend to do before any big life event, I "decided" to melt down emotionally last night and today. As I recall, we got married on Sunday nearly 7 years ago, and on the Friday night previous to the ceremony I flipped out under the pressure. By the day of the wedding I was ready to go, and I hope that by Monday I will be the same! So, while unpleasant, this development wasn't unexpected.

I didn't sleep last night worrying that the induction of labor was the wrong choice. However, what I didn't realize at the time was that the worries I was experiencing were a result of accepting the wrong presuppositions. Basically, I had assumed that the "reasons" we had been discussing as justification for induction were limited to the two on my mind, which were not, on their own, reasons to induce, which made it boil down to an elective procedure. I made this mistake because in talking to the doctor, we had agreed with the course of action he proposed without having heard his reasons for it, which meant he hadn't actually spelled out the case for us, so we just operated on what was in our minds until those reasons failed to justify the action.

Some elective procedures I'm okay with, but not those that take two lives into the balance when nature has been doing a pretty good job of accomplishing the same thing since the advent of humanity. So, I fretted and read and worried and cried off and on for 12 hours until finally, mercifully, had an appointment with our OB just before office closing time.

We left the office with a completely different perspective, because what we got in this visit was his professional opinion: that I am at substantially above average risk for adverse outcomes as pregnancy progresses, which means that there is more risk inherent in leaving the baby where he is than there is in urging him out while we know he's healthy now that he has reached a very favorable point in development.

He gave me three medical reasons having to do with my own personal status and health:
1. I am right on the cusp of "advanced maternal age" and the risks that attend it, and there is nothing magical that happens on my quickly-advancing 35th birthday that might not be an issue now.
2. My blood pressure is borderline high, which increases risk to the baby.
3. My gestational diabetes - which can cause premature aging of the placenta, such that it fails to provide adequate oxygen and nutrition to the baby as pregnancy progresses, and which also places me at higher risk of developing pre-eclampsia - is an ongoing concern.
He proviced one reason that is his own selfish motive and not a real reason for us:
4. He would get to attend the delivery.
And one reason that is evidence-based statistical data about fetal outcomes at various gestational ages:
5. Fetal morbidity based on gestational age at delivery decreases from an already low rate at 36 weeks to its lowest at 39 weeks before increasing again at 40 weeks and beyond. This is without regard to particular maternal risk factors - babies born at 39 weeks, for reasons that are not entirely intuitive or clear, just do better.
To these 5 reasons we can add two more:
6. We're both exhausted, physically and mentally, by the pregnancy and its complications.
7. There would be an advantage to getting antibiotics in a timely manner, which is more likely with an induction than with spontaneous labor, given how far advanced I am already at this stage.

None of these reasons is compelling on its own, and even a combination of 2 or 3 is not enough to make it wise; they are "soft" concerns. However, when we add them all up, they spell higher risk that it makes sense to more actively manage, which means there is a medical case for induction, making this a choice, yes, but not a purely elective procedure.

We have heard nothing but good things about our doctor from the nursing staff at the hospital, people in his office, other doctors at the hospital, and even the guy that sold Daniel his suits (his own kids were delivered by him 2 decades ago) at Men's Warehouse, and so when our judgment is wanting direction, it seems like his opinion is worth trusting.

Our choices, he said, are two:
1. Proceed with the induction on Monday
2. Choose not to proceed with the induction - which is fine as long as the baby looks healthy now - but, if I do, I will need to begin twice-weekly non-stress tests immediately to make sure that the baby's health is not deteriorating as he and the placenta age, and if the baby is not born by week 41 due to an emergency or spontaneous labor, induction would become extremely strongly advised.

He explained his professional opinion but he also stressed, quite honestly and supportively, that it is our pregnancy and that the choice is absolutely up to us and that he won't force the issue aside from ordering more tests if we refuse. He then answered my specific questions about the risks and benefits of both approaches for about 40 minutes. He was very straight-talking, which I really appreciate. He also said that if he felt like an induction was absolutely necessary, he would not mince words about that. We have a choice, essentially, as long as the baby looks okay and my health holds up, but we also have and the benefit of his opinions as to why he feels strongly that induction at the gestational age the baby will have reached on Monday is the safer course.

After he did the usual exam, which didn't show any growth of the uterus for the last 2 weeks and showed a lower-than-usual fetal heart rate (still acceptable, but on the slow end of the scale), I was sent to have a decidedly more scientific examination: a non-stress test done at the hospital, which was performed tonight. I had instructions that if it did not look good, the doctor from the practice that is on-call this weekend would order more tests or even deliver us immediately. If we passed the test, on the other hand, then we should be fine until Monday's planned induction, or non-stress test, if I refuse the induction.

Thankfully, we passed, which means we still have the choice, and the opportunity for spontaneous labor in the meantime.

So, after the test, lots of talking and taking into consideration the factors that were presented to us, I'm again feeling more peaceful about the possibility of induction. Hopefully I will now be able to just chill out and accept what may come. I would love to have labor begin spontaneously between now and then (the doctor on call this weekend is my second favorite in the practice, and I would much prefer a more natural process if that is possible), but I also feel like it can be the wise and loving thing to proceed with induction on Monday if it does not. So... it looks like we'll most likely have a baby on his way out sooner than later, and it is a fun thing to contemplate... if also the scariest thing I have faced in a LONG time!