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Connor’s mother found herself in a common predicament; she was approaching 42 weeks gestation and showed no signs of labor. She had tried every natural trick and old wive’s tale to bring about labor, but nothing had moved her baby along and she was getting nervous. She asked about the risks of going late and I counselled her that post-term pregnancies were at an increased risk of meconium fluid, poor fetal tolerance of labor, cesarean section, and, the most frightening of all, stillbirth, but reassured her that vast majority of post-term babies did well, that the overall risk of serious complications were low, and she was not in a substantially different place than she was just a few days before. I also counselled her that some studies had shown a possibly reduced risk of some of those complications with induction, but that induction did carry its own set of issues and she was more likely to need an epidural and possibly more likely to need a cesarean with an induction. She very much wanted a natural labor but also did not feel comfortable with the increasing risks of a post-term pregnancy. We decided on a day for induction, swept her membranes to help encourage the process along, and met at the hospital the next evening. We administered a small dose of a prostaglandin every four hours. She still was able to ambulate, with the aid of the mobile monitor, and eat as she wished. We placed a hep-lock IV just in case the baby did not tolerate the process.

Roughly ten hours later, she was nicely dilated to five centimeters and having strong, active contractions. The prostaglandin having done it’s job, we now discussed the options from there. We could simply wait and see if the labor continued without any additional intervention, we could break her water to help ensure the process would continue, or we could do the more medically aggressive thing and start pitocin now that her cervix was ripened. She wanted to minimize medical interventions, but was still nervous about the labor slowing back down, so she decided to have her water broken. That really seemed to do the trick and she was eight centimeters two hours later. At this point, it had been over four hours since she had received any medication and she was uncomfortable, so we took her off the fetal monitor and she spent several hours in the labor tub with intermittent auscultation. She began to feel a lot of pressure, but when she was examined she was still only eight centimeters. She was very frustrated and, at this point, was tired and having trouble managing the labor.

We all encouraged her that she was doing really well and this was just a bump in the road. Again we discussed her options. She could get back in the tub, where she seemed to be managing her labor better, and we could just ...

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