38 Weeks and 4 Days Pregnant: I Declined Induction

On Friday, November 15th, I had my third NST (Non-Stress Test). During the test, three distinct variable decelerations were detected, with the baby’s heart rate dropping to 90 bpm at the nadir. My baseline was around 135 bpm, and the normal range is not supposed to fall below 110 bpm. Based on these results, and under questioning admitting that maybe the baby had been moving less because I wasn’t sure (at that night, I did the baby movement count, he moves normally). The OB recommended we go to the hospital’s labor and delivery department for longer, more precise monitoring (a 1-hour NST), which we did.

After approximately 45 minutes of testing, the on-call doctor (OB) reviewed the results and noted the same pattern as in the earlier NST. She said that whenever I had a contraction, even ones I couldn’t feel, the baby’s heart rate would drop to 90 bpm. And there was also at least one drop without contraction which was also worrisome for the doctor. She said the baby seemed unable to tolerate even mild contractions.

An ultrasound was done to check my amniotic fluid, which appeared normal. I also underwent a cervical exam, which showed 30% effacement and a fingertip dilation—indicating that my cervix was still far from ripening. Despite not identifying a clear cause for the decelerations, the doctor strongly recommended starting the induction and labor process immediately. Her primary concern was that if the baby was already reacting poorly to gentle contractions, waiting for natural labor and stronger contractions might put him at significant risk. She emphasized that both the baby and I were currently in good shape making it an optimal time for delivery with fewer complications.

My husband and I were shocked by the sudden recommendation. Induction involves extensive medical intervention and can be a lengthy process, especially since I was not even in early labor. We requested time to speak with our doula, understand the situation better, and gather more information about both the test results and the induction process.

Our doula recommended us to try some movements, the baby might be playing with cord and provided guidance on asking informed questions, such as:

• What is the success rate of induction in my current situation?

• What assessments (e.g., Bishop’s score) will be used?

• If progress is slower than expected, how long can we wait before moving to the next step without overstimulating the cervical, and so on?

These questions helped us better understand the process and weigh the risks and benefits of induction.

After speaking with the nurse (who noted that the on-call doctor tended to lean toward a conservative approach) and reflecting on our prior knowledge and instincts, we decided to decline induction. I felt the baby was likely fine—perhaps his position or interactions with the umbilical cord were contributing to the decelerations. The doctor was insistent, and asking: “Do you want to put your baby at risk?” We had an additional intense discussion in a tiny staff room with a fridge that felt like 20 minutes, where we acknowledged the high stakes and appreciated her concern. Ultimately, we stood firm in our decision, and agreed to come back for another NST test the next day.

We returned for another NST the next day (Nov 16th, at 5pm when the baby was more active). Upon arrival, the nurse mentioned that the doctor’s team had already planned for our stay for induction and labor that day. When we expressed our preference to avoid induction, the nurse advised that we needed a “perfect” report and even suggested I have something sweet to eat or drink before the test. Fortunately, the results were normal and reassuring. An additional ultrasound confirmed that my fluid levels were good, and we were allowed to go home with the blessing of the staff.

Some information about induction and thoughts on healthcare system

The labor induction rate in the United States in 2022 was 41%. This is an increase from 9.5% in 1990 and 22.1% in 2004. The rate of induction for first-time births in the US also increased from 30.1% in 2016 to 39.7% in 2022 and is likely higher after the ARRIVE Trail (great article: Evidence on: The ARRIVE Trial and Elective Induction at 39 Weeks) . While induction can be a necessary and beneficial intervention in certain situations, it often aligns with hospital and medical team convenience. Unfortunately, only 14% of women who undergo induction report being fully informed and consciously choosing it. Many express dissatisfaction with the experience and even regret.

Induction comes with significant potential side effects for both mother and baby. While I don’t blame the doctor—who was performing her duties according to her training and the system in which she operates (people are often the products of their environment)—this experience highlighted systemic issues. Our healthcare system often prioritizes medicalization over humanization. That said, we also encounter deeply compassionate professionals within the same system.

And also the legal liabilities that likely contribute to OBs recommending the “safer” course when there’s a hint of an issue. The data shows approximately 83% of obstetricians are sued at least once during their careers, with many facing multiple claims. On average, obstetricians can expect about 2.53 malpractice lawsuits filed against them over their professional lifetime. They face a notably higher rate of lawsuits compared to other medical specialties.

What We Learned

1. Empowerment and Autonomy: Women should have ultimate authority over decisions related to their bodies and pregnancies. It’s crucial to feel empowered to say “no” when necessary.

2. Education/ knowledge is Power (both Mom and partner): Educate ourselves, and be equipped for high stakes and stressful conversations with health professionals. Seeking knowledge and consulting experts, such as doulas and nurses, helps facilitate informed decision-making.

3. Building relationships with care providers: Mutual respect between patients and healthcare providers can foster a nurturing environment. As patients, we should try our best to set aside our emotions to have constructive conversations with the medical team. And foster a nurturing environment for the medical team to set their emotions and egos away. We were not challenging the doctor’s authority but rather seeking clarity to make decisions that best served both me and my baby in the long run.

Disclaimer: This is solely my personal experience and thoughts, and doesn’t constitute any medical advice.