Had our 39 week exam today with Holly, and things with baby look great. Her heart rate is steady in the 150s where it should be, and her position is mostly favorable for delivery - she's head down and seems to be sort of sideways facing the left right now. Her head is low, about a 0-station, so engaged in the pelvis which is also good news! My cervical check showed about 80% effacement and a fingertip to 2cm dilated, with soft and stretchy tissue. Because the PUPPS rash has gotten worse over the past few days and is impacting pretty much all of my sleeping and waking hours negatively, we discussed possible induction this weekend. She said that they calculate a score called a Bishop Score to note how "favorable" conditions are for a successful induction, and she said my score was "high" but didn't give me an exact value. Basically, she felt that my cervical status (haha) was such that it would likely respond to induction and have a higher likelihood of vaginal delivery. I could try a round of steroids first for the rash, but neither Holly nor I felt that at this point that made much sense. I'd rather not put myself and baby through the side-effects of steroids when we could just get her out and solve the problem. The rash won't necessarily go away immediately, and could take days to weeks to get totally better, but it will begin to improve following delivery. Holly swept my membranes today as well, which could get labor going within 24 hours, but is certainly no guarantee. That was about 7 hours ago now, and I have to say I haven't noticed much change, perhaps a few more contractions that typical, but nothing consistent. So, we wait and see. Depending on scheduling at the hospital, we could get in for an induction Saturday or maybe Sunday, but Holly was going to give us a call and follow up. She's not on call until next Tuesday, so it's unlikely she'll be the one there for delivery unless I hold out until then for induction. Keeping in mind that Monday is a Full Moon, and it's bound to be crazy full on L&D Monday and Tuesday!
I'm doing my best to weigh my options, and I'm not 100% sold on induction just for the selfish reason of resolving my discomfort from this rash. It could go great and I could end up having a vaginal delivery with no additional interventions, or my body could just not be ready and I could end up not making enough progress and have a c-section. Or the Pitocin induced labor could be so intense that I end up with an epidural way early, can't feel well enough to push effectively, and end up with a vacuum delivery. Are those risks worth avoiding a few extra days of intense itchiness? I don't know. Of course, there's still no guarantee that she'll come on her own even after her due date, and I might end up facing induction then, too. As far as the actual induction goes, I'd still be followed by the midwives for delivery, but would obviously need an IV and have continuous fetal monitoring. Holly said the rooms have telemetry monitors, so I could at least walk around and not have wires tied to the monitor, and they are waterproof so I could still labor in the water for pain relief, either the tub or shower. I'm leaning towards going ahead with the induction this weekend if she doesn't spontaneously decide to arrive tonight or tomorrow, and just see how it goes, because nearly every inch of my skin is covered with itchy welts at this point (my face and back and upper torso are saved so far...) and it's not going to get better the more I wait.
So tonight and tomorrow I will just keep talking to this little lady and encouraging her to come out on her own...surely it will be better out here than in there, I'm trying to convince her ;) Send your happy, spontaneous labor thoughts our way! We'll be sure to update everyone if anything changes, of course!