At Physicians and Midwives, our highest priority is insuring a safe delivery of every baby. We set guidelines to assure that each patient is given the best opportunity to have the childbirth experience that she wants, with certain safeguards in place to protect her health and that of her precious cargo. We have high risk specialists (perinatologists) with whom we collaborate and co-manage a special portion of our OB population and we have established our guidelines in accordance with the American Congress of Obstetricians and Gynecologists (ACOG) protocols and their research and expertise.
- The due date (expected date of delivery- EDD) is based on 40 completed weeks of pregnancy. Any woman may request an elective induction of labor (IOL) at her EDD, however we strongly recommend that the cervix be assessed as favorable (Bishop’s score of 8) to reduce the risk of a Cesarean section.
- Women who are low risk and less than 38 years of age may await spontaneous labor up to 41 weeks gestation. It is our preference to schedule IOL at 41 weeks, if Mother Nature is not taking the lead at that point. Antenatal surveillance, including biophysical profile (BPP), Fetal Non-Stress Test (NST), Amniotic fluid index (AFI), is also initiated at 41 weeks.
- Women with a history of one Cesarean section, who have been risk assessed and deemed a good candidate for a trial of labor after Cesarean (TOLAC) and who have no other high risk conditions, may choose to wait until 41.0 weeks gestation before a repeat Cesarean section is performed. We do not offer TOLAC after 2 Cesarean sections, or vaginal breech delivery.
- High risk patients who are being co-managed with the perinatologists will be scheduled for induction by their due date, based on the perinatologists’ recommendation. This does include otherwise healthy women who are beyond 38 years of age. High risk women will begin their antenatal surveillance at 36 weeks gestation.