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think twice, no think three times before being induced for labor April 11, 2009

Posted by guinever in birth, labor, pregnancy.
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My pregnant readers often ask if I think they should be induced.  After reading each scenario, my usual thought is, “No.”  But that is a decision to be made by a woman after discussing it with her medical care provider.

Read “Don’t let this happen to you”  part 1 and part 2 written by a labor nurse all about a birth that started with an unnecessary induction.

Questions to consider before saying yes to induction:

  1. Will my health be compromised if I continue my pregnancy?
  2. Will the baby’s health be compromised if I just wait for labor to start on its own?
  3. What will happen if I don’t induce today, tomorrow or next week?
  4. Why does the doctor want to induce? Is it for his/her convenience or is it for the health of me and my baby?

Consider this:  50% of inductions in first-time mothers result in a cesarean birth. Yikes!  That’s half. The over-all cesarean rate in the U.S. is currently 31% according to the CDC (Center for Disease Control and Prevention.)

The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States.

Not all inductions are bad or unwarranted. If you have a medical condition such as very high blood pressure, diabetes (not gestational diabetes), pre-eclampsia, an induction is desirable. An induction should be considered only when mother or baby is in danger if the pregnancy continues.

Common non-medical reasons for induction

  1. Doctor is going on vacation
  2. Doctor wants to do all his deliveries during the day and not get called in the middle of the night. He wants to control the timing of your labor.
  3. Doctor gets paid more for a surgical birth than for a vaginal birth.
  4. It’s the last week of December and the couple wants to be able to claim the new baby as a deduction on their taxes.
  5. Couple’s parents are in town for the birth and so they “need” to induce before they go back home.
  6. Mom wants to plan her birth so she can time her maternity leave for work.

So why do many inductions end in surgery?

It’s because the body just isn’t ready for birth. The cervix isn’t ready to dilate. If you’re nearing your due date and you or  your doctor wants to induce, please consider the bishop score which takes into account baby’s position, and the dilation and effacement of the cervix. You can take this short 5 question quiz based on the Bishop score to see if being induced might work for you.

Here’s an all too common labor scenario:  Mom can’t handle the high doses of pitocin so her blood pressure goes up. This affects the baby. Mom gets the epidural because she can’t handle the contractions on pitocin. The epidural makes the labor slow down, so the pitocin is increased. Afterall,  she can’t feel the contractions anymore. Baby increasingly gets worse and worse until a cesarean is needed to save the baby. Mom is worn out and can’t take care of her baby who is having trouble breastfeeding because he’s so lethargic from the drugs that crossed over the placenta.

induction 101

If your cervix is really soft, you might get to skip this first step and just go to the hospital in the morning. But if your cervix is hard like the tip of your nose, you’ll be asked to come in at night and you’ll be given a prostaglandin on your cervix for the purpose of softening it. Some women are able to sleep through the night. Other women feel contractions and are uncomfortable enough that a good night’s sleep is impossible. By morning, your cervix should be nice and soft and ready for the next step in the induction. How long does it take the cervix to dilate 5 centimeters?  But first, let’s answer the following question:

what’s a prostaglandin?

Naturally occurring prostaglandins are in semen. Therefore, you can have all the prostaglandins you could ever need and want in the comfort of your own home. The best way to soften your cervix is to have sex with your husband several times during the last month of your pregnancy.

There are two chemical prostaglandins approved by the FDA for the purpose of inducing labor. They’re the pge2 type and they’re cervidil which is similar to a tampon that is inserted and then can be pulled out and prepadil which is a gel that is rubbed onto the cervix.

But there’s another prostaglandin that’s a lot cheaper than the two mentioned above.  It is not approved by the FDA for labor.  It’s called cytotec and it is used in the treatment and prevention of stomach ulcers. But because it is a prostaglandin and it’s cheap, doctors started experimenting with it to see if it would work during labor.  To quote a labor nurse,

Cytotec turns the cervix to mush. It works really well.

Another name for cytotec is misoprostol. Here’s the FDA fact sheet on misoprostol. Cytotec should not be used during labor; it can over-stimulate the uterus at the least and cause death of mother and child at the worst.

so what happens if you say no to induction?

Wait. Be patient. It’s hard sometimes; I know. Be aware of baby’s movements. Continue your pre-natal visits to monitor the baby’s health and your health. If everything is ok, be confident in your body’s ability to birth your baby. Your body has grown and nourished your baby for nine months and still can. Labor will start. No one was pregnant forever.

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giving birth makes her feel feminine April 1, 2008

Posted by guinever in birth, birth stories, labor, midwifery, pregnancy.
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Thanks to Molly for sharing the birth stories of her third and fourth children.

I did not use a doula for baby #3. I really wanted to, but it wasn’t practical at that time. My previous doula wasn’t available any more, so we decided to take the info we had learned from her, and all our experience, and try a natural birth on our own. We chose a practice with midwives because I did not want to use a doctor. When I got to the hospital they wouldn’t admit me because I wasn’t progressing.

My contractions felt strong to me, but the nurse told me I probably wasn’t even in labor and sent me home. I didn’t want to go home because lived over an hour away. So we went out for dinner and saw a movie. I had a stress ball with me which I squeezed every time I had a contraction. Fortunately, we were at a movie that was very loud so hopefully no one heard my moaning. When we got back to the hospital, they still refused to admit me. They told me to take a tylenol p.m. and go home to bed. Bummer.

At home I got in the bathtub and tried to relax. The tylenol wasn’t cutting it. Go figure. I told my husband that I couldn’t bear to feel like this and not be in labor! He said I should get dressed and go back to the hospital, but I told him I didn’t feel like traveling. I didn’t even want to get dressed. And I wasn’t in labor anyway, according to the nurse, so why bother?

I was going to just lay down and try to sleep (ha!) He was getting very worried and insisted that I get dressed just in case. I could barely lift my leg to put my pants on. By the time I was dressed, it was clear we should get back to the hospital ASAP. Another hour and 15 minutes in the car was torture. I was panting, trying not to bear down. Transition happened in the car this time, and when we got to the hospital it took less than 10 minutes before the baby was born.

I had been in labor after all, LOL!

in labor with baby number 4

With our last baby, a fortuitous move placed us just 10 minutes from the hospital. Yeah! When my water broke, we drove straight over. My midwife wasn’t on duty and I had to use a different one. She didn’t know me, but I made my commitment to natural birth quite clear to her up front. I was frustrated because the staff didn’t want to let me get up and walk around since my water had broken. I was afraid that labor wouldn’t progress if I couldn’t do something active. I didn’t want to sit in bed the whole time.

laboring in the bathroom

They couldn’t keep me from going to the bathroom, so I got up and walked to the toilet and squatted there as many times as I felt I could justify. After awhile, they finally allowed me to walk around the halls, with frequent monitoring. My labor progressed at a good rate and it was finally time to push. I was having a hard time and the midwife suggested I squat on the bed. I had never given birth in that position before and it hurt like crazy to try and do it. The pressure was almost unbearable. But it worked great.

Unfortunately, the baby’s shoulders weren’t coming out. He was too broad shouldered. The midwife grabbed the baby and turned him like a corkscrew and pulled him out. That is probably the strangest thing I have ever felt, and not something I care to ever repeat! But it was amazing once he was out to hold him, and to know that, once again, I had given birth.

Giving birth naturally makes me feel so feminine! I may not be very lady-like in the process, as I tend to be one who makes noise. But I feel like I am doing what my body was created to do.

It was less than 5 minutes after our fourth son was born that I turned to my husband and said, “I want to have another one right away!”

You can read Molly’s other birth stories.

You can submit your birth story too; please click here for guidelines.

I don’t know how I could have given birth without a doula March 31, 2008

Posted by guinever in birth, birth stories, birth story, doula, health, labor, midwifery, pregnancy.
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Thanks to Molly for sharing her birth stories with us:

When my first son was born, I was living in post-communist Eastern Europe. Think America in the 1940s and you’ll imagine the situation in the hospital correctly. I had already suffered a miscarriage while living there, which was devastating. I tried to prepare myself for natural childbirth by reading a book about the Bradley method, but I was young and didn’t really know anyone who had done natural childbirth. In the hospital the nurses told me they were going to give me a shot which would make everything better, and I wouldn’t have any side effects from it at all. I didn’t realize that they were giving me a narcotic until it was too late. I had the strangest out of body experiences and felt convinced that I was dying and no one knew it except a big dog that was beside my bed the whole time. Of course, no one saw the dog except me, LOL!

After the birth, my baby was taken away from me and I didn’t see him again for about 12 hours. He had Strep B so they made him stay in the nursery and I could only see him when I wanted to nurse. My confidence as a mother was pretty low. I had already lost one baby, then I didn’t have the victorious birth I was hoping for with the 2nd, I couldn’t nurse very well and his health problems prevented us from bonding the way I had been told we should. As a new mother, far from family and home, I felt very isolated and insecure.

hiring a doula for her second birth

It was almost four years before I would birth baby #2. I felt that my poor birth experiences had robbed me of much of the confidence I should feel as a mother. I was 100% committed to having a natural birth this time, and I felt sure that it would be very empowering. I was back in the USA, and I decided to use a doula. She encouraged me to write a birth plan and submit it to the hospital when I came in for the birth. Part of my birth plan stated in large, clear type that I did not want any medication and that no one was to offer me medication at any time. I didn’t want to be tempted.

using a midwife

I also decided to use a midwife instead of a doctor. I was a little worried that having the doula there would take something away from the experience I hoped to have with my husband. Nothing was further from the truth. The doula enabled me to have a much better experience with my husband. During my first birth I felt like I barely saw my husband…he was too busy rubbing my back and applying counter-pressure for me to see much of his face.

With the doula, she rubbed my back and did a lot of the physical things I needed (getting ice, heat packs, etc) and my husband was free to totally focus on meeting my emotional needs. He was always right there where I could see him and talk to him, and I was able to hold his hand and feel his reassuring presence. My doula handled the nursing staff for me as well, which allowed me to turn my focus more inward and just relax and think about the task at hand.

As it turns out, I don’t know how I could have done it without the doula.

I was in the transition phase for over 2 hours….I think transition isn’t supposed to last more than about 30 minutes! It’s the time when you are sweating and cold at the same time, and the contractions are so intense. All you want to do is push but it’s not time yet. My doula enabled me to take each contraction one at a time.

thanking the Lord for a natural birth

I feel confident the staff would have pushed me toward C-section if she hadn’t been there, because it was almost unbearable and it just took so long. But between the doula and my husband, I had plenty of support and was able to make it through. The doula also suggested that my husband sit behind me on the table and I leaned against him. During the contractions I dug my fingers into the knees of his jeans. When it was time push, he leaned forward and I leaned forward with him and bore down. When the contraction was over I could lean back against him for a moment to catch my breath.

It felt so safe and secure to be so close to him.

When I finally was able to push my baby out, I felt so great! I was so thrilled that I had accomplished my goal of having a natural labor and birth. I immediately felt much more confident as a mother…as a person. I can honestly say that the Lord used this birth experience to redeem much of the loss and frustration of my previous one. I felt very exhilarated and empowered by the whole thing. It was like being on top of the world. I was fully alert and could immediately nurse my baby and bond with him.

an epidural after the birth for repair

All my sons have been big, and baby #2 was no exception. I had a rectal tear when he was born which necessitated a trip to the surgeon when he was a few weeks old. They gave me an epidural and I got to find out all about what I had missed out on. It made my legs all trembly, and they had to catheterize me, as well. When the catheter came out it was painful, and I couldn’t make myself pee. It was so uncomfortable to have the urge and not be able to go. This further strengthened my resolve to NEVER have an epidural during birth.

You can read more of Molly’s birth stories

You can submit your birth story too; please click here for guidelines.

Katherine’s birth story: cervadil induction, natural birth January 21, 2008

Posted by guinever in birth, birth stories, birth story, health, labor, midwifery.
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Thanks to Katherine for submitting her birth story. In her words, she was committed to an un-medicated, un-managed, natural birth, but was also birthing at a big university teaching hospital, albeit with a team of very cool midwives. She and her husband took a Bradley® class, followed the Brewer diet, did yoga once a week, and walked 2-5 miles per day.

41 weeks along in my pregnancy

On Thursday, my 1-week postdates checkup, I had borderline low amniotic fluid levels (which increase the chance for a “cord accident” and are an indirect marker of potential placental insufficiency, which can both be serious complications) with 1 cm dilation and 50% effacement, so the midwives wanted to induce me the next day. As I suspected, they “don’t do inductions on the weekend,” but I didn’t want my son to be born based on the hospital’s scheduling practices. I got them to agree to give me an extra day to research and think and see if labor would start on its own.

After reading in Ina May’s Guide to Childbirth that low amniotic fluid was a reason that Ina and the other midwives who work with her would transfer to the hospital, I decided it might be serious, and I’d better see what I could do to get labor started. I got acupuncture twice, did nipple stimulation, sucked my thumb to stimulate an acupressure point on the roof of my mouth that helps get contractions going and helps them be stronger once they do start, visualized and told my cervix to efface and dilate because the baby needed to come out.

an induction with cervidil

By Friday night when I went in for what I was hoping was just a check, I was still 1 cm, but 75% effaced and having small contractions every 10-15 minutes. I was thinking I’d be told, “Yes, you’re in early labor. Go home.” No such luck. The midwife and nurse weren’t convinced I was in early labor and told me that I needed to start a cervical ripener in preparation for a pitocin induction the next morning. The midwife inserted cervidil at about 8:30 p.m. I was still pressing the acupressure point in my mouth and chanting in my head for my cervix to efface and dilate. By 10:30 p.m., the nurse had decided that maybe it was real labor after all. I remember the nurse kept asking me to rate the pain of contractions on a pain scale, and I went from, “Oh, maybe a 1.5″ to “That was…mmmm, a 3.” to “Um, 4?” The nurse said at one point, “Are you sure that was only a 4?” and I told her that I was trying to save the bigger numbers for later. My husband said I never went higher than a 5, although some of the contractions were pretty painful. For the most part,

I would say that labor wasn’t so much painful as it was all-consuming. It’s like being in the ocean and being carried up and down in huge waves. If you give in, accept it, and ride out each contraction, it’s not so bad. But if you tried to avoid it, I am sure it would be more painful.

I did a lot of ‘vocalizing’, i.e. moaning like a zombie or mooing like a cow, and that helped dissipate the intensity of the contraction and kept me breathing. Or, I would be quiet, but trace the outline of a cabinet door with my eyes or stare at a speck on the floor as a distraction from the contraction. My husband talked me through a lot of contractions too, putting up with me saying, “No touch!” or “No talk!” for some of them. He called our doula to come be with us sometime in the dead of night, but I don’t really remember when…

laboring in the tub, floating like Ophelia

The Cervidil fell out (it’s on a little string like a tampon and is supposed to stay in for 12 hours) at about 2:30 a.m., and the midwife found that I was 6 cm dilated. My first question was, “Do you have to put it back in?” to which the midwife and nurse both started laughing, “No, you’re in labor and progressing well.” My next question was, “So, this means I can go in the tub now?” Thankfully, I was able to have the rest of my labor in the deep whirlpool tub they had in the bathroom, floating like Ophelia and dozing between contractions,then flipping onto my hands and knees for mooing and pelvic rocks when one was starting.

pushing

After some indeterminate time (being in labor is really an altered state of consciousness, and I had no idea about time except when I looked at the clock and marvelled that it was so late at night), my doula recognized that I was getting pushy and asked for the midwife to come in. I had noticed that the contractions felt different, like I was being wrung like a dishrag from the inside out, but I didn’t recognize it as transition. I thought some part of my BRAIN would say, “Wow, I really have the urge to push.” But in a homuncular version of a laboring woman, the head is about the size of a cherry tomato, and the abdomen is the size of a VW bus — there is nothing intellectual about birthing a baby.

The midwife listened to one contraction (think yodeler being strangled, and that’s the noise I was making) and told me to get out of the tub NOW (they are not certified to do water births at the hospital). She checked me and said I was fully dilated except a little lip of cervix that she pushed back.

I pushed in a number of different positions for about 2 1/2 hours, changing when it seemed right to squat or kneel or lunge, made more primal noises, but did the final pushing on my hands and knees, smelling coffee and marvelling that I could see daylight through the venetian blinds. My son came into the world easily and gently with some minimal guidance and lots of encouragement from the midwife, nurses, my husband, and my doula.

analyzing my birth

I feel really lucky that my labor was not too fast, and not too long either, and that I never felt the need for drugs. I am glad I had a midwife who literally sat on the couch drinking a cup of coffee until it was time to catch the baby. And she told me just what I needed to hear, “

You’re doing a great job working with your body. Remember that half of pushing is molding the baby’s head, so even if it doesn’t feel like anything is happening, you’re doing a tremendous amount of work with every contraction.”

I am also lucky that after pushing, I came away with a minor skin tear, but no terrible damage to my anatomy. I think pushing for 2 1/2 hours gave the tissues a lot of time to stretch, and the midwife was really good at telling me to push and hold, push and hold, so the baby came down really slowly.

I managed (somewhat awkwardly) to flip from my hands and knees to sitting up, passing my leg over the umbilical cord and having the baby handed to me, wet and warm, by the midwife. The first thing he did was poop all over me, but I didn’t even notice until later. I was just amazed that he was finally HERE, that he was so big (8 1/2 lbs, 21″ long), but so little, and that he’d just come out of my body, that I’D DONE IT! I’d had the un-medicated, unhurried, relaxed, un-traumatic birth that I had hoped and prepared for!

After the cord stopped pulsing, the midwife clamped it and asked my husband if he wanted to cut the cord. At first, he declined, afraid that he might hurt me or the baby, but the doula, nurse, and midwife all said, “C’mon, neither of them can feel it. Just do it,” so he did. Severing the umbilical cord strikes me as kind of a funny ritual, like the human equivalent of a ribbon cutting ceremony at a library or a new shopping mall. I think new fathers are encouraged to do it so they can feel like they really had their hands in the birth process in some active way. I kind of wished that they had waited longer, but I was in a bit of a daze and not really capable of speaking up at that point. I felt kind of loopy, almost like I was stoned.

After my placenta came out (I’m pretty sure the midwife asked if she could give it a little tug to help it along, and at that point, I figured she knew best what to do), the medical staff got down to business. I had a little 1st degree tear that the midwife stitched up while the nurse helped me try to get my nipples perky so the baby could latch on. The stimuli from the stitching and this motherly but energetic L&D nurse trying to help me was a bit much, but the babe latched on like a champ and the repairs were done soon enough.

Aside from the family practice doctor coming in to check the baby over and take his height and weight, some hard pushes from the L&D nurse on my uterus to make sure it was involuting (shrinking) and checks that I wasn’t bleeding profusely, they left me and my husband and our baby son in relative peace, free to stare at each other and be totally amazed that in just nine months, a being who didn’t exist had come into being inside my body and made his way into the world.

postscript

As it turned out, the amniotic sac didn’t burst until three contractions before my son came into the world, there was plenty of fluid, and the placenta was perfect. I could have waited for labor to start spontaneously… In the final reckoning, though, with all the negotiating between my desires and hospital “standards of care,” I am glad that I got to give my son what I consider the best birth we could possibly have had, given the setting and the small, but real, possibility that we could have ended up with a true complication.

Thank you, Katherine for submitting your birth story for other women to read.

You can submit your birth story too; please click here for guidelines.

sing during labor: an inspiring, beautiful video especially for my pregnant friends January 14, 2008

Posted by guinever in doula, health, homebirth, labor, midwifery.
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a beautiful woman with a beautiful voice
a quiet birthing at home
a reminder that the Lord will help and guide us through labor

When I saw this, I immediately thought of Karla, Erin, Rebekkah, Kate, and Kellie who are pregnant now… and of every other woman

surely, surely goodness and mercy will follow me
and I will dwell in the house of the Lord
close by His side
I will abide
in His lovingkindness

forever