Benefits of Spontaneous Onset of Labor ~ 6-16-12

Many of us have heard about the dangers of unnecessary inductions, but how many of us have heard of the BENEFITS of allowing labor to begin on its own? With all the talk about inductions, the methods and medications used, what is or is not considered 'medically necessary', the convenience for moms and caregivers and so on, we can easily forget that not only are there risks associated with induction, but that there are great benefits to simply letting nature take its course and let labor start on its own. 


One of the biggest, and most obvious, benefits of letting labor start when your body and baby choose is avoiding an induction. 


Here is just a quick overview of our nations stats when it comes to inductions.

Labor Induction: Alarming Statistics In 2005, 22.3 percent of all U.S. births were induced — a 50 percent increase since 1990. A national survey by Childbirth Connection showed that 21 percent of U.S. women who gave birth in 2005 tried to self-induce labor because they were tired of being pregnant. They wanted to induce to avoid a medical induction, to control the timing of their birth, or because their caregivers were concerned about the size of the baby.
Elective induction rates vary widely among hospitals (12 percent to 55 percent) and among individual physicians (3 percent to 76 percent). But more than four out of 10 mothers (41 percent) reported that their caregiver tried to induce labor. For some women, an elective induction can almost double the risk for a cesarean, depending on the individual physician’s practice style and medical specialty. And all of these statistics are even more frightening when compared to the World Health Organization’s recommendation that appropriate induction rates in any geographic region should not exceed 10 percent.

         (http://mothersadvocate.wordpress.com/2010/11/15/labor-induction-exposed/)  



We have discussed inductions during a previous meeting, which you can find the notes for here. Most of us know there are different methods of induction ranging from 'natural' techniques to chemical options. With every type of induction, there are risks since you are, after all, trying to start a process that isn't quite ready to start yet. Medical induction usually requires staying confined to the hospital bed with continuous fetal monitoring. This inhibits the laboring moms ability to get up and move into different positions to help with comfort and to help baby move down into a good position. Pitocin is a common, and probably most widely recognized, drug used to medically induce women in the US today. This medication is synthetic oxytocin, which is the hormone that triggers the uterus to contract in labor. The pitocin label clearly shows and spells out that it is not intended for use in pregnant women. Many negative side effects have been reported with pitocin use during pregnancy, including: nausea; vomiting; more intense or abrupt contractions of the uterus, severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood clotting problems; changes in heart rate; heavy or continued bleeding after childbirth; irregular heartbeat; pooling of blood in the pelvis and ruptured uterus. There have even been side effects reported to the fetus, including: bleeding in the eye; irregular heartbeat; seizures and slow heartbeat. (http://www.drugs.com/sfx/pitocin-side-effects.html)



Another benefit of letting labor being on its own is simply knowing that your baby is really ready to be born. When labor starts on its own at term (37-42 weeks), it is thought to be due to the baby’s mature body sending signals to the mother’s body saying that their lungs are mature and ready for life outside the womb. In a study, UT Southwestern researchers found evidence that a substance secreted by the lungs of a developing fetus contains the key signal that initiates labor. The substance, called surfactant, is essential for normal breathing outside the womb.

"We found that a protein within lung surfactant serves as a hormone of labor that signals to the mother's uterus when the fetal lungs are sufficiently mature to withstand the critical transition to air breathing. No one really understands what causes normal or preterm labor. There may be several chemical pathways that lead to labor, but we think that this surfactant protein, which is also produced by the fetal lung in humans, may be the first hormonal signal for labor," said Dr. Mendelson, who is co-director of the North Texas March of Dimes Birth Defects Center at UT Southwestern.

(http://www.utsouthwestern.edu/newsroom/news-releases/year-2004/fetal-lungs-provide-a-signal-initiating-labor-ut-southwestern-researchers-find.html)

      Many times women are induced or schedule a c-section due to being what they believe to be 'postdates', when in reality, due dates are not 100% accurate. Due dates are typically measured from a woman's last menstrual period (LMP), and assumes that every woman has a 28 day cycle and ovulates on cycle day 14. Obviously, this is NOT true for many women and, therefore, their due dates are not accurately calculated from the beginning. The ’40 weeks’ (or 280 days) of pregnancy comes from Naegele’s Rule, which was NOT based on actual stats or empirical data, but on his personal beliefs based on pregnancy being stated as 10 lunar months in the Bible. (http://doulamomma.wordpress.com/2009/06/13/pregnancy-really-isnt-40-weeks/) Even when women have ultrasounds and are given a measurement and/or weight and 'due date' estimate, it has been found that ultrasounds are not very accurate in measuring baby’s size, weight or calculating due dates. (http://icpa4kids.org/Wellness-Articles/the-due-date.html)

      

      Finally, and most importantly, spontaneous beginnings to labor is actually good for babies.  The ‘stress hormones’ in the baby, catecholamine and adrenaline, are triggered during labor, which clears the baby’s lungs and changes their physiological characteristics to promote normal breathing, mobilizes readily usable fuel to nourish cells, ensures that a rich supply of blood goes to the heart and brain, and may even promote attachment between mother and child.  (gentlebirth.org/archives/lbrygood.html)

      I wonder how many mothers would still consider elective procedures if all of this information was widely shared with pregnant women? So, please, feel free to share this blog post with all of your friends and family that you know are expecting or even planning and hoping to get pregnant soon. Knowing the TRUTH about birth and the options each family has is essential to having the best birth for you. 

sSuggested reading:
 The Thinking Woman's Guide to a Better Birth buy Henci Goer


 Additional links
 40 Reasons to Go the Full 40
 Consumer Reports: What to Reject when you're Expecting

Finding joy in an unexpected pregnancy

I must admit, when choosing "Finding joy in an unexpected pregnancy" as a meeting topic, I was not truly prepared for what my research would glean.  Certainly, I knew that putting the phrase "unexpected pregnancy" in a search was going to yield some discussion about whether or not to keep the baby.  What I did not expect was for almost every single post  to begin with something along the lines of "if you should decide to continue with the pregnancy..."  Now, I'm not here to begin a pro choice vs. pro life debate.  This is a natural childbirth support group, so I'm working with the assumption that you're interested in actually giving birth.  The sore lack of women finding joy in an unexpected circumstance was disheartening to me.  The miracle of a brand new life with a perfectly clean slate and endless possibilities set before him or her is a beautiful and joyous thing, indeed.  Even when it wasn't planned.  My first two pregnancies were very much unplanned and unexpected.  As my daughters grow into young ladies, they bless me and bring joy to me daily.  Even on the tough days.  Sometimes especially on the tough days.

First and foremost, remember that babies are a blessing. No matter when, how or at what time of life, bringing a new life into the world is a beautiful thing,

It's OK if you're not totally excited. Go ahead and grieve a little. Whether you're grieving that you're going to be a first time mom, or unexpectedly adding to your brood, you're not the first mom to have an unexpected pregnancy, and not the first mom not to be totally thrilled about it. Don't, however beat yourself up about it. Don't feel guilty.

Just like in any other traumatic or life-changing event, you may go through the 5 stages of grief.

Denial

Anger

Bargaining

Depression

Acceptance

Hold on to the joyous moments. When I got pregnant with my daughter at 18, most everyone acted like it was the end of the world. Only one person had the initial response of “Congratulations!” I held on to that. Although she was little more than a passing acquaintance, it meant a LOT to me. I was tired of the sober faces and apologies. I was pregnant, and ready to get on with being excited for the new life inside me. My world as I knew it was totally over, but a whole new one as a mother opened up to me.

Surround yourself with these kinds of positive people. You may also need to limit your contact with the other kind of people in your life who are too negative.

Have a snappy comeback for the people who you know are going to say something stupid. “Yes, we know what causes it, and we're good at it!” or “What can I say? He's pretty cute.” Whatever you want. Just don't let those snide little comments get to you. For whatever reason, people seem to think a pregnant woman is carte blanche to say tacky things that they would not otherwise say.

“Discouraged with life in general and feeling somewhat sorry for myself at the time, I will never forget the words of a close friend when I told her that I'd accidentally become pregnant. Her face lit up, she beamed from ear to ear, and said: "You clever girl!"

It was one of the rare moments in life that left me speechless. I'm aware that this was not a standard response, but I have always interpreted her comment as a conscious choice on her behalf to focus on the miraculous concept of motherhood rather than the negative circumstances under which they had occurred. Regardless that a pregnancy may be unplanned, bearing a child is a unique experience and an accomplishment that one can be proud of. It by no means lessens having to deal with the negative circumstances, and no matter what anyone in your life may say or do in an attempt to help, at the end of the day coming to terms with an unplanned pregnancy remains a deeply personal and individual task.” ~Lisa Cooper


Seek out wise counsel. Whether that's a pastor, a women's group, a trusted family member, or an actual therapist, having someone to use as a sounding board can be a huge help in dealing with whatever feelings you have.


Don't forget to take care of yourself! Eat well, drink plenty of water, exercise, enjoy yoga and meditation, go ahead and splurge on that pretty maternity outfit you really want, even though you'll only wear it for a few months.

Finding out the sex of the baby and naming him/her can help to form a bond and get excited about being a mom. Just being able to refer to the baby as “he” or “she” or better yet as “Zachariah” or “Clara” instead of “it” or “the baby” can make a world of difference in how you feel about your new bub. Something happens when you give things a name. They start to become yours.

Remember that whatever goals you may have been working towards before the pregnancy are still attainable. Work out a plan with your husband and surround yourself with supportive friends and family. It may take a little longer than you had planned, and that's OK.  You'll get there.

Work on getting your finances in order now. Buy a coffee pot and brew your own instead of going through the Starbucks drive through in the morning. Ditch the satellite and go to Netfilx only. Consider cloth diapers. Hit up garage sales or thrift stores for cheap baby clothes. Most of all, don't buy into the Babies R Us hype. Really, babies need a blanket, a boobie, and something to catch the poop. All that other mess is just extra.


Make time for your marriage. Pregnancy and a new baby can be taxing on a relationship when it was planned. It's especially so when not. Making time for your partnership with your husband will help to give you a more positive outlook on life in general, and will help him bond with baby when the time comes.

Relax.  Even if you feel a disconnect with baby now, and you never quite get excited about being pregnant, that wonderful release of oxytocin in labour, and prolactin in breastfeeding will almost certainly ensure a bond with the baby.  Placenta encapsulation can further help even out those roller-coaster pregnancy and postpartum hormones, and restore essential vitamins and minerals.


You may want to read the story of Leslie Layland Fields, who at 43 found out she was pregnant with baby #5 followed shortly thereafter by baby #6.
Surprise Child – Finding Hope in Unexpected Pregnancy

http://www.crosswalk.com/family/parenting/surprise-child-finding-joy-in-unplanned-pregnancy-1465697.html


Just a friendly warning – almost all the following links address the option of abortion. If that isn't something you want to read through, don't! Just citing my references! :)
http://www.babyzone.com/pregnancy/coping-unplanned-pregnancy_71218
http://pregnant.thebump.com/pregnancy/first-trimester/articles/how-to-deal-with-surprise-pregnancy.aspx?MsdVisit=1
http://www.justmommies.com/articles/unplannedpregnancy.shtml

When birth doesn't go the way you planned

This month, we discussed what to do when birth doesn't go the way you plan.  Here are my notes.  As always, these are sort of a rough draft, as I can never predict what way the discussion will go.  The input I get from the other amazing women attending is absolutely invaluable, so THANK YOU!!!  :)

It's OK. You did the best you could at the time with the information and the situation that you had. I think we forget that. I think a lot of times in the natural birth community we get so caught up in the idea of a “better birth” meaning natural, intervention and drug free, that we completely miss that all of us, as mothers, need support. We need to hear that if we didn't have the picture perfect birth that it's OK. We still love our babies. We still did the very best we could. It's really OK.

In the same vein, allow yourself to grieve the birth that you didn't have. I know when I had a traumatic birth with my first child, and a c section with my third, and was disappointed, I heard a lot of “At least you got a healthy baby. That's what matters.” Honestly, that's bull. Of course, the desired outcome is a healthy baby. That shouldn't even be the issue. We're talking here about the health of the mother. When momma isn't healthy, either physically or emotionally, it's terribly difficult for her properly take care of the baby. The birth experience DOES matter, tremendously. The following are quotes from mothers hearing the phrase “At least you had a healthy baby”

“I heard those words after my unnecessary cesarean- they cut like a knife. It was like I owed credit to my doctor that my child was alive and well, instead of I had a healthy baby because I did my best to make sure I had a healthy pregnancy. My cesarean was traumatizing, and recovery was tough and I felt guilty enough for being so gullible in letting the c-section happen in the 1st place because it wasn’t a peaceful birth for my daughter either- those words just piled on more guilt.”
“(it makes me feel) like my feelings don’t count…like I am just a baby machine and I should take everything bad that happened and put it in a box and forget it…its something someone that has never experinced birth trauma would say.”
“I was induced for medical reasons on my due date with my middle baby. I still am upset with that birth experience…. I mean I am happy she is healthy but she was not ready to meet the world yet. I feel like I didn’t give her the start in life that she deserved.”
“As a second class citizen. I had all my babies in hospitals, I didn’t know I had a choice. I would have loved to had them all at home. My first three were mostly uneventful, really my second and third daughters. My first daughter was traumatic due to induction, episiotomy . My last was a c-section, it was AWFUL, the recovery was horrible, I had a giant hemotoma under my incision, etc. I only wish I had known I could have a birth at home with a midwife, I would have.”
“I felt like I was put in a box. I felt like I couldn’t possibly rejoice and breathe a sigh of relief that- in spite of all of the trauma my baby was healthy- and at the same time grieve and mourn the very real physical, mental and emotional trauma I had been through.”

When a woman’s wedding cake tastes like crap, if she didn’t land the part, if a relative passed or is going through a hard break-up, her closest friends and family members don’t say, “tough shit.” At least the good ones don’t.

Rather, a good friend lends a listening ear. A good friend gives hugs, sympathetic cards and flowers, they do not say “get over it.” And the one who is feeling low gets to vent, thus encouraging feelings of acknowledgment, validity and ultimately, relief.

Talk about it with anyone who will lend a sympathetic ear. That's what this group is for. We love to talk about birth! I don't think I've held a single meeting where every single mother attending didn't have at least one disappointing experience. The facebook page is always open for comments or questions. There's also groups like ICAN for cesarean support. Talk about it with your ob or midwife. I don't mean be ugly or anything like that, but expressing your disappointment can be very cathartic. If your experience was negative because of something your care provider did, addressing it with them could lead to a change in policy or practise. Regardless, you put your trust in that person, and if they broke it in some way, it will help you process the disappointment just by simple discussion.

Get help. There's no shame in going to a counselor or taking antidepressants for a period of time. Be sure to let your doctor know if your breastfeeding, so they can give you a medication that's compatible with nursing, and if they tell you they can't, FIND ANOTHER DOCTOR!

Write it down. I blog, and just writing it down helped to process my feelings immensely.

Spend some time on yourself. I know that as a mom, it's easy to forget about YOU. I have a particularly difficult time getting away without the kids, but it's good for you. Sometimes, even momma needs a break. Go out with a girlfriend, get a massage, or just go grocery shopping all by yourself.

Exercise. I always find that when I take some time to do something good for myself like take a walk or do some yoga, I have a more positive outlook.

Learn to appreciate the present. Go snuggle that baby, because baby snuggles always make you feel better!

Look to the future. Get a copy of your medial records, and go over them to find out what went wrong, and make a plan of action to avoid, if at all possible, the same situation.

http://www.pregnancyandbaby.com/pregnancy/articles/945729/overcoming-a-traumatic-or-disappointing-childbirth-experience

http://bringbirthhome.com/birth-experience/birth-experience-matters/

100 "Likes" giveaway number three!

Michelle Wardwell, you are one lucky momma tonight, because you won the bag, too!  It must have known you had something tasty to go inside!  :)

The third and final giveaway is a super cute Thirty-One thermal tote donated by Samantha Allison, and a Trust Birth wrist band.

To enter this giveaway, you must:
Like Trust Birth North Dallas on facebook
Follow Trust Birth North Dallas on Blogger
Check out Samantha's Thirty-One website, and leave a comment on this post telling me what you would buy from a Thirty-One party!
Winner will be chosen via Random.org at 10:00 PM CST Sunday, January 22.
Official rules in their entirety can be found here.

100 "Likes" giveaway number two!

Kristina R.  You are the lucky winner of these gorgeous prefolds and wipe tester!  Please contact me at marjerie.martin@gmail.com with your info.

Prize number two:
A set of three hand dyed, diaper quality prefolds from Hip Green Baby a tester of wipe solution from Gingerbread Cottage, and a Trust Birth wrist band

I cannot rave enough about these prefolds!  I have some for my boy and love, love, love them.  Funny, no matter what kind of fancy-dancy diapers I buy, I always end up going back to prefolds.  Don't cloth diaper?  No problem!  These also make great burp cloths!

Be one of the first to try this wipe solution from the amazingly talented Ginger of Gingerbread Cottage!

To enter this giveaway, you must:
Like Trust Birth North Dallas on facebook
Like Hip Green Baby on facebook
Like Gingerbread Cottage on facebook
Follow Trust Birth North Dallas on Blogger
Comment on this post
Winner will be chosen via Random.org at 10:00 PM CST Sunday, January 22.
Official rules in their entirety can be found here.

100 "Likes" giveaway number one

Michelle Wardwell!  You are the lucky winner!  Please contact me at marjerie.martin@gmail.com with your contact info so I can get you your cookies and tea!

I'm so excited to see our group growing!  My next goal is to do more with the blog, but for now...  Let's have a party!  I have three prizes to giveaway!

Prize number one:
One dozen oatmeal chocolate chip lactation cookies generously donated by Cookies by Jesi, a box of Earth Mama Angel Baby organic Milkmaid tea, and a Trust Birth wrist band.

Lactation cookies help boost milk supply naturally, but aren't just for nursing mommies.  I've shared with my teenage daughter, and even my nursling (who is 15 months old) and I promise no one has lactated but me.  Shhh!  Don't tell my husband!  I don't want to share.  ;)

I've never tried anything Earth Mama Angel Baby that I haven't liked, and this tea is no exception.  Be advised though, that Milkmaid tea is not recommended for pregnant mamas.

To enter this giveaway, you must:
Like Trust Birth North Dallas on facebook
Like Cookies by Jesi Shop on facebook
Follow Trust Birth North Dallas on Blogger
Comment on this post
Winner will be chosen via Random.org at 10:00 PM CST Sunday, January 22.
Official rules in their entirety can be found here.

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So how DO you tell your family you're home birthing?

"Do what you feel in your heart to be right- for you'll be criticized anyway. You'll be damned if you do, and damned if you don't."  ~Eleanor Roosevelt

I promised tips on how to tell your family that you're going to be having a birth center or home birth.  In researching this topic, I asked on several message boards how other mothers had told their families and got overwhelmingly the same response...  They didn't.  Not exactly the answer I was hoping for.   About the most helpful advice anyone had was to have your family watch The Business of Being Born or Pregnant in America on Netflix.

Whether or not you choose to tell your family is, of course, entirely up to you.  If you should choose to do so, understand that it is not your job to change their minds about birth.  Try not to get your feelings hurt if they're upset and repeat after me - "My body.  My baby.  My birth." 

In the event that your family decides to  do a little research of their own, they're bound to run into "Doctor" Amy Tuteur.  Henci Goer says it best:

"Ahh, I see you have run across Amy Tuteur, our very own Bill O’Reilley of the birth world. Like him, her intent is to steamroller you; any overlap with the facts in her rants is strictly coincidental."

Dr. Amy's goal in life is to trash homebirth.  There is actually some question (read quite a lot of discussion) about whether or not all the things posted by "Dr. Amy" are actually made by her.  Regardless, her medical license expired in 2003, so she is no longer a doctor.

A few quick facts about childbirth in America that you could point out - Maternity care in the US is abysmal.  In the World Health Organisation 2010 World Health Statistics report, the US ranked 34th in maternity mortality, 38th in neonatal mortality and 41st in infant mortality.  The average price tag to have a baby was significantly higher than in all other countries reporting.  Every country reporting better maternal and infant outcomes have a higher percentage of births attended by midwives as opposed to obstetricians.  If that isn't reason enough not to birth at a hospital, I don't know what is.

All about VBAC

I'm slow getting the notes up this month.  SO sorry!  We had our biggest group ever at the meeting this month and four VBAC moms shared their stories.  Thank you so much to everyone who came, and a very special thanks to those willing to give encouragement to future VBAC moms!

For hospital c-section rates and VBAC stats, check out The Unnecesarean.

In 2008 Texas had a VBAC State rate of 5.96 DFW is slightly lower at 5.32.

John Peter Smith Hospital in Fort Worth had the best VBAC rate at 18%.
Hospitals on the west side of DFW seem to have better VBAC rates ranging from 1.92 at Denton Regional Medical Center to 18 at John Peter Smith in Fort Worth.
Dr. Cummings at Texas Health Presbyterian Hospital in Denton (17.83% hospital VBAC rate) is noted for his support of VBAC moms.
Where the east side of DFW ranged from negligible at Dallas Regional Medical Center in Mesquite, to 12.4 at Methodist Dallas Medical Center.
*UPDATED* I received a comment from one of our moms regarding Dallas Regional Medical Center in Mesquite informing me that they have closed their L&D department.  While, according to the numbers reported to the CDC, 15 cesareans and <5 VBACs did occur at the hospital, they no longer accept planned deliveries there, which accounts for the negligible number of VBACs there.  The next lowest in the list on the east side of DFW is Texas Health Persbyterian Rockwall with 0%.
Dr. Downey at Methodist Richardson Med Ctr (19.1% hospital VBAC rate) or Plano Medical Center (6.68% hospital VBAC rate) is also noted for his support of VBAC moms.


The results of a 10 year study of uterine rupture.
Out of 114,933 deliveries, there were 39 total ruptures (.o34%), with 36 of them having a previous cesarean (.031%). Complete ruptures counted for 18 of those (.016% chance of complete uterine rupture). No mother deaths.
2 infant deaths (2 0f 114,933 deliveries is a 0.0017%). One of the deaths the mother had a previous cesarean, one had no previous cesarean.
According to the American College of Obstetricians and Gynecologists (ACOG), if you had a previous cesarean with a low transverse incision, the risk of uterine rupture in a vaginal delivery is .2 to 1.5%, which is approximately 1 in 500. - These numbers include labours that have been induced or augmented, which will increase risk.
RCS risks:
Usual risks of a surgical procedure (excessive blood loss, reaction to anesthesia
Hospital stay of approximately 4 days
Development of an infection in the uterus, bladder, or skin incision
Injury to the bladder, bowel, or adjacent organs (including the uterus which could result in the need for a partial or complete hysterectomy)
Development of blood clots in the legs or pelvis after the operation
On-going pain & discomfort around incision
Small chance that the baby will have respiratory problems – could be due to miscalculation of due date, also due to the fact that during a vaginal delivery, baby's lungs are compressed, helping to expel amniotic fluid from their lungs.)
Increased rick of asthma
Chance of baby being cut when the incision is made
Increased risks with each subsequent surgery - After you have two C-section scars, each added scar in the uterus raises the risk of placenta problems in a later pregnancy. These problems include placenta previa and placenta accreta, which raise the risk of problems for the baby and your risk of needing a hysterectomy to stop bleeding.
Baby doesn't get the advantages of mom's good bacteria coming down through the birth canal.
Increased chance of PPD
Challenges breastfeeding


VBAC risks
Less than 1% chance of uterine rupture. If uterine rupture occurs you have risks of blood loss, hysterectomy, damage to bladder, infection, & blood clots
Best research suggests that about 1.9 more babies die due to problems with the scar in every 10,000 VBAC labors, compared with planned c-section deliveries. Thus, about 5,200 women would need to experience risks of surgical birth to prevent the death of 1 baby from scar problems during VBAC.
Hospital stay of approximately 2 days (or none at all with a birth centre or home birth)
Risk of infection doubles if vaginal delivery is attempted but results in cesarean
Possibility of tearing or episiotomy
Temporary pain and discomfort around vagina
Urinary or bowel incontinence (about 3 in 100 still have a problem 1 year after birth)

Induction Information

I missed everyone in September so much!!!  Not to mention that it's never fun to have to skip doing something because you're sick.  I've been hearing so much lately about people having elective inductions and them going poorly that I really felt strongly that it was something we should discuss.  I, myself had two inductions and an augmentation of labour and did not know half the risks involved.  Of the women attending our meeting that had children, all of us had experienced at least one induction.  I think this is absolutely an epidemic, and mothers are not being informed of the risks to them or their babies.

I tried really hard to find good numbers concerning how many women are induced, and wasn't able to find anything solid.  The following are the different results I came up with.

1 in 5

One study listed a rate of 43.6%

Varies widely from hospital to hospital 12%-55%

A survey done in 1998 showed that 81% of women had been given Pitocin.

As you can see, finding actual information can be difficult.  Based on talking to women in our area, I think the numbers are pretty high, probably falling somewhere between the 55% and 81%.   

The most common method of induction is a combination of having your bag of waters ruptured and IV pitocin,.

Some women will also be given a cervical ripening agent.

Cervidil/prepidil - Dinoprostone is a gel that is placed directly onto the cervix through the vagina using a special applicator. Your doctor, nurse, or other healthcare professional will give you this medication.  Sometimes, it is inserted with a string, so it can be removed if mother has a reaction.

Yet another method of induction is a drug called Cytotec or Misoprostol.  I will discuss side effects and risks of induction a bit later, but I just want to say here that if your doctor or midwife does Cytotec inductions that you may want to seriously think about looking for a new provider.

When you have an induction:

You will be attached to an IV

You will have continuous fetal and maternal monitoring, which inhibits your movement.

You may or may not be allowed off the monitor even long enough to go to the restroom, having to use a bedpan.

What reasons are given for inductions?

According to Mayo Clinic:

You're approaching two weeks beyond your due date, and labor hasn't started naturally.

Your water has broken, but you're not having contractions. (within 24 hours)

There's an infection in your uterus.

Your baby has stopped growing at the expected pace. 

There's not enough amniotic fluid surrounding the baby. (oligohydramnios) - Be sure to drink plenty of water before a sonogram.  Some doctors will use "low fluid" as an excuse, when, in fact, your fluid will replinish itself.  Drinking extra water should ensure that you have adequate fluid levels unless there is actually a problem.

Your placenta has begun to deteriorate.

The placenta peels away from the inner wall of the uterus before delivery — either partially or completely. (placental abruption) 

You have a medical condition that might put you or your baby at risk, such as high blood pressure or diabetes.

Reasons offered for induction, but not advised include:

Social – namely, convenience or just wanting to know the date your baby is coming

Maternal age – namely, inducing you because you are ‘older’

Because it is your caregivers ‘standard management’
For hospital convenience (unless lack of anaesthetic cover is a consideration)
Mother being “over it” or sick of waiting
Doctor / Midwife going on holiday / golf / conference / disruption to consulting sessions
Partner going on holiday
Family staying from out-of-town and needing to return home
Wanting your baby born on a specific date
Wanting a smaller baby (unless medical indication)
‘9 to 5 obstetrics’ – some hospitals, mainly private ones, have a 90% induction rate termed 9 a.m. to 5 p.m. obstetrics, so the care-giver is not woken overnight to attend births.

What are the risks of inductions?

According to Mayo Clinic:

The need for a C-section. Labor induction is more likely to result in the need for a C-section — particularly if you've never given birth before and your cervix hasn't already begun to thin, soften and dilate (unfavorable cervix).  (Doubles your chances)

Premature birth. Inducing labor too early might result in a premature birth, which poses risks for the baby, such as difficulty breathing. 

Low heart rate.  The medication used to induce labour - oxytocin or a prostaglandin - might provoke too many contractions, which can diminish your baby's oxygen supply and lower your baby's heart rate.

Umbilical cord problems. Inducing labor increases the risk of the umbilical cord slipping into the vagina before delivery (umbilical cord prolapse), which might compress the cord and decrease the baby's oxygen supply. 

Uterine rupture.   Uterine rupture is a rare but serious complication in which the uterus tears open along the scar line from a prior C-section or major uterine surgery. An emergency C-section is needed to prevent life-threatening complications. 

Bleeding after delivery.  Labour induction increases the risk that your uterine muscles won't properly contract after you give birth (uterine atony) which can lead to serious bleeding after delivery.

Additional risks include:

Increases the chances of needing forceps, or vacuum delivery.

Doubles the mother’s chance of urinary incontinence in the future.

Stronger, more frequent contractions put additional stress on baby.

Pitocin (synthetic oxytocin) inhibits the body’s production of natural oxytocin.

The long-term effects of labour induction to the child are not fully known or researched.

Cytotec:

Cytotec is NOT approved by the FDA for labour induction!

Unlike Pitocin or Cervadil, once Cytotec is given, either in a pill form by mouth, or inserted vaginally, so there is no way to stop its action, even if trouble occurs.

Cytotec was invented to treat gastric ulcers, and that is the only use that the manufacturer recommends for it.

Searle, Cytotec's manufacturer, sent physicians a letter reminding them that Cytotec was not approved for use as a cervical ripening agent and that it was contraindicated for use in pregnancy. The letter listed serious adverse effects associated with using Cytotec, including maternal or fetal death, uterine rupture, and severe vaginal bleeding and shock.

Research your health provider carefully!  As I was looking for information on Cytotec, I discovered that certain local midwives actually use Cytotec.

Notice the image of a pregnant woman with a big red cross through it!

Some natural methods of induction can be effective.  While induction is not optimal, if you're in a situation where one is needed, trying some natural methods first may be a good option for you.  None of these, however, are full proof.  If the baby isn't ready, they won't work.

Natural methods of induction include:

Nipple Stimulation – causes oxytocin release

Sexual Intercourse

Castor Oil

Enema

Acupuncture or TENS

Herbal induction methods all of which should be researched thouroughly.

Bottom line?  If you don't have to, don't.

I thought the following statement was particularly interesting given the number of inductions done in the American health care system.  Again, from the Mayo Clinic.

“Inducing labor is a serious decision. Work with your health care provider to make the best choice for you and your baby.”

Mark your calendars for our next meeting on November 17th and join us!  :)

Clara liked the Hummus!  :)

Birth Attendants

Thanks to Leslie for taking some pictures of our meeting!  I love that we can enjoy a comfy place while our little ones play together and the older ones love on some babies!  :)

My big girl loving on Leslie's little girl.  I think it's so beautiful that these young ladies will grow up learning to Trust Birth!

In case you've missed it, our meetings have been moved to the third Thursday of the month, so as not to conflict with the Tarrant County Birth Network meetings.  This month, our focus was on birth attendants.  We touched a bit on anyone who can be a birth attendant - an OB or Midwife, a birth photographer, of course, your partner and family, and doulas.  I went for a specific focus on doulas for the majority of the meeting.  The following notes were mostly copy-pasted from various websites, which I will site at the ending of this post.
The word doula means "women's servant", or "one who serves women".
There are three kinds of doulas.

Antepartum Doulas provide help and support to a mom who has been put on bed rest or is experiencing a high risk-pregnancy. 

 

Postpartum Doulas are there to support you in your first weeks of being a mom. They provide informational support about feeding and caring for the baby. They provide physical support by cleaning, cooking meals and filling in when mom needs a break, and they provide emotional support by encouraging a mom during those times when she feels overwhelmed.

Birth Doulas who provide support during birth, whether a mother wants a un-medicated birth, or is having a planned cesarean.

During delivery, doulas are in constant, close proximity to the mother at all times. They can provide comfort with pain relief techniques, such as breathing, relaxing, massage and laboring positions. Doulas also encourage participation from the partner and offer reassurance. A doula acts as an advocate for the mother, encouraging her in her desires for her birth. The goal of a doula is to help the mother have a positive and safe birth experience, whether the mother wants an un-medicated birth or is having a planned cesarean birth.

After the birth, many labor doulas will spend a short time (typically 2-3 hours) helping mothers begin the breastfeeding process and encouraging bonding between the new baby and family members. 

A doula doesn't provide medical care, so she can completely focus on the emotional and physical support of the laboring woman.

Doulas encourage fathers and birth partners to engage in the process with greater confidence and effectiveness and relieves them of the pressure to know and do everything.

If unforeseen circumstances should arise, a birth doula remains calm, keeps you informed on what is happening, and helps you adapt to changing circumstances.

Studies have shown that women who birth with a doula have better overall birth outcomes.

Reduced the overall cesarean rate by 50%

Reduced the length of labor by 25%

Reduced pitocin or oxytocin use by 40%

Reduced the use of pain medication by 30%

Reduced forceps deliveries by 40%

Reduced requests for epidural pain medication by 60%

Reduced incidences of maternal fever

Reduced the number of days newborns spent in NICU (neo-natal infant care unit)

Reduced the amount of septic workups performed on newborns

Resulted in higher rates of breastfeeding

Resulted in more positive maternal assessments of maternal confidence

Resulted in more positive maternal assessments of maternal and newborn health

Resulted in decreased rates of postpartum depression

I think those numbers really speak for themselves.  Certainly as a VBAC mom myself, I would never attempt birth in a hospital without one, and I really think that if I had that support, I never would have had the C-section in the first place.

Many thanks to Rosemary from Sweetbirth Maternity Services, and Tiffany Fleming from Doulable who both spent some time chatting with me about what local doulas specifically do and charge.  Some of our amazing mommas who came to the meeting also had wonderful input about birthing with doulas from their personal experiences.

References:

http://www.americanpregnancy.org/labornbirth/havingadoula.html

http://www.birthingfromwithin.com/why_invite_a_doula

http://www.midwifeusa.com/what-is-a-doula/

http://birthingbody.org/services-i-offer/labor-doula/benefits-of-hiring-a-doula/

http://www.portlandlabordoula.com/doulas.html

Introduction

Following are the notes I wrote before our very first Trust Birth meeting.  In the end, I put it in outline format, so this isn't EXACTLY what was said, but I wanted to get a clear idea of what I wanted to say.  Five women attended, and we had a great time!

I'm so glad to see all of you here tonight! Since it's our first meeting, I thought I would share with you why I have such a passion for Trust Birth. See, I am a very unlikely person to spread the word that natural birth is safe. Though I've always believed that in theory, I've never actually experienced an unhindered birth, even though I have three children. I do however know all about the risk of interventions. During my first birth, I had both demerol, which made me so loopy I lost several hours of the labour experience, and an epidural as well, all because I was assigned a hostile l&d nurse. I had already been in labour for more than 24 hours, and I was tired. When this nurse checked me to see how dilated I was, I was given the absolute worst pelvic exam of my life. I mean we're talking excruciating pain. I had this idea that I was going to have a drug-free birth, and she completely broke my spirit with a heavy hand. I think a lot of us forget about that factor. You spend all this time picking your doctor and developing a relationship with him or her, and they're really not the people who are going to affect your labour. And if you're anything like me, they may not even be there at all. When your baby arrives at 6:02 in the morning, you're going to be pot luck in the doctor department. The doctor on call at my first birth was also a real gem. I won't go into details, because it could be a trigger subject, but if you're interested in exactly what happened, let me know and I'll tell you.

My second birth went much smoother. My blood pressure was getting a bit high, and I was retaining more water than a sea sponge. I think my feet were roughly the size of cantaloupes, I was having contractions pretty religiously every 15 minutes for the last month of my pregnancy, and I was already dilated to a four when I went in for my prenatal exam on a Friday afternoon. My doctor recommended that we induce, so we scheduled a date for the following Wednesday. After the doctor fiasco with my first birth, ensuring that MY doctor would be at this one sounded like music to my ears.

Fast forward 11 years to the birth of this little guy here. I have a wonderful husband, (this is my second marriage, by the way, so my hubby wasn't present at either of my girls' births) and he knew that my first labour had not gone so smoothly, and I just sort of assumed that he would be assertive enough to take care of me when I was in labour, because I'm just not. Some women really are able to voice what kind of birth they want and stick to it, but I'm not one of those women. I am in other things. I mean, don't even think about telling me that my kid should eat in the bathroom because you might catch a glimpse of boob. But during childbirth, not so much. So I really should have spelled it out for my husband. If there's someone in that room bringing me down, I need you to kick them out. I don't care who they are, we can be reassigned. But I didn't tell him that, and even though he knew I was upset, I think he just assumed it was because I was nervous, and I tend to be high-strung when I'm nervous. Anyway, we knew that Zachariah was likely to be a big baby. My second child was a full two pounds bigger than my first one, and my husband was a 10 plus pound baby. So if babies get subsequently bigger, this one could potentially be a pretty good size. When I got to 39 weeks and was dilated to a four again, inducing sounded like a pretty good idea. I enjoyed my induction with my second child. I mean, as much as you can enjoy being hooked up to an IV with drugs giving you killer contractions. But this labour did not go as smoothly as that one did. Once again, I had a nurse who was condescending, and controlling. She had me in tears before I even had the hospital gown on. Honestly, I wanted to turn around and go home, but I felt committed to it at that point. Now, my husband and I had taken the hospital tour, and I expected to be able to do things like use a birthing ball, and you know, actually go to the bathroom to pee. Not with this nurse. She did let me sit in a rocking chair once, because I asked when my doctor was in the room. And man, if looks could kill, I would be stone dead now. But that was what it took to get anything out of this woman. I had been begging for water for what felt like hours, and only got some when my doctor was there, too. After a while, I needed to go to the restroom, and asked if I could. The nurse brought me a bedpan. Seriously. Because she didn't want to have to hook me back up to the monitors when I was finished. I asked for an epidural after that. Because peeing in a bedpan is humiliating, and I would rather be catheterised. Basically, it all went downhill from there. My blood pressure dropped really low, which caused Zachariah's heart rate to drop as well. They gave me oxygen, and I think it must have been cranked pretty high, because I could barely keep my eyes open. After several hours of laying in bed doing nothing,I completely stopped progressing. As a matter of fact, I actually moved backwards. My cervix swelled. The doctor called it CPD, which means that the baby's head is too large to move through the mom's pelvis. So after 12 hours on pitocin, they wheeled me into an OR, and I had a cesarean. That had been my worst fear for the entire pregnancy, and it happened. He weighed 9 pounds, which is admittedly more than the middle child was, but with a significantly smaller head circumference.

Now I'm not telling you all of this to scare you, or to be a negative Nellie. Certainly the choices I made like being induced affected the outcome of my birth, so a lot of my problems I brought on myself. I know that people can, and DO have really positive experiences giving birth in hospitals. But talking to other mothers, I realised that my experiences were not exactly unique. Women all over the country are checking into hospitals wanting one thing, but getting something completely different. You know, if there's one thing you should never have to fight for, it's the right not to be mistreated when you're birthing a baby.

Which is what brought me here. It took me three times to get the message, but I finally realised that birth is NOT supposed to be this way. I blogged about my experience, and one of my close friends shared it in some of the natural birthing communities that she's a part of, and I met a midwife named Carla Hartley. She is actually the lady who started the Trust Birth Initiative. I looked for a group meeting here in Dallas hoping to find some healing there, and discovered that there wasn't one. As unlikely as I am for this task, I hoped that by sharing my experiences – those decisions I made that lead me to crummy birth experiences, could maybe help other women from making those same mistakes. Since having my son, I've talked to a lot of moms who had also had traumatising birth experiences, and it's an epidemic! Women are being diagnosed with Post Traumatic Stress Syndrome from childbirth. This is not right. And our society, as a whole has the medical model of childbirth so entrenched that some people will actually get angry when you suggest that labour can happen without a bunch of professionals interfering. We really need to get back to the basics of birth here in the US.

During the seventeenth and eighteenth centuries, about 1 percent of all births ended in the mother's death as a result of exhaustion, dehydration, infection, hemorrhage, or convulsions. Today 1 in 3 births will end in a cesarean section. Yep, I'm right in line with those statistics. Three births, one ending in a C. OK, so I'm sorry, but that doesn't compute. So 300 years ago only 1 percent of births ended in disaster, but today 30 percent can't cut it? What are we de-evolving?

I want to read you an excerpt from an essay written by

Judith Lothian is a childbirth educator in Brooklyn, New York, and the Chair of the Lamaze International Certification Council.

In the last month of pregnancy, the cervix softens and ripens like a piece of fruit. Contractions of the uterus become noticeable, and the baby settles into the pelvis. The contractions become stronger, the cervix stretches and opens, and the baby moves lower and rotates, eventually moving down the birth canal. With each contraction, pain sends a signal to the brain and oxytocin is released. With the release of oxytocin, the contractions increase in intensity. As the pain of contractions increases, more oxytocin is released and the contractions become harder.

The pain of labor is what most women worry about. It is important to understand that the pain of the contractions in labor is valuable. It is an important way in which nature actually helps women find their own ways of facilitating birth. In a very real sense, the pain of each contraction becomes a guide for the laboring woman. The positions and activities she chooses in response to what she feels actually help labor progress by increasing the strength and efficiency of the contractions and encouraging the baby to settle in and move down the birth canal. When the pain is entirely removed, the feedback system is disrupted and labor is likely to slow down and become less efficient. As labor progresses and pain increases, endorphins (much more potent than morphine) are released in increasing amounts. The result is a decrease in pain perception, quite naturally. Nature's narcotic! The rising level of endorphins also contributes to a shift from a thinking, rational mind-set to a more instinctive one. Endorphins create a dream-like state, which actually helps women manage the tasks of birthing. Inner experiences become more important than the external environment. As labor progresses and the pain of labor increases, women “go into themselves,” become much less aware and, at the same time, much more focused on the work of labor, and are able to tap into an inner wisdom.

A woman surrounded by family, friends, and health care providers who remind her of the power of labor and encourage her quietly and patiently is a woman who is not afraid. Her support team is totally present and comforts her as she does the hard work of labor. She eats and drinks and, even if labor lasts a long time, she has the energy she needs to persevere. She rests between contractions. No one looks at the clock. Everyone trusts the process of birth and believes that she has the strength and the wisdom to give birth.

The woman moves in response to what she feels. Whether she gives birth in a hospital, birthing center, or at home, she is able to use a wide variety of comfort measures; for example, moving freely, listening to music, taking a shower or bath, and having her feet and hands massaged. She is able to create an environment that is just what she needs as she does the hard work of labor and birth. She pushes her baby down the birth canal, responding now to the pressure of contractions and the baby as he rotates through the pelvis and moves down the birth canal. She moves, changes position, and grunts, sometimes holding her breath—all in response to what she is feeling. In this way, she not only protects the muscles of the birth canal and perineum but also protects her baby as he is born. A great surge of adrenaline insures that the mother is alert, even if her labor has been long. She is totally focused on her baby, ready and eager to embrace him. Baby is eager and alert, too. The stimulation of his journey has primed him for the transition to life outside the womb.

With her baby in her arms, the mother is engrossed, excited, at peace, proud, and astounded at the miracle she has produced. No one tells her what to do. They know that she knows what to do—not because she and her baby have read the books or attended Lamaze class, but because their journey has physically and emotionally prepared them both for this moment. The weight of her baby on her belly helps her uterus contract and expel the placenta. Baby stays warm in his mother's arms. Baby knows just what to do to survive in the world he has entered. He is awake and looks around. Within seconds or minutes, he has his hands in his mouth and is smacking his lips. Unpressured, he slowly but methodically crawls to his mother's breast and self-attaches. As he nurses, his mother's uterus contracts, insuring that bleeding will not be excessive. The two greet each other unhurried, confident, and unpressured. Together, over the next hours and days, they will get to know each other and fall in love.

For all of its simplicity, nature's plan for birth actually requires a fair amount of flexibility. Each mother and each baby are different. While the anatomy and physiology are standard, how each labor and birth proceeds is fine-tuned through the active involvement of the laboring woman. All through labor, her body tells her what is happening and helps her discover what she needs to do to help. The active involvement of the laboring woman is a critical piece of nature's plan for birth, and it is the least understood. The hard work of labor is not meant to be accomplished alone. Changing position, avoiding exhaustion, and staying adequately nourished require assistance. So across the world, women giving birth are supported, encouraged, and comforted by family, friends, and professional birth attendants. Giving birth as nature intended is not “biting the bullet and letting it happen.”

Childbirth is an intense act of love and passion. Interfering with the process can really hinder things. The best way – the very best way to have that natural birth that you want is going to be to stay out of the hospital. Really, stay home. Because that's where you're going to be the most comfortable. Nowhere else are you going to be free to let loose and labour the way you need to labour. But I know that idea takes a little getting used to, and there are lots of other alternatives out there. We're actually really fortunate here in DFW, because there are a dozen or so birthing centres in the area that are staffed with midwives and can be a happy medium for moms who don't want to go to a hospital, but can't quite get used to the idea of birthing at home. And if that's still too far out there for you, there are a select few midwives who practise out of Baylor Dallas, McKinney Medical Centre, and Presby Allen. And I know there are probably some of you here who may be risked out of a home birth, or a birth centre. You may have health conditions that require you to birth with an OB. But most of you can still have a natural birth if that's what you really want. Remember that 1 percent in the 18^th century? You can find an OB who's natural birth friendly. Honestly, if I had it to do all over again and HAD to have a hospital birth, I would stick with the same doctor I had, because I really just love her. What I wouldn't do is agree to an induction. That really, really, really increases your chances of having a cesarean. I would also hire a doula. Doulas take the pressure off of you and your partner. They go to bat for you with those L&D nurses and remind them of your desires for birth. They can also be the bad guy for you and refuse the interventions that you don't want.

And while we're on the subject of interventions, you can refuse those, you know. Those vaginal exams that you get every week for the last month of your pregnancy don't tell you anything. I've walked around for DAYS for all three of my pregnancies dilated to 4 centemetres. Doesn't mean a thing. And there are very few real reasons for an induction. So do your research, and know what interventions you're willing to have and which ones you're not, and exercise your right to say no. That doctor you hired? Remember that YOU hired THEM. Not the other way around. You're giving them their paycheck. And if they won't work with you to provide you the kind of care you want, you can fire them. Keep that in mind when you're deciding who will or won't be present at your birth. Just because you've always gone to that doctor, or because your mother, or your sister or your best friend's aunt, or whoever used that doctor, or midwife... If you're not clicking with that person, then mama, you need to find a new care provider.

Look, I'm no expert. I'm just an average momma who had what unfortunately has become typical birth experiences. I certainly don't have all the answers. But there has to be a better way than what is happening now, and it's not going to change if we don't speak up and start demanding better. Our babies deserve to have a better entrance into the world than loud shouts of “push, push”. Or worse yet, the bright lights of an OR. I'm so glad you all came here tonight. We may be small now, but I hope that we can all spread the word that birth doesn't have to be this big scary thing. It can be beautiful, and spiritual. It's time for women to get back to the simplicity of birth the way it was designed to be.