Sunday, March 1, 2009

But the Natural Methods of Induction Didn't Work...

I hope that no one ever has to refer to this post, but it's there just in case...

As I mentioned before, there are a number of ways of medically inducing labor. If I wrote about all of them, we'd be here all night, so I've chosen, what I believe to be the top three methods used to induce labor.

First of all, fight to get your full 42 weeks out of your care provider. I mentioned that in the last post, so I'm not going to dwell on that again.

If I were in the 41st week, I would do the following:
1) Sex and nipple stimulation 3 times a day.
2) Have my spouse, friend, mother, doula (if available for such) "massage" pressure points.
3) Strip the membranes.
4) Use a breast pump several times a day to release oxytocin to stimulate the uterus to contract. 5) Drink castor oil.
6) Argue that if the baby is doing fine, fluid levels are good, mom is doing well, what's the harm in continuing on with the pregnancy?

Some of those, as said before, I am NOT a fan of, but they beat the alternatives which we are about to discuss. If your doctor is suggesting a different form of induction than what I am going to talk about, feel free to leave a message and we'll talk about it.

Three most common forms of induction are:
1) Prostaglandins to ripen the cervix.
2) Pitocin through an IV drip.
3) Breaking the bag of waters.

If you have read my post about vaginal exams, you know how I feel about them and their "usefulness." Chances are, however, if you are approaching 42 weeks, you have probably had one. If the cervix is still thick, not softening or thinning, they will likely want to start you with a prostaglandin gel to try to soften the cervix. If they went straight to pitocin, with the cervix not "ripening," it would not be effective. The cervix is about 2-4 inches thick, so when they give you "effacement" numbers, in a percentage form, this is what it is referring to. For example, you may be told you are about 50% effaced and dilated to a 1. A lot of women only hear the number of centimeters they are dilated to and don't know what the effacement number really means. Effacement is huge! You cannot dilate with a thick, hard cervix. So, prostaglandins are often used to encourage the cervix to soften and thin out. Yes, this can cause contractions. There are many kinds of drugs used by doctors and some are more controversial than others. You might recognize some of the names: Cervidil, Cytotec, and Prepidil. These drugs are very powerful and can cause dangerously strong contractions for the mother and the baby. They are given in different forms, generally applied to or near the cervix and can be taken out or wiped away if need be. And remember, any time you have a drug in your system, you are required (necessarily so) to be on a fetal monitor because of the possible danger to the baby.

It's worth repeating -- your body produces prostaglandins and it is also found in semen. I'm thinking, no matter how uncomfortable sex might be at this point, it sure beats the alternative!

Pitocin: Where to start... Pitocin is the synthetic form of oxytocin. When oxytocin is released in a woman's body, it causes the uterus to contract. One of the most fascinating things about this is that when it happens naturally, the woman's body produces endorphins that cross the blood-brain barrier so she is able to deal with the intensity of the contractions. Often pitocin is given with prostaglandins or administered shortly thereafter. When pitocin is given, it is forcing the uterus to contract with no relief for mom provided by her body. So, relief usually comes in the form of an epidural. The uterus can function for a period with an epidural in place, but after a time, it gets sluggish, to the point where it has to be stimulated to keep contracting, which means more pitocin. It's a vicious cycle and often the baby is the one who suffers the most. His heart rate is all over the place, the doctor cries fetal distress, a c-section is performed, and isn't it wonderful, they saved the baby!

If you really have the threat of pitocin as an induction method, ask for the lowest dosage to see if it stimulates labor. If it seems to establish labor, they may stop the pitocin and let the mom labor on her own. This is the best case scenario, but if you don't speak up, they will not make this this option available to you. Just for the record, I've had several people over the years be induced with pitocin and not have an epidural. It can be done, so if this becomes your reality, don't resign yourself to the epidural. Yes, it will be hard, but try, for yourself, and especially for your baby.

Breaking water: I do not like this option at all, and yet, I recently heard that in labors that are planning to be unmedicated, this is the preferred method of induction, at least at one of the local hospitals in the DFW area. Here's the problem: the time clock. You now have to give birth within a certain time frame, usually 24 hours. If you don't, you are most likely looking at a c-section. Find out your hospital's policy. I've seen women be in active hard labor, but the 24 hour mark came and went and a c-section was performed. That is totally unforgivable! There is also loads of information out there that suggests that 72 hours is completely acceptable.

Breaking water may or may not start labor. I've had women in class whose water was broken for many hours (at home) before they started labor, let alone had their baby! There are some dos and don'ts when your water breaks, but it's not necessarily pertinent to this post. Here are some things to consider if you are contemplating this method of induction:
1) How often do they want to do vaginal exams? (The more you have, the more likely infection becomes with water broken.)
2) Can you walk around? Many hospitals do not want you to walk around if your water is broken because of the "risk" of a prolapsed cord. FYI -- the risk is .3%. The risk of not walking, using gravity, to help your baby out, is much greater, especially with that time clock going!
3) How long will they "let" you go before they want to start pitocin? Often, if you do not begin labor within a couple of hours of breaking water, they want to start pitocin. Find out! If this is the case, it would have been better to just have pitocin (that can be turned off) and not have a time clock added to the stress.

Ultimately, an induction can be stopped with the first 2 methods, but not with the 3rd. I recently had a student start labor by breaking water and her baby was born 6 hours later. But there was no way to know that going in. It's just a gamble and you don't know if you are going to win.

One more thing: You can always refuse. You do not have to consent to anything. If everything is fine with mom and baby and the only reason you are being forced to induce is because your "due date" has come and gone, it's obviously not about good medical care. It's now about a legal system, not a healthy baby. If there is a medical reason to induce, you need to decide which method is the best for you. Like I said earlier, there are other methods that I did not address here. If you'd like more info about a certain induction technique, let me know. I truly hope that no one who reads this ever has to make these decisions. It is a tough call.  I do feel obligated to mention that if you refuse consent and sign an AMA (Against Medical Advice), your insurance will potentially deny your claim.  Lovely, huh?

The mind is a powerful tool though. My friend, Alisa, has been 2 weeks "overdue" with all 4 of her babies. Some of that is likely her ovulation is different than the standard woman -- if you knew her you'd understand! -- but some of it is the letting go. Letting go of the pregnancy, tension, and apprehensions you might have about labor. Sometimes it's about relaxing, resting, nourishing your body, and being ready to welcome this little one into your arms.


Christina Pond said...
This comment has been removed by the author.
Christina Pond said...

Do you think a lot of the time it all has to do with is Lung Development?

Because the lungs when they are good and ready secrete a protein that triggers this and that and baby and Momma start working in harmony.

I see the high levels of premature babies, and the hoppin' neonatal units and I wonder, is it our bodies "failing us" by not working, or are some of these apples just not ready to be picked so soon?

Soon being, when they are ready. Who's to say that 42 weeks isn't right on time, and sometimes even 35 weeks is right on time... according to that Babe's body.

Donna Ryan said...

Yes, I agree, Christina. There is evidence that the baby triggers labor, which is all the more reason to wait for labor to start. Baby and mom are truly working together. Drugs to induce labor affect this delicate balance, not to mention mom's ability to deal with what's happening.

Christina Pond said...

I actually watched this awesome docu on birth from National Geographic, and it was pretty amazing. They talked a bit about that, it is called In the Womb, and they showed the whole thing, conception to birth, and the birth was a midwife assisted home birth, and I was SHOCKED! hehe