Tuesday, March 31, 2009

The Birth Survey

For those of you who haven't heard of The Birth Survey, listen up. If you have heard of it, but haven't filled yours out, do it now! If you have filled it out, encourage your friends and family to do it too. I had heard about it, but learned so much more from Elan McAllister, President of Choices in Childbirth, who spoke at the Controversies in Childbirth Conference. This is the first item I wanted to write about from the conference because it is of the utmost importance.

All women are asked to participate who have given birth within the last three years. The Survey is gathering data on providers, doctors, midwives, hospitals, etc. When women learn they are pregnant, they will be able to go to The Birth Survey to find information about different doctors or midwives in their area. Obviously, the more women that participate, the better the data, the more information women are able to get to make informed choices about their medical care.

So far, over a third of participants have given birth with a Licensed Midwife or Certified Professional Midwife and gave birth out of the hospital. My reasoning for this is that these are the women who are excited to report about their wonderful and empowering birth experiences. This is a survey for all women and all types of births.

Here's how it works:

Share:
Take the survey. Simple.

Connect:
View the survey reports. This will include consumer feedback on the hospitals, doctors, midwives, and birth centers in your area.

Learn:
View the hospital intervention rates. This is so empowering to have this information in order to make informed decisions about where and with whom to birth your baby.

What I love about this is that it is real. No one can tamper with the results. It will speak for itself, based on actual births. It gives women a voice, who perhaps had a less-than-perfect birth, to help other women avoid the same birth attendants, etc. That is why I say that all women should participate in the survey.

The project was just started Fall 2008 by CIMS (Coalition for Improving Maternity Services) and the first results are due out the beginning of April. It will be regularly updated and will include birth surveys filled out for 5 years, so the data stays current.

So what are you waiting for? Go do the survey! Make a difference.

Sunday, March 29, 2009

Controversies in Childbirth Conference

I have spent the last 3 days at the Controversies in Childbirth Conference here in Ft. Worth. I had no idea what to expect, and I must say, it exceeded my expectations. There were roughly 200 people attending from all over the country. Midwives of all types, doulas, educators, family practice doctors, OB/GYN doctors, nurses, community health workers, attorneys, etc. It was great.

I took pages and pages of notes, so I'll be reporting on it, probably, for weeks. My house, as you can imagine, has fallen apart while I've been away, so I'll be catching up with laundry and doing some major clean up. I did want to share some of the highlights of the conference through pictures, however.


I got to meet Debra Pascali-Bonaro, the director of "Orgasmic Birth" and even eat lunch with her and some other fantastic women who are "movers and shakers" in the world of birth. She also started out as a Bradley Instructor many years ago before moving on to other things. It was fascinating to hear how the movie came about. I'll share more about that later. She was a delightful person.


I recently read a book called "Homebirth in the Hospital" by Dr. Stacey Kerr, a Family Practice doctor working in CA. I didn't realize it at the time of reading it, but she was asked to be a speaker at the conference. It was exciting to get to meet her and get to know her a bit. If all women could have a doctor like that by their side when they give birth, we'd certainly be in good hands. It's a fabulous read, for anyone interested. It also has a chapter in the back of the book written for the doctor who is interested in implementing a program like hers into his/her practice. Amazingly, I bought mine at our local Barnes and Noble.



The next person I met was the President of Choices in Childbirth in NY, Elan McAllister. You'd recognize her from "The Business of Being Born." In fact, my favorite "feel good" quote from the movie comes from her -- when she describes that moment in birth where you think you just can't do it, and then you do it, you "scale the wall." She was great. Definitely a person making a difference in a big way. She is very involved in The Birth Survey, which I will talk more about later. She said that my movie cover is the first she's ever been asked to sign! I hope it was as fun for her as it was for me.



The last person I got an autograph from and picture with was Robbie Davis-Floyd, who appears in all the recent birth movies. She is the anthropologist who gives so much history of midwifery and really helps us understand where we came from, where we are, and where we are going, in terms of birth in not just this country, but in the world. Again, I have lots to share from her talks at the conference.

It was such a privilege to meet all these women who are making such big differences in the world of birth. They truly do it for the women and the babies. Stay tuned for lots of exciting information from the Conference.

Saturday, March 21, 2009

Birth of a Family

I wanted to share this email from a DVD student that gave birth last weekend. I have wanted to put it up here all week, but it's been Spring Break and we were dog sitting THREE dogs. Darcy also had her 4th birthday party. So it's been a little crazy around here!

I enjoyed this birth story for a number of reasons. This couple, before switching to a midwifery group in a hospital, was with an OBGYN at a hospital with a 60% C-section rate. It took a lot of courage to change their birth attendant and birth place towards the end of pregnancy, but they are so thankful they did. FYI -- I left the names of the midwife, nurse, and hospital out of this story on purpose – you'll understand why as you read the story.

We headed to the hospital around 11 am yesterday. Got there and they did an initial check. I was at 5 and a -1 station. The nurse we had was great. She brought in a birth ball for us, encouraged me to eat whatever I needed and drink as needed. I got in the bathtub/jacuzzi just to help me relax around 2. Transition set in probably around 2:40, and I started pushing around 3:00. We found out later that the policy at (the hospital) is not to let people have a tub birth, but at that point I wasn't getting up, and my midwife practice was awesome. They let me labor exactly how I needed to. We had never even considered giving birth in the tub, but it felt so great to be in the water that I didn't want to get out. Donna--I'm a pretty reserved person. I'm very polite--you know, the whole pooping thing. I made noises during pushing that I didn't know I was capable of. My throat is still sore today from my grunting. I didn't scream, but I was definitely loudly yelling. My midwife, told me at one point, "I know you feel like you're out of control, but you're completely in control. You sound great." It was very encouraging. The pushing was just like you described it, feeling like you have to poop, then the burning when the head is coming out. When he finally made his appearance at 4:41, he had the cord wrapped around his neck four times. I didn't even think to panic because the midwife and the nurse didn't at all. They just unwrapped it and immediately put him on my chest skin to skin. He pinked up right away. He's seven pounds even and 19 3/4 inches long. I did tear slightly, but it was in two places on my labia. My midwife said it wasn't bad at all. All in all labor was just shy of 12 hours. Much quicker than I expected.

So, my thoughts after this are that I'm so glad we went through Bradley. As soon as the birth was over I was able to get up, move around, hold my baby and walk the room with him, hug my family, and eat! It was so worth it to be able to move--and I don't feel like recovery is as big of a deal. Also, every time they checked the heart beat during labor it was nice and strong, around 150. The nurse and my midwife both told me later that if we had been on constant monitoring then they would have probably picked up distress with the cord being around his neck so many times, which could have ended up with a c-section of course. It's awesome that we knew what we wanted and were able to make that happen. Thank you SO MUCH for helping us with this! Also, I honestly believe if we had a doctor and the cord was wrapped around his neck, then they would have gone into emergency mode and I would have been separated from my baby. That might not be true, maybe I'm now skeptical of doctors, but I am SO GLAD we were with the midwives.

Kyle wanted me to tell you that he's sorry he couldn't get back in touch with you yesterday. His phone died, and I didn't have your number stored in my phone. Oops! He also wanted me to tell you thank you so much for all of your help--not just yesterday, but with the classes. We both are still on a high from the whole experience.”


First of all, hats off to the midwife and nurse for trusting this mother, her desires, and most importantly, her needs. They encouraged her to listen to her body and follow her instincts. They were even willing to "break the rules" in order for this woman to do that. They trusted birth. I also loved that they encouraged her to eat and drink in labor. They wanted her up and moving, not strapped to a fetal monitor, which, as mentioned, could have potentially led her to a C-section.

Anyone who has sat through my class knows I spend a lot of time talking about poop -- poop stories, as we call them. We have some good laughs about it, but it is a very serious issue for many women. So serious, in fact, that I've seen a C-section happen because she was so afraid of pushing out something other than just her baby. So, I loved her comments about being reserved and "polite" -- followed up with being shocked by the sounds she made as she pushed her baby out. I encourage women to sound out their contractions, which makes people uncomfortable when they are not exposed to natural birth and its associated sounds. Ina May Gaskin talked about this in "Orgasmic Birth."

Another item I wanted to address was the cord being around the neck four times. She must have had a long cord to do that! One in three babies will have the umbilical cord wrapped around their neck, so it is very common. The midwife will just slip it over the baby's head. I have heard this time and again as a reason for a C-section. Or I've heard comments like, "It's a good thing the doctor did a C-section because the cord was wrapped around the baby's neck," like the c-section saved the baby. It is very common to have the cord wrapped once or twice around the neck -- not so common to have it wrapped FOUR times! So glad they had a midwife to calmly handle the situation without all the unnecessary drama.

I had the opportunity to talk with her husband a couple of days after the birth and he was on a total birth high. This is something I see with couples who work together to give birth without medication or interventions: it brings them closer together and the men have a deeper admiration for their wives. The husband who sits back and lets the doctors take care of everything does not feel this same sense of accomplishment as the man who actively helps his wife give birth. This particular husband and new father simply gushed over what his wife had done. He said that it was "awesome" to see his "Southern Belle" do something so amazing. He pointed out how cool it was to see her give birth, and then after the placenta was born, she got up and walked to the bed with blood running down her leg. I think he thought she was amazingly tough, and yet so feminine! He said the next baby will be born at home! This is an experience that will be imprinted on his heart forever.

Congratulations Jessica and Kyle. Thank you for allowing me to be a small part of this experience in your lives.

Monday, March 16, 2009

If I Were an Insurance Company, I Would NEVER Pay For an Elective C-section

If I were an insurance company, I would not allow women to choose to have a C-section for no medical reason.  It would cost me twice as much money as a vaginal birth.  I would, however, be happy to pay for out-of-hospital births, as it costs me a fraction of the money a hospital birth does.

Oh wait, the only people I actually listen to, as an insurance company, is doctors and hospitals, who have a financial interests in these policies.  This is not about evidence-based care.  It's about putting the doctor on a pedestal and ignoring the midwife.  The doctors are thrilled to allow a woman to selfishly choose to have a C-section because it fits nicely into the doctor's schedule, and, oh yeah, cha-ching, it's twice as much money!  The doctors have done a great job of convincing me, the insurance company, how dangerous, reckless, and incompetent a midwife, especially a CPM or LM, is -- the smear campaign rages on against midwives.  

How can I, as an insurance company, in good judgement, take the advice of people who stand to gain financially by their recommendations?  The majority of doctors are trained to believe that birth is dangerous and needs to be managed.  The only place this can be done is in the hospital. They are convincing the insurance companies that homebirth is unsafe and women who choose to do this are placing their babies lives at risk.  (But let's go ahead and make abortion legal and accepted.)  Birth is safe for mothers and babies, as most midwives know and believe, because they see it and live it, day in and day out.

I have had a number of students who have wanted to have their baby at home or at a free-standing birthing center, only to be told that, no, they may only give birth in the hospital.  They have a choice of several doctors but only one or two midwives.  But if I am an insurance company, and I am in this for money, why am I ignoring a viable option -- homebirth?  Why, from a financial standpoint, am I covering a woman to have surgery to remove her baby because she is too scared to go through labor and give birth vaginally?  (I am not even going to address the moral and physical reasons why this woman is an idiot.)  I am paying thousands of dollars for a procedure that in 100% unnecessary.  The irony is so thick, it makes me sick.  And women who want to spend a fraction of what they would be allowed to spend if in the hospital are denied that option?  Unbelievable.  

When will the insurance companies begin to listen to midwives and to informed consumers who want to birth their babies at home?  We have to speak up to be heard.  Insist on options from your insurance companies.  They have to provide you with options.  I actually had my first homebirth reimbursed by our insurance company because they failed to give me all the information when I insisted that I needed options.  They could not make me give birth at that one hospital.  There was another hospital they were contracted with, but I was not given that information until the baby was 5 weeks old.  After 3 appeals, I had a hearing where we all sat around a big conference table listening to the recording of the phone conversation where I was told that I had no options.  Needless to say, we were fully reimbursed for our entire homebirth. But we didn't know that would happen at  the time we hired our midwife and we still made the choice to pay, out-of-pocket $2500, instead of our $100 co-pay at the hospital.  

I am not a fan of going into debt, but I do believe that sometimes we have to take our healthcare into our own hands and not leave it to the insurance to make all our choices for us. Fight for your right to birth your baby where you see fit.  Maybe, just maybe, we'll be heard. It's more important now than ever, as the AMA is on a campaign to make it impossible for homebirth midwives to practice.   If a woman wants a homebirth, she would have to illegally hire a midwife to attend her birth.  This is wrong.  Women deserve this choice in childbirth. They can legally kill their babies through abortion and choose to have them surgically removed from their bodies, but they can't lovingly and fearlessly birth their babies in their own homes and beds with midwives who believe in the natural process of birth.  

Friday, March 13, 2009

The "Big" Baby

Contrary to everything you may have been told, a big baby is a good thing!  Women have become afraid of giving birth to a big baby because their doctors, and even some midwives, have instilled fear into these mothers.  When a woman hears the phrase "birth trauma," do you think she's excited to start labor and give birth?  Of course not.  A woman's body is less likely to start labor when she is fearful.

How does your doctor know the size of you baby?  Ultrasound?  While ultrasound can be a useful device in estimating a number of things, when it comes to the size of the baby, it can be off by more than 2 pounds, either way!  So if you have a doctor telling you that you are carrying a 10-pound baby and a C-section is the way to go, you likely are NOT really having a baby that big.  Do not allow a doctor to conveniently (for him/her) cut you open because he/she is afraid of your "big" baby. They do not trust your body to give birth if they are recommending a C-section.  I have a lot of confidence in a woman's body being able to give to birth to the baby that her body allowed her to grow.

And what if you are carrying a 10-pound baby?  Congratulations!  My dad was 10 pounds, born at home.  So was his brother.  My grandma, who I lovingly call a "hillbilly," lived on the land. She ate the food she grew.  She knew where her food came from.  And she grew healthy, big babies.  

Most women are afraid to birth a big baby because they are afraid they will tear at the time of birth.  You are actually more likely to tear with a smaller baby than a bigger one.  How can this be?  A small baby tends to come through the birth canal faster and the skin, or perineum, doesn't have as much time to stretch.  A bigger baby allows the skin more time to stretch over the baby's head.  I've seen women be fearful of a bigger baby, because, surely if they tore with a 6-pound baby, an 8-pound baby would be dreadful.  Just the opposite is true.  

I have a lot more to say on the subject of tearing, episiotomies, etc., but I'll reserve that information for those lucky enough to take my class!  Wink, wink

I would also like to point out a very important statistic:  The #3 reason for a C-section in America is for CPD, or cephalopelvic disproportion, but only 1/2500 women actually has this very rare condition.  This is when a doctor says that your baby is too big to fit through your pelvis.  The only way for a doctor to truly diagnose this condition is when a woman is in labor and has spent a considerable amount of time pushing or has had an X-ray.  No one is going to do an X-ray on a pregnant woman, let alone in labor!  

We all know the tiniest women who have birthed 9 and 10-pound babies.  You cannot tell by looking at woman's hips whether or not her baby will fit through them.  During labor, there are hormones released to help soften the cartilidge within the pelvis.  It shifts with the baby, allowing more room for him or her to pass through.  The baby's head will also mold to fit through. Understanding the process of birth instills confidence in this natural process of the baby passing through the pelvis.  

True CPD was more common in the 19th century when a lot of women had suffered from rickets, causing the pelvis to be misshapen. Very rarely does a mismatch occur with the baby's size and the mother's pelvis, but there is no way for a doctor to prove it, so it is used as a diagnosis very often, even in pregnancy when a woman has never even experienced labor!  Give me a break!

Let's talk about that "birth trauma" we hear so much about.  Specifically, shoulder dystocia, is seen more often with bigger babies, but certainly not as common as the doctors make it sound. This is when the head is born, but the shoulders are "stuck."  Honestly, the baby doesn't have to be huge for this to happen -- just to have really wide shoulders.   A doctor will usually deal with this by giving the mom an episiotomy and then by breaking the baby's collarbone.  Ina Mae Gaskin, who I consider to be the nation's leading midwife, has a different approach, called The Gaskin Manuever:  have the mom get on all fours and lift a leg.  This will release the baby's shoulders. I have done this with one of our births.  It's amazing.  

Briefly, let's contemplate what is believed to be a "big baby."  What do you believe to be a big baby?  If 7 1/2 pounds is average, does that mean anything over that is "big."  I don't believe so. I do not consider a baby in the 8 pound range to be "big" -- just healthy.  We want this!  I, personally, think that once a baby is over 9 pounds, they are "bigger."  I love asking moms that have "big" babies if they tore, and I am constantly amazed by the amount of moms that say no, or very little.  

I had a mom in my class a few years ago that gave birth to a 12-pound baby with a 1st degree tear.   She gave birth in a hospital with a midwife.  Her family and friends couldn't believe that no one knew the baby was going to be so big.  They insisted that if she'd had a doctor instead of a midwife, they would have known.  I made the point that if she'd had a doctor who was expecting a 12-pound baby, she would have had a scheduled C-section and not the wonderful birth experience that she did.  


 

Tuesday, March 10, 2009

Nancy and Frank's Birth Photos

Everyone enjoyed the birth stories so much, I thought I'd pass along Nancy's link to see her birth photos. She wanted me to mention a big thanks to her doula, Gina Phillips, who not only took the pictures, but put them to music. A job well done. All couples should have this done for their births.

It's only a couple of minutes, but you'll love it. My favorite is when big sister meets little brother shortly after his birth and she gets a kiss from her Mama. For those of you who have not had a baby at home or attended a homebirth, the midwife is weighing the baby for the first time with a type of hammock. In the hospital, babies are placed on a cold, hard, metal or plastic surface to be weighed. At home, they are snuggled in a sling and rarely cry at this time. Yes, the baby weighed in at 9 pounds, 8 ounces, and Nancy did not tear. (I promise to write about "big" babies soon!)

Just a reminder, Nancy and Frank had the unplanned homebirth. For having an unplanned homebirth, they sure had their ducks in a row, didn't they?

Saturday, March 7, 2009

9 Months of Preparing -- A Last Minute Change in Plans

I was joking in the last post about having another homebirth from this class, but low-and-behold, Rachel and Andrew decided in the middle of labor to have a homebirth. Let me back up a bit:

According to her LMP, Rachel's due date was Feb. 18. Her ultrasound said a week later. I always tell everyone, and you've heard it here before, to fight for the latest date possible because it literally buys you more time. The midwifery group she was to birth with at the hospital would not allow her to go more than 10 days. They wanted to induce her yesterday, a Friday, even though that was day 9, but more convenient for them. She refused, insisting that she was taking every day she had been told she had. Good thing she did...

She had been contracting all week long, thinking it was the "real thing", several times. I see this a lot, where the mom finds it hard to believe it when she is actually in real labor. They tend to become obsessed with not doing things that will possibly stop labor. And so it goes...

Their doula, Hannah, was nervous for them to be induced, so she went to their house Friday afternoon and worked with Rachel on several different positions to help bring the baby down into a more favorable position. She also applied several acupuncture and pressure points which really got things going, to the point that the contractions were consistent and not stopping. Really, if the nurses could/would do this at the hospital, there would be no "need" for pitocin!

About 5:00 in the afternoon, Rachel started mentioning the homebirth midwives and by 7:30, they were at their house. Her cervix was almost 100% effaced and she was dilated to a 4 or 5. They announced that a baby would likely be born that night, and they were correct! Eventually, there were 2 midwives, 3 apprentices, and their doula in their home. Rachel said that the more people that showed up, the more confident she felt. It is so important for a laboring woman to have other supportive women around her -- women who believe in her abilities to birth her baby.

Their baby girl was born in their bathroom at 11:47 p.m. Baby weighed 7 pounds, 10 ounces, and was 21 inches long. Baby did have to be resuscitated with oxygen and even CPR, but she is doing fine. According to Hannah, the midwives were incredibly calm and never appeared to not know what to do. The reason I include this in this story is simple: this would have happened no matter where their baby was born, including the hospital. But it would have been handled entirely different. The baby would have been rushed to the NICU, where she likely would be kept for many hours, maybe even days, for monitoring, meanwhile, racking up a huge bill. Breastfeeding and bonding would have been drastically affected. Rachel and Andrew knew the midwives knew what they were doing and had absolute confidence in them. In fact, when I talked to them this morning, this was a very minor part of their story. I got more of the details when I talked to Hannah, who found those moments a little more intense than the new parents. I thought that was interesting. Fear was not present at their birth. Baby has a strong suck and is breastfeeding well. Everyone is happy.

Rachel said this entire week she kept thinking, "As long as the baby is still inside me, I have choices." She is a true example of this statement I am always making. I am so proud of them for taking control of their birth experience and making it their own. She really listened to her body, not just in pregnancy, but in labor. She was not reckless in her decision making. She was educated and fought for the birth she wanted. In the end, she knew the hospital was not where she wanted to give birth. And she did something about it! This took a lot of courage -- hats off to Rachel and Andrew. You have set a wonderful example of being educated, prepared, and willing to do what it takes to have the birth you want.

There have now been 4 homebirths from this class -- unheard of! I like to think that I have instilled the safety of birth, and homebirth, in my couples. The fact that I have birthed with an epidural in my spine with a C-section-happy doctor, and then with a CNM in a hospital, followed by 2 homebirths, my experience with birth is vast. I believe home to be a better place to have a baby. I am truly happy these couples have all chosen homebirth -- even Nancy and Frank, who did not choose it, but it certainly chose them!





Thursday, March 5, 2009

Two Extrordinary Birth Stories

Story #1:

First of all, congratulations to Nancy and Frank, from my class that just ended a few weeks ago. They were pregnant with baby #2, and very much like me, had an epidural with the first, got educated about birth after-the-fact, she became a doula, and wanted an unmedicated birth. She was planning a hospital birth and both her and her husband were very well prepared. She had all her plans in place. Her first baby arrived 3 weeks early, so she has been ready for quite some time, just in case. She had a doula, a babysitter for baby #1, even a sort of back-up doula, or shadow, to the first doula. Frank says she was supposed to be his doula.

Her water broke during the night, about 3:00 a.m., and by about 5:00 a.m. she realized that it was moving very fast. She called her doula who came right over. The shadow doula was on standby for someone else and had another birth to be at by 7:00, and since it would likely be many hours, she didn't go to their house.

It wasn't long before Nancy was making pushing sounds, grunting and the like. At this point, they were waiting for the babysitter to get there when the doula told her that she had two options. 1) Call an ambulance and have the baby at home, or 2) Call a midwife the doula worked with and have the baby at home. Thankfully, she chose the midwife.

The baby boy was born 20 minutes after the midwife arrived. He weighed 9 lbs. 9 ounces and was 21 1/2 inches long. And she did not tear! (I know I promised that the next post would be about the "big" baby, but I had to share these stories. I will be bringing this story back up though.)

A few things to point out about this birth: had they called the ambulance, they would have treated her birth as an emergency, clamping the cord immediately and still rushing her to the hospital afterwards. There would have been lots of "drama," as I call it.

With the midwife, it was just a normal birth. At least as normal as an unplanned homebirth can be! Their pediatrician, however, was freaking out. He wanted the baby and mother to check themselves into the hospital. Can you imagine?! He totally dismissed the midwife's credibility, education and knowledge in checking the mom and baby out.

Another concern is her doctor's office will now use this story to scare women into induction, telling them that they certainly don't want this (awful) thing to happen to them. It's better to be induced in the safety of the hospital. Can't you just hear it now? In their eyes, she was "lucky" that things turned out so well, as it could have been a dangerous situation, especially with a big baby and all the possible birth trauma.

Isn't that what all homebirthers hear from all the naysayers? That we are "lucky" that nothing went wrong. I just love that.

Anyway, I was thrilled with their story. This was a full Bradley class, with 8 couples. So far, we've had 3 wonderful homebirths, 1 unmedicated hospital birth, and one unfortunate C-section (failed induction). No one else is planning a homebirth, but after such an inspiring story, who knows (!!)...

Story #2:

I have a friend who, after 8 years of infertility treatments, started down the road of adoption. They adopted a baby boy, now 9 years old, followed by two beautiful girls, now ages 5 and 3. Just when my friend started wondering if she was going through menopause early, she found out she was pregnant! After 16 years of not being able to get pregnant, can you imagine the shock? That story gives such hope. I am so happy for them. They have a beautiful family. Just goes to show, those kids are meant to be a part of their family, and they wouldn't be had the infertility treatments worked. Congratulations Angie and Mark.




Tuesday, March 3, 2009

What Would I Do?

I have been thinking about my last 2 posts about induction. I gave a lot of info, and I believe that everyone needs to make their own decision based on education and what is going on with her body.

I did not mention that seeing a chiropractor might really help get things aligned and ready for labor. Ideally, seeing a chiropractor is a good idea in the last trimester, but if you haven't done so, I would recommend it at this point.

But, it's still bothering me, I didn't really answer what I would do if I were in this situation. So, if it were me, and I had been doing the entire list of natural induction methods, and my induction date has arrived without a baby...

To be perfectly honest, if everything was fine with the baby, fluid levels, blood pressure, etc., and the only reason for induction is because my 10 days is up, I would seek out an out-of-hospital midwife (most likely a CPM or LM), and see if they would attend my birth, either at home or at a birthing center. They will give you a few more days of pregnancy, for sure! Most midwives like to be able to see their clients for at least a month, but a lot will still take you on. In fact, some midwives will discount the price since your prenatal care is finished. It doesn't hurt to ask. You will only give birth to this baby one time -- there are no second chances.

OK, but insurance is what keeps most women where they are, at the hospital. Depending on whether my cervix was softening, I would possibly need to make a choice between a prostaglandin gel or pitocin. If I chose to have a prostaglandin applied on or near the cervix, depending on the type used, I would ask for the smallest amount possible, and then use my own natural techniques with it, such as nipple stimulation or pressure points. Same thing, if I end up "choosing" pitocin, I would start out really mild, the smallest they would allow, and combine it with natural methods. I would really want my birth attendant to agree to stop the induction drugs if my body starts labor with the push.

I would not allow anyone to break my water. I would likely end up on pitocin if labor didn't start right away. I really don't like that time clock. They would be less likely to let go of the pitocin if my body started contractions because of the fear of the time. Labor does not like to be rushed. Adrenalin is the opposite hormone running through the body as oxytocin! It's hard to perform under pressure.

I have loads of stories that illustrate these different things I have talked about, but I am holding back! I will be addressing the dreaded "big baby" in the next post.

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.