Monday, December 5, 2011

Not Just Another Induction Post

You might remember me posting on my Banned From Baby Showers Facebook page about a mom who had been declared "high risk" due to "maternal age."  She is 35 years old.  Her OB had also told her that her amniotic fluids levels were low.  At about 37 or 38 weeks, she recommended induction.  My student declined induction and I'd just like to take a moment to relay to you what the "Treatment Declination" form said:

Our records indicate that you have declined medical induction.

The medical induction was indicated for the following reasons:
1.  Maternal age
2.  High risk pregnancy

You have also been informed of the risk of declining said treatment/procedure, including fetal death, worsening maternal condition, irreversible neurologic (brain) fetal damage resulting in cerebral palsy, mental retardation, developmental delay and motor skills delay.  You are also aware increased cesarean section risks and increased risk of poor fetal or maternal outcome.

By signing below you have indicated that you completely understand the risk of delaying or declining the above procedure and willingly have decided to do so.

From the beginning of classes, I had told her she had some other (great) options in the Ft. Worth area.  Thanks to several of your comments on the Facebook page, she realized that she likely was not really high risk, and decided to go ahead and switch care providers.  It was  39.3 weeks when she transferred to the UNT Midwives.  Her charts had lots of doomsday stuff in it and the midwives recommended that she visit with their perinatologist. He commended her for declining the induction and told her there was absolutely nothing wrong with her, her baby, or her pregnancy!   She had a fabulous unmedicated birth 4 days later!

I've had some overseas births (France and Switzerland) in the last couple of months who were really pushed into using pitocin too.  One of them ended up not having it, but the other one did.  The nurses were very aggressive in wanting to keep upping the dosage and the mom was barely on top of things as it was.  She was dilating very quickly, but for some reason, the nurse wanted her baby to just fall out, I guess.  It made for a very difficult labor for her.  Afterwards, she hemorrhaged and battled dizziness for hours.  The very quick labor really took a toll on her.  Had they not pushed pitocin on her the way they did, she could have enjoyed her labor instead of gripping the rails, so to speak.

In 8 1/2 years of teaching, I've never had a baby die until recently.  The mom was pressured into induction (those declination forms are really scaring) and had a uterine rupture due to "misuse of pitocin."  The OB was extremely negligent and went in with a vacuum to try to get the baby out.  The mom was only 9 centimeters.  After 3 hours from the beginning of the rupture, they went to a code-red emergency c-section.  The baby was flown to an out-of-state hospital where he received "head cooling" for the brain damage and hematoma from the vacuum attempts.  The baby had such severe brain damage, after many tests, the parents were told the baby would not survive.  He lived 18 days.  They buried their sweet baby on November 1.  To make matters worse, this mom had to go back in for surgery because they left 4 centimeters of placenta and membrane inside the uterus.  She is understandably completely devastated.  I sincerely hope she knows this is not her fault.  This is the fault of her OB who pressured her into the induction and then went about it negligently.  My heart goes out to her and her family.  I am so very sorry they are living this tragedy.

As an Educator, I have gone through many emotions this weekend as I learned what happened to this couple and their baby.  Women are being scared into induction -- being told it is the safe thing to do.  Declining the induction is the unsafe route.  Are these parents being told about the risks of the induction themselves?  Never!

The women who are asking for VBACs are being told it's too dangerous -- they might rupture and kill their babies.  But we never hear of women being told about the risk of rupture when they are induced with pitocin, albeit, a small risk. Did you notice in the Treatment Declination form that it said that by declining induction, you were risking a cesarean section?  I love that.  When a woman is induced, she is twice as likely to have a cesarean than if she starts labor on her own.
Shame on these doctors for leading women to believe that induction is harmless.  As birth advocates, we must stand up and be loud about the risks of induction!  Risks to moms and risks to babies.  These babies deserve their time to grow inside the uterus and not be forced out.  They will let us know when they are ready to be born. 


They Call Me Mom said...

Such a sad story. People often comment on how scary and risky my home births are. I cant imagine a birthing situation more fearful than one in which you are completely uninformed on what your body is supposed to be doing naturally. My heart and prayers are with this family.

Roxy said...

This makes me angry, but mostly very, very sad. Inductions are at almost epidemic levels in our area. I had to find a midwife 25 miles away just to get away from the doctors around here. I've had several friends who were pregnant recently. ALL of them were induced before 39 weeks.

Sarah said...

I had the honor of attending a friend's birth on Friday night and while in the hallway I overheard 2 doctors who had (inconveniently to them) to be called in to deliver her baby. The older doctor said (about my friend's actual doctor who never showed), "When Friday comes it should be induce, induce, induce so we don't have to be called in." I cringed and held myself back from slugging him so I would not be kicked out of the hospital.

Samantha said...

I am so, so sad to hear about this mother losing her newborn. No mother should ever have to go through this and I give my heartfelt condolonces to her and her family. I will always be a nautrual childbirth advocate. I truly feel doctors create dangerous scenarios and then just cover it all up and tell the woman some falsehood. And all this for convenience.

Wanda said...

I was Never told the risks with my youngest and they tried to induce me 3x, about 4 days apart. He was stubborn and came when he was ready, but they never told me about the risks of rupture or I would have refused. Now things may have changed in the last 23 years, but this is scary as I had a friend was being induced this last week. I need to call and make sure she and baby are okay as I have not heard yet if the baby was born or not, Friday.

Kathy said...

I have a question about your statement that: "Did you know that a woman who is VBACing has the same risk of rupture as a woman who is being induced with pitocin, having never had a c-section? ... Both carry a risk of less than 1%."

While it's true that both carry a risk of less than 1%, from what I have found, they are not "the same risk". This link discusses multiple studies and says, "the modern rate of unscarred uterine rupture during pregnancy is 0.012% (1 of 8,434)", and a few pages later in the article, it says that the rate of UR in a spontaneous TOLAC is 0.45% -- still less than 1%, but 40x the risk of rupture in an unscarred uterus.

Granted, the studies on UR in an unscarred uterus do not differentiate between spontaneous and Pit-induced/augmented labors, nor do they list the incidence of Pitocin uterine ruptures with a denominator of total number of Pitocin labors, so the absolute risk may be higher than the quoted rate.

If you have the stats or studies that demonstrate a near-equivalent risk of rupture in a spontaneous VBAC vs. an induced labor with an unscarred uterus, I'd like to see it, so I can add that to my list of stats, but so far I haven't found anything concrete. Thanks.

Amy said...

I had a horrible experience with being induced! The dr insisted I be induced on my due date even though I didn't want to be. He never gave me the option to refuse he just told me it had to happen and since it was my first I didn't know better. Well everything was fine until they kept upping the pitocin, my body reacted badly and swelled shut instead of opening farther. Ended up in a c/s instead. Thankfully we were both ok though.

SingleMom4God said...

No one ever explained the risks of being induced to me, and being a first time mom I just assumed everything my OB was telling me, was for mine and my baby's well being. I was induced because I had developed Bells Palsey and my tongue had started to go numb as well.
After I delivered my beautiful son, I was not allowed to hold him immediately because I was losing a lot of blood and apparently I had torn pretty badly as well.
When I was finally able to hold him, I sat up and a few seconds later yelled for someone to take him, I was going to pass out.
Little did I know that I wouldn't wake up for over 3 hours! During those 3 hours my blood was drawn numerous times, and my aunt (RN for over 30 years) thought I was dying. I opened my eyes once and she said "You weren't in there."
While I can't blame all of this on being induced, I do believe it had something to do with my abnormal amount of blood loss and the swelling that happened the next day.
A week and one day after my son was born I had to have emergency surgery because I had a piece of retained placenta left in my uterus causing me to pass blood clots the size of a medium to large fish.
It's very scary how we are manipulated into "choosing" to be induced. If I'm ever blessed enough to have another child, I am definitely going with a midwife and quite possibly a birthing center instead of a hospital birth.

Sarah Elwer said...

what about if you make it to 42 weeks? How do you get out of an induction then? I went to 42 with my first and felt very bullied into an induction. I'm 9 days from my due date right now and I'm really scared this baby won't be out by 42 and i will be forced into another induction! Do you have any advice for my situation?

Summer said...

I had my 4th this year. I declined additional testing after finding out Baby had a "single artery umbilical cord". We did u/s every two weeks the last trimester to be sure baby was still growing. I declined induction (with my OB blessing) and ended up being an entire week late. Started on my own, delivered a tiny guy at 6# 4. a week late. I cannot imagine the complications had they induced me two weeks early! he would have been so under-weight!! I am blessed to have such a great advocate in my husband, he really encouraged me to "do the right thing". Including BFing through an abscessed mastitis at 3 weeks, He was there through it all. and we are still Bfing after 8 months, and plan for longer....
Don't let people PUSH you but Push for yourself.-=-wisely please.

Magbtrfly said...

I had my son via induction and it was one of the worst experiences of my life. They hospital started the induction procedure on December 20, 2001 at 6am in the morning. I had my son via vacuum assisted vaginal delivery December 22, 2001 at 8:16pm. It was a terrible exhausting experience that left long lasting issue with my body. My son has autism and there are days I wonder if the birth played a part in it.

Karen Joy said...

I, too, am interested in the stats comparing uterine rupture in VBAC moms to those who are induced.

I am a natural childbirth advocate -- I'm teaching my first classes right now. However, I want to make sure all my facts are straight before I state stats.

The mother's story is heartbreaking. Heartbreaking. I do remember the other mother who transferred at 39 weeks; I was *SO HAPPY* for her great outcome, especially when the consent/denial form was so misleading. Stats have shown that there is NO BENEFIT for primiparas to be induced before 41 weeks. At 41, the risk of perinatal mortality does go up -- slightly -- by 1 in 1000. For multiparas, the risk doesn't increase until 42 weeks.

I have noticed that for these sorts of forms, and from the mouths of many doctors, that they list the risks that are most convenient to them, and they twist them in such a way so that there is most often a shadow of truth, but it's so far skewed, and such an incomplete picture, that it's pretty much the same thing as outright lying. It is really, really tragic and maddening.

Thank you for this post. The #1 thing I tell friends, family, strangers, students, anyone who will listen and a few who don't, is, "DON'T CONSENT TO AN INDUCTION!" Just don't.

And, Sarah Elwer, just don't go. They can't make you show up at the hospital for an induction. Also, there are a number of natural induction methods. (It's still technically induction, but they are nonmedical and lightyears better than Pitocin or Cervadil induction.) Also, do remember that births vary WIDELY. I myself, with my five children, have gone the gamut from 11 days "early" to 9 days "late". I just finished reading the fabulous book Gentle Birth, Gentle Mothering by Sarah Buckley, and her own experience with her four is from four weeks early to three weeks late. By the way, if you haven't read that book, PLEASE DO. It's fabulous. She has a whole chapter on avoiding unnecessary interventions, and is really big on patient's rights. The biggest issue with doctors is that your refusal is INFORMED. Even the ACOG's official position on informed refusal is (from p. 41 of the book) "Once a patient has been informed of the material risks, benefits and alternatives, as well as the option to refuse, the patient has the right to exercise complete autonomy in deciding whether to undergo the recommended medical treatment, surgical procedure, or diagnostic test; to choose among a variety of treatments, procedures, or tests; or to refuse to undergo these treatments, procedures, or tests."

IOW, the more informed and educated you are as a patient, the less leverage it gives the doctors over your life, your baby, and your body.

Jesica said...

i have a question and would like to ask you privately if possible as it's personal about myself, my email is jeshogan at gmail dot com.

Banned From Baby Showers said...

I must have worded the risk of rupture information in a confusing way, as a few people have asked me for more specific data. Mine is the same as yours. I was simply trying to point out that we scare a VBACing mom into thinking her risk of rupture is very good and therefore should opt for another c-section, but a woman who is going in for a pitocin induction is not warned of her risks of rupture -- in fact, just the opposite -- she is made to think that she's being reckless by not inducing. Both instances carry a less than 1% risk of rupture. One group of women is being told it's dangerous (and in many cases, not even allowed) and the other group of women is pushed into it. I hope that clarifies the point I was trying to make.

The outpouring of sympathy towards this family has been overwhelming. I'm sure they are reading this and I pray they are able to feel your thoughts and prayers. Thank you.

blessedx11 said...

I am sorry for the loss of the child. Such a senselss tragedy. Sounds like incopetent doctors.
I am the mother of 11. I have alwasy wished to home birth, but between the laws in Alabama, and my husbands concerns, I have always gone to hospitals.
I have been blessed to have good labors and non overly intervention happy doctors, and then I foudn a midwife that delivered a the hospitals that is wonderful.
I have been able to have all mine without an epidural. I went to a friends birth and she had an epidural, and after seeing that, I hope I never ever need one.
I did have a couple inductins. One was at 38 weeks because the aminiotic fluid was low. It was a long (for me) labor, but not to horrible, and Iwent throgh it all unmedicated. (I am wierd, even with pitocin I have no pains, and then once they finally start, delivery happens within 30 minutes)
Teh worst labor experience I ever had, I had somehow wound up wiht the high risk doctors (I kow how to prevent that now) adn they did not want me to go like a second over my due date. Theyh listed all kinds of things to make me high risk. Anyway, I went ahead and accepted the induction (mostly because I would get to have the baby on my dads birthday) but the worst thing was the stupid doctors would not let me out of bed AT ALL. They startd the pit, and wanted to break my water but baaby was too high. Then they got upset becaus she wasn't moving down quick enough. (think that would have been taken care of if I could have gotten up, or even been allowed to use the birthing ball) then they decided, I forget why, that I needed internal monitoring. So they did that and once my water broke things happend fast. Then they got made becauase I was almost 10 but had a lip (again, probably woldnt have happend if I had not been confined to bed) so since i wanted to push, they manually strechted it.. OUCH. THEN they told me not to push untill the doctor got inthe room. I said (in not so polite terms) I would ont wait, so the nurse had to catch,a nd she was mad. I decided if I ever had another baby, I would go into labor on my own and just wait too long to get to the hospital. I actally did have two more after that, but got to have my midwife for prenatal care and delivery, so it was much better. I also have never been otld hte risks of rupture with pitocin.

Jessica said...

Thank you so much for YOU and your blog! I was lucky enough to have a girlfriend who opted for a natural childbirth and shared her experience with me which lead me to find out more information and educate myself. I wasn't in a position to have a homebirth (I wish!) but I was at least educated and informed and I had MY birth, MY way. My son was even spontaneously born 10 days late with no induction because I didn't want to be induced! (Thanks to a GREAT OB I was lucky enough to find who was cool with my wishes for an all natural, unassisted birth!) I really wish more women would EDUCATE themselves! I definitely plan on sharing your blog!

Sara said...

The morning my daughter was born there was a coworker's daughter who was in L&D also. She had been induced the morning prior to my arrival due to being past her EDD (about a week, I think). She was still there almost 24 hours later, and had her baby several hours after my daughter was born (20 minutes after we arrived at the hospital, crowning!).

I don't know how many times I've heard "my body just doesn't go into labor" as a justification for an induction, either! How do you know if you never wait that long?!

Knitted_in_the_Womb said...

Regarding Kathy's comment further up on the rupture rate...Kathy, I think you are comparing two entirely different things than what Donna is comparing. You quote a rupture rate during *pregnancy*--which possibly does not include ruptures during labor. It certainly is not the rupture rate for only labors with an unscarred uterus and Pitocin induction/augmentation.

Donna...Could you please post your reference for the rupture rate with Pitocin induction? I'd like to add that to my resources.

Also, in discussing the baby who died (SO tragic!) you say that the emergency cesarean was performed 3 hours after the "start of the rupture." Should that say "start of the induction?" It would be a shocking case of malpractice if a rupture was known to have occurred, and a cesarean was delayed by 3 hours. Of course using a vacuum at 9 cms I think also qualifies as shocking malpractice! I hope this family files complaints with the state medical board and sues.

morgan66 said...

I was induced twice after 14 days over due my first was a bit complicated but that's due to my sons 40cm head that didn't cone at all my daughter was induced at midnight and delivered 9 hrs later. I slept through most of that. With both when they turned down the drip I would stop labour. After my son was born I delivered my placenta which had already deteriorated with calcified spots. Both my waters had broke 4 days prior to delivery. I don't agree with all induction but I would have or baby died back in the olden days. Induction is for a select few but scaring the crap out of women makes for difficult decisions harder. I would love to go into labour naturally and pray for it for the next but I'll be induced in a heart beat if I go 14 days over and. My water breaks for 4 days. I also tried every potion, acupressure midwife trick to get it going:( women should educated informed and discuss all with their doctors long before delivering so they know all options no matter what.

Shasta said...

I have had 2 children and am now pregnant for baby 3. I hd my first baby naturally and it was horrible!! 2nd baby I was induced and it was an amazing experience. I was able to enjoy the whole delivery and post recovery was amazng! My ob for my first son was crazy! My OB now is amazing so I think it all depnds on the doctor. Do your research! Very sad about that poor mommy and baby..

Kathy said...

Knitted, it's true that some of the ruptures were pre-labor, but it depends on the study, e.g., one of the studies said that all but 3 ruptures occurred during labor. However, at the time, I considered them all intrapartum, so I did misread it a bit, or skimmed it too quickly. Many of the studies discussed in the link, though, were definitely labor-focused, if not labor-exclusive (e.g., one study noted that some variation of prolonged labor and/or medical neglect was the primary cause of UR in developing countries, although they used the term "pregnancy-related" in some studies). Still, this would lower the rate of UR during labor for any cause, including oxytocin use, which would make the disparity greater.

Melissa G. said...

Oh, this made me cry. I hope this family is surviving the holiday season.

Kathy said...

Here is a blog post that looks at studies to find what the rate of UR is with VBAC vs UR with induction in an unscarred uterus. As we know, it's hard to get facts and stats on this, but the blogger has made a good case for saying, "In other words, a woman with a prior cesarean section has a uterine rupture risk 29 times greater than the risk of uterine rupture due to induction in a woman without a prior cesarean, 0.64% vs. 0.022%."

Josh said...

This story makes me sad and angry for momma & baby. How dare medical "professionals" pressure this momma for NO reason? When I was 41 weeks my midwives *had* to refer me to the OB attached to the practice. who did her best to tell me that my child would be brain damaged at best and still born at least if I decided not to heed he advice and induce that day. I declined and let her know that i did not appreciate attempt to scare me. Our brilliant and completely healthy baby girl was born beautifully and naturally 6 days later. Our next bean will be birthed at home with a midwife.

Trinity GoldenChild said...

What an awfully sad story, and such an unnecessary death. I personally feel as if that obstetrician is directly responsible for the baby's death, and the trauma caused to the a decent world they would be made to atone for the damage they have caused, but instead I guess the medical community will protect them and continue allowing butchers to damage families for their own convenience. I am so grateful I live where I do, where my obstetrician allowed this geriatric multigravida (35 yo, six previous pregnancies) to go full term with my twins. We safely and happily went into spontaneous labour at 40w3d and had a practically pain free natural labour and delivery of two very healthy very happy baby boys. I wish everyone had the opportunity to do this, without the horrific pressure that the medical community puts on mothers to have "manageable" deliveries the way the "professionals" are trained to handle. Because that's one of the major med school you aren't taught how to manage a normal complication free labour, you're taught how to handle a medicalised one. So doctors feel much more comfortable DOING something, even if that something is detrimental to a safe outcome. They just don't know how to be hands off, they aren't taught that.