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Reasons to Induce: Poor, Controversial, and Solid September 10, 2009

Filed under: Pregnancy — Rachel @ 9:09 pm
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What’s a good reason to induce and what’s really NOT?  Today I’ll be sharing thoughts from Jennifer Bock’s excellent exposé, Pushed: The Painful Truth about Childbirth and Modern Maternity Care, as well as opinions offered by Ricki Lake and Abby Epstein via an article “Choosing to Wait” in Fit Pregnancy magazine, Sept 2009.  Ricki Lake and Abby Epstein produced the film The Business of Being Born and have since published a new book Your Best Birth

Gary Hankins, MD, chair of the obstetric practice committee of the American College of Obstetricians and Gynecologists (ACOG) says he never induces for convenience.  “And induction absent a solid indication absolutely increases all risk to mom and baby” (Block, pg. 8).  So maybe you agree.  You don’t want to induce.  Considering that the induction rate is growing by leaps and bounds, waiting for spontaneous birth may not be as easy as you’d assume.  Educating yourself about what constitutes a “solid indication” for induction may help you choose a good caregiver or at least bolster your resolve if your doctor pressures you at some point to an unnecessary induction. 

Pressures?  Do doctors really pressure women into induction?  Author Jennifer Block shares the stories of several women who were induced, all for different reasons.  Interestingly, all three women report being encouraged to induce earlier on in their pregnancies. Here’s what one woman experienced:

“It started at 39 weeks,” says Hilton.  “She said, ‘When do you want to be induced?’ I said, ‘I don’t.’ She said, ‘Well, I’ll give you one more week and that’s it.'”  At her 40-week appointment, Hilton says her OB asked, “So are you ready to have a baby?” and offered to schedule her the following day (Block, pg. 16).

Unfortunately, this kind of attitude is all to common with doctors, for whom an induction scheduled during regular business hours or before a upcomming vacation is so much more convenient.  Doctors are people too, with families to see and personal business to do.  It is easy to see how they would be tempted to put the needs of their families before the best interests of their patients when our culture becomes accepting of questionable medicine.

Poor Reasons to Induce:  Included in this category are indications commonly given for induction that are discredited by medical studies discussed in both Pushed and The Business of Being Born.  There is not sufficient medical justification for inducing based on any of these reasons.

  1. The ultrasound technician moves your due date– an ultrasound can accurately determine a due date early on in pregnancy.  Late in pregnancy, an ultrasound technician can only estimate your due date, and can be off by plus or minus 3-4 weeks (Fit Pregnancy, pg. 54).
  2. An ultrasound shows your baby is “measuring” big– although you’d think this would be an exact science, ultrasounds only estimate baby’s weight and can be off by pounds in either direction!  This justification is not supported by the American College of Obstetricians and Gynecologists (ACOG).  And, what’s more “statistically, fetal size appears to level off after 40 weeks gestation” (Block, pg. 9).   
  3. An ultrasound show your amniotic fluid is low – again the ultrasound is only an estimate of your amniotic fluid level.  “Amniotic fluid shifts constantly, with more being produced all the time (Block, pg. 11).  Your doctor should be recommending you drink plenty of fluids and rest, not scheduling an induction (Fit Pregnancy, pg. 54).
  4. Your doctor is leaving town – as much as it helps to have the right caregiver, it doesn’t make sense to increase your chances of c-section by 2-3 times to ensure your doctor will be available (Fit Pregnancy, pg. 54). 
  5. You’re 40 weeks pregnant – you are not “overdue” until 42 weeks.  A baby is considered normal, “full-term” if it is born between 38 and 42 weeks (Block, pg. 11).  “In other words, if we were to distribute a large sample of pregnancies along a graph, we’d see a bell curve.  Forty weeks would be the height of the curve, and an equal number of women would give birth before and after… Thus a due date would be expressed more accurately as a ‘due month'” (Block, pg. 11). 

Controversial Reasons to Induce:  Included in this category are indications commonly given for induction that are rejected by some doctors and most midwives, but not entirely without reasonable medical support.

  1. You’re 41 or 41.5 weeks pregnant – One large study shows that slightly more stillbirths occur after 41 weeks.  Researches disagree as to the reason why this is so (Block, pg. 11).  If time in the womb is not to blame, than inducing every pregnancy at 41 weeks is foolish for the vast majority of women (pg. 12).  A wise doctor will consider other factors such (fetal nonstress test) and childbirth history, as well as suggesting natural means of encouraging labor, rather than making a beeline for the drugs.
  2. Your bag of waters is broken– Most women go into spontaneous labor within 24 hours of the bag of waters breaking (pg. 13).  But, sometimes labor might not begin for a few days.  During that time, there is concern for infection since the seal has been broken, so to speak.  How does infection make its way up there?  Through vaginal exams.  A study of 5000 women (the largest to date) “found no increase in neonatal infection in (women) that were watched for up to 4 days after rupture.  The vagina is a nearly airtight passageway, so loss of the plug and rupture alone don’t significantly increase the risk of infection…” (pg. 12).  As a matter of course, hospitals insist a baby must be delivered within 24 hours of the waters breaking, which means induction within 6 hours in most cases (Fit Pregnancy, pg. 55).  Midwives disagree with this approach, instead opting to use natural means of induction at this point, while avoiding vaginal examines.
  3. Baby is smaller than normal – while the authors of Your Best Birth state this is a solid reason for inducing, it seems an odd generalization to me (pg. 55).  If you’re still 39 or 40 weeks, maybe you baby needs more time to grow?  Also, remember that ultrasounds only estimate weight and can be off by over a pound in either direction.  Jennifer Block does not address this issue, and neither have I read about it elsewhere. 

Solid Reasons to Induce:  Included in this category are indications commonly given for induction that are supported by good reasearch.

  1. You’re 42 weeks pregnant:  the placenta may start to deteriorate after this point, failing to support baby properly with oxygen and nutrients (Fit Pregnancy, pg. 55).
  2. Baby is moving less:  your observations and further testing show baby is moving much less than normal (pg. 55).  Keep in mind that babies do move less as they reach term because they have less room!  But, if baby stops moving at all, you should seek care immediately. 
  3. Baby’s heart rate is irregular:  clear irregularities indicate distress and should be treated seriously (pg. 55).
  4. You have signs of Preeclampsia:  spiking blood pressure and protein in the urine indicate preeclampsia (pg. 55).
 

Would you Like to Induce Labor? September 1, 2009

Filed under: Pregnancy — Rachel @ 8:07 pm
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Would you like to choose your baby’s birthday?  Would you prefer to get baby out ASAP, rather than wait that last week or two?  If you’re considering inducing, you’re not the only one. 

Last night I began reading Jennifer Block’s Pushed: The Painful Truth about Childbirth and Modern Maternity Care.  It is well-written and clear, with compelling stories about real births too.  Block cites the information she shares in detail in her book, so you can look up any studies or reports of interest.   The first chapter,”Arranged Birth” examines the subject of induction in detail, with interesting perspectives from nurses and doctors too.   

According to the CDC, the induction rate was under 10% in 2004 (Block, p. 5).  Contrast that with 40% induced into labor and 70% receiving Pitocin during labor to speed up progression in 2006, according to a study of 5500 low-risk, first-time mothers (p. 5-6).   Pitocin is a hormone-mimicking drug that stimulates contractions and is commonly used to induce labor. 

Why are doctors recommending inductions and women agreeing in such drastically increasing numbers?  There are any number of official reasons that a woman may be given when an induction is ordered.  We’ll look at these in more detail next week.  But, before we get bogged down in medical debate, take a step back and ask yourself this:  Do you think our ability to give birth, to progress in labor has drastically changed in the last 6 years?  Or, could it be, that it’s just more convenient for mothers and doctors to induce?  In America, isn’t convenience king?  We want to do the best for ourselves, for our babies, but when something is touted as pretty safe, easier, more convenient for everyone, will mom say “no”?  Judging by the popularity of fast food, obviously not. 

It is convenient, but is it safe?  Is it wise?  Here’s an excerpt from Pushed, beginning with a quote from Kathleen Rice Simpson, PHD:

“‘I firmly believe that mothers are not informed enough to know that this is not a good idea, and that any woman who has the right information would not want to have her baby induced.’ Inducing tends to create longer, more difficult, more painful labors in general, and it ups a woman’s chance of a C-section by two to three times.” (p. 14)

But who is this Simpson?  She’ s only a professor of nursing at St. Louis University School of Nursing, a labor and delivery nurse of 30 years, author of dozens of journal articles, conductor of several studies, author of safety manuals for the American Society of Healthcare Risk Management, the American Hospital Association, the Association of Women’s Health, Obstetric, and Neonatal Nurses, etc.  She claims that liberal use of Pitocin to start and speed up labor often violates safety standards and is under-reported.  “Mismanagement of Pitocin, she says, is the leading cause of liability suits and damage awards” (p. 14).

So if Pitocin is the most common mistake doctors make, why do we feel so at ease to induce labor for convenience?  If this is beginning to bother you, you’re not alone.  That’s why Jennifer Block subtitled her book “The Painful Truth about Childbirth and Modern Maternity Care.”  A mama ought to be informed.  More on induction next week!

 

Must-Reads for Pregnancy & Birth August 27, 2009

Filed under: Pregnancy — Rachel @ 3:57 pm
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As soon as you began thinking about getting pregnant (or realized you already were!) your mind was filled with a million questions.  There’s a lot to learn about pregnancy and birth.  Here’s a book list to get you started:

Healthy Pregnancy

  • The Mother of all Pregnancy Books: The Ultimate Guide to Conception, Birth & Everything In Between by Ann Douglas.  A great introduction and resource for first pregnancies.  Lots of information on common problems of pregnancy.
  • Mothering Magazine’s Having a Baby, Naturally by Peggy O’Mara.  “We’ll inform, you choose”  Having a Baby, Naturally reflects this spirit with straightforward, uncensored information about pregnancy and childbirth, addressing common concerns and questions in a compassionate, nonjudgmental style.
  • Eating for Pregnancy: The Essential Nutrition Guide and Cookbook by Catherine Jones and Rose Ann Hudson.  A practical book from a perinatal nutritionist on proper eating and weight gain goals, with a large collection of recipes.  It’s a cookbook in its own right.  Also addressing the requirements of diabetic, vegetarian and vegan diets during pregnancy.

Safe Childbirth

  • Ina May’s Guide to Childbirth by Ina May Gaskin.  A classic, full of positive birth stories to prepare you mentally and physically for natural childbirth.
  • The Doula Guide to Birth: Secrets Every Pregnant Woman Should Know by Ananda Lowe & Rachel Zimmerman.  Insights from experienced doulas and real moms for birth and the welcoming a newborn.
  • The Thinking Woman’s Guide to a Better Birth by Henci Goer.  A truly empowering resource covering the many procedures and tests available during pregnancy and birth.  Offering data and advice so you can make informed decisions regarding your care. 
  • The Doula Advantage by Rachel Gurevich.  Why and how to hire a doula, with interviews from more than 235 women and birth professionals.  So much good information, and real life tools to help women choose the best doula for their birth.
  • Pushed:  The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block.  “The United States has the most intense and widespread medical management of birth” in the world, and yet “ranks near the bottom among industrialized countries in maternal and infant mortality.”  This provocative, highly readable expose raises questions of great consequence for anyone planning to have a baby in U.S.

Fun, Encouraging Reads

  • Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent.  This fun, lighthearted book is chock-full with Peggy’s experiences delivering babies in Berkeley, California, including 40 birth stores from a wide-range of diverse, interesting women.  It’s the perfect prelude to your own labor, sure to leave you with realistic expectations for your own birth and some inspiration too.
  • The Girlfriend’s Guide to Prengnacy by Vicki Iovine.  Although I don’t share the perspective of the author, this book is so hilarious that I had to include it here.  The author’s sassy writing style will have you laughing at your pregnancy woes. 
  • Pregnancy Stories: Real Women Share the Joys, Fears, Thrills, and Anxieties of Pregnancy from Conception to Birth by Cecilia Cancellaro.  A collection of honest short-stories written by real mothers about the ups and downs of pregnancy and birth.  Support for the journey.
 

Why & How to Find a Midwife or Doula July 21, 2009

Filed under: Pregnancy — Rachel @ 2:17 pm
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When you’re pregnant (if not before) you’ve got to investigate all of your options.  Is your OB-GYN making you feel comfortable and capable?  Finding time to answer all of your questions?  Helping you prepare emotionally and intellectually for childbirth?  If you’re not happy with your current caregiver, it’s not too late to make big changes (provided you’re not already 36 weeks!). 

A midwife’s model of care is totally different than an OB-GYN.  While an OB is trained to be well-versed in medical ways to address problems during childbirth, a midwife is trained to appreciate the process of childbirth as a natural, powerful and sacred event.  And, she brings natural tools for addressing problems and pain of which an OB is often completely unaware.  An OB views birth as something to be controlled or “made-safe”.  A midwife views birth as something to gently assist (both physically and emotionally)  and respect – it’s already safe in most cases. 

Of course, these are just generalizations – there are many exceptions to the rule.  The first midwife I interviewed was discouraging and controlling!  But, the other two I hired were wise, respectful and reassuring.  I encourage you to consider the care of a midwife and/or that of a doula, who can make a tremendous difference in how you’ll feel about your birth experience.  Each birth is a unique, miraculous experience that only occurs once.  It’s yours to be enjoyed – yes, really!

Here are some great links for beginning your search:

http://www.midwife.org/
http://cfmidwifery.org/index.aspx
http://www.dona.org/mothers/index.php

 

Elective Cesarean – Every Week Counts! May 26, 2009

Filed under: Pregnancy — Rachel @ 2:08 pm
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Considering or planning for an elective cesarean?  Fit Pregnancy’s June/July issue includes a good reminder:  every week counts!  When mama’s reaching the end of her pregnancy and growing increasingly uncomfortable and increasingly excited about meeting baby, it’s hard to wait out all 40 weeks.  According to the New England Journal of Medicine as reported by Fit Pregnancy, “36% of elective C-sections are performed before 39 weeks, putting newborns at risk for complications.”

“Being born by elective Cesarean section at 39 weeks – just one week early – increases a baby’s risk of health problems, such as feeding and breathing difficulties, according to a study of women undergoing repeat C-sections.  The researchers noted that babies delivered at 41 and 42 weeks are also at higher risk for complications. ‘We found there’s a very tiny window between 39 and 40 weeks where baby outcomes are optimal, ‘ said co-author John Thorp, M.D.”

And therein lies one of the main drawbacks to elective cesarean – that “very tiny window” of timing for baby’s ideal birthday.  Instead of allowing our bodies and babies to choose, we are “taking the baby” (as it’s so often said) at our convenience.  Scientists are still working to understand the complicated symphony of communication and cooperation between baby and mama that results in spontaneous labor.  If you’re set on an elective cesarean, give your baby that last week and aim for a 40-week pregnancy.

 

The Birth Survey March 10, 2009

Filed under: Pregnancy — Rachel @ 8:44 pm
Tags: , ,

Pregnant with your first baby, you start to think about that all-important, rather intimidating day – the day you will give birth.  You want to be prepared, so you read books, take a class, talk to other moms.  But, how to choose the right doctor, midwife, hospital, doula, etc?  Word of mouth seems to be the best bet… but wouldn’t it be great if you could hear from hundreds or even thousands of moms about the practitioner you’re considering?

Giving women that kind of access to patient feedback and care-related statistics is the main goal of The Birth Survey.  The Birth Survey is an actual online survey put out by The Coalition for Improving Maternity Services.  Any woman in the USA can go online to fill out a detailed survey regarding her most recent birth.  You’ll be asked to give feedback about one or more specific health care provider(s) through straightforward ranking systems, along with opportunities for your comments.  It’s, “a mechanism to share, systematically track, and retrieve up-to-date information about the quality of care received” so that women can make informed, confident decisions about their caregivers and location of birth. 

Last week, I filled out the Birth Survey.  It felt so worthwhile to take a few minutes (about 20) to share my experiences, so that others can make an informed decision on this critical question.  Unfortunately, local results from The Birth Survey are only available to NY residents, as the survey was first released in NY in a testing phase during 2007.  After success in NY, they expanded the program nationally and have been collecting national results since.  They plan to release national results this year!  Let’s get involved and share the news to improve maternal care and transparency in our nation.  I hope that this database will help women who are considering homebirth or birth at a birth center to feel more confident about their “unusual” choice.  Seeing the statistics of different options side-by-side will really help those on the fence to see that midwives provide excellent, oftentimes superior care to healthy moms, and that those moms are usually quite delighted by their experience!

Click here to visit The Birth Survey now!

 

Hot Topic: Private Cord Blood Banking? January 4, 2009

Filed under: Healthy Living,Pregnancy — Rachel @ 8:57 pm
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Read any pregnancy magazine and you’ll see it, that huge 4 page ad for Viacord and maybe another for CBR too.  Has it occurred to you yet that these companies are making quite a profit on private cord blood banking?  Because, let me tell you, those ads are NOT cheap!!!  Well, they are making a killing.  Parents pay $1500 – 2000 to have their child’s cord blood collected and another $100 per year to keep it in storage for use at their discretion. 

Many parents don’t have a spare $2000 when baby is born, so why are they banking cord blood?  I think it’s the angle these companies take.  Banking that cord blood is a once-in-a-lifetime chance to buy a precious substance that might save the life of one that you love.  Given parent’s intense feelings of protectiveness at the time of pregnancy and birth, it’s no wonder many feel compelled to private banking. 

It’s true that cord blood can be used to treat many diseases, and it’s true that in the future it may become even more useful as science advances.  It’s also true that a parent or sibling is more likely to be a match to that new baby than anyone else, but does that really mean that private banking is the answer?  I say, “NO”!

Did you know that there are public, not-for-profit cord blood banks?  These organizations are taking cord blood donations and making them available to those in need NOW.  If everyone used public cord blood banks, we could save lives today, while at the same time making it likely that in 2050 some new baby’s cord blood will be available should the need arise in your family.  It’s much more efficient to see that cord blood used this year, instead of saving it for 50 years for some unkown, possibly non-existent use.  Unfortunately, public cord blood banks are not available everywhere.  But, if we start asking for them and stop private banking, they will be available in time.

In my opinion, private cord blood banking is not the right choice for a healthy family with no forseeable need for that blood.  I suggest parent’s use that $2000 to eat healthy, make non-toxic lifestyle choices and pursue good health today.  Give away that cord blood, just as you would give away your blood to the Red Cross, and help someone who needs it now.