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

Filed under: Pregnancy — Rachel @ 9:09 pm
Tags: , ,

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).
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Must-Reads for Pregnancy & Birth August 27, 2009

Filed under: Pregnancy — Rachel @ 3:57 pm
Tags: , , , ,

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.
 

The Business of Being Born May 15, 2008

This weekend I watched Ricki Lake’s documentary, “The Business of Being Born”.  I was absolutely blown away by the clarity and gentleness by which the film discussed what is so often a messy topic: what should birth and maternity care look like?  

The film brought together the voices of OB/GYN’s, Labor & Delivery Nurses, Midwives, Pregnant women and Postpartum mothers to take a fair, unbiased look a the issues at hand.  What issues, you say?  Well, when you look at the stats on maternal mortality, infant mortality, and c-section rates, the United States trails most every “developed” country and even lags behind certain “undeveloped” countries.  And this despite the fact that Americans put soooooooo much more money into maternal and infant healthcare!  We pay more and get less.  What’s going on here? 

You have GOT to watch the film to find out, but here’s a taste of the action from the director, “When my friend Ricki Lake approached me about making this film, I admitted to her that I was afraid to even witness a woman giving birth, let alone film one. I had never pronounced the word “midwifery” and I thought Ricki insane, as she planned the birth of her second child, for passing up an epidural in a hospital delivery.

But as I did the research, I discovered that the business of being born is another infuriating way medical traditions and institutions – hospitals and insurance companies – actually discourage choice and even infringe on parents’ intimate rites, ultimately obstructing the powerful natural connection between mother and newborn child.”

I LOVED THIS VIDEO!  If you’re pregnant, you should watch it.  It’ll give you such a realistic preview of what healthy birth looks like, including all types of normal births from vaginal to breach to medically necessary c-section.  It was inspiring to the point of tears, and entirely real through and through.  Before you make your birth plan, watch “The Business of Being Born”!  

 

The Best Prep for a Non-Medicated Birth April 15, 2008

Many women desire to give birth without pain medication, or at least with as few heavy medications as possible.  How do you prepare yourself for that challenge?  What makes the difference between a woman who throws out her birth plan and gets that epidural and the one who manages her pain in the way she had hoped? 

For one, you have to realize that women feel contractions differently.  Some experience contractions as extremely painful, but others just feel tightness or almost nothing at all.  My friend Chihiro said she couldn’t even tell when she was contracting with her first baby, but with the second she experienced intense pain.  Prepare yourself by keeping an open mind to how easy or difficult the actual experience may be for you.  It’s completely unpredictable.

That said, countless women who experience intense pain during labor do manage to forgo medicating.  Now, I realize that a non-medicated birth isn’t for everyone, but if this is one of your goals here are some tips:

  1. Limit your exposure to medication opportunities.  Really.  If you don’t want to take drugs, try to avoid having them offered to you.  When you enter the labor room, personally tell the nurse that you prefer she NOT offer you medication.  Ask your birth partner to keep new nurses updated.  I heard of one woman who hung a “Don’t Offer Me Medication” sign on her labor room door.  Hey, it’s easier if you don’t have to say “no”.  If you really, consciously change your mind, I bet you’ll find the words to ask for that medication!
  2. Train your mind to think of birth positively.  Birth is an opportunity to bond with your mate, work hard for something worthwhile, experience the thrilling joy of success hard-won, and embrace that new baby for the first time.  Read LOTS of natural birth stories!  This is the most enjoyable and probably the most effective way to prepare for a natural, non-medicated birth.  Each time you expose yourself to stories of women who experienced birth like you desire, you set yourself up to approach birth with a positive, confident attitude. 
  3. Prepare to be flexible.   Your birth will probably NOT go exactly as planned.  Maybe your contractions will stop temporarily. Maybe your doula will not make it.  Maybe your labor will drag on for over 24 hours.  Maybe you’ll go from 2 to 10 centimeters in an hour – who knows!!!  It’s great to have a plan, but be prepared to throw it out the window.  Spend some time imagining very different possibilities and how you would like to react.  No matter what happens, you can have a fulfilling birth experience if you keep your perspective positive and take control of your choices.  In birth you are not the victim or the patient, you are the mom.
  4. Gain access to alternative pain management options.  If you’re saying “no” to drugs, say “yes” to something else! Read, talk to other moms about what worked for them, and arrange for the services of a midwife or doula.  There is a rich culture of birthing aids from warm water to massage to visualizations that can make a huge difference in your perception of pain during labor.  Your labor nurse is very unlikely to be of help in this area.  You’ve got to proactively plan ahead to arm yourself with safe, effective labor tools.  Again, reading positive natural birth stories is an excellent way to fill your mind with pain management ideas. 

Bottom line: managing pain is 90% mental.  The difference between achieving your goal to birth without drugs and making a decision to medicate that you may regret is usually how prepared you are mentally.  Know that you can do this.  Focus on the positives and let every contraction bring you closer to holding that baby in your arms.

One great classic full of positive birth stories is Ina May Gaskin’s “Ina May’s Guide to Childbirth”.  You can also find a rich resource of birth stories at Mothering.com

Many blessings!

 

Who will witness your baby’s birth? December 3, 2007

Filed under: Pregnancy — Rachel @ 7:53 pm
Tags: , , , ,

You’ve made a birth plan, you’ve packed your hospital bag (or set aside a stash of supplies for your home birth), but are you still a little fuzzy on who you’d like present at your baby’s birth?  This is a very personal decision, and one that doesn’t necesarilly lend itself to the receiving of advice.  I had a very hard time deciding with both my babies who to include. Perhaps this will get you thinking… 

If one of your goals is to have a natural birth, it’s especially important that those who accompany you in the labor room play a supportive, encouraging role.  I loved this quote in the latest edition of Fit Pregnancy, “For the best possible delivery, surround yourself with people who understand that giving birth is a heroic, if painful, act that benefits those who embrace its challenge.”  Isn’t that beautiful!  Think carefully before including loved ones that are critical of your birth choices.  On birth day, you simply won’t have enough emotional energy to deal with nay-sayers.  You want to see excitement and hope in the eyes of your attendents, never pitty or fear.

You will almost certainly be including your mate, but what about sisters, mothers, and friends?  Don’t feel obligated to invite family members.  Your first priority must be giving birth, not the feelings of others.  That said, if you are close to your sister (and especially if she’s given birth before) or your mother, their presence will probably enhance that special day.  My mother was a very important member of my birth team when I birthed my firstborn.  During the times that I felt hopeless and scared, looking into her face gave me strength.  There is something powerful about being supported in birth by the very one who birthed you.     

When I read of births in which mothers were attended by excited, joyful friends, I love it, love it, love it!  But in planning my own birth, I felt odd inviting friends.  For my second birth I did get up the gumption to invite a close friend who shared my own vision of birth.  Technically she was there to watch my toddler, but she also was meant to share the actual birth.  During my labor, it was fun having her there.  It made that night more like a celebration, less serious and more exciting.  When I was actually giving birth, I barely noticed her presence because I was so focused on the task at hand.  If I was to do it again, I’d invite more friends and make the labor itself more of a party!

Don’t skip a doula!!!  If you can arrange for it, do look into having a doula attend your birth.  There’s nothing like it!  Having a doula around at my second birth took the pressure off my husband to know how to comfort me.  She helped him with suggestions and did so much to help me herself.   I would never go without a doula again!

Many blessings on your special day!

 

    

 

Common Hospital Practices are Counterproductive October 25, 2007

Filed under: Pregnancy — Rachel @ 7:06 pm
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I was so happy to see this column in the October/November issue of Fit Pregnancy, “For low-risk women, common hospital practices such as labor induction do not improve health outcomes for mothers or babies and often cause harm.  Electronic fetal monitoring, nonemergency Cesarean sections, routine use of IV fluids, amniotomy (breaking the bag of waters), withholding food and water and episiotomy were all found to have adverse effects on mother, baby or both.  The study, “Evidence Basis for the Ten Steps to Mother-Friendly Care,” found that inducing labor increases fetal distress and that babies born after elective inductions are more likely to require admission to a neonatal intensive care unit. To avoid these problems, the researchers recommend midwifery care for low-risk women. – Erica Jorgensen The Journal of Perinatal Education.”   

Granted there is a place for most of these common hospital practices.  The point is that you should push for a natural birth, delaying interventions such as induction or Cesarean until they are absolutely necessary, as this is what’s best for you and for baby.  It is sad, but true that sometimes caregivers are more interested in their convenience then your best outcome – doctors and nurses are only human.  Be your own advocate for a safe, healthy birth!