I am not sure how many of you have been following the plight of one Dr. Wonderful (aka Dr. Biter), but I am so happy to hear him finally speaking out on the whole ordeal (as much as he can). I have been silently reading about him for about 3 years now, and been following his ordeal with prayers that all would turn out well for this marvelous advocate of women and babies!
And finally, for my favorite statement from Dr. Biter:
They don't even know the difference between natural birth and a vaginal birth. They think that, just because a baby is born out of a vagina that that is a natural birth.
But a natural birth is an unmedicated birth, a birth that is honored, where women and their partners are respected, and where that little buddy comes into this world in a solemn sacred moment. That's what a natural birth is!
Labor induction is significantly associated with a cesarean delivery among nulliparous women at term for those with and without medical or obstetric complications. Reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population.
This makes for even more worrisome fodder, as the study also includes this information:
Labor induction was used in 43.6% of cases, 39.9% of which were elective.
Inductions for 43.6% of cases?! How many inductions are too many?? And, based on the information given just previously, how many of those resulted in maternal or newborn risk?
Another study printed with the National Academy of Sciences researched what microbiota habitat a newborn at birth... depending on their mode of birth. The small study found that:
So, in conclusion, to lower cesarean rates and increased risk of newborn strep infections, we should stop inducing for mundane reasons. To lower strep infections, lower the risk for newborn death, respiratory distress, incidences of autism and other SENs, and modestly lowered IQ scores, we need to stop inducing so much.
This is only the tip of the iceberg, people. Oh, the tangled web we weave.
With the rate of inductions being so high in the United States, the question is raised of, beyond maternal and birth risk, what additional risks are there for babies immediately after birth and long-term?
Babies Born at 37-39 weeks gestation are at an increased risk of autism or an SEN (Special Education Need). It was already known that children born very premature were at increased risk for this, but, until just now, no research had been done on closer-to-term infants. The findings report that these babies, babies born between 37-39 weeks gestation, are 1.16 times more likely than truly full-term babies to develop autism or another SEN.
An interesting bunny trail regarding this particular article is that, although the article points out many risks for babies born prematurely, as well as Dr. Michael S. Kramer pointing out that
..... both obstetricians and women should be aware that labor induction at the 37th or 38th week is not without risks. And studies should continue to examine the potential public-health impact of the rising labor induction rate.
He is careful to include the comment that:
"I'm not saying we're at the point that we're doing too many labor inductions," Kramer said. But if the rate continues to increase, he added, "eventually, we may get to the point where we do more harm than good."
hmm... so, even though the induction rate is at or above 22%, and...
Precisely why labor inductions rose between 1992 and 2003 is not known; Kramer's team had no information on the medical reasons for individual women's inductions...
... he is sure to point out that he is not saying that they are at the point that they are doing too many inductions! Even though those inductions carry obvious risk and the rates are still climbing. Hmm...
I digress... So, all of this to say that there is a great wealth of supporting information and studies to show that we are, indeed, introducing unnecessary risk when we induce women without valid medical reason: when benefits CLEARLY and COMPLETELY outweigh the risks.
I cannot stress this enough. You would not believe the number of women who succumb to an induction because they were 'told they had to if they wanted a chance at a vaginal birth', were 'told their baby was due and now we were risking things by allowing baby to stay in past (supposed) 41 weeks', or were 'told that the baby was getting too big for a vaginal birth unless we have them now'. And on and on...
A good reason is when the medically sound benefits of getting baby out of the womb OUTWEIGH the risks of a possible early induction (again, because we cannot know beyond a shadow of a doubt how 'due' a baby truly is until they are born) combined with the risks associated with induction (regardless of when it is performed).
I think it is high time that we start to really consider how much faith we put in human interference versus nature's design.
Kate from Heffalumps and Woozles shared her beautiful birth story with me and I am so excited to share it with you! Go check out her birth story of her son, Logan James.
I was delighted, two weeks ago, to have received the 'early labor phone call' of a dear friend. I invite you to read her story below:
What can I say?
Our girls love weekends. Fridays to be more exact, even though technically this one held out until early Saturday morning.
Last Friday morning I woke up to some strange pains in my back... nothing too unusual as the 60 pounds this little girl and I added could be known to catch up with me. I got up to use the bathroom, an also customary and frequent ritual those days, when I noticed bright red blood. I fought back a few tears, but we've had enough pregnancy scares to know that blood isn't always a big deal. Bright red blood most certainly can be.
So began the choking back of my fear.
We got in touch with our midwives, who felt that things were probably fine but assured us we could come in if we wanted. Since I had an appointment already scheduled for the afternoon, Joe and I decided to head up early. A dear friend was going to watch the girls for me that morning so I could take advantage of a prenatal massage Joe got me for Christmas, and when I called to let her know what was happening she immediately began to pray and encourage! We then called a sweet neighbor, who the girls adore, and she came over to watch them. We smiled and totally relaxed when once on the road our phone lit up with a picture of the girls inside a fort they had built in the family room.
We put in the worship CD we made and during the 45-minute drive north I had at least two contractions. Once we arrived the midwife checked me out and told me things indeed looked fine. I was dilated a whole whopping half of a centimeter. She was encouraging and hopeful, even still, that our little girl would be coming sometime soon.
Across the street from the office is a big beautiful park, so Joe and I set out to walk around it. Just to see if things would pick up. We did one lap hand in hand and my legs felt so tired I told Joe that I really needed to take a break. We headed back to the car with my contractions still sporadic but definitely coming. Next we went to Trader Joes to stockpile a few final things for the girls, and I only had one or two small contractions while there. With that we decided to head on home, pray, and wait.
The girls went down for naps shortly after we got home. The contractions began to come a bit more frequently and many of them much more intense. Yet still nothing that made us believe we should jump in the car. I called my former doula who agreed that I should rest if my body was telling me to do so, and so I tried.
I couldn't sleep for the excitement so I clicked around on the computer, watched a little "Pride and Prejudice," and read over and over my verses of truth while Joe took care of me and feverishly worked to get a big project caught up. By early evening we knew that even though everything wasn't exactly time worthy, it was getting close.
We called our same neighbor and within minutes she and our back-up neighbor arrived. I gave the girls, who both love animals, a movie gift I had been saving... "Diego's Jaguar Rescue Adventure." They were beyond thrilled at such a special treat! Our friends fed them a carpet picnic while Joe and I took a walk around the neighborhood. I just wanted to see if things would pick up consistently before we made the drive.
About fifteen feet into the walk, we knew it was time to get going. Every three feet or so I had to sway through yet another contraction. Several neighbors stopped to wish us well, to tell us they were praying, to let us know they were there if we needed anything. We treasured up all that encouragement and headed back to our cul-de-sac.
I left some final instructions, fought back tears again to hug and kiss the girls, and called my parents to tell them it was time. Mom cried and prayed for us. Dusk was settling as we pulled out of the drive. I could see the light on in the playroom over the garage where the girls were being treated to pink pedicures, popcorn, and "Cinderella." We rolled down the windows and listened to the worship songs as I breathed through each hard contraction. Something about the evening breeze, the words of truth, the knowing that she was probably coming. It was one of those times you just know you'll never forget.
Once we got to Vanderbilt, we were trying to find the parking garage and the contractions were peaking. Joe started to ask me questions about the detour signs, as they were reflective and hard for him and his tricky eyesight to read when I barked back, "Are you serious? I'm the one in labor!!" Needless to say, the pain was starting to cloud the nostalgia a bit. :)
Thankfully, we quickly found the right garage and made our way inside. My bladder was about to burst so Joe found me a lady's room asap; then I was able to calm down so we could make it to check in on the fourth floor.
Being with the midwife practice, I didn't have to do the standard check-in which was a God-send. They got me back to a room quickly where I got into my gown and the attending nurse took my vitals. My contractions seemed to slow down, and I thought to myself what a bummer that would be to still only be at half a centimeter! When the midwife and her apprentice came in to check, though, I was joyful to hear the verdict... 4 cm! Active labor had indeed begun! This would be the time, after all.
When the midwives left me to go check on other patients they had suggested that I try to rest all that I could. I agreed as I still felt so tired. Not thirty minutes after their leaving my room, though, my body kicked it into high gear again. HIGH gear!
The rest of the labor and delivery can be described as hard. And healing. A combo that I've learned often go hand in hand, especially when the end result is nothing short of miraculous. And beautiful... very, very beautiful.
Joe immediately started playing our songs, quoting scripture from our book, praying for God to give me strength, encouraging me to breathe and believe. I tried my typical methods of pain management... swaying, rocking, leaning in to "dance" with Joe. I was too tired, and it seemed my legs would not hold up. I tried our birthing ball... still, no relief. The midwife suggested the rocker padded with pillows. It was there that I spent 95% of the labor.... rocking, holding onto Joe and them, stretching out and vocalizing when each contraction would hit the maximum, repositioning once a short break would come.
At one point they were coming so hard and so fast that I began to hyperventilate a little, which scared me as we all know how prone I am to passing out. After I slowed down and got things under control I asked Joe out of a place of fear, "I will get to go home, won't I?" and then I began to sob. All I could think about was climbing into our bed piled high with books and reading to the girls. Joe assured me that, of course, I would go home and he began to cry too.
I spent a good portion of this labor letting go of fear and past memories, crying, letting healing happen. Then I told them all I needed some relief and I needed it NOW... as in go hunt down anesthesia and give them your right limb if you have to! :)
They assured me that I was so close, but the level of pain did little to help me believe them. The midwife suggested we check in again, and sure enough I was right at the door. She had just begun to also recommend we break my water when I had a contraction to beat all contractions and my water literally broke like some kind of Olympic event. They had never seen anything like it! It was God's emphatic exclamation point to our prayers, and then I had the most wonderful three or four minute lull I have ever known.
During this time I centered myself, surrounded in truth, and shoved fear out of the way. God would give me the strength to see my little girl and soon... Philippians 4:13. I can do all things through Christ who strengthens me!
As the music continued to softly play and everyone got into position I rested quietly and securely in His grace. Fear was gone. Then came the urge to push. The midwife and I communicated well, and in the peace I kept going until I heard the words I had been waiting almost nine months to hear...
She's here... and she's perfect!
Joe and I cried again and marveled at her dark hair, her olive complexion... her striking resemblance to our first born. Joe made me feel like I had basically hung the moon as did those attending the birth. The midwife's apprentice told me through glassy eyes that she had attended nearly sixty births and this is the one that really had her in tears. This love and encouragement was especially beautiful to me because of some afterward complications that required a specialist and almost two more hours of holding on.
Finally we were back to our post-partum room. Phone calls were made, texts given and received, celebrations abounding! We thanked God for bringing us through, for His gift of healing, for the little one who we would come to name Alysse Maribeth Martins. Believing she will speak truth and be a woman after God's own heart, very much like our mothers for whom her middle name is a combination.
As I look down at her right now nursing in my arms, warm against my own body I can't imagine that there was a time she wasn't here. I know she was destined before the foundations of the earth to be in our family, and I feel honored to be her Mama. Her Daddy and sisters certainly agree.
Like so many other professionals on the blog-sphere, I am very geeked about this film:
Doula-la, Rixa, Kathy, and Stork Stories, to name just a few, all said it already. So, simply go to their blogs to read some great information on why skin-to-skin and immediate nursing on the OR table is still a valid option for cesarean mamas.
When I requested doula-attended birth stories for International Month of the Doula, Emily offered the slide show of her son's birth. Enjoy with a box of kleenex. :)
When it comes down to it, there is an average induction rate in the US of 22% (as of 2006), it may be even higher at this point, and induction carries quite a few risks. There are a few different methods of induction, although this post is specifically about Pitocin.
How is Pitocin administered and how does it work? Pitocin is the brand name for a synthetic oxytocin administered through an IV port into the maternal blood stream and diluted with saline ringers.
Oxytocin is naturally produced by the hypothalamus and sent to the pituitary to be released. It stimulates contraction of the uterus as well as let down (milk) and release. It is released in spurts, causing rhythmic contractions of the smooth muscles of the uterus. Naturally occurring oxytocin also enter the brain and cause a euphoric high. When synthetic oxytocin is used (pitocin), it enters the blood stream and does not cross over to the brain, hence, mom and baby are deprived of the love hormone that causes the post-birth high.
Why do doctors recommend induction? Post Date/Overdue: We have talked before about Estimated Due Dates and what they actually mean. Some childbirth educators liken due dates to popcorn - that, just like when you pop corn, some kernels are ready and pop before the others, others pop later.
Big Baby: Throughout history, women have birthed babies of all sizes with no issues, no complications. I know of many many women of different shapes and sizes who have birthed babies that were upper 9 and 10lbs with no issues. Late-term ultrasounds are known to be off by a pound either way, and there is no accurate way to determine how large a baby your hips can accommodate without a serious trial of labor.
Likewise, late in pregnancy, babies are gaining fat stores more than length and girth in bone structure. And the great news? Fat squishes. And, if nothing else can convince you, during a naturally occurring labor, hyaluronidase and relaxin help to loosen your joints and ligaments, including your pelvis, increasing the size of the outlet. These hormones are missing in an induced labor.
Old Placenta: Also known as calcification of the placenta, this is when the placenta begins to show it's age by calcium deposits showing up as white spots on the surface of the placenta. This is very common toward the end of pregnancy and, in most instances, does not inhibit the safety and health of the baby. A care provider may monitor baby more closely to make sure that growth is not restricted as a result.
PROM (Premature Rupture of Membranes): The rule of thumb is this: if your water breaks without contractions, you have a 12-24 hour window in which to deliver your baby before the risk of infection sets in. In reality, there is a large body of evidence to show that induction for this reason alone is not justification, as infection rates do not increase substantially enough during this window. In addition, there are a great number of women whose leaks reseal themselves or end up being 'surface leaks' and not true amnion breaking. Spontaneous labor occurs in 85% of women within 24 hours and in 95% of women within 72 hours.
To further decrease the risk, there are other steps a woman can take. These include: her GBS status (GBS negative, automatically there is a lowered risk for infection), vaginal exams (the less vaginal exams administered, the less risk of infection), and hydration (a woman who remains hydrated has less chance of having a 'dry birth' (although there is no such thing) and less chance of infection as amniotic continuously acts like a natural douche, pushing bacteria out of the vagina) to name a few. A great study on PROM and infection risk can be found here.
Infectious morbidity may be more influenced by the interval between vaginal examination and delivery rather than between rupture of membranes and delivery. “It would seem that the clock starts ticking after a vaginal exam,” she added.
Another issue is to consider this: a woman who has S/PROM at 30 weeks would be closely monitored for infection and given plenty of fluids... hoping to avoid infection and possibly even reseal the leak. The benefits outweigh the risks of induction at this point. Nothing changes 'at term' except that you are now 'at term'.
Other Conditions: Other reasons commonly given for induction may include Gestational Diabetes, infection of the uterus, Pre-Eclampsia, diabetes, hypertension, or other conditions. When these complications present themselves, look into the risks and benefits of both an induction and the possible risks of waiting-and-seeing.. then make an educated decision for yourself.
Risks of Induction One of the most comical, but accurate, media representations of these risks can be found on the Business of Being Born, and seen below:
Some of the risks they touch on in this excerpt:
Contraction intensity - synthetically produced contractions do not slowly build in intensity, length, and duration, as natural labor does, which results in more intense labors. Also, prematurely sending a body into labor means that the body has not had the chance to produce thecocktail of hormones that help labor to be more effective, resulting in longer labors, on average. In some instances, the contractions become tetanic.Additionally, women who are induced are refused nourishment, because the risk for cesarean increases.
Fetal distress/bradycardia - the more intense, longer, stronger contractions of induced labor increase the risk of a baby being deprived of oxygen or experiencing distress because of the intensity of labor.
Severe allergic reactions including itching, swelling, difficulty breathing.
Additional interventions necessary - induction automatically necessitates the use of an IV for administration of fluids as well as the medication. It also requires that mom be on continuous fetal monitoring, in the event that any of the numerous risks do occur to mom or baby, including bradycardia or abnormal uterine activity as discussed above. There is an increase risk of internal fetal monitoring being used as well for the same reasons above.
Bed confinement - because of the increased use of interventions (the difficulty keeping a baby continuously on the monitor when a woman is active laboring), many times a woman is confined to bed or just beside the bed (on the birth ball or chair), further increasing her discomfort, the chance of malpresentation, and the below risk.
Increase chance of pain medication use - because of the increased intensity, increase in duration of labor, and the increase risk of being 'bed ridden' pain medication is used more often, which carries it's own list of risks.
Increase chance of cesarean (because of either iatrogenic complication or failed induction).
And additional risks that the video didn't touch on:
Increase risk of fetal malpresentation - because baby has not had a chance to naturally move down into the optimal position for birth and trigger labor on it's own, a baby may be in a less-than-optimal position for birth, and be forced further into the birth canal in that position, because of the synthetic contractions of an induced labor. This means more incidences of posterior babies, shoulder dystocia, asynclitic positioning, or flexation issues.
Increased risk of vacuum or forceps - because of the aforementioned issue.
Increased risk of infection and postpartum hemorrhage - because of the aforementioned issue, blood clotting issues, as well as the risk mentioned below.
Premature separation of the placenta/placental abruption - the unnatural contractions caused by induced labor can lead to the placenta detaching from the uterine wall before baby is born.
And, for first time laborers, the risk for cesarean increases by two to three times
Uterine rupture - hyperstimulation of the uterus can cause preexisting weak spots or scarring in the uterus to rupture/tear.
Higher rates of neonatal resuscitation due to fetal hypoxia or asphyxiation
Increase NICU risk - with the risk of epidural use being increased (which has the added risk of maternal fever), and the risk of premature labor being increased (baby has not yet sent signals to mom's body to start labor, indicating that they are most likely not yet completely ready for life outside the womb), there is an increased risk that baby will be born prematurely. An induction baby may also be more likely to suffer from jaundice. A baby born even a week or two too early can result in he/she being a near term or late term preterm infant. This means that they are more likely to have troubles breathing, eating, and maintaining their core temperature.
Women "buy" a package of intervention when they ask for induction. Make sure that you know what that package is and carefully weigh the benefits and the risks.
So, now that we know the how, the why, and the risks.. how do we avoid the pit?
Education and rights. Know your rights and your risks. Know your Bishop's Score to make a more informed choice whether you are truly ready to birth your baby or not. What reasons are your care providers giving for induction?
Big baby? Late term ultrasounds are notoriously off on weight estimates. Even if your baby is big, fat (which is what your baby is gaining the most in the last weeks) squishes. Trusting that your body will not grow a baby too big for your body. The average baby will weigh 7lbs and 14oz.. And many many women of all different shapes and sizes have birthed babies that are double digits with no problems.
Overdue? How was your due date determined? Are you solidly sure that your body and baby are truly overdue or is your care provider determining your date of due-ness by a standardized formula? Throughout history babies came when they were ready, induction has not improved the rates of prematurity and maternal/fetal morbidity and mortality.
PROM? Remember that there is no guarantee that you will ever get an infection. Remember the ways to minimize this risk. Remember that, if you were 32 weeks, they would be ensuring close monitoring vs delivering a premature baby.
Other conditions? Understand and research your diagnosed condition. Then carefully weigh the benefits and risks of induction vs. the wait-and-see approach.
Antsy family/mom? If you have to, turn your phone off or change your VM to tell family and friends that, unless they have gotten a phone call stating you are in labor, then you are NOT in labor and baby is NOT here. Ask your SO and other supportive people in your life to spread the news to family and friends that you only want supportive comments, not discouraging ones, about your continued pregnancy. Remind yourself that you are doing a great job of growing your baby, your baby will start labor when he/she is ready, and that you can do anything for 1 more month.
Be prepared to assume the risks and benefits of an induction by pitocin.
Prepare your body for naturally occurring labor and birth before the last trimester by remaining active throughout your pregnancy, eating a healthy, balanced, and whole foods diet, reducing chemical interference and salting your food to taste. Educate yourself to the benefits of using Evening Primrose Oil for cervical ripening and Red Raspberry Leaf Tea for uterine tone.
I give this information not to condemn the choice of induction, but to fully inform and educate so that women (and partners) can make the best choices for their situations. There is to flippant an attitude in our obstetrical model of care to the risks and implications of forcing nature's hand. Be educated.
References: March of Dimes. (2006). If you’re pregnant: Induction by request. Retrieved September 21, 2007, from http://www.marchofdimes.com/prematurity/21239_20203.asp March of Dimes. (2006). Late preterm birth: Every week matters. Retrieved September 21, 2007, from http://www.marchofdimes.com/files/MP_Late_Preterm_Birth-Every_Week_Matters_3-24-06.pdf American College of Obstetricians and Gynecologists [ACOG]. (2004). ACOG Practice Bulletin No. 55: Management of postterm pregnancy. Obstetrics and Gynecology, 104(3), 639-646. Ben-Haroush, A., Yogev, Y., Bar, J., Glickman, J., Kaplan, H., & Hod, M. (2004). Indicated labor induction with vaginal prostaglandin E2 increases the risk of cesarean section even in multiparous women with no previous cesarean section. Journal of Perinatal Medicine, 32(1), 31-36. Condon, J. C., Jeyasuria, P., Faust, J. M., & Mendelson, C. R. (2004). Surfactant protein secreted by the maturing mouse fetal lung acts as a hormone that signals the initiation of parturition. Proceedings of the National Academy of Sciences of the United States of America, 101(14), 4978-4983. Cunningham, F. G., Leveno, K. J., Bloom, S. L., Hauth, J. C., Gilstrap, L. C., & Wenstrom, K. D. (2005). Williams obstetrics. (22nd ed.). New York : McGraw-Hill. Glantz, J. C. (2005). Elective induction vs. spontaneous labor associations and outcomes. Journal of Reproductive Medicine, 50(4), 235-240. Goer, H., Leslie, M. S., & Romano, A. M. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care. Step 6: Does not routinely employ practices, procedures unsupported by scientific evidence. Journal of Perinatal Education, 16(Suppl. 1), 32S-64S. Kramer, M. S., Demissie, K., Yang, H., Platt, R. W., Sauve, R., & Liston, R. (2000). The contribution of mild and moderate preterm birth to infant mortality. Journal of the American Medical Association, 284(7), 843-849. Tanner, L., & Associated Press. (2000, August 16). Death risk higher for preemies: Study reassesses danger for those born just a few weeks early. Dallas Morning News. Vahratian, A., Zhang, J., Troendle, J. F., Sciscione, A. C., & Hoffman, M. K. (2005). Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstetrics & Gynecology, 105(4), 698-704. Wang, M. L., Dorer, D. J., Fleming, M. P., & Catlin, E. A. (2004). Clinical outcomes of near-term infants. Pediatrics, 114(2), 372-376. And all linked sources throughout this article.
Hallelujah! After having gone nearly 24 hours with no internet connection, I am hanging on by a string to send you the winner's list for the International Doula Month Giveaway!
I used Random.org to draw these names and am happy to post the winners by giveaway number:
Wendy
Rochelle and Heather
Megan Morton
Paige (mini blooming belly) and Katy Rose (yoni pendant)
Dawn Star Borchelt
TopHat
Krystel
Peace Love and Leener
KBH
Kim Schellingerhoudt
Sheridan
Heather
Lindsay
MamaVee
Delightful Pregnancy
Michelle @ Knitted Together
DoulaLuvMe
Ladies - I will leave the winners open for 1 week. You must have contacted me by email (wonderfully_made139 (AT) yahoo (DOT) com) by June 8th with: Your real name Your address Your winning giveaway #
If I have not heard from you BY THAT DATE, I will redraw for your giveaway and notify the runner up.
It was so much fun getting to know the vendors and getting all of the reader's feedback on different items and stores. Thank you, everyone, for making this a success and so much fun! Congratulations ladies!!!
