Induction

Hmmmm...what to say about this subject?

Well, there is plenty to say, but not always without offending someone. So, let me just say this upfront...I am not here to knock anyone for the induction/c-section that they had. If you are happy with the things done during your pregnancy/labor/delivery and the reasons given for those things, I do not want to 'induce' (ha, nice) regrets into your life.

Yesterday on Facebook I posted the following status:

all pregnant women out there: DO NOT GET INDUCED unless there is a real need for it, i.e. preeclampsia, etc. be sure to research the things that actually constitute REAL NEED (a day past due, size, etc. don't make the cut). i'm so sad every time i see a friend heading for the c-section table...all because they induc...ed. just be patient, people. the baby will come when he/she is ready...God knows what He's doing.

If there were good reasons for your induction/c-section and you are at peace with that, like I said, not trying to stir up un-peace. In fact, if you don't plan on having more children biologically, don't read any further (unless you want to inform yourself in order to help others, which would be great). Again, don't want to stir up regrets.

If you choose to read on, just know that it is not a personal attack. These decisions are very, very personal. But, everyone should be able to make an informed decision. Many are not informed. I have a passion to inform.

IF you do plan to have more biological children (or you want to be informed in order to help others in the future), it would be a good idea to inform yourself really well. And, of course, from the comments yesterday, there are definitely those who are very unhappy with their outcomes. Sadly, I hear that over and over.

Yesterday I saw where yet another one of my friends was induced and ended up with a c-section. That's what sparked that status.

FYI sidenote: I will be using the word 'intervention' alot here. Interventions include the use of medication to start/speed up labor (Cervidil and Cytotec are put into the vagina to soften the cervix, although Cytotec is not/should not be used readily anymore because of dangers; and Pitocin is given in IV form...most of the time, doctors just start out with Pitocin), IV (even if not receiving Pitocin or pain meds), continuous electronic fetal monitoring (external and internal, where a little wire is screwed into the top layers of your baby's scalp...see picture), pain meds, breaking your water, episiotomy, the use of forceps/vacuum (suction) to pull the baby out, c-section, etc. There are many possible interventions within pregnancy/labor/birth/postpartum care. Just wanted to give that little FYI.

Here's the truth backed up by research...once you start to intervene in the birth process, there is a definite domino effect. One intervention usually leads to another intervention, to another intervention, etc.

Two things don't help:

1. As great as doctors are for sick people, they are not that great (with the exception of a few very rare birds) for non-sick people. And pregnancy is not a sickness. NORMAL pregnancies (which are BY FAR most pregnancies) should not be treated like a sickness. As great as doctors are, they have been trained to treat sick people...even ob/gyns.

We have a huge hole in our maternity care in the United States (and Brazil). We need midwives to treat the normal pregnancies and doctors to treat the pregnancies which include sickness. That is done in many, many countries other than ours (developed countries) where they have a much lower infant mortality rate and much fewer complications.

Because of this training that doctors have, unfortunately they are very good at 'creating' problems (watched a documentary last night which included a doctor himself saying that very thing). They hover and trust their equipment/interventions more than they trust women's bodies. I really am not trying to badmouth doctors. They truly are just doing what they've been trained to do...take care of the sick. The problem lies in the fact that most pregnant women aren't sick.

2. Nobody wants to give birth naturally anymore. OH HOW VERY MUCH I COULD SAY ABOUT THIS (and eventually I will I'm sure). This definitely effects your likelihood of interventions. Pain meds (most commonly in the form of an epidural) obviously effects your ability to move. The lower part of your body is numb after all. You can't walk or move around or change positions. Therefore, you are definitely limited in what you can do.

So many times, a 'stuck' baby or 'prolonged' labor would not be if the laboring woman was able to move around and change positions. God thought of EVERYthing, I'm telling you. EVerything. He made our bodies so very able to birth the babies that He puts in them. If you really studied every single little thing that happens during pregnancy and the process of birth (natural, umimpeded birth), wow...it's just literally amazing.

Your pelvis is not fixed, but very flexible due to these joints (shown in picture) and hormones like relaxin. With movement (which is not possible with pain meds usually...or, also, sometimes isn't allowed because of policies about continuous fetal monitoring), the pelvis can shift, allowing for the passage of your baby...even a big one. Different positions open your pelvis up more. Unfortunately, lying in a bed with your legs up is a position that doesn't cause any opening of the pelvis.

Not only are you effected physically by pain meds, but also your baby. Your baby has an active role to play in birth too...but, often times is too sluggish to do it.

So...given just these two bits of information being in place, no wonder there are so many interventions which so often lead to c-sections.

What do we do about it? What is best for us and for our babies? We are so 'comfortable' in our conveniences these days. The documentary I was watching last night is a Brazilian documentary. One doctor was bringing up the point that planning leads to success in most of life. But, birth in its natural state cannot be planned. So, our 'successful' selves worked out a way to plan it out...unpredictability is not acceptable anymore. Let's induce.

I believe that unless there is a medical reason to induce it should not be done. Studies show it's best not to. Even ACOG (American College of Obstetricians and Gynecologists) suggests this. In this link (in the last sentence) to the release of new ACOG guidelines in 2009, there are a couple of statistics cited...1) the rate of labor induction in the US has more than doubled since 1990, and 2) in 2006, more than 22% (roughly 1 out of every 5) of all pregnant women had their labor induced. Wow...that is definitely out of control. 1 out of every 5 women do NOT have a medical reason to induce.

This is a great article about inductions. Love that it very clearly states that macrosomia (big baby) is not an adequate reason for induction (as do many articles out there). As does ACOG.

These are the 2001 ACOG guidelines on macrosomia (couldn't find where they have revised it since then). I had a macrosomic baby. Eissa (#3) was 9 lbs. 14 oz (my first was almost macrosomic at 9 lbs. 2 oz.; picture to the side is of me in labor with little Miss 9 lbs. 14 oz.). According to ACOG, 9 lbs. 4 oz. is considered macrosomic. I am not petite, but I'm not Mrs. Huge either. Eissa was born with no problems, even though her shoulders did get stuck a bit. It was no big deal though...my very experienced midwife just helped her out a bit and I was, of course, in a great position (squatting and then moving around a little when the shoulders got stuck...not lying down) to help with the process. I pushed (and move around) for only 9 minutes with Eissa and then she was out. I have another friend who has given birth five times at home...she is very petite (around 5'3"). All five of hers have been over 10 pounds...one was over 11 pounds.

God knows what He's doing. But, then again, of course it's better to do it nature's way...otherwise, yes...you are more apt to have problems because of the effects of meds and positions and interventions. But, to say that it's not possible from an estimated weight (that is often way off) should NOT be done. It is possible and is proven over and over every single day. And also to say that goes against what OB/GYN guidelines themselves say, as you can see.

The ACOG committee provides the following recommendations for the management of fetal macrosomia:

Recommendations based on good and consistent scientific evidence (Level A):

* The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold's maneuvers).

Recommendations based on limited or inconsistent scientific evidence (Level B):

* Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes.

* Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g (11 pounds) in the absence of maternal diabetes.

* With an estimated fetal weight more than 4,500 g (9 lbs. 4 oz.), a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. (Michawn's addition: Natural births very rarely have this problem.)

Recommendations based primarily on consensus and expert opinion (Level C):

* Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

* Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery. (Michawn's addition: Awesome. If you are fighting to try for a VBAC, you might want to politely and respectively bring this ACOG suggestion up with your doctor.)

I also really like this blog post with lots of information...along with all the comments.

Several articles cited distance from caregivers as sometimes a prudent reason for induction. IF you have a history of very rapid deliveries, that is a choice you have to make. But, if you do not have a history, don't let fear make your decision for you. The average first-time labor is 16 hours. I don't know anyone who lives 16 hours away from their caregiver. The average for labors after that is 7-8 hours. My 2nd was 5 hours (active labor). My 3rd was 7 hours. My 4th was only 3 hours and 20 minutes of active labor, but even that would've been long enough for me to get to my caregiver who lives over an hour away. And...IF you are informed and prepared the way every pregnant couple should be, you would not be fearful of even delivering that baby on your own. Thank God for knowledge and truth...it really does set you free.

Please...get informed. Take a class...not just any class that the hospital gives (those are so very often, to put it bluntly, horrible). Get in a class that really gives you tons of information (of course, I recommend a Bradley class). It might cost you something, but isn't preparation for the entry of your baby into the world worth it?

Birth is likened to a triathlon. If you knew you were going to be participating in a triathlon, you wouldn't think of showing up for it that day having had no training! But so often couples just show up with no training for bringing their baby into the world...an event MUCH more important than a triathlon.

Train. Learn. Research. Question. Believe in yourself and God who made your body.

Please, feel free to ask any questions. I know that this sort of thing can really stir up lots of feelings, esp. when you've done it the way that I've just 'spoken against.' Again, not hear to 'bash' the way you did things. Just want to inform others...many are looking for different ways. You might not be one of them and that is your choice. But, if you are, please be informed.

I'll leave you with just a few other things I've found in researching. Of course, there are tons more that I've found over the years...SO many more. But, for now, this will do. Enjoy.

This article is a very objective article focusing on pain medications used in labor. Gives some great information in a concise way, including effects of these drugs on baby.

I love this article. It is very informational. And, for those who don't know, doctors of osteopathy (a DO instead of an MD) undergo a very similar curriculum as MDs (almost equal), but with the addition of the study of osteopathic manipulative medicine, which basically just applies a more holistic view to patient care. We had a DO in Phoenix...loved him!!

This article is really good as far as information too. I don't love the video, but it is informative.

Incredibly written and respectful article about avoiding the 'cascade of medical interventions.' I love Mothering magazine.

Not saying your baby is too big? Maybe they are worried your pelvis is too small. Here's just a little something I ran across on that.

And this little snippet with great links and great sources (listed at bottom).