Newsflash: Pitocin could harm your baby

For some of us, the idea that Pitocin is not exactly a walk in the park is nothing new. So when this official proclamation came from ACOG, a lot of people were like, "Well, duh." 

Apparently this is "the first study of its kind to present data on the adverse effects of Pitocin use on newborns." Considering how deeply entrenched its use has been since its inception as the drug we know today, I find that incredibly shocking.

Unfortunately it seems like either those who swear up and down that it's the Devil's poison end up getting it, or those who are warned "don't induce!" often find out the hard way that in many cases, yes, it does suck as badly as everyone said it would. (Although obviously this is not the case for everyone.)

Back when my niece was expecting her first child, she said she was not planning on inducing but asked for advice about it. I tried to offer my opinion without sounding preachy, and a many of her friends said that in their experience, it was terrible and to avoid it if she could. I don't know what happened, but the next thing I knew, she was getting induced, had a hellish labor, and now apparently doesn't want any more children. *sigh*

What I've noticed is when people are asking about Pit, there are usually tons of people who relay their experiences - some okay, some great, some perfectly horrific and the stuff of nightmares. I'm not one to try and scare women by propagating horror stories, and whenever I speak of this stuff I try to be as balanced as possible. But I can't help but notice that usually, all the dissenters are ignored, their advice chucked to the curb and the mom is induced, sometimes with not so happy results. Sadly, it seems like those who filter out what they don't want to hear seem to have the worst time of it.

Either that, or one of two things happen: a dozen people say, "Well, I had it in labor and did just fine," as if they refuse to believe there is actually a problem. Or, they list the numerous reasons why they needed it in a defensive tone, which is kind of sad. Again, for some women, it's what they need and can really benefit them. But for everyone? I don't believe it.

I think some women get defensive because their hackles immediately go up and they miss the part where, again, it says that for some women, it can be a life-saving, very important drug to have on hand. I also wonder if they are in denial that their doctor could ever give them something that might be unsafe, completely trusting them with their own wellbeing as well as their unborn baby. I'm not necessarily saying that they aren't acting in your best interests, but rather questioning why this needs to be standard fare in so many hospitals today. One source suggested that approximately 81% of women receive Pitocin either to augment or induce labor. 81 percent?!

And because it's become so commonplace, it's perceived as unequivocally safe, a perfectly normal and acceptable routine of labor. If you question it, I highly doubt your doctor or nurse is going to calmly say, "Oh, you don't want it? Okay, that's fine." Administration protocols seem to vary by hospital and doctor, and while some appear to follow perfectly reasonable guidelines (especially the idea that if this isn't working, let's send mom home), others are outrageous - as expressed by nurses who work with these people, not just "natural birth hippie chicks."

From a popular internet forum for nurses. Click to enlarge. 

Some things to consider:
• Sometimes inductions and Pitocin use are completely necessary and the best thing for both mom and baby. If at all possible, perhaps suggest a gentle induction that can get things started in a minimally invasive way. Remember that in first-time moms, inductions can increase the risks of cesarean, although sometimes this is unavoidable. (Pre-eclampsia is a good example.)

• Sometimes it is not necessarily the best course of action but is given anyway. Know that you have rights. Some women do say that while they refused it during their labors, they had it given to them anyway; perhaps hiring a doula or having a birth advocate present with you may help. Some reasons for its use are dubious at best, and can cause more harm than benefit. (For an example, click here.)

• Get all the facts prior to an induction and ask lots of questions. If your doctor starts talking about an induction early on as a matter of course, this could raise some major red flags.

• Throughout its history, it has affected different women differently. This can depend on a number of factors, including how aggressively it's administered. While it can have many benefits, it is not without risk to both mother and baby.

More reading:
Pitocin side effects
Five ways Pitocin is different than oxytocin

The $64,000 question: Why do you "need" Pitocin in labor?

Photo credit: Brian Hoskins

A few months ago I posted this article from a labor and delivery nurse who admitted the real reason why you "need" Pitocin: to free up hospital beds. Over 200 people shared it, and I don't think many people were happy about her piece. When this article was posted on the mothering.com forums, it got the discussion thread shut down. So I guess Nurse Jenna created quite a stir!

I reposted this article on FaceBook yesterday and have been thinking about it ever since. The use of the word "need" irritates most people, including me. But there were some other things that set me off.

It underscores, among other things, the absolute garbage medical practices that pervade in obstetrics that not only put mom at unnecessary risk, but her baby as well. What Nurse Jenna's article does is unintentionally admit that often the best interests of both mom and baby are not in the forefront. In the very opening paragraph of her article, she sets a rather condescending tone:

Many women come to labor and delivery fearing Pitocin, loathing Pitocin, and swearing up and down that “over their dead body” will they have Pitocin to augment their labor.

Truth be told, if anyone knows how miserable Pitocin can be, they've probably heard it from other women who have been there, done that. This winter my niece was facing a (basically unnecessary) induction and everyone on her FaceBook were telling her to "avoid the Pit! It's miserable! You'll hate it! Don't do it!" You would have thought she was contemplating suicide, their tone was so adamant. Did she listen? Nope. (Because, after all, we were a bunch of "uneducated women" and her doctor "knew best.") She ended up getting induced and having a horrible labor, although I still haven't heard the details and am not sure I really want to.

Nurse Jenna sort of tries to absolve the doctors and nurses of their guilt over improperly administering Pit by taking the "blame the mother" approach: moms don't stay home long enough, want pain medication in early labor, and in the comments section, moms "insist" on being admitted before they're actively laboring. No where does she really say that doctors are doing it all wrong, but rather, "We want the mother to stay home as long as possible." She mentions how "we" want you to labor comfortably at home in the early stages, where you have access to food and fluids, supportive family members, a bathtub, etc. Seriously?! (Because we all know that once you enter the hospital, all of those things are often restricted to you, even though they can help progress your labor tremendously.)

While I agree that staying home until you no longer feel comfortable is the best idea, a) this seems to contradict what hospital staff often tell us and b) it doesn't necessarily mean you won't be given Pitocin, regardless of whether you need it or not. According to Dr. Roberto Caldreyo-Barcia, former president of the International Federation of Obstetricians and Gynecologists, "Pitocin is the most abused drug in the world today."

Because there is such widespread misuse and abuse, patients often think it's totally normal. Few are going to tell you "Hey, you don't really need this stuff, you know. You can refuse," and instead make you feel like the bad guy if you don't do it. Your baby is the weapon of choice against you, and a powerful one at that. Nurse Jenna's article also highlights how trusting some are of the medical profession and just put everything in the doctor's hands. Many mothers, especially first-timers with no prior experience, will take their doctor's advice as the gospel and comply, even if it goes against their better judgment or wishes. They don't want to be seen as difficult, and if you appear to be questioning your doctor's judgment it could be a long haul for you as the patient. Of course she doesn't mention fetal distress, the rising rate of cesareans and how induction can contribute to that, especially in first-time mothers. And the idea that, even in a woman who is laboring well on her own, maybe with an irregular pattern of contractions (or not even) you might still stand a good chance of getting it. I wonder if this is less about freeing up beds and more about "Ok, let's get it over with so we can move on to something else."

(Case in point: my neighbor had her second child in May, this time going into labor on her own. Labor had slowed down, apparently, and her well-meaning mother-in-law told me that she was given Pit and "the baby was born 20 minutes later." What?!)

Nurse Jenna's post illustrates the problem our maternity industry has in general: more beds are needed, so let's rush things along over here to make room over there. That is not good medicine, and treats the patient like a number or as if they're giving birth on an assembly line. (Which explains why some maternity units are unaffectionately called "baby factories.") How many women do not even get to this point because their due date falls near a holiday, someone's vacation or other important event? People have criticized the idea that "OB's golf, so they need to induce you so they can be there for tee off." Maybe not golf, but the idea that they do not want to be "waiting around all day/all night for you to deliver" is pervasive, so don't kid yourself. The days of your OB rushing in at 11:30 at night in a tux (like my mom's OB did in delivering me) are long over.

While Nurse Jenna blames mothers on "insisting" they be admitted early, I wonder how common this is. It seems more commonplace to keep mothers who should be sent away because you'll simply Pit them into oblivion. I've also read accounts where they aren't "allowed" to go home, even though they want to. Staying home longer is probably key in reducing your risk of getting Pit, but how many of us have heard, "Well, you don't want to deliver in the backseat of your car/on the toilet/in a public place, now do you?" Many women who are in the advanced stages of dilation but not in active labor are sent directly over to the L&D unit ("Do not pass go, do not collect $200!") to be induced when they don't even want to be, including a woman commenting on Nurse Jenna's post. Just because you're 4 cm doesn't mean "it's time," and even though it's not what mom wants, she somehow feels compelled to cave, often because of pressure from her physician.

I'm sure doctors and nurses grow increasingly frustrated at patients who know little and "insist" on care they think they should be receiving, when really, there is an alternative. Instead of accusing, though, healthcare providers should be informing, and telling patients why you should go home - but I think that would reveal other faults on behalf of the hospital and they're not willing to admit to unnecessarily aggressive induction practices. Conversely, it seems that if you know too much - enough to question and refuse - you're treated like crap then, too.

More women probably stay because they don't realize they have a choice, rather than because they "insist." In my time both as a hospital employee and a patient in L&D, I have never witnessed a mother becoming belligerent because she can't stay. And never, in all my talks with mothers, have I heard someone say "I insisted on staying in the hospital because they were threatening to send me home!" Usually, mom thinks there's something going on, hospital staff say no, and she's sent home, tail between her legs. (Yet all the while with the threat of "You don't want to give birth in the car!" hovering in the back of her mind, right?)

Basically, Nurse Jenna is part of the greater conundrum of "modern" obstetrics: don't stay home too long, don't get here too early. If you want to walk, stay home (one L&D nurse's comment). If you walk while in the hospital, it means you can't be hooked up to monitors and machines, but it could progress your labor - but still, don't walk. If you get here too early, going home is not an option anymore. If you labor at home, you'll be punished for not seeking medical 'care.' If you come to the hospital too early, you'll be punished for seeking medical 'care.' So deal with it. Either way, you can do nothing right and it's your fault. 

Some of the comments on Nurse Jenna's article are interesting, and very telling:

The pitocin seriously made me want to kill myself, even after having the epidural.  It truly was awful.

Unfortunately this woman had come in for induction because her baby had died. After 30 hours of hell, she ended up with a cesarean. (!?)

A failed induction, but hey, thank God for the Pitocin!

i had come in for an induction and had pitocin to get things moving faster the next morning...i didnt care, im not that anal about stuff like that! i know there were other women that needed a bed too! and i am grateful for the pitocin post-delivery/csection to help my uterus contract.. 

At 4 cm but not in labor yet? Who cares! Let's just induce!

I got to the hospital at 4cm, but would have much rather still been at home.  I had a severe headache, and dizzyness, and called the dr's office and they sent me in to have my blood pressure checked.  I wish they would have let me go back home since my blood pressure was fine (I only live 5 mins away), but instead once they checked me and I was a 4, they called the dr., and he decided to just come break my water.  I was so frustrated, because he broke my water and started pitocin and the contractions practically stopped for about 3 hours.  But I could get up or anything since they'd already broken my water.  I was so irritated because it was not my choice to go to the hospital yet.

One commenter kind of blows Nurse Jenna's argument out of the water, and probably many of us can agree:

I certainly was told about "Pitocin-passing" by a nurse.  I was in a car accident when I was 24 weeks pregnant and moving to a new city.  While they monitored my contractions in the hospital I had a great chat with a nurse who gave me the low down.  When I told her I wanted a completely drug free birth she told me which hospital to avoid (named the baby machine hospital because they do so many births and regulate with Pitocin) and which drs. would be sympathetic to a drug free delivery. 

And probably the best comment EVER:

Who is we? The God's of the delivery room? NATURE decides when the baby will come! I'm glad I was informed and confident in my birth not to let a dumbass like you [be] in control! 

Am I on a birth crusade?

I think I need psychiatric help. The more I read, the more I want to bang my head against a brick wall.

I often like to punish myself by reading (and answering) questions on Yahoo! Answers, an internet forum where people can write in and ask questions about all kinds of topics. I am a regular in the pregnancy forum, and consider it, on a good day, a way to reach hopefully hundreds of women and perhaps help them out in some way, whether it's by providing comfort, information or just my own personal experience.

However laughable it sometimes is, I consider this board and others like it (BabyCenter, etc) a network of "real" moms, a healthy cross-section of what women are experiencing in today's obstetrical system. One hot topic is induction of labor and c-sections, and of course, I have a lot to say. I've never been induced, but have three kids, have been through the 'labor and delivery system' with my own share of roadblocks, and have read a ton. Sometimes I think it's never enough, because I keep learning more each day that makes me want to run screaming for the hills.

I'm "just" a mom. Not a doctor, nurse, or even a doula (although I might be one when I grow up!). I haven't labored with countless women to see firsthand. So for those who are and have, I don't know how you do it. Combatting the myths and ignorance on a face-to-face basis every day would be enough to make me want to drink. Heavily. All the time.

One gem on the Y!A board of questions today made me cringe and laugh out loud. A concerned mother was writing in because her baby's heart rate during a non-stress test was over 160 beats per minute, and the doctor was concerned and mentioned an induction.

I thought back to all of my pregnancies and how, more often than not, the baby's heart rate was hovering between 150 and 160 BPM during each checkup, which the doctor said was perfectly normal. In fact, there's a wide range of "normal" when it comes to this.

I answered her and told her that was considered normal (one source I read suggested even up to 180 was "normal,") and that I thought her doctor was trying to scare her. Bring on the thumbs down, of course. As it often plays out with doctors, if you are pregnant and don't want to be induced, poked or prodded, people don't know what to do with you. Women were quick to reassure her that what the doctor was doing was right, that inductions are no big deal, blah blah blah. One poor woman had this to say:

I was induced at 11am, when I hadn't progressed at 4pm the inserted IV and gave me epidural, I had no pain so read a book, then at 7.15pm I gave 2 grunts and my baby was out without and (any?) need of intervention ...

This is the part where I started laughing. If an IV and epidural aren't interventions, what exactly are they?

Someone else responded with this:

Don't worry about it too much, it really isn't that bad. If they want to induce you, it'll be for a good reason. My baby wasn't ready either, but you have to do what's best...I had a perfectly normal labour and a beautiful baby boy. Ignore the horror stories, everyone's experience is different.

I honestly don't think this woman would know what a "normal" labor was even if her doctor beat her over the head with it, which is unlikely because her doctor probably doesn't know what "normal labor" is, either...

(I hate coming off as anti doctor, and it pains me to accuse doctors of not having their patients' best interests in mind, but really, how could they when they submit women to these things?)

What really gets me is that if you ask these same women if it's okay to take Tylenol during pregnancy, they'll probably say no, that it's unsafe for the baby. And yet you willingly go through this for no reason?  *scream*

We can blog all we want, but do we know if we're really reaching enough women to change anything? Sometimes I feel like they don't want to change, because they have no idea the reality of the situation. Their reality is not their own; it's their doctor's. Whatever he or she is telling me must be true, and therefore I'm not going to trouble myself to find out otherwise. Anyone who comes along and tries to tell me differently is a nut, and I'm just not going to listen.

For those who are true birth advocates in the field that offer support and truth-based, evidenced-based care to your patients, I don't know how you do it without coming apart at the seams.

I wonder if perhaps putting a list of the dangers of inductions and c-sections on the side of a milk carton might be the way to go here...

Pitocin: the most abused prescription drug in the nation

"Pitocin is the most abused drug in the world today." -- Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists

Depending on how you look at it, I agree with Dr. Caldreyo-Barcia - I think Pitocin is one of the most overused, often abused, prescription drugs in the medical industry today. There are lots of suspected reasons for our out on control c-section rate in this country, but to me, one sticks out like a sore thumb: the number of induced labors.

Sources vary, but it's estimated that one in five labors are induced . (This criteria alone can be a bit murky; to many women, induced labors mean Pitocin and cervical ripening gel. To others, induction can merely be breaking your water artificially, which can start labor for some women. At any rate, it's interference of a non-natural kind.) One day while reading the physicians forum at www.obgyn.net I "listened in" on a discussion of how a particular OB's rate of inductions was at 66 percent  . Holy crap.

He also went on to note that around 30% of inductions fail. Those aren't very promising numbers, then, are they?

The standard procedure among the vast majority of laboring women is that they approach 40 weeks of labor, sometimes within a few days, and an induction is recommended. A holiday might be around the corner, or you're just miserable and sick of being pregnant. Who isn't, by that stage? Or you're 12 hours over your due date and the doctor thinks your baby should come out now, even though a typical pregnancy goes from 38 to 42 weeks.

What no doctor will probably tell you, is that if you're not ready, an induction will likely fail.

In a lot of news articles I've read about the staggering c-section rate, the increased rate of inductions often fails to even register a blip, which is troubling. Some won't even cite physician preference or convenience as a reason, but rather implicate the parents. Others like to cite the age of a patient as a reason, and still others say that the mother's obesity plays a role. Either way, it seems like the blame is increasingly placed with the mother.

And it seems like if you have a birth replete with interventions and something happens that necessitates a c-section, the patient is grateful to her doctor for 'saving her and her baby.' That's like an arsonist setting a building ablaze and then going in to rescue everyone inside. Until you know he was really to blame, you're going to heap on the accolades because he saved everyone, right?

I often log on to several pregnancy and childbirth-related web sites, and the number of women asking questions about elective inductions is troubling. What's even more astounding is that many either 1) don't know the risks, 2) think it's no big deal, or 3) don't really want to do it but are pressured by their doctors.

One woman, Nicole, asked about being induced at 39 weeks because her baby was 'already weighing over 8 pounds.' She said she'd heard nasty stories about being induced, and wondered if anyone could tell her anything positive about it. (Basically, I'm going to do this, my doctor is making me because he's scared my baby will be 'big,' and I only want to hear the good stories and ignore the truth about what could happen.)

The answers she got were a mixed bag, and a few of us  were honest in telling the original poster what could happen. Of those who had 'good experiences,' one said she ended up with a c-section because her 'daughter was too big,' and presented shoulder first (another risk of induction). Her experience, she noted, was that the induction began at 8 a.m. and got increasingly painful as the nurse upped the dose of Pitocin. By 1:30 she asked for the epidural. She then retorted that of all the answers that included an induction going "well," all of them received a 'thumbs down,' and said she was 'so so sorry that my induction went better than yours.'

Funny, I wouldn't call her experience a good one. (Ironically, her answer was chosen as the 'best answer.') Some of us expressed our concerns, but the majority said don't worry about it ... you'll do just fine!

Just today I answered another question that a poster had about an induction of labor scheduled for tomorrow, because the father was out of the picture and no other family would be present. She is 39w4d.  Of course, I politely chimed in and told her that if her baby's not ready, it's not coming out, short of a c-section. I posted some links, and tried to answer her question as nicely as I could. Then another woman put in her two-cents' worth:

I don't know why people say "oh it raises your chances of c-section, blah blah blah." You run the risk of some type of intervention any time you give birth. I had a friend that went into labor on her own and after 10 hours of not dilating they had to do a c-section on her. So don't let people on here freak you out about that.

Ummm, yeah....whatever! You just go ahead and turn a blind eye, hon....*sigh*

Perhaps you run the risk of some type of intervention because your doctor is pressuring you, and you are blind to the risks and benefits of what you're about to do (because goodness knows, it seems like no one's doctor is telling them these things anymore!). One mom's blog (we'll call her Em) detailed her induction, of which she and her husband laughingly 'had no clue what to expect.' Unsurprisingly, it ended in a c-section. How can you be so unprepared for something they're about to put you and your baby through? How can you not want to know everything about it, and just put blind faith and trust in your doctor?

If people like this continue to be the standard procedure at most OB's practices, then of course those of us who actually have the gall to refuse are going to get harassed. We represent a dangerous contingent of women who are actually informed of our choices and stand to pose a roadblock to what the doctor thinks should happen, regardless of whether it's really needed or not. While these are anecdotes or 'just stories,' I find them the most useful - because they're real experiences of real people, and it speaks louder than any 'study' that can often be flawed or skewed. Whatever the case, it represents a growing trend of medicalizing, and interfering, with birth to the point that we're causing more harm than good.

My question is, shouldn't Nicole and Em have obtained all this information before their induction? What is it that their doctors are (or aren't) telling them?

In other words, these women are probably their OB's perfect patients.

Is the rising c-section rate in this country going ignored?

The current c-section rate in this country is hovering at about 33 percent. I don't expect everyone to know the exact percentages, but it would be nice if some people for whom this might pertain would at least know and understand, simply, that it's definitely on the rise.

I had a conversation yesterday with two friends, one of whom has had two vaginal deliveries - both induced - and the other, two sections due to breech presentation. One woman has a sister currently five months pregnant with her first child, and she's scared to death of having a c-section. "Well, the current c-section rate in the US is at about 33 percent," I said, stating that her fears were completely founded. Both women looked at me in complete shock and had no idea that that many sections were being performed.

How can you not know? Based just on the experiences of our common friends, it's so obvious it's like a slap in the face. When several of us were each expecting our second child, our friends held a baby shower. I recall thinking during that shower that all four of us had had c-sections, and three out of the four of us were on either our second or third section. I was the only one who had a successful VBAC. (One woman, a nurse, had attempted one with her second but was unsuccessful due to fever during labor. At least she considered it as an option, though!) Another of us - one who was also on her second section - mentioned to me that her doctor actually admitted once, somewhat tearfully, that she "loves surgery." Well, I wanted to say to her, no shit she loves surgery. This woman is on the American College of Gynecology Liability Committee, so VBACs are definitely a no-go in her book!

I live in a unique community. My husband is a teacher, and we're required to live on campus with other couples and families, many of whom are near my age and have small children. So in a sense, we are all 'victims' of the modern obstetrical system and all have similar stories. Of those women who are older - say, those who are over 50 - their birth stories are dramatically different, and reflect the days in which doctors had knowledge and experience at avoiding a cesarean. Breech vaginal births, twin vaginal deliveries - none of them, that I know of, had c-sections, and know even less about the current trend in surgical deliveries because they are far-removed from their childbearing years.

All these women my age, then, reflect different levels of income, education and backgrounds. Most of us have different obstetricians and some of us have labored in different hospitals. And even though I obviously haven't talked to every pregnant woman in the US, we reflect that trend of an increase in c-sections. How can that not be troubling, or even obvious?

When I think of the people I know who have had children in the last 15 years or so, I am one of three women who've had a VBAC. I know of only two women who have dared to have a successful home birth. And yet, I know 17, including myself , who've had c-sections, all but one of them repeat, and from what I can tell, only one was truly a matter of life or death (the mother had advanced HELLP Syndrome). That figure could actually be substantially higher, but I haven't discussed birth with all of them, so it's hard to say.

It seems that obstetricians aren't held very accountable for the increasing rate of sections they are performing. Yes, there are a number of reasons for them - some of them even legitimate - but it makes you wonder about the not-so-good reasons for them, and why OB's are still getting away with it. The World Health Organization recommends that the rate not be above 15 percent, and our rate is more than double that - and yet no one is waging a mass offensive to change this. That's not to discount the groups, individuals, bloggers and organizations who make it their life's passion to educate people about this - but, even with their efforts, there are still large circles of women who either think people like Ina May Gaskin and Henci Goer are "fruity," or don't even know who they are. ("Ricki Lake? She had that talk show, right? What's she got to do with this?" *sigh*)

Essentially, the increasing rate of cesareans is going unnoticed by the people it should matter most to: those who think VBACs are extremely dangerous and yet don't bat an eyelash at having their second, third or fourth c-section. Those whose doctors still get away with inducing for convenience because their baby had the grave misfortune of being due near a holiday weekend. Those first-time mothers, past their due date by 48 hours, who are sectioned after the Pitocin drip failed to work because their cervix wasn't ripe yet and only were allowed to labor for a measly eight hours. And now with the revelation that some health care providers are refusing women who elect for a repeat section - no doubt at the dire advice of their doctors - it appears clear that, no matter which choice women make, they are being punished, instead of the people who are really to blame. When a fear-mongering doctor builds his practice around half-truths and misinformation in order to protect his bottom line instead of yours, it's not a wonder.

Birth Day: A Televised VBAC

This morning I was watching tv at my inlaws - they have fancy cable with all the premium channels I don't get at home. While flipping through I spotted a half-hour show on Discovery Health about VBACs and froze in my remote-controlled tracks. What?! They're showing a VBAC on tv? Skeptically, I thought it was going to end in the obvious way: mom would be scared into giving up her hopes of delivering vaginally and would be wheeled into the OR, pronto. I was pleasantly surprised to hear that the laboring mom had already had a successful VBAC and was now having her third child. Of course, doctors gave her the familiar warnings that her uterus could rupture, baby could die, blah blah blah. Not discounting that those things can happen, I'm sure she's heard it before, seeing as how she's already done it once. Granted, it was a half-hour show, so they could really only go over the major points: who should have them, who might not be good candidates, etc. etc. Her reason for a prior c/s was fetal distress, which is definitely a legitimate reason, but sometimes can be misinterpreted by a particularly overzealous doctor who is ready and waiting to slice you open. Halfway through mom's labor, an OB resident became concerned that the uterus was rupturing, as the baby's heart rate was starting to show decelerations. The patient's doctor came in, examined her, and thankfully determined that she could proceed and that the baby was probably fine. The baby was successfully born via VBAC, but was very blue. The minute they showed his little head coming out, I thought, Oh my God, he's blue, and was lifeless and limp as they moved him over to the warming table to clean him up. They would have to pick this particular birth to show a VBAC, I thought, meaning that whoever seeing it that might actually be considering one is probably sufficiently scared off from ever attempting it now that they've seen this episode. But something else struck a familiar cord in me as I watched this child enter the world: his cord was wrapped around his neck, just as my son's was. I sobbed as I held my baby and watched this show, not only for this fellow VBAC "sister," but also for what could have been in my own situation: I knew my VBAC was unsuccessful for a reason. While this woman's baby ultimately was fine, a healthy pink color and breathing on his own, I wondered if perhaps it would have been different for us. I try not to dwell on it too much, because, after all, I look at my chubby, healthy son and praise the Lord that he arrived safely. There are some points I wished the program would have touched on, though.

• Many doctors will give you the option, yet do everything in their power to dissaude you from choosing it, including the use of scare tactics and even harrassment.
• Your chances of a successful subsequent VBAC increase with each prior VBAC you've had.
• The overuse and even abuse of Pitocin (which has often been called "the devil's drug" in some medical circles) and how studies show that the chance of uterine rupture, although rare, was increased in those women who had Pitocin during their labors. The risks further increased with the use of prostaglandins such as Cervidil, which are used to ripen the cervix.*

This last point is the scariest, because it might actually (well, you would hope, anyway) force doctors to re-examine how they 'manage' labor. I found an article dating from 2001 that discussed how the increased risk of u/r might turn patients off from the idea of having a VBAC, but yet goes on to say how the risks increase because of the use of Pitocin and similar labor-inducing agents. Which begs the question: When are doctors going to admit they can't control all aspects of the birth process, and change their practices accordingly? (Even though the article is almost a decade old, the same ideas and mentality are still very much at work here.) Sadly, probably never. It's too much of an industry for some, which turns the birth process into little more than a baby-making assembly line where all laboring moms should fit the same model or want the same thing from their births; the idea that 'it doesn't matter how you got here, just as long as you did.' After awhile the "you" part of this equation starts to feel like you have very little involvement in the whole process and are just a vessel, prodded and poked and insulted like you're a piece of flesh that has no feelings whatsoever. The following phrase comes to mind: "Doctors will get down from their pedestals when patients get off of their knees." *It's important to note that some doctors, even against dire warnings to do so, will still induce labor with the synthetic prostaglandin Cytotec. Its off-label use for induction of labor can cause miscarriage, severe birth defects and uterine rupture even in women who have had no prior uterine scar. Doctors will sometimes use it because it's supposedly cheaper than Pitocin, and claim that it's just as safe to use. I'm not sure how many doctors are still using this drug, but if yours is one of them, please know the risks and then run the other way. Searle, the drug's manufacturer, has issued numerous warnings against its use in labor inductions, and personally I think doctors who ignore those warnings are throwing all common sense and caution out the window in favor of the all-mighty dollar.

The Fight To Give Birth in the Age of Fear-Based Obstetrics

As I quickly approach the 40-week mark in my pregnancy, I am thankful for many things: namely the fact that my body has essentially "proven" itself to not only me but to my OB's. I am preparing for my second VBAC (Vaginal Birth after Cesarean) and while my journey has been fairly uneventful thus far (I won't say totally uneventful, because that's not the truth), it is nothing less than a tooth-and-nail fight for thousands of women to do the same all over the US. 

I am also thankful that my only reason for having a c-section was breech presentation of my first child - not failure to progress, a "small pelvis," or failed induction of labor. I went into labor on my own even then, and had already progressed well despite the fact that we knew the baby had to be delivered via cesarean. With my second pregnancy, to my OB's credit he did offer me the choice to do a VBAC initially (which I declined, knowing nothing about it) and I think he was secretly relieved when I said no. But as I approached 37 weeks, my baby was heads down - something I wasn't even sure my children could do because of a physical defect of my uterus - and realized quickly that I really didn't want to go through the painful recovery of another c-section. 

I consulted with my OB, whom I thought was going to stutter himself into oblivion at my choice. I had since done lots of research, lots of praying, and lots of reading of very positive birth outcomes that I felt was essential to the preparation process. I couldn't believe what I was about to embark on, but with God's help and my husband's support, I could get through this. And I did. Beautifully!

I'm not totally against c-sections: of course I think there are instances where they are totally necessary. Breech presentations, multiple births (although not necessarily with twins alone, as long as they present correctly), severe prematurity, dangerous pre-eclampsia, and fetal distress are all obvious red flags, at least to me. But with a c-section rate of roughly 30 percent in this country, you have to wonder if those reasons are really why women are having c-sections?

More common reasons that the c-section rate is so high is because OB's want to practice "daylight obstetrics" - they want the baby out in time for dinner, essentially. With the ability to control so many facets of our lives, why not birth? Anymore if you go one day past your due date, you seem to be a candidate for induction. Pitocin-happy doctors willingly try and induce (more like coerce) a baby out even if it's not ready. Unfortunately it seems that fewer and fewer women are sent home as a result and are almost definitely candidates for c-section. Pitocin can bring with it a cascade of interventions that can sometimes alter or stop labor completely - increased use of epidurals because of harder, stronger contractions is not uncommon, which can, in turn, stall labor - leading to an increased number of c-sections. 

Insufficient pelvis size is another common reason many women are encouraged to have a c-section. Scores of women are even told their babies are too big to deliver vaginally just by an estimate on ultrasound, which further scares them away from attempting a vaginal delivery. Sadly, there is no definite way to know how big a baby will be until they're born and put on the scales - and ultrasound measurements can be off by as much as a pound either way. Many, many petite women give birth vaginally to "large" babies (according to the March of Dimes, anything between six and nine pounds is considered average) and do just fine. Even many babies deemed to be "stuck" can be birthed vaginally provided the medical practitioner knows to instruct the woman to change positions to facilitate further widening of the pelvis (known as the "Gaskin Maneuver," named for renowned midwife Ina May Gaskin). 

Because of the high rate of c-sections in the US, many women are faced with a two-fold problem: if they want more children, do they deliver them via cesarean too? 

Not necessarily. The mantra "once a c-section, always a c-section" is thankfully being disproved by women everyday in this country, although we still have to fight for the right to do so. But unfortunately few women choose this option - whether because they're uneducated about the risks, their doctors scare them out of it, or they have no interest - which is their right. I would never advocate a woman do a VBAC if she really doesn't want to, but neither should I think women should be scared into repeat c-sections for no reason, either. 

One reason many women are scared away from VBACs is the phrase "uterine rupture." It is possible, but is rare, provided you have a low, transverse incision (bikini incision). Also, your chances of receiving Pitocin to induce labor are less - because it can increase your risk of rupture. To many women, the risks of a c-section, if they even know what they are, are somehow more acceptable than the risks of a VBAC, even though the percentage of complications is about the same. 

Risk of VBAC, with non-induced labor, include:

• uterine rupture - this is rare, and the rate is around 1 percent, depending on which source you site

• risk of needing emergency c-section, should the same complications arise as in the first birth

• if you can't go into labor on your own, induction is not recommended 

Risks of cesarean section include:

• increased blood loss and chance of infection

• respiratory complications in the infant because of spinal anesthesia

• increased risk of scar tissue adhesion, especially after several c-sections (which can cause pain and sometimes infertility)

• premature birth because due dates are off 

• risk of uterine rupture (without even going into labor) (although small, still a risk)

It all boils down to which risks you are more comfortable in taking - because don't kid yourself that a repeat c-section isn't without significant risks, too. Neither of them are decisions that should be taken lightly, but unfortunately many women shrug it off as though it's nothing. This unwittingly affects birth outcomes and choices for thousands of women they don't even know, because they either don't care or aren't willing to fight their doctor for the right to give birth. And if you don't fight it, nothing will change. 

http://www.ynhh.org/healthlink/womens/womens_11_01.html

http://www.vbac.com

http://www.vbacfacts.com

http://www.mothering.com/articles/pregnancy_birth/birth_preparation/inducing.html

http://www.buffalonews.com/248/story/573154.html

http://www.msnbc.msn.com/id/17796664/