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

OB bribes mothers to deliver babies on 11/11

"I'll pay you if you give birth before midnight tonight!" 

As we approached the landmark "11/11" this week, I'm sure all of us were waiting to hear "miraculous birth stories!" of babies that "happened" to be born on November 11, 2011 at 11:11 a.m. (or p.m.) Most of us are jaded enough to realize that no, usually none of these babies just happen to come into the world at such an auspicious moment all on their own, and when you read more details on many of these births it's no surprise that they are either planned cesareans or inductions. Yay.

The birth of a baby is always a joyous occasion and something to celebrate. But I cannot imagine actually planning the date, no matter how close I was to my due date, just to have a "fun birthday" like this. Kind of takes the magic and suspense out of it, you know?

So one Iowa OB has decided, back in February, actually, to put money into a savings account for those patients who delivered on 11/11. Oh, how nice! Helping baby to get a good start in life with a tidy sum saved up in an account just for Junior. Excuse me while I go vomit.

So far, he's had two scheduled cesareans lined up and one induction. Surprise!

In just reading between the lines, I get a few creepy suspicions about Dr. Valone. Two of his patients are repeat cesareans because "they delivered that way in the past," which sounds like he is not very pro-VBAC. Perhaps his idea of informed consent about surgical births and the dangers of VBAC includes, "Well, I could pay you to deliver your baby by repeat cesarean on November 11. How about that?" His fees, according to the article, range from $900 to $2,000, "depending on the case and the insurer." Financial incentive much? Does this almost sound like "the better insurance you have, the more I charge" to you?

Further down in the article, it says he will deliver two more women by induction "whose pregnancies have reached full term." Full term, to most people, is 37 weeks. His comment, "We're doing it proactively rather than just waiting to see what happens" sounds like he pushes the big baby scare tactic. How much do you want to bet this patient is not very close to 39 weeks? $2,000, maybe?

One of his patients, a young 20-year-old mother has passed her due date by THREE DAYS and is awaiting induction today. This is her first child. I fear for this woman, for many reasons. I hope she has a vaginal birth, but honestly - who can say? The article also says things like, "Natural birth proponents urge women to avoid the medications that induce delivery unless there is a strong medical reason to take them," but Dr. Valone assures us all that "it's safe" and you're better off if they go that route (meaning, "Take the Pitocin!") rather than trying to start their labor at home.

No sources, no nothing that indicates that Dr. Valone perhaps is a c-section, induction-happy doctor who is basically bribing women to give birth before the clock strikes midnight (or five p.m., which is probably the end of his shift). And these women are eating it up like candy, which is nauseating, at best. Yeah, it's their choice, but when you're presented with the possibility of a wad of cash and the assurance that "It's safe and you're better off!" how can you resist?

I would hope that offering financial rewards to patients in order to force their births to take place (or coerce them) would be considered, at the very least, unethical. When you blab in the media about doing such a thing, you'd better be willing to offer sound proof that they do, in fact, have some medical condition (besides a prior uterine scar) that means this induction or cesarean was necessary; otherwise all those hospital bans on elective inductions and cesareans don't mean a thing. I'd love to think an official from ACOG, and perhaps the Iowa State Medical Board, would be questioning this doctor on his choice of practices and perhaps taking a look at medical records. But then again, I doubt anyone will bat an eyelash.

Didn't have to dig very hard to find this one.

There's a hurricane (and a baby) a comin'

Rock you like a hurricane: Who knew giving birth during
one of the worst storms ever could
be such a normal, natural experience? 

As the nation tenuously waits for Hurricane Irene to make landfall on the east coast, I can't help but think of all the expectant mothers, nervously waiting for their due dates to arrive and praying that it will pass uneventfully: will the baby come during the storm? Will I make it to the hospital in time? Will I be stranded somewhere?

I wouldn't be surprised to hear of a slight increase in the number of cesareans or inductions in the days prior to Irene's arrival, as doctors and patients took a "just in case" approach to avoid any such incidents from happening. It also reminded me of a passage from Jennifer Block's book, "Pushed," regarding Hurricane Charley in Florida - an F-4 storm that was the most powerful they'd seen since Andrew over a decade before. The storm lasted nearly a week, with winds topping out at 150 miles per hour. Pretty scary stuff.

With limited electricity, the hospital was facing measures to treat labor and delivery patients more efficiently given the lack of resources they had. Tracy Lethbridge, a nurse working on the unit during the 2004 storm, was on duty.

"...Hunkering down that evening was a minor interference compared to the week that followed. The hospital's emergency generator kicked in, but, like the rest of the town, the facility lost main power until the following Friday. With only enough generator capacity to run essential functions, there was no air-conditioning and no lab capabilities. That meant that the 13-bed labor and delivery ward wasn't a very comfortable place to either labor or deliver, nor did it have the lab setup required to manage epidural anesthesia safely. Lethbridge and her colleagues had to treat their patients much differently."

With limited power and no access to epidurals, what do you do?

 "We canceled all labor inductions," recalls Lethbridge. Normally, two beds a day would have been reserved for inducing women into labor, an often lengthy process that begins with drugs that "ripen" and dilate the cervix (Cervadil or Cytotec) and contract the uterus (Pitocin). Normally, even women who arrived in early labor – when the cervix is minimally dilated and contractions are several minutes apart – would often be encouraged to stay and would be administered Pitocin to hasten contractions. Lethbridge observed that under normal circumstances, the vast majority of babies were delivered during the day. 

 –––

"We only admitted women who were in active labor – regular contractions and progressive cervical dilation," says Lethbridge. "If they were not in active labor, we'd send them back home." 

Block speaks of this new, relatively unusual situation as an "altered universe" and writes that the nurses on duty during that period started noticing some surprising changes.

"Women were delivering within hours of arriving, even first-time mothers, without any Pitocin," says Lethbridge. ..."We had no cases of fetal distress during labor and no respiratory distress of neonates following delivery..." "We had an incredibly low cesarean rate. Amazingly, the babies were about evenly distributed between day and night shifts."

 "What happened was, women were going into labor all on their own, having good labor courses, and delivering healthy babies. Even the women who were scheduled to be induced that week, three-quarters of them came in and delivered anyway. And basically, they did better than if they had been induced. We thought, wow, this is amazing!"

Block notes that nurses, including Lethbridge, observed during the week period that among the 17 women who gave birth, "one was induced, two had scheduled repeat cesareans, and just one had a cesarean for 'failure to progress.'" Block states, "That works out to a cesarean rate of 17%; excluding the repeat cesareans, it was 6%."

Perhaps this almost informal "study" reveals that yes, birth can be a normal, physiological process if only it's allowed to proceed as such. That, instead of a "94 percent of births are complicated," it's quite the opposite - that 94 percent of births are over-managed, which has completely skewed our idea of what "complicated" means. In other words, that we're treating it as an accident waiting to happen and sometimes creating or precipitating that accident in the process.

As a result of this little experiment, surprised nurses reported their findings back to the charge nurse and hospital officials - who were relatively blase´ about the whole thing. The hospital's lack of action spoke louder than words: "this is not the way we do things because it doesn't make us money." You can't bill a patient for an induction, Pitocin, epidural and cesarean if she doesn't have those things, instead laboring naturally at home and letting her labor unfold by itself, with little to no interventions. Because Mother Nature is completely free - and perhaps not quite as flawed as they want us to believe. Technology can be very useful and life-saving, but only when used appropriately and wisely.

For a number of reasons, including what Lethbridge felt were safety concerns as well as the hospital's lack of support of normal, physiological birth, she quit her job - mostly precipitated by what she saw in women during Hurricane Charley. Within the year, many of the nurses she worked with left their jobs as well, perhaps completely jaded by the system. I don't blame them.

Pushed: The Painful Truth about Childbirth and Modern Maternity Care - Jennifer Block
Why You Need Pitocin in Labor

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! 

Avoiding unnecessary inductions and c-sections: "Every week counts"

I was going to title this post "Sick of being pregnant? So what?!" but thought maybe that would come off as a little harsh.

I've written about this several times, as have a lot of others. Unfortunately, I'm not really sure who's listening (one woman decided that since the Huffington Post, whose link I've included below, was not an unbiased source of news, that perhaps the article wasn't true). I've been posting links ad nauseam to the March of Dimes website for months about Why the Last Weeks of Pregnancy Count, in hopes that someone out there is actually reading it. And this month, they and ACOG have teamed up in hopes of decreasing unnecessarily early births because of elective, non-medical inductions and cesareans.

Obviously there are some exceptions, as this article from the Huffington Post noted. While I was glad to see this subject go mainstream, I did have a problem with this paragraph:

“If a baby needs to be born for a medical reason, that baby should be born,” said Dr. George Macones, an OBGYN at Washington University’s School of Medicine in St. Louis. “But when I was practicing in Philadelphia, patients put pressure to deliver early for what I call ‘social purposes.’”

While I'm certainly not denying that mothers do pressure doctors to do inductions, let's not lay the onus of blame completely on the mother. Doctors are often notorious for scheduling for convenience, and so many women can testify to that in their birth stories. It's also not uncommon for a diagnosis of "failure to progress" to come hours before a physician has an important upcoming event to attend. And sadly, we hear of plenty of doctors who pressure moms into cesareans before their shift runs out at 5 p.m.

As far as 'medical reasons,' this is often another gray area. True medical problems are one thing, but we're also finding more and more that doctors are using questionable medical diagnoses - like big baby and low fluid, most frequently - to assess whether or not the baby should be born. In the case of a big baby, there is no definitive answer to that question, except weighing that child right after birth. Some estimates are more accurate than others, and some are way off. In this case, you need to ask yourself, do I want to risk having major surgery - for this baby and potentially all my children - if my child happens to weigh substantially less than estimated?

It probably sounds like I'm anti-physician. Not really. But I wish people who think that doctors are incapable of doing these things would pull their heads out of their butts for a moment and take a look around.

As far as the Every Week Counts campaign, I'm hoping it gains some serious traction. I am not completely sure what the best answer is - but I wish we'd see some disciplinary action on the part of hospitals and medical boards for those who do like to practice "9-5 obstetrics," or have a higher-than-usual rate of cesareans. Many are coming down on the WHO's recommendation that the optimal c-section rate be around 15 percent, because they consider it an outdated (circa 1985) standard and acknowledge that the ideal c-section rate is a figure no one is really sure of. While that may be true, I think we can argue that this is far from optimal.

I've blogged before about the myth of the emergency cesarean, and have come to realize that words like "medically necessary" are relative terms. When you start questioning what is truly necessary, there are those who quickly become defensive, and assume that you're trying to say you know more than their doctor. No one likes the feeling of being pinned into the corner about their choices, or to essentially be told that perhaps they had choices they didn't even know about. I remember one particularly heated exchange on a pregnancy forum of a mother asking for induction techniques because her baby was 35 weeks gestation and she didn't "want a 9-pound baby." Why, dear God, why?! 

When it comes to laying blame, it probably fits squarely in both corners, as the above quote suggests. There are no shortage of women who want it their way, for a number of reasons - that much is true. HufPo user Trillian4210 writes:

My second baby's tentative due date was 10/10/10. My OB/GYN laughingly told me he hoped I didn't go into labor that day because he was BOOKED SOLID with scheduled c-sections of women who had no medical reason for it but that they wanted that birthday for their kid. That's not a birthday, that's a vanity story. 

What I want to know is, what is this physician doing about it? Are you informing your patients the dangers and giving them a realistic outlook of what could happen? They complain so much about mothers demanding it, when really, you're just facilitating and enabling it to happen by not informing or counseling your patients adequately to stop this from happening. This would be a perfect opportunity to go over with your patients why it's unsafe, and stop the practice altogether, not give in to their whimsical demands.

If a mother's excuse of "I want my baby's birthday to be 10/10/10!" sounds frivolous, then a doctor saying, "Your baby might get too big and then die!" should be code speak for "I have vacation to the Bahamas coming up, and there is no way I'm waiting around for this baby to be born!"

And speaking of the etched in stone due date, those people who like to criticize women for wanting to deliver their babies early are also throwing stones at women who decide to go post-dates and let the baby pick its own day. You just can't win.

For generations we have had instilled in us the idea that every "large" baby will be difficult to birth, that every baby born past 40 weeks "will die," or that because the baby has reached that magic benchmark of 37 weeks, that "it's ready!," like some kind of turkey pop-up timer.

So while it sounds great to blame the mother for going Princess Renegade and wanting everything done according to her plans, the medical community has no one to blame but itself.

The Obstetrical BS Series: My Doctor will Tell me Everything! Part I

"I'm 38 weeks and am going in for an induction
tomorrow. What should I expect?"
Photo credit: Karol 

A lot of times when I hear women asking pregnancy and birth questions, the usual response is, "Your doctor will tell you everything! Don't worry!" I think we can all agree that this isn't the case, most of the time.

Some doctors do take the time to inform their patients, true - but many do not. Many cannot, because they are often limited to the typical 4 1/2 minute visit that consists of little time to go over your aches, pains and other complaints. I remember asking my doctor about having no urge to push during my last labor, and wondered why. His quick, tidy response was "We'll help you with that when the time comes." I wasn't exactly sure what that meant, but it didn't sound like much of an answer to my question.

Later on in the pregnancy I had a lengthy discussion with another doctor in the practice who then asked me, "How do you know so much?" I'd like to think it's probably refreshing for him to see a patient who truly is informed and can make decisions accordingly. I imagine some doctors wish their patients were more informed, and they feel bound by time constraints that prevent them from delving into a topic that can't easily be answered with a "yes" or "no."

As mentioned in my last post about inductions, I am amazed - overwhelmed - saddened - by the number of women who go into something as serious as an induction of labor with no preparation or information ahead of time. Countless women ask at zero hour what they can expect of an induction, with it looming large in the headlights in a matter of hours. Would you prepare so poorly for brain surgery? Probably not. Even my gastroenterologist - her secretary, even - prepared me more thoroughly for an upcoming procedure in more ways than these women are.

Outside the scope of obstetrics, uninformed consent is a huge problem - and the source of more costly procedures that are completely unnecessary. I remember those commercials in between cartoons while growing up in the 70s and 80s - "Knowledge is power!" And if you don't have that knowledge, you've effectively been rendered powerless.

Considering the rising induction/cesarean epidemic, I think more childbirth classes should cover inductions more extensively. While I took a class seven years ago, I don't remember it being given more than a passing mention.

While I don't doubt that some women won't listen to their doctor's warnings about the risks, it sounds like not many doctors are even bothering to mention the risks. I consider what my doctor told me about the risks of primary cesarean - nothing. Had he done so, I'm sure my attitude about it would not have been so casual, that's for sure. I think that's what contributes to the rising problem of inductions - attitudes about them are way too casual because women are simply uninformed about what can and does often happen, and how it can change their perception of "normal" birth. A few women I've talked to don't even realize that an induction ending in cesarean is not really a successful outcome - at least I don't think it is. But unfortunately, there apparently is little criteria defining what a "failed induction" really means.

Perhaps doctors need to draw up a realistic outline of the risks and benefits of labor induction - and have the patient sign off on it. I know this is what I had to do when signing consent forms for doing a VBAC. Of course, this might actually force the physician to be more forthcoming with how he handles inductions, and some aren't willing to admit to more aggressive practices, I'm sure.

When it comes to overall pregnancy and birth questions, perhaps a list of recommended reading would be helpful. Then again, unfortunately not all pregnancy books are the same, and can offer wildly different, sometimes slightly inaccurate, ideas about what's normal and what isn't. And there's nothing saying that patient will actually read them, either.

If anything, I think some doctors mitigate the risks or outright lie about them, simply because they don't want you to change your mind. I've heard some doctors say that Pitocin contractions aren't worse than regular ones, for instance, even though lots of women feel this isn't true. Perhaps for a number of reasons, inductions hurt more because you are more monitored and allowed less freedom of movement, which is no doubt why so many women choose an epi during an induction. If a woman knew that perhaps her labor could be more painful, or at least more intense, during an induction, she might decide against it.

People blather on about "just talk to your doctor" about the risks, but I think you'd be hard-pressed to find one who is up front and on the level about it. Conversely, perhaps not many women ask beforehand (or perhaps their concerns are rebuffed) simply because inductions have been so routine. And sometimes, even when you do try and tell them, it's like they put their hands over their ears and sing, "La la la!" loudly to block you out. They don't want to hear anything negative or that sounds "wrong." They might as well go into the labor and delivery unit with a blindfold on and paper bag over their heads.

I felt badly when a thread showed up from a woman 40w6d who was on the verge of an induction. She wanted to know what to expect, and namely if it hurt more than a traditional labor. She had no cervical dilatation or effacement, and was facing an induction in less than 24 hours. By the time I responded, 11 hours had passed, so I figured she was already well on her way to whatever by then. I looked on, horrified.

It reminded me of that Sally Field movie where the mother is stuck in heavy traffic and on the phone with her daughter. Suddenly the mother can hear something going on in the background, as her daughter is attacked by a stranger in the house. The mother can do nothing but listen, helpless. Sometimes I feel like that - like if only we could better inform patients ahead of time, they might not have to go through this stuff. It's like being on the edge of a cliff, holding on to her shirttail, and you can't get a footing before she goes over the side, tumbling into a cascade of interventions that are probably neither wanted nor necessary.

More reading:
"The Benefits Outweigh the Risks" - My OB Said What?!?
"I highly doubt you have the intelligence to read a medical journal." - My OB Said What?!?

The Obstetrical BS Series: The Induction Seduction

Perhaps one of the biggest pregnancy myths circulating today is that "Doctors won't induce unless it's medically necessary!" I wish I had a nickel for every time I hear someone say that. I find that the more people I talk to, the definition of "medical" and "necessary" gets fuzzier and fuzzier. I've even heard medical professionals - labor and delivery nurses, for God's sake! - say this. Maybe not on your watch, or in your hospital. But please get your head out of your butt and put down your Kool-Aid: this is a very real problem that often does nothing more than trade one set of complications for another, all in an effort to prevent them.

It's hard to resist, I know: you're big and huge, cranky and tired, and sick of getting up to pee every 45 minutes all night long. Your ankles are swelling, your mother is bugging you about when the baby is coming, and you just want it over with already. Who, at this point, doesn't?

It's estimated that one in five women is induced, and some numbers suggest it's higher than that. It's probably hard to estimate how many of those are 'social' inductions, but it's not uncommon for a doctor to at least offer an induction at some point during the pregnancy, regardless of medical "need." While most think that a doctor only brings it up as the due date comes and goes, it's increasingly clear that some OB's will discuss it early and often.

“We’ll just make sure you deliver by 40 weeks! Don’t worry, almost *EVERY* woman gives birth before her due date!” – OB to mother.

"At my 39 week appointment, my doctor said she wanted to induce me the next week if I did't go into labor on my own. I asked why and she seem surprised I didn't want to have the baby ASAP...I was also due in late Dec., so it's certainly a possibility that the induction was at least partially for doctor's convenience."

When I asked friends in the birth community what their experiences were, one reader says her doctor brought up induction before she was even out of the first trimester. She thought it was odd, considering how she was going for a VBAC and induction is not recommended.  Out of all the responses I've had so far, only one person said her OB didn't mention it and was respectful of her birth plan not to induce unless it was medically necessary.

The most common reasons cited for induction are "big baby," low fluid, and post-dates. We have great diagnostic tools (sarcasm) that can tell us how big that baby will be or how much fluid there is, only sometimes it's off - by a lot. One reader stated that her baby was estimated at above 11 pounds, and agreed to do a cesarean - later finding out her baby's actual weight was just over 7 pounds. The famous line "Fat squishes!" is true: lots of women find that it's easier to push out a squishy, chubby baby than one who is smaller, with sharper, bonier angles. I think the common misconception is that bigger babies will hurt more, somehow "tear you up" and are generally indicative of miserable deliveries. That idea is probably deeply rooted more in the way labor is managed: your position, as well as the baby's, might have more to do with it than sheer size alone.

I'll never forget the eve of one particularly interesting labor - I could hear the mother crying out while laboring as I made my pharmacy rounds. I was stunned to see that she hadn't ordered an epidural - I mean, doesn't every laboring mother request one? but was relieved because that meant I didn't have to make one, either. LOL Then as I filled her prescription for ibuprofen two days later I looked down across the counter to see her lugging a kid out in his carseat - a kid that already looked three months old - and realized, This woman had no epidural. I can't remember, but I think he was nearly 11 pounds. And he wasn't the first of her big babies, either.

This was probably the first of many encounters that shaped my perceptions of birth. That yes, you can labor without drugs, and you can even deliver a "big baby," too.

Another reader said her friend was being induced because she was tired of being pregnant. Most of the moms I knew were approaching due dates - my neighbor had her first last year and was due around a holiday. A good friend was experiencing heart problems throughout her first pregnancy, but apparently they were not grave enough to exclude her from having a vaginal birth. She was, however, induced at 38 weeks, and told me later that she still doesn't know why. (Her baby was born at the beginning of June, so if you add two weeks to the calendar, that lands you around Father's Day. Perhaps someone didn't want to miss a cookout or outing with dad?) To make up for it, her second was nearly born in the car. :)

In reading some pregnancy books, I find it alarming that some consider an 8 pound baby to be "big." Others give or take at least a pound and a half, thankfully. I wonder what our definition of big hinges on - perhaps it's still a leftover from the days of when women restricted their dietary intake and smoked more, creating smaller babies that were perceived as 'easier' on the mother.

Low fluid - which some pregnancy sites almost approach with dire concern - is increasingly becoming another dubious reason. Gloria LeMay considers it a "scam " and I agree - it seems like one more "medically necessary" reason to move things along and get it over and done with. In some cases, low fluid can be remedied by simply drinking more fluids and making sure you're not dehydrated, which is an easy fix compared to the process of inducing labor.

Another disturbing trend is for women facing inductions to ask strangers on internet chat rooms, "What can I expect when I get induced tomorrow?" Even Dr. Amy agrees that induction is a very serious matter, and isn't something the patient should walk away from the office knowing nothing about. I asked my Memorial Day-induced neighbor if her doctor had told her the risks and disadvantages, and she said she had. But I can still find countless sources where women are completely and totally uninformed about the process, from all angles. When looking for a desirable answer in which to seek comfort, they usually won't choose the one that says, "Don't do it - mine was a disaster because my baby wasn't ready and I had a cesarean!" but will pick the one that says what they want to hear: "I had all my children induced and I did just fine!!"

In this sense, there is something to that old "blame the mother" argument. Women who blindly go into things uninformed don't even know enough to make the best decision for themselves or their babies, and therefore can't really make any decisions - because their doctor has essentially taken that power away from them. Anyone who tries to inform them otherwise is perceived as 'snarky' or branded as the Arm-Hair Braiding Lunatic, which is really unfortunate. If an induction is necessary, I don't think any doctor should allow his patient to go home without first reviewing a list of the pros and cons. That is truly informed consent.

From what I've read, an alarming number of women do not fully, if at all, understand the risks of induction. They do not understand even when they are truly necessary. Some of the more interesting comments I've heard include:

"After all the hoopla of the appointment [heartbeat check, growth check, etc...] and after my internal; he said "Meet me at the hospital at 6 am tomorrow morning." I asked him why and he said "Meet me at the hospital at 6 am tomorrow moprning. Baby's ready. We induce."

"I feel every woman is different and if she is at least 38 weeks she should be able to make her decision rather to get induced. it shouldn't be the doctor's choice as long as the baby is healthy."  

"My second was born at 38 weeks perfectly healthy. Now my doctor wants me to wait 39/40 weeks to give birth to my third baby. I mean, sheesh, what's the hold up? No one should have to wait the whole 42 weeks or more unless due to medical reasons concerning the baby. I agree that we should be able to decide as long as we have made it to 37/38 weeks with no complications."

An overwhelming number of women, when asked about the risks, said they were not sure of the risks, but thought it was "pretty" safe. Only one person said "Run! Run far away!" and gave a detailed horror story of how she was treated like dirt by her doctor and hospital staff, including them ganging up on her and getting her visiting family to push her into it. She added that hospital staff "kicked her mother out of the OR and tried to remove my brother from the hospital when they asked too many questions." (And as if you couldn't guess, her answer received a thumbs down.)

Even more so than that, they realize even less how it could impact their baby. Just because you hit the magic 37 week mark, it does not mean your baby's lungs are fully mature. Studies have shown that babies born by elective cesarean had complications - with one fetal death - up until the 39th week.

And even though elective cesarean and elective induction are two totally different things, they can sometimes lead to the same outcome. Studies have also shown that for first-time mothers, inductions can lead to an increased risk of cesarean, which plants that seed of doubt from the get-go: that my body is broken. That "failure to progress" diagnosis sticks with a patient oftentimes, and can totally change the way birth happens in the future. Rightly so, many women are starting to realize that "failure to progress" often means "failure to wait," and no where does this make more sense than in a failed induction. The mother has no guide - no prior births - on which to base her experience, and therefore doesn't know if she can even go into labor on her own or not. My own sister-in-law, herself a nurse, was socially induced with two pregnancies (because her doctor was going on vacation), and one birth nearly ended in cesarean with suction and shoulder dislocation. By the time she was approaching labor with her third, she had no idea what to expect.

One comment I read came from a mom of five who was expecting her sixth baby. All of the prior births had been induced, and this time she was ready to head to the hospital simply because she was dilated. She admitted that she had no idea what going into labor on her own was like - even after five kids.

While no one is arguing that sometimes inductions aren't truly necessary, the abuse of them is like treating something with a solution when we don't even have a problem. Not only are we fostering a completely false notion of what birth can be like, but we couple it with the idea that our bodies are somehow inadequate, broken, and incapable of handling what is otherwise a normal physiological process.

"Obstetricians have always been trained to believe that pregnancy and labor are disasters waiting to happen." - Dr. Bruce Flamm

More reading:
Why Do Doctors Induce Labor?
Cesarean Deliveries Rise Alongside Rate of Induced Labor
5 Reasons to Avoid an Induction of Labor
Reasons to Induce Labor
Saying "No" to Induction
What is a Bishop's Score and How Does it Relate to Inducing Labor?
Australian woman visited by police after failing to show up for induction

Part 1: The Obstetrical BS Series: Redefining Normal 

Between a rock and a hard place?

A few weeks ago I went to an acquaintance's baby shower. She was due sometime in early March, but apparently was developing kidney problems as she got closer to the end of her pregnancy. She told me that doctors were concerned, and even though she had no swelling and no high blood pressure, protein was spilling into her urine and it had her doctors puzzled. Therefore they were considering inducing her two weeks before her due date.

I have to remember that often times my facial expressions are so easy to read, and I need to do a better job hiding my feelings. I probably looked annoyed? Concerned? Puzzled? Who knows. I try to remember, it's not my pregnancy, it's not my baby, it's not really my business. I asked if maybe she could go on bed rest and take a wait and see approach, but not really knowing the full scope of her problem, I wasn't about to offer too much advice. But in the back of my mind I thought, There is no way this is going to work. I felt so badly for her.

I asked her coworker about her yesterday, and he told me she'd had the baby. They tried to induce, it didn't work, and did the section around 4 a.m. He told me her mother had kidney complications, and I knew her mother had died a few years ago. I thought, What should she have done? She was put between such a rock and a hard place.

Ultimately, her baby was born healthy, and that's the best thing for everyone. I won't say "that's all that matters," because for many women the journey to having that healthy baby is very important, too. But I just wonder why they even bothered putting her body and her baby through all of that when they knew it wasn't going to work? Why kid her about entertaining the possibility of having a vaginal delivery?

That was her first lesson in the School of Childbirth, and I felt so badly for her, but even more so for not really being able to avoid it. I felt the same way with my last section. It's sometimes a daily struggle to not feel "ripped off" by the whole experience, and somehow come away from it positively and hope to help other women (without coming off as the "Pregnancy Police" or a "birth nazi" - I hate that term).

Maybe if she has another baby she'll have a chance for a "do over."

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.

The more things change, the more they stay the same

Reading, talking about and experiencing birth have got me thinking lately. Most of us women seem to love to talk about childbirth and pregnancy when we get together, and our mothers seem to be no exception. How we managed to come into the world is always a fascinating topic, and it's interesting to see how, over the generations, some things have changed for the better - and yet some things, for better or worse, tend to stay the same. 

I was born in a Catholic hospital in a small, semi-rural community in the mid-seventies. My mom checked herself in in the morning and didn't have me until nearly midnight. During that time, she apparently repeatedly refused meds of any kind - probably even saline, it sounds like - because she wanted to have a totally med-free birth. Before I was born, she had even insisted on having a hospital tour, at which point most people thought she was out of her mind, because you just didn't do that back then, apparently. 

The response to no pain meds was this: My mother labored all day and most of the night, in a room by herself. Nursing staff probably saw her as a difficult patient because of her refusals, and decided to basically completely abandon her as a form of punishment. 

Ina May Gaskin talks about this in her book, Ina May's Guide to Childbirth, when citing the story of a woman laboring in a New York City hospital in the late 1960s. With no hospital beds left, apparently, the woman was relegated to an empty gurney in the hallway, where she labored the entire time. Nurses, apparently, were the same brusque, seemingly uncaring kind that my mother ran into during her labor. I can't remember if it resulted in a c-section, but I wouldn't be surprised: lying flat on your back during labor works against the nature of gravity that can help the baby move down the birth canal, not to mention it is extremely uncomfortable, to say the least. 

Another story, from around the same time period, involves a friend of mine (whom we'll call SB), who was ready to deliver her second child in the space of one year. You could say that, because her children were so close together, that perhaps her body was more primed to birth, and as SB arrived at the labor and delivery unit, her baby was nearly crowning. The nurses insisted on giving her an epidural, (insert "You're going to need this!" here), to which SB replied that she didn't want, or even need, one at that point. What good would that do? You're nearly done!

And lastly, the story of a friend's mother, who birthed her daughters throughout the early and late 1970s, who was given, against her knowledge or will, a pill to dry up her breast milk, even though she was adamant on nursing her newborn. In a panic, she asked her pediatrician if she'd still be able to nurse, and he assured her she would and that everything would be fine. 

I find that even though many of these tales seem crazy, the same thing kind of still happens today. Perhaps procedures aren't as overtly clandestine, but patients seem little more informed than they were then. No wonder the pro natural birth movement was spawned in the 1970s, probably because of the nearly robotic nature obstetrics had taken on. In some of the mothering circles I've frequented, the overuse of Pitocin, epidurals and c/sections almost seem to harken back to those days, and for a minute you again start to feel like the anomaly - or at least like a troublemaker, for daring to speak up and question something that just doesn't sound quite right. 

In "the old days," births were often attended by the mothers, sisters, aunts, and other female relatives of the laboring woman. Usually with nothing more than personal experience - whether it be from having gone through labor before or having attended hundreds of births - a midwife delivered the baby, and those deliveries were often deeply spiritual events that signaled a rite of passage. I can attest that there is nothing more spiritual or empowering than giving birth in the company of women, something I will never forget from my one vaginal birth. Not only did I physically give birth via VBAC, but to a daughter - under the direction of a midwife, with female nursing staff in attendance. While it was a hospital birth, I no doubt labored with women who were sisters, wives and mothers - all of whom have probably attended the births of their sisters, nieces, daughters ... there was something so beautiful about that that I just explain any other way. 

While there were negative outcomes of childbirth before modern conveniences, technology and information, there were also many positive outcomes. And sometimes, unfortunately, there can still be negative outcomes even with a modern hospital birth. Some of these things, as Ina May hints at, can be prevented, but some cannot, and I think that's very difficult for some people to accept. With the onset of tons of medical interventions, you're often taking away the deeply feminine aspect of birth - as well as creating more problems in the long run. This kind of thinking has totally changed the way obstetricians practice medicine, as well as how the women in this country give birth, as evidenced by the c-section rate in the US that hovers around 33 percent. 

We seem to have traded one set of concerns for another: yes, the infant mortality rate has improved with modern care, but our cesarean section rate is definitely increasing. Back when doctors (and midwives!) knew how to turn babies in the womb, deliver breech-presenting babies and manage difficult labors, c-sections were rarely performed. It seems, however, that in many other countries - that also practice modern obstetrics - the rate of cesarean is much lower, no doubt because doctors respect and practice concurrently with midwives, and still practice many of the 'old school' techniques our doctors have long-abandoned. 

Women who are informed about their care and act on that information are often discriminated against, treated rudely or seen as nuisances by their doctors. In talking to many of my friends, the routine model of OB care seems to be one of two paths: You approach your due date, possibly go overdue by a day or two, and the doctor brings up the possibility of induction. You decide to do it, and either the baby is born on the doctor's time table (between the hours of 9 a.m. and 3:30 p.m.) or the induction fails, and you are shipped off to the operating room for an "emergency c-section" for fetal distress. End of story. 

In the meantime, it seems that that model of care mirrors the kind our mothers received - treated, on the whole, as robots, whose job is to just lie there and shut up, no questions asked. 

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.