The more I am around birth the more I have opportunity to see that these interventions we have can be both blessings and curses to laboring mothers.  The more I am around birth the more I see births that truly did need medical intervention.    And on the flip side the more I am around birth, the more I see births that certainly could have done without so much fiddling.

And so I get to Christine’s post on Pitocin.  I think it’s great because it cautions parents not to  blindly enter into an elective induction or augmentation simply for the sake of time when mama and baby are both doing fine.  I have supported labors where the labor was progressing just fine and the OB ordered Pit simply because that’s how she rolls, and then watched as the baby quickly became distressed.  I have also supported labors where a little Pit at the end of a long labor kept the mom out of the OR by giving her body the nudge it needed to finish well.

So to all you pregnant women check out the link, learn a little about Pit, watch the video clip and then file that info away for your labor or your discussions about inducing your labor. . .

And to you mama’s who have labored before with Pitocin -  I’d love to know what your experiences with Pit have been.  Love it?  Hate it? Necessary? Unnecesary?

My personal Pit experience was with number two.  I was unnecessarily induced.  I was in early labor and didn’t realize it and was asked to come in for an induction.  At that point in my life I didn’t even think to question the advice so we went home (THAT should have been a clue that the induction was NOT a medical emergency!!) got our stuff and returned for the induction.  Well, I certainly didn’t need it.  Within two hours of starting the Pit, I was in the throes or transition and my dear little daughter was almost born in the elevator on the way to the delivery room.  (She was born overseas in a maternity clinic that had a LABOR floor and a DELIVERY floor.  You have no idea how sensible the whole L&D combo is until you are trying not to birth your baby in the hospital’s elevator!)  I would have much preferred my body’s slower pace because it would have been so much more manageable.   Spreading out all that work over a little more time would have been so much nicer.

So there’s my little trip on Pit.  What’s yours??

This birth pretty much took everyone by surprise. She was a first time mom who was two weeks early and her labor went so much faster than anyone anticipated. I ended up turning around on the way to their house and meeting them at the hospital. As soon as she got up to L&D she was already crowning! No time for an IV, not even a gown. That beautiful baby was here!! As soon as someone the hospital saw fit to catch the baby arrived, this mom gave her first real push and birthed her baby. That baby was so excited to be born that she had both her hands raised – celebrating her birthday.

The best was later when the mom looked up while cuddling her beautiful baby and said she wouldn’t change a thing.

Birth is one of those few moments in life when the natural process of things makes you keenly aware that a powerful transformative event is about to happen.  I love how labor begins when it is ready and how not only are babies born, but mothers, fathers, big sisters and big brothers.  It is one of those few moments when Life takes over, we drop everything and pay attention.

Check out the AP’s article here.

The burden of so many cesareans is starting to weigh on more than just the women and families involved.  Regulators are beginning to hold practitioners and hospitals accountable:

Hospitals also will have to report cesareans for first-time mothers, too often a result of a failed induction.

“That’s not a good outcome for the baby or the mom,” says joint commission president Dr. Mark Chassin. “We believe this will be a very important driver of improvement in perinatal care.”

It’s time that those who set the rules and protocols for hospital birth start to realize that unnecessary cesareans are not a good outcome -  as more babies have respiratory problems, moms have much longer and more difficult recoveries while simultaneously caring for a newborn and possibly other small children, and many moms suffer from post-op infections, not to mention many other risks and side-affects of major abdominal surgery.

For more info on inductions check out Henci Goer’s articles on elective induction and due dates. Henci Goer has made combing the medical research for best practices and translating that evidence for the rest of us her life’s work.  She is the author of The Thinking Woman’s Guide to a Better Birth.

Nursing Birth gives some great advice in her “Don’t Let This Happen to You” series when describing how one couple dealt with an induction.   Nursing Birth accurately describes the birthing climate in many of today’s hospitals and writes from an evidence-based point of view.

Related Posts:

• Do We Even get a Choice?
• One Choice We Make: Where Do We Give Birth?
• Good Things Come to Those Who Wait

Pregnant the second time, Jennifer was determined not to repeat her first experience.  Her first order of business was to find a supportive caregiver.  She had two litmus tests for each doctor she interviewed: “Do you support VBAC?” and  “Do you encourage repeat cesarean  for women who haven’t gone into labor by 41 weeks?”  Both of these were deal-breakers for Jennifer.    Coming from a family who has a history of babies being born between 41 and 43 weeks, she was not going to settle for a practice who routinely induced at 41 weeks.  It was imperative that she be given the opportunity to let labor begin on its own.  Committed to putting herself on a different path for this second birth, if she didn’t like the answers to either of those two questions,  she scheduled another interview with yet another doctor.

After several interviews with several practices she finally found an OB who was more than nominally supportive of VBAC and who looked at the big picture before encouraging induction.  Then as she educated herself about the various interventions, she decided that this time around she wanted to avoid an epidural for as long as possible as she was convinced that this had significantly slowed things down last time.

As her due date came and went,  she was sent in every 3-4 days for a biophysical profile.   She made sure to stay very hydrated so that she had the best chance at her amniotic fluid not appearing too low.  She also made sure to eat something before the visits so that her baby would be awake and energetic during the tests.  She stayed calm and did not stress out as 41 weeks passed.  41 weeks 2 days.  . . 41 weeks 4 days. . .

Her due date was just around the corner and still there were few signs that labor would be commencing any time soon.  Stripping the membranes wasn’t an option as she wasn’t dilated enough for the doctor to perform the procedure.   Her OB finally gave her a deadline of 42 weeks 3 days.  If her body hadn’t done something by then, medical interventions were going to be pursued.  The clock was ticking, but Jennifer stayed calm.

Of course Jennifer did not wind up becoming the first eternally pregnant woman.  At about 11pm on the eve of 42 weeks past her due date labor began.   Throughout this labor she and her husband  made many decisions to help make sure she stayed on a path that had the best chance of ending in a vaginal birth.

The first nurse assigned to care for her did not want her out of her bed when hooked up to the fetal monitor.  Jennifer immediately knew this was not a good fit.  She requested a new nurse from the charge nurse and was presently assigned a nurse who was studying midwifery.  Much better!

Later when her blood pressure was showing high readings, she labored on her left side even though this made dealing with the contractions much more difficult.    Jennifer knew that if her blood pressure didn’t come down, she wouldn’t even have the option of dealing with contractions as she would soon be having another surgical birth.   Laboring on her side was super effective at keeping her blood pressure in the normal range.

When the doctor on call (not the same doc who had cared for her during the pregnancy) lectured her on the risks of VBAC while she was in active labor, and later the risks of shoulder dystocia as this baby looked large, Jennifer kept her cool.  She had educated herself on these things before the birth and was more comfortable with VBAC  and birthing a large baby than she was with the risks associated with major abdominal surgery.

Lastly, she changed positions every 4 or 5 contractions while pushing to effectively use gravity and lots of movement to bring her baby down.   It so amazing when  Jennifer finally eased the baby out. Not quite two hours since she had begun, Jennifer pushed out all on her own body’s power, a 9lb 5 oz.  baby boy.  It was so amazing to see.  He slipped right out and was placed right on her chest to hold and cuddle and nurse.

VBAC moms always impress me.  Not only becasue they face the normal challenges of labor and birth (which are significant!) but they have the added challenge of birthing in a system and an environment that is not designed to facilitate VBAC.  It took determination, patience, and  skilled high pressure negotiation (there’s not much more pressure than when your doctor tells you that your baby might die from the decision you are making!) just to get to the moment where she could even have the opportunity to go into labor.     She later told me that the next day a nurse came in and told her that she was the only one of the floor to birth vaginally that night.

Jennifer had learned since her first birth that it was not her body that had failed in her first birth, but the induction. Her body simply wasn’t ready to give birth yet when she went in for the induction and so the labor was more difficult and ended in a surgical delivery.  This time around, Jennifer’s determination to trust in her body and give it the time it needed payed off.

Good things come to those who wait.