Artificial induction of labor at its worst...

Sometimes you realize how blessed you truly are; I did this morning. I met a girl whose birth story just broke my heart. She wanted a birth center birth or home birth and was bullied out of it by everyone telling her it just wasn't safe. The anger and pain in her face as she spoke of the events that unfolded and seeing how her and her beautiful baby would never be the same and never have a 'normal' life.... and to think that I was all cranky due to a lack of sleep the last couple nights. I know that story could have been from either side of the fence and I am sure there are stories that argue FOR hospital birth. I just wish that people would respect that A MOTHER KNOWS. Let her choose the birth she wants without imposing the birth YOU think she should have. If you had a wonderful hospital birth, you can share that as I do my home birth but never make a mother feel bad about her choice. To love a mommy-to-be is to encourage her to follow her own vision and help her along that path. -Aug 9

I cried at the social security office that day and it wasn't because I had to sit there all over again just to get my card with my married name on it. My mom was hanging out in the car with buddha baby while I waited inside because she is sweet enough to do that and ease my neuroses about having him in places such as crowded government buildings at 11 weeks old. There was a girl sitting next to me with a stroller that had a baby small enough to still need the carseat locked in and of course this brought out the social part of me as a new mommy. I asked her how old her baby was and explained that I had an 11 week old outside. She told me her baby was 6 months old and immediately asked me where I gave birth. I told her that I had our baby at home and, with this, she opened up about her entire birthing story. While speaking, she was so angry and so passionate that the guard at the front actually had to ask us to keep it down a couple times. It was clear that she was unhappy with her hospital birth and at first, I was happy to agree and interject a few great upsides to having a baby at home. Even now I feel a little bad because I know that as soon as I start talking about our birth I glow a bit. I can feel my face flush a little and I will gush about as much as anyone wants to hear about the entire experience. She was glowing too, but with rage at her whole experience and I cannot even pretend to know how she feels. Sitting here, I can see her face and my heart hurts for her.


I want to note here that if you are pregnant I would prefer you not read the following section until after you have given birth. I will mark 'STOP' and then 'START' where to pick up again. I believe it is best not to read about any scary birth stories while pregnant because you get enough of them everywhere else and also because it is a minority of people who have such things happen. There is no useful purpose in scaring yourself. In hypnobirthing, I was taught to stop people who wanted to tell me all their painful horrors during birth until after I was pregnant and I was glad I did. What I will do is post important information at the end so you can become informed of certain risks involved with medical labor inductions. I will just guide you to ask the right questions and have an idea how to protect yourself from unnecessary risks. So please skip this for now and scroll down to the 'START'

[STOP]

She told me how she had wanted to actually have a birthing center birth and even knew about the birth center in Ft Lauderdale (our ladies at Palms Birth House were not finished with the licensing until about a week after buddha baby was born, making it the first licensed birth house in Palm Beach County). She explained how everyone around her was so against it because they swore it was just too dangerous to birth outside of the hospital. As I have said before and will again, the people around you can really influence how you feel about your birth and birth in general and their fear can easily become your own if you let it. Even if you try not to let it, it can still get you because it is ingrained in our culture. At this point in the conversation, I am still interjecting little tidbits about my birth too. As she delves into a story about elective induction because the doctors said it would just be more convenient and prevent her baby from getting "too big," booster pitocin to move things along faster, an epidural given at 9 cm, and of course an episiotomy to top it all off, I get quiet and just listen. While these things bother me, along with all non-medically indicated pregnancy interventions, they aren't as uncommon as one might think so I wasn't sure where she was going. As she brought her baby out she explained that the extensive use of inducing drugs during her labor caused contractions that were so long and intense, her baby was being deprived of oxygen-rich blood. It was about now that I realized that her 6 month old was smaller than my 11 week old and had very little muscle control. She continued on with this horror story only to explain that her baby, who initially scored highly on the apgar test, deteriorated quickly in the first 24 hours and now has been diagnosed with cerebral palsy. As she pulls out a bottle she tells me how she wanted to breastfeed but the nurses told her a couple hours after birth that her baby was now too hungry and since he hadn't latched they had to give him formula (instead of helping her latch of course).   As she continued on about lawyers, disability and NICA, I froze, I wanted to reach out and tell her how beautiful her baby was but I didn't want her to feel placated since telling me this story. I felt awful that she was so heart-broken and I had been sitting their gushing about my awesome birth. My eyes swelled with tears and I simply told her how sorry I was. I didn't even want to really look directly at them for fear she thought I was staring, At this point my number was called and I had to go. I offered my condolences and walked off in a daze. On the way out, I stopped again and told her good luck but that was it. What else could I say? I don't know her and can't pretend to understand her experiences. So, I write and decide that all I can do is familiarize people with the reality of convenience induction and warn against the practice of chemically boosting while already in labor.
      
  [Since I had no idea at the time what NICA was or why she was so angry about it, I looked it up and according to http://www.justiceforall.com/neurological-injury-compensation-act/  NICA is an acronym that stands for Neurological Injury Compensation Act. It is another attempt to chip away at an injured individual’s right to hold the person that hurt them responsible for his or her actions. It is a no-fault system that provides that if certain situations regarding notice and type of injury are met, an injured child may be deprived of his or her right to sue, and instead be given a nominal amount of money by the state. The lawyers for the insurance companies and medical profession know this, and they try to thrust NICA on these children that bring claims. I used this website because at the official website it tells you simply how wonderful NICA is and that did not seem to be her take on it at all.]

This beautiful girl with a 6 month old baby was pouring out her heart to me and it was like watching her walk through a nightmare. I know I can't feel guilty about my own happiness but I sit there thinking, "Why did I go on about delayed cord clamping and skin-on-skin contact?! Did I really boast how my awesome midwives encouraged me to take all that time while buddha baby crowned? Seriously, I feel like an ass!" She is the epitome of my fears about hospital births and yet the logical part of me knows that this story can be told from both sides. I could have just as easily sat next to someone who had a horror natural birth story (well maybe not JUST as likely but it unfortunately happens). I was not there for her birth nor can I confirm the exact facts of it, but in her heart, this was the hospital and doctor's fault entirely and I am one to trust the mother. She did not want to be induced at 37 weeks because she felt like her baby wasn't ready yet. She had NO medical indication for induction aside from the doctor telling her it would be most convenient for everyone. This horrifies me and makes my blood boil! The continued use of pitocin as a booster and then being ignored by nurses when telling them that something wasn't right once her baby was born, the list goes on. It is insane! Its like when I hear, "...thank god they did a c-section, the cord was wrapped around the neck." [The umbilical cord is often wrapped around a baby's neck and as long as there is not a severe knot in this cord, it poses no danger and is simply slipped off at birth. Babies get their blood and oxygen from within this cord, not from traditional throat breathing as they do after birth.] It baffles me that induction is used so often without proper warning of the very real side effects that come with it. I did a brief search on correlation between induction and cerebral palsy and in a recent study by Elkamil et al  (2011) "...found that labor induction at term was associated with excess risk of bilateral spastic CP and in particular CP with four-limb involvement." http://www.ncbi.nlm.nih.gov/pubmed/21275920

[START]

What is induction of labor? It is defined as the process of artificially stimulating the uterus to start labor. In a hospital and OB setting, it is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes. But, please note that there are many other ways of encouraging labor naturally. To medically induce labor, the risk of staying in the womb should outweigh
 the risk of induction to mother and baby. These medical indications include things such as cancer, hypertension, diabetes, kidney disease, small-for-dates baby and waters releasing without labor beginning in a reasonable time frame.

Why is this important to know about induction?

It is so common now to know someone who has their labor induced. In fact, the majority of people I know did have their labor induced and in only one of them was it medically indicated. According to the World Health Organization, induction rates in any geographic area should not exceed 10 percent. This is nuts when considering that a U.S. hospital can vary from 12 to 55 percent and individual doctors can have a rate upwards of 80 percent. What compounds the scariness of this is what ISN'T being told to mothers such as how this will affect them and their unborn child. A baby born at 37 is considered full-term but that by no means means that baby is ready to be born. At 37 weeks, a baby's brain weighs only 80 percent of what it will weigh at 40 weeks. That all-important cerebral cortex is the last part of the brain to develop and it is essential for things like cognition, reasoning and motor control. The point I am making is that there is a reason a baby stays in the womb as long as he or she does and that reason has NOTHING to do with a doctor's social schedule or yours. Convenience is not an indication for labor induction and while those last few weeks can seem like an eternity for some people, they are so important to the health and well-being of your child.

Some of the risks that artificial induction of labor brings are: increased pain to the mother which in turn increases the use of epidurals (which carries a whole other set of risks); increased fetal distress; lack of oxygen-rich blood reaching the fetus during these often more intense and frequent contractions; lack of oxygen to the fetus causing neurological problems in the newborn baby; continuous fetal monitoring which inhibits mobility during labor and increases pain; a huge increase in likelihood of cesarean; and an increase in the passage of meconium during labor which if inhaled by the baby causes serious breathing difficulties. There is also the risk of having a premature baby from induced labor and the risks that come with being born premature a far too great for me to cover in this blog. Again, these are just some of the risks that come with a practice that is supposed to reduce labor and birth complications.

I want to interject here that the suggestion of induction was one of the factors that changed my birth plan from an OB to a midwife. At 16 weeks I wanted to start establishing who my doctor would be so that I did not have to keep repeating my birth plan to all of these people. Also, different doctors had different answers to my questions and this was frustrating. I was told that if I wanted to know who would be there then I should just be induced at term and hope I had the baby while that doctor remained on duty. This horrifying suggestion was said to me in such a casual way that I as I left the building I burst into tears swearing that I couldn't do this, I couldn't have a baby like this- this was INSANITY to me!

The World Health Organization is clear in stating:

-Induction of labour should be performed only when there is a clear medical indication for it and the expected benefits outweigh its potential harms.

-In applying the recommendations, consideration must be given to the actual condition, wishes and preferences of each woman, with emphasis being placed on cervical status, the specific method of induction of labour and associated conditions such as parity and rupture of membranes.

-Induction of labour should be performed with caution since the procedure carries the risk of uterine hyperstimulation and rupture and fetal distress.

-Failed induction of labour does not necessarily indicate cesarean section.

Questions to ask
(Remember that it is your RIGHT as a pregnant woman to have ALL of your questions answered! No matter how annoyed the doctor may seem, or how rushed for time they appear, this is your body and your baby. Ask questions before it is too late to switch providers, this really is all about you and not about the provider at all. If someone won't answer you or keeps brushing you off... switch.)

• Why are you scheduling an induction of labor?
• What are the risks of inducing my labor?
• I know that my due date is only an estimate. What precautions will you take to make sure my baby is not born too early?
• How do you plan to induce my labor?
• How will an induction affect my labor and the health of my baby?
• I know that compared to waiting for labor to begin on its own, an induction is more likely to lead to a cesarean section. What measures would you take to reduce my odds for a cesarean?

All I am posing here is that you get informed. Know your risks and rights and double check. If what the provider is saying doesn't feel right, get another opinion, or another provider. A mother's intuition is an amazing thing, don't ignore it. Your body is designed to do this, it is not flawed and you are capable of having the perfect birth, whatever that means to you.

My Pregnancy

I wrote this about my pregnancy and where I was at before I gave birth. I wanted to remember how I felt and essentially, who I was in those moments. It often takes me days to go over things and proof them and this story ends just as I left it right before I went into labor….

May 21, 2012

My birthing day is coming rapidly so I figure it is the perfect time to write. I know that once our son is born, I will be different, in a slight, yet magnificent way and maybe I won’t remember what it felt like to be… the now me. The now me is a blank slate about my birthing experience, where the future me will be a full story. That is the difference I mean- the person I am now has not experienced birth, aside from when I was born on my mother’s birthing day. Which is the funny thing about a birth day, we are celebrating a day that shaped our lives and yet we rarely remember that it shaped our mother’s too.

Briefly, I must rant so that I may come full circle;) I sit here finding myself shocked that at this stage in my pregnancy there are still those who wish to impose their unsolicited and unprovoked fear mechanisms onto my family. The other night, someone decided that it would be appropriate to sit at the bar while Ricky was working and relay to him that she “heard about what we are doing and wants to have a chat with me.” (The snarky know-it-all tone could not possibly be appropriately relayed, so just assume it is in the most annoyingly superior and drunk tone). As Ricky defends us, and me, there proceeds to be a lot of eye rolling and other women joining in to display their expertise on the horror of birth and thus my stupidity. Ricky handled himself as best as he could when going up against cowardly attackers (to attack a man right before his wife is about to give birth, knowing that he cannot defend an experience he will never have, is cowardly and doing so while I am not present is shameful). He also proceeds to point out, that talking to me may not go well but she can feel free to after I have given birth. I may not have experience, but knowing that I would never come at someone from such an ultimately negative place tells me all I need to know about our lack of similarities in reality.

Don’t get me wrong, I get that the majority of people feel this way. I understand their opinion and truly respect that they have THEIR experience to show for it, but I will say this-THEY ARE NOT ME and their reality is not mine. The point is, that no matter how my birthing experience goes, it will be Ricky’s, our baby’s and mine. Even if it does not go how I envision it, I am still not going in filled with horror. What I don’t get is why anyone would want to put his or her horror on us. To save us?? From what? How could anyone who has ever met me, even once, not assume that I have become as informed as any one person could be about birth since the second I was positive I was pregnant? I get being helpful and the want to inform, but just for the record, putting a smirk on your face and saying something like “Oh you’ll see,” isn’t helpful, it’s shitty.

Those same people that think I am so naïve forget the most important thing- while I agree that I am naïve, I believe my naivety is my gift.

So, where am I and how did I get from the “typical” and “normal” birth plan to here? I cannot imagine knowing what birth really feels like, but for the rest of it I have put in the work, educated myself and spent the last months training for this. Yes, training. Could I expect to run a marathon without training? Of course not, so how can I expect to have the calm birth that I want without spending time everyday preparing; through my breathing and relaxation exercises, as well as keeping my body healthy. This isn’t something I just knew to do. I sought out the best birthing team for myself and for my growing family. Our midwives and doula kick ass! They are capable, trustworthy and (here’s the kicker) SUPPORTIVE. Not only am I encouraged to ask whatever questions I have, they are really willing to take time to answer all of them. Seriously, they just freaking rock.

I feel lucky for the path that led me here because it started with fear and that fear led me to seek peace. In the beginning, I did what pregnant women do: I went to the OB I got all the tests and sonograms, I sat in a backless gown and waited… and waited. Then, I met with a doctor who rushed around and left. I did this a few times and I was able to get questions answered, reluctantly, but it was enough to know that this was not going in a good direction for me. When I was barely 18 weeks pregnant and I started hearing words like induction, epidural, and what the doctor would “let” me do in response to my questions, I freaked. I already cried every time I had a doctor’s appointment, and I literally did not want to physically give birth. I was terrified! I felt like I had lost a race that I hadn’t even started. I had to do something, this felt wrong in every way that it could and I hate to fail at anything. I began searching and I found my way to Amazing Births and Beyond. I met with Lorie (our now doula) and everything changed! No seriously, its like a birthing parade broke out inside of me with rainbows and sunshine and all that jazz. I sat down and spoke with this amazing woman and for the first time, I felt like I could do this. I felt like I really could give birth! No, I am not an idiot; I know that in one way or another, our baby would eventually physically come out. It was the spiritual, emotional, and mental part that I had been worried about. I am not saying that I went home and everything has been confidence and roses since. What I am saying is that Lorie gave me my first glimpse of what I wanted, a beautiful and empowering birth, and showed me how I could get there. For this, I will be forever grateful.

Since then, I have concentrated on increasing that confidence little by little until it just stopped leaving. Everything from there is a bit of a whirlwind: we met with Miriam first and made sure that we could have her as our midwife and learned what it means to have a midwife; we took a 5 week Hypnobirthing course and did all our homework; we met and bonded with our other midwives Colleen and Allison; and we have grown (I have done most of the growing) with our birth team throughout this journey.

Importantly, we have taken every step to enjoy this process throughout a hectic move and outside imposed drama. While my hormones have gotten the best of me from time to time, I must say that pregnancy is an amusing time. Everything has become a bit funny. I think it has to in order to appreciate the miracle while being a bit roly-poly. Sometimes my transition from laughing to crying is a little abrupt which, in turn, becomes funny again but it is a real laughter in a way that is new and beautiful. Ricky and I laugh with each other and at each other (although he has to be a bit more careful when laughing at me lol). In preparing for the baby and the many things he will need, Ricky and I have learned the art of garage sale-ing and really have a lot of fun doing it. I have been able to embrace pregnancy, in part because I am lucky and I am blessed. I have an amazing husband who has taken interest in this process and decided to dive in head first. He loves me and knows that I am not one to settle if things don’t feel right. I need solutions and he helped me find them. He has helped me make decisions that will shape ours and our baby’s life, all while learning that pregnant life is not exactly predictable. I have a magnificent mother who has really embraced and supported my journey and continues to be here for me daily. The other aspect that has shaped this pregnancy has been CHOICE. We have CHOSEN to make the effort to learn about pregnancy, throughout history and the world, and then decided the best course of action for us. I refuse to be belittled because I put so much effort into this. We are talking about a human life and experiencing the most majestic gift one can be given- so excuse me if I discount the unwanted opinion of someone who believes its ok to spend weeks researching a new tv or camera, but thinks its silly to learn about circumcision or cord clamping. The point is, I am not attacking anyone else’s decisions and I do not attempt to share my choices, unless asked, or unless its on Facebook but that’s a whole different story...

To be completely honest, I respect all women and all birth so much that the very process leaves me in awe. No matter what your birth experience was, or what circumstances you had, you are a champ! Just because I believe in what I am doing does not mean that I do not believe in what you have done or will do. I truly believe that our reality is our choice and I just ask that the next time you scoff at someone’s choice, consider how qualified you are (or are NOT) to pass that judgment. I know that once people make up their mind, it does not matter what I say. What if… what if my birth is amazing, perfect, and painless? (“OMG did she just say PAINLESS!? How dare she suggest something so preposterous!!”) Oh yea, that is totally what most of you will think and oh yea I said it. So what! You want my goal? There it is and remember, I am not saying feeling-less, just painless. What if it is- most people wouldn’t believe me anyway- they could see it with their own eyes and still refuse to believe it. But that’s not my concern and never will be. Those who know me know that I will tell you truthfully, one way or another, and while I hate to fail, I am ok with admitting if I was wrong. Our baby is coming into this world and we are going into this journey together…