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if I didn’t dilate, am I doomed to failure the next time too? December 5, 2009

Posted by guinever in : birth, labor, pregnancy , comments closed

I get a lot of questions on my website from women wondering about induction. This comment from a reader is an all too familiar scenario. Her induction eventually led to a cesarean birth. She writes,

Hello. I was induced on my due date with my first baby. I was only at 1 cm, had no contractions, nor had my water broken. After I was induced, I was in labor for about 19 hrs. My baby’s heart rate kept dropping because the contractions were putting too much stress, so I ended up with a c-section. I had only reached 2 1/2 cm of dilation at that point. I do NOT want another c-section. MY husband and I want to try for baby number 2. I want to know what my chances are of not dilating fast enough before the baby goes into distress again. Am i doomed with bad luck in not being able to dilate? Please help me understand this!

baby-feetI’m so sorry that this happened and that you feel that your body failed you.  (((hugs)))  You are a victim of the  current obstetrical system that is quick to induce when it’s not necessary and when women are not ready for labor.  Your next pregnancy is not doomed and you  will dilate and you can have a vaginal birth. Make sure to choose a birth team who will “allow a trial of labor” and  attend vaginal births after cesarean–VBAC– or better yet, plan a homebirth!

Unfortunately, situations like this happen everyday in labor halls. You were induced on your due date. The due date is not a magical day when the baby needs to be born by.  The average length of first pregnancies is over 41 weeks if allowed to wait for labor to start on its own.Your body simply wasn’t ready for labor and the induction didn’t work.  You were probably diagnosed with failure to progress. It’s as simple as that.  Not every baby can handle the stress of a lengthy pitocin induction and will go into distress, necessitating a cesarean.

For next time, you can figure out if an induction is likely to be successful by finding out your bishop score or you can always  just say no to induction. One of the things you can do to avoid a repeat cesearan is to prepare for a natural birth.

To answer the question, am I doomed to failure the next time if I didn’t dilate with my first pregnancy, the answer is no. A resounding no. Each pregnancy and labor are different.

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think twice, no think three times before being induced for labor April 11, 2009

Posted by guinever in : birth, labor, pregnancy , comments closed

bag-of-pitocinMy pregnant readers often ask if I think they should be induced.  After reading each scenario, my usual thought is, “No.”  But that is a decision to be made by a woman after discussing it with her medical care provider. If you’re interested in natural labor induction methods, go here.

Read “Don’t let this happen to you”  part 1 and part 2 written by a labor nurse all about a birth that started with an unnecessary induction.

Questions to consider before saying yes to induction:

  1. Will my health be compromised if I continue my pregnancy?
  2. Will the baby’s health be compromised if I just wait for labor to start on its own?
  3. What will happen if I don’t induce today, tomorrow or next week?
  4. Why does the doctor want to induce? Is it for his/her convenience or is it for the health of me and my baby?

Consider this:  50% of inductions in first-time mothers result in a cesarean birth. Yikes!  That’s half. The over-all cesarean rate in the U.S. is currently 31% according to the CDC (Center for Disease Control and Prevention.)

The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States.

Not all inductions are bad or unwarranted. If you have a medical condition such as very high blood pressure, diabetes (not gestational diabetes), pre-eclampsia, an induction is desirable. An induction should be considered only when mother or baby is in danger if the pregnancy continues.

Common non-medical reasons for induction

  1. Doctor is going on vacation
  2. Doctor wants to do all his deliveries during the day and not get called in the middle of the night. He wants to control the timing of your labor.
  3. Doctor gets paid more for a surgical birth than for a vaginal birth.
  4. It’s the last week of December and the couple wants to be able to claim the new baby as a deduction on their taxes.
  5. Couple’s parents are in town for the birth and so they “need” to induce before they go back home.
  6. Mom wants to plan her birth so she can time her maternity leave for work.

So why do many inductions end in surgery?

It’s because the body just isn’t ready for birth. The cervix isn’t ready to dilate. If you’re nearing your due date and you or  your doctor wants to induce, please consider the bishop score which takes into account baby’s position, and the dilation and effacement of the cervix. You can take this short 5 question quiz based on the Bishop score to see if being induced might work for you.

7182_pitocinHere’s an all too common labor scenario:  Mom can’t handle the high doses of pitocin so her blood pressure goes up. This affects the baby. Mom gets the epidural because she can’t handle the contractions on pitocin. The epidural makes the labor slow down, so the pitocin is increased. Afterall,  she can’t feel the contractions anymore. Baby increasingly gets worse and worse until a cesarean is needed to save the baby. Mom is worn out and can’t take care of her baby who is having trouble breastfeeding because he’s so lethargic from the drugs that crossed over the placenta.

induction 101

If your cervix is really soft, you might get to skip this first step and just go to the hospital in the morning. But if your cervix is hard like the tip of your nose, you’ll be asked to come in at night and you’ll be given a prostaglandin on your cervix for the purpose of softening it. Some women are able to sleep through the night. Other women feel contractions and are uncomfortable enough that a good night’s sleep is impossible. By morning, your cervix should be nice and soft and ready for the next step in the induction. How long does it take the cervix to dilate 5 centimeters?  But first, let’s answer the following question:

what’s a prostaglandin?

cervidil_10825_5_big_Naturally occurring prostaglandins are in semen. Therefore, you can have all the prostaglandins you could ever need and want in the comfort of your own home. The best way to soften your cervix is to have sex with your husband several times during the last month of your pregnancy.

There are two chemical prostaglandins approved by the FDA for the purpose of inducing labor. They’re the pge2 type and they’re cervidil which is similar to a tampon that is inserted and then can be pulled out and prepadil which is a gel that is rubbed onto the cervix.

But there’s another prostaglandin that’s a lot cheaper than the two mentioned above.  It is not approved by the FDA for labor.  It’s called cytotec and it is used in the treatment and prevention of stomach ulcers. But because it is a prostaglandin and it’s cheap, doctors started experimenting with it to see if it would work during labor.  To quote a labor nurse,

Cytotec turns the cervix to mush. It works really well.

Another name for cytotec is misoprostol. Here’s the FDA fact sheet on misoprostol. Cytotec should not be used during labor; it can over-stimulate the uterus at the least and cause death of mother and child at the worst.

so what happens if you say no to induction?

Wait. Be patient. It’s hard sometimes; I know. Be aware of baby’s movements. Continue your pre-natal visits to monitor the baby’s health and your health. If everything is ok, be confident in your body’s ability to birth your baby. Your body has grown and nourished your baby for nine months and still can. Labor will start. No one was pregnant forever.

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these women show their doctors CPD was a farce: a video November 17, 2007

Posted by guinever in : birth, health, home birth, homebirth, midwifery, pregnancy , comments closed

Many cesareans are done because the doctor diagnoses CPD which stands for cephalopelvic disproportion. This means that the pelvis is too small to birth the baby or the baby’s head is too big for the pelvis or a little of both. The problem with this diagnosis is that it is proven incorrect when the woman goes on to birth a baby vaginally, often a bigger baby. Here is a slideshow of women who had a c-section for CPD and then later had a vaginal birth. For more information on this topic, read the article Can my baby be too big for my pelvis?

[youtube=http://www.youtube.com/watch?v=roFVkDV45MM]

Let’s give a big thanks to icanvoices for posting this. For more information about cesarean, and vaginal birth after cesarean, go to International Cesarean Awareness Network.

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