Induction Increases the Risk of C-Section

Well, the journal of duh strikes again – it’s being reported that induction increases the c-section rates for first time moms.  This is nothing new to those of us who have been around the birth world for awhile, but the medical acknowledgment of this is still rewarding.  The issue really relates to what do we do now?

If we take this study and put it on the shelf, not changing the practices that have led to the high induction rates – does it really matter?  And just what can the birth activist do to help lower induction rates, particularly the elective, “I’m tired of being pregnant.” inductions?

_{Photo © iStockPhoto}

It can wait for tomorrow…

I had one of those days where I had a list of things to do while out on the town, had my 10 month old in tote, and because of forces out of my control, got none of them done. I planned my outing to go something like this: get the oil changed in my car, go to the bank, and pick up dog food. NONE of this happened. I was waiting around way too long at the oil change shop when they said I was next in line (they lied). During this time the baby got cranky and by the time we were out there (without the oil change), it was nap-time so we did not proceed to the bank or the dog food store. What a HUGE waste of my day. When I got home I was really worked up and frustrated and then yelled at my husband who unfortunately works from a home office and is available to yell at whenever the mood strikes me, poor guy. On top of this, the baby would not go down for her nap when we got home so she was still cranky. Great.

When daddy stopped work for the day and was able to lend a hand in childcare, I was able to breathe and reflect a bit. My anger subsided and this feeling of  ”it’s okay, it can wait for tomorrow” took over me.

This got me thinking about all those mommas that are being persuaded into labor induction and this made me sad. In my first pregnancy my OB asked me if I’d like to schedule a cesarean when I was about 17 weeks along. There was no medical reason for this, it was for convenience! This is when a light bulb went off for me and I got the momma sixth sense that something was very, very wrong here. I immediately proceeded to change providers and practically ran to a natural birthing center where ended up having a non-complicated, peaceful, water birth.

What about the mommas who do not know that there are birthing choices? Do women think that it is normal to schedule a date to induce labor? To schedule cesareans?

It seems that many young, healthy women that I’ve had conversations with recently do not believe it is possible to have a natural birth. They were told for one reason or another that they aren’t “allowed” to. That they “have to” schedule inductions to not pose any “risk” to the labor process. These women pack their bags, do their hair and makeup before they leave for their scheduled date at the hospital, get induced and often receive an epidural when they get there, and with one or two pushes the baby is out.

Is this what birth has become? Do we have our babies like we shop online? For convenience? If there is no MAJOR medical reason why you need to have your labor induced, please stop to to think of the risk you are really putting your baby in by inducing.

Why would labor be induced?

There are several possible reasons. Those nearer the top of this list are cases where the benefits may outweigh the risks. Those nearer the bottom of this list,  the risks are more likely to outweigh the benefits.

1. If the baby or mother has a SEVERE health condition which makes it riskier to continue the pregnancy than to induce;  severe pre-eclampsia, diabetes with complications (it is estimated that this rationale for induction only applies to 3% of pregnancies)
2. Water breaking. If mom is more than 35 weeks pregnant, and it’s been more than 24-48 hours since membranes ruptured, most caregivers recommend induction to reduce risk of infection.
3. A baby that’s “overdue” – pregnancy lasting over 42 weeks.
4. If baby or mother has a MILDER health condition.
5. A pregnancy lasting over 41 weeks.
6. The baby is “too large.” (Although this is a common reason for physicians to recommend induction, research seems to indicate that there are not significant benefits to inducing labor)
7. Convenience or preference. Of the mother, or the caregiver. The risks outweigh the benefits.

Summary of induction risks.

All of the forms of induction can lead to stronger, more painful, and more frequent contractions, which may lead the mother to use pain medications she might otherwise not require. These powerful contractions may also limit oxygen supply to the baby, so increase the risk of fetal distress. Also, due to the uncertainty of due dates, and the variation in the amount of time any given baby requires to reach maturity, early induction carries a risk of causing premature birth. There is a significant increase in the chance of cesarean.

Questions to ask your provider if induction is recommended:

1. Why? What are the reasons why it would be better to deliver the baby sooner?

2.  How? Could we start with one of the non-medical options and see if that works?

2.  When? Is this something that needs to happen today? What would happen if we waited a few more days? Another week? Is it possible that it can wait for tomorrow….

Think about it, challenge providers, do your research. Only you know what’s best for yourself and your baby. 

Much love,

Amy

Angie’s List Induction-Turned-Cesarean Commercial

Screen cap of laboring woman being rushed to surgery

Transcript of an actual Angie’s List review:

At my 41 week appointment, my OB decided to induce me, but I guess I took longer than he expected because just as I went into hard labor, he told me he was leaving for an important meeting. On his way out, he said goodbye, dressed in his tennis clothes. One hour later, I was getting a c-section… while he was out practicing his serve.

Late Preterm Birth – STOP THE MADNESS

The CDC released another report on lat preterm birth today. ?Here are some of the key findings:

• The U.S. late preterm birth rate rose 20% from 1990 to 2006. If the late preterm rate had not risen from the 1990 level, more than 50,000 fewer infants would have been delivered late preterm in 2006.
• On average, more than 900 late preterm babies are born every day in the United States, or a total of one-third of 1 million infants (333,461).
• Increases in late preterm births are seen for mothers of all ages, and for non-Hispanic white and Hispanic mothers.? The rate for black mothers declined during the 1990s, but has been on the rise since 2000.
• Late preterm birth rates rose for all U.S. states, but declined in the District of Columbia.
• The percentage of late preterm births for which labor was induced more than doubled from 1990 to 2006; the percentage of late preterm births delivered by cesarean also rose markedly.

Okay so what do you need to know about this? ?DON’T GET INDUCED.

Don’t do it for any of the following reasons:

• You are tired of being pregnant. (Your baby is still enjoying the ride.)
• You are uncomfortable. (Long, hard labors don’t make you comfortable.)
• You can’t sleep. (Sleeping in the NICU is hard too.)
• Your doctor is only on call on X date. (Then wait until baby picks their doctor.)
• Your mom has a plane ticket to visit on your due date. (Either change her flight or suck it up.)

Seriously how many sick babies have to be born before someone takes a stand and says enough? ?900 per day. That is a lot of babies who are greater risk of breathing difficulties, trips to the NICU, dying from SIDS, problems breastfeeding…

Surely you can stick it out a few more days or even a couple of weeks. Do it for your baby.

The Infamous Cascade Chart

As someone strongly involved in the birth community, this is probably one of my favorite pictures floating around the internet that I run across every once and a while.? One day when I find out the person who actually put these thoughts and cascade of interventions into a physical chart to view, I am going to kiss them!

I have always loved how it starts with induction, because lets face it, so many women today are starting their labors with some kind of artificial labor stimulant. Whether it be pitocin, or the oh so dangerous cytotec. I can personally say I have been the victim of the cascade myself with my first child. Had I seen this before my pregnancy with him, I would have never opted for the induction. Many do not realize that induction in many cases will fail, almost half of the time according to the most recent figures, and when I quote that, I am quoting Robbie Davis Floyd in a 2008 interview, I believe it was in Pregnant in America but my birth/pregnancy movies and interviews all start to blur together when you watch so many of them. These babies are not ready to be born in many cases, especially when we are seeing these inductions before the “due date” or the 40 week gestation mark. Although we know that “due dates” aren’t much to put stock into, many women and providers use them as some type of eviction date, which history has shown to be a pretty bad idea. No one is going to be pregnant forever and many women left alone will go into labor on their own. Now granted, there are cases that induction is medically necessary and for these special cases, I am completely thankful. Without induction these women would be subjected to cesarean sections instead of labor inductions which could in turn be even more hard on their body, and experience over all.
What we do not understand with the induction of labor is, we are creating unnaturally strong contractions in attempt to simulate something similar to natural labor. As someone who has experienced pitocin labor, and natural labor, I would take a million natural contractions over being on the receiving end of pitocin again. The comparison in my opinion is not even in the same ball park. Another issue with these contractions as most know, is the fact that they are more likely to cause fetal distress on the baby because they are not natural contractions or what normal contractions are supposed to be. So in turn we are putting our children under unnecessary stress. Especially if they are not ready to come and join us in “our world” yet. Again something I learned with my first.
Then we have the provider who comes in and looks at the fetal heart monitoring and says, “Oh No! Your baby is in danger!!” So off to the operating room we go for an “emergency” cesarean which in reality was caused by the pitocin to begin with. You would think by this point there would be a bit of common sense in the Obstetric community to say, ya know, I think we are causing these actions instead of blaming the increasing cesarean rate on “patient choice cesareans” which only make up 3% at most of the incredibly high cesarean rate in our country.

But a cesarean is only one path that this induction cascade can lead to. There are still women out there that will have a vaginal delivery when subjected to a labor induction, but in turn these women have greater risks for other procedures including episiotomies which have all in all been proven to really have little to no benefit to women in the long run. While episiotomy rates are starting to decrease, they are still over used in many communities. For example, here in my state of Connecticut, some hospitals have an over 25% episiotomy rate, when science tells us there really shouldn’t be over 10%. Trying to obtain these numbers are like pulling teeth too FYI!

We also have vaccum extraction. I had never really discussed this or spoken with someone who experienced this until I met my Chiropractor in the summer of 2008. He was discussing with me why Chiropractic care in infants is important, and then he described his own daughters birth, they had applied the vaccum to the top of her head, and while “assisting” her out, they pulled so hard the vaccum literally flew right off of her head. My Chiropractor described it so vividly… “I thought her HEAD popped RIGHT OFF! I was horrified to even look!”? My heart broke for him because no parent should have to go through that kind of fright during the birth of their child!

These all often lead to epidurals, which especially if you are going to have a cesarean section, you will either have this or a spinal block. All types of anesthesia that will have a direct impact on the baby. Although I have experienced women told there will be no effects on their baby at all.
I am sure most know about the “breast crawl” and I can say after watching a baby who’s mother did have an epidural, as opposed to a mom who had a natural birth, there is no comparing the instincts of the baby. While I had epidurals with both of my children, I didn’t have the opportunity to breastfeed then until they were a little over an hour old. My first was almost 2 hours. For more information on epidural effects on babies, click this link!

The last thing I want to touch on is the separation of mother and baby after a cesarean section which is very common. It is pretty uncommon for an newborn to be allowed to stay in the OR with mom, although it does happen sometimes. I can really related to the lack of bonding, breastfeeding problems, and reduced bonding because of this because I deeply experienced this with the births of both of my children. While I bonded, it was not that “instant motherly love” I am sure most feel. It hurts me to this day to know that my bonding was an almost learned bonding because I knew as a mother it was something I needed to do in order to protect my babies.? While most women who have had cesarean sections are not quick to admit this, I think by discussing this and acknowledging that this is a true problem it will only help to improve it for others in the long run. I also noticed that mothers who do experience this may be ashamed or fearful to admit this because it make portray them in a less than perfect light, or maybe others may look down on them because of this, but they should not be ashamed. It happens and there is nothing we can do about it but help other women to not go through what we did!

Be empowered by your birth, no matter how you birth!
If it is a bad experience, help to educate others so they do not go through what you did, so they can avoid the pain or heartache you have dealt with!

Labor Begins On Its Own

The first healthy birth practice is simple enough – let labor start on its own.? This means no meddling around.? You don’t need to tinker with a process that’s ultimately perfect for the vast majority of women.? Your baby’s brain grows so much in the last few weeks of pregnancy – why lose that?? Why risk induction?? Here are some ways to avoid induction:

• Don’t whine about being uncomfortable to your doctor or midwife.? That’s what you do to strangers, your family and your girlfriends.? Your practitioner might just put you out of your misery (and theirs).
• Just say no to late pregnancy vaginal exams.? Sure it might tell you how far your are dilated (or not), but you also risk breaking your water, infection and the like – not to mention who enjoys vaginal exams?
• Don’t answer your phone or except pressure from email.
• Do not be swayed by false promises of fast labors or easy starts like stripping the membranes.

What would you add to this list?

Be sure to check out the advice from Lamaze on the Healthy Birth Practice #1: Let Labor Begin on its Own.? You should also see the materials provided at Mothers Advocate, including a really great, but short video.

ACOG Revises Induction Protocol

The American College of Obstetricians and Gynecologists (ACOG) has issues a press release saying that there is a revision to it’s labor induction guidelines. The basics from the press release do not look very different from what I had heard from ACOG before, so I’ll have to wait to have the paper in my hands. Here are some basics from the press release:

• Wait until 39 weeks or do fetal lung maturity testing
• Use cervical ripening before full blown labor induction
• Do not use Cytotek on someone with one prior cesarean
• Induction reasons may be for physical reasons with mom or baby or other reasons that are reasonable, like distance from hospital in a rural area
• There are risks to induction
• There are some reasons induction is not an option (placental, fetal position, etc.)

What are your thoughts on labor induction? One thing that jumped to my mind was that they said labor induction had doubled since 1990 and that now 1 in 5 women were induced. That number sounded really low to me.