Sunday, June 27, 2010

Induction Musings Part 2- How 'bout we Don't?

Reasons to Not Induce Labor... or... Please Just Let the Baby Be

Before I get to the reasons to induce labor, I have to touch on some reasons that people induce labor, when really, it would be better to just keep gestating.

Please, for the love of God, ignore your OB advising you to induce labor because:
  1. You're 39 weeks pregnant, so why not?
  2. You're 40 weeks pregnant, so why not?
  3. You're 41 weeks pregnant, so we have to.
  4. You're 42 weeks pregnant, so we have to.
  5. The baby will be TOO BIG, and never come out.
  6. Your doctor is the one on call that day.
  7. You're tired of being pregnant.
Let's address each of those:
  1. Being 39 weeks doesn't mean your baby is ready to come out. The last couple weeks in utero baby works on the sucking reflex, so more time in means better breastfeeding.
  2. Congratulations! You're 40 weeks. A good marker to make it to, gestationally speaking, but not a reason to evict the baby. See my last post for more about how we got the "40 weeks" number.
  3. 41 weeks. This is frustrating, but normal. Since doula training, I've read over and over again that the average first pregnancy is 41 weeks. That would mean that most first babies need that "extra" time.
  4. 42 weeks. Goodness, at this point, your OB is threatening to come to your house and hook up the pitocin, the birth center says they won't take you and all of your relatives are calling. It's annoying, but it seems your baby is just not ready to come out.
  5. The first two births I went to featured 9lb and 9.5lb babies. The baby WILL come out. And really, there's no way for your doctor to determine if the baby will fit until you're actually pushing the baby out (unless you have a misshapen pelvis).
  6. Ah, the "I want my doctor to be there." First of all, inducing labor the day your doctor is on call doesn't mean they'll be present because the labor could take longer than their shift. Secondly, they really only show up when you start pushing anyway, at which point the kindly nurses, your partner and your doula have done all the real work of helping you through labor.
  7. At the end of pregnancy, aren't we all. Even I tried most of the "natural" ways of starting labor. The good news is that if you go out to dinner, go to a movie, clean your house, etc, eventually whatever you're doing will be interrupted by you going into labor on your own.
Waiting for your baby to decide that it's time to come can be extremely hard, especially if you do have a doctor who is offering induction, but you have to weigh the risks of induction against the benefits of having your baby a day or a week before you would have anyway.

Thursday, June 17, 2010

Induction Musings Part 1- The "Due Date"

Lately, I've been reading a lot about the medical induction of labor. Reading about when and why parents should consider induction and about when it's best to wait and "let the baby decide."

Generally, what happens is that somewhere between 37 and 42 weeks, the baby will send out a hormone that tells your body that it's time to let the baby come out. Your cervix will start to soften and thin out in preparation for beginning to dilate. Uterine contractions will kick in and the the baby will move lower in the pelvis as the cervix opens up to allow the baby through the birth canal. In a normal, healthy mother (and a great number of unhealthy ones) this process will start when the baby and the woman's body are both ready for birth.

In 1830, a doctor named Franz Naegele invented the way that due dates are calculated. Doctors, who love numbers and being able to measure things, still use his formula today. The issue here is that the "due date" gives us a rough estimate of when a baby might decide to make his or her apearance. There are several factors that will affect how accurate a due date is, such as the length of that woman's menstrual cycle and how long the individual baby needs to mature.

Now, since doctors like measurements so very much, what tends to happen is that an OB will look at a "due date" as the actual date by which the baby needs to have arrived. If the baby continues inside the womb past the date that they've decided on, doctors will start to get nervous and begin talking to expectant parents about "inducing labor." Some doctors even want to talk induction before the "due date," because once a baby is considered full-term, they are more comfortable getting the baby out of the uterus (an environment that they can't control) and into the hospital where they can assess, measure, and test.

One thing that obstetricians in our area seem to do as a rule is to begin doing ultrasounds and non-stress tests once a mother hits 40 weeks. What they then do is tell parents that they have to come in to the office anywhere from every 2-4 days for more testing to make sure that everything's ok, creating the atmosphere for convincing parents that continuing a pregnancy at this length of gestation is risky and something that needs to be closely monitored. What seems to be the norm at these appointments is that the doctor will work on talking the parents into a medical induction.

Doctors will say things like:

"So, when do we want to schedule the induction?"

"If you go home now, I can't be held responsible for what happens."

"You'll be begging me to get that baby out of you be 39 weeks."

"I let you go this long." (OB to a mom who was 41 weeks)

"Because your cervix is lousy."

Quotes taken from My OB Said What?

To sum it up, the "due date" is a good predictor of what month you may end up having your baby, since it falls in the middle of the four week time span when most babies tend to make their appearance. Being 40 weeks, 41 weeks or 42 weeks along is not a medical reason for induction. It just means that your pregnancy isn't over and your baby is still maturing. If you choose an OB (and even some midwives do it) as your care provider and you go past 40 weeks, you need to be prepared to deal with pressure to induce labor.

In the coming posts, I'll be writing more about real reasons for induction, the Bishop score, natural ways of encouraging labor and handling when you are the one who is "post-dates."

Sunday, June 13, 2010

Mother's Advocate- The Last Clip!

I've come to the end of the Mother's Advocate video series. I hope that it has been helpful to someone. Lamaze's Six Steps to a Healthy Birth, however simple, aren't yet the standard in every hospital and obstetrics practice. As a consumer, you need to demand what you want from your birth, and the medical industry will change, the same way that they changed to allow fathers in during birth. Obviously, I also recommend having a doula at your birth, to be your advocate while you're doing the hard work of having your baby.

Friday, June 11, 2010

Friday, Really? & Mother's Advocate Video

It's amazing to me that my last post was this Monday, and here it is, Friday night. This week was incredibly busy, and also lovely.

Tuesday was my 8th wedding anniversary. That means that the incredibly patient Husband Tim has been tolerating my hippie weirdness for 8 years now (nine if you count when we started dating). We had a babysitter come put the kids to bed and we went out to dinner at the Strong Hearts Cafe in Syracuse.

Wednesday evening was the first official meeting of the CNY Doula Connection. Our 6:30-8pm meeting ended up being a 6:30-10pm meeting, as we spent hours in the Barnes & Noble cafe talking about birth, doula-ing and our new network.

The past couple of days, I've been working on the new website for our doula group. You can see it at . If you haven't visited yet, check it out and tell me what you think. This website designing is all new to me.

I am continuing the Mother's Advocate series:

Monday, June 7, 2010

Mother's Advocate Videos; Day 5

Today's clip is on avoiding unnecessary interventions. As a doula, part of what I do is to help parents avoid interventions that they don't want. One example of this is keeping a mom who doesn't want an IV hydrated during labor.

One thing she says during the video is to save interventions for when the parents and caregiver think that the benefits of the intervention outweigh the risks. If you are someone who wants to avoid interventions during birth, it's important to carefully choose who you have attending your birth. Ask for actual statistics on how often they do the interventions that you are trying to avoid. Don't just take their word that they only do it "when necessary." I have seen an OB who told a mom during pregnancy that they didn't usually do episiotomies try to talk the mother into one during pushing.

Sunday, June 6, 2010

"Colors" LENS Contest

Here is Delilah, my six year old, doing what she picked for homeschool "art" last week. Basically, she was playing with mushy goo.

Delilah says that she wants to be a midwife when she grows up and that we're going to work together, like our doula friends, Diane and Naomi Starsiak.

To enter the photo challenge yourself, you can go to

Mother's Advocate Videos- Day 4

Today's clip is about the value of continuous labor support. It's one of my favorite ones in our series, because that's what I do. A doula is someone who stays with the laboring mom from when she's called until the baby is born and nursing.

Some of the good things that come from having a doula are:

- reduced risk of having a surgical birth
- less risk of postpartum depression
- better satisfaction with the birth expereince
- more sucessful breastfeeding

Thursday, June 3, 2010

Mother's Advocate Videos- Day 3

You all thought that there wouldn't be a nifty video today because of my baby carrier/ pictures post. Never fear, I'm not skipping the childbirth ed portion of our day.

The narrarator in this clip points out that women who spend labor in bed report more painful labors than women who are moving around, walking and changing position. That has definitely been my experience with my own births. Sitting up, walking, swaying, moving... just felt better for me. Take note of the one woman who is laying down and goes "Ah, I need to move." She is doing what her body is telling her is best.

Baby K'tan Carrier

When we got home from the YMCA today, there was a box under the mat on the porch. The kids, of course wanted to know if it was something for them. Turns out it was a new carrier from the Baby K'tan company. Unlike most of my baby carriers, I didn't have to buy this one. A few weeks ago, a representative from Baby K'tan contacted me about their Doula Outreach Program (which I think is a great idea, good marketing). They sent me the carrier, an instruction DVD and a box of brochures to give clients.

Ben (2 1/2 years old) served as my tester. We tried the back carry and the front position (Hug). He's a little heavy for me to use the "Hug" position very often, but the Back position was pretty comfortable. I could totally see going to the mall or the zoo with him in the back carry.

Here's the "Hug" position.

One thing I like about the Baby Ktan is that it is a "double sling" carrier, so you can wear two babies. The website and the instruction guide show you how. I would have liked to have had this when I was doing childcare at home.

I've boxed it back up so that I can use it as a demonstration model for clients, but Baby K'tan people, if you're reading this, feel free to send me one in Sage Green or Warm Cocoa to use for myself.


Their videos:

Wednesday, June 2, 2010

Mother's Advocate Videos: Day 2

"Let Labor Begin On Its Own"

Today's clip covers reasons to induce labor and when it makes more sense to wait for labor to begin on its own. Many doctors recommend induction for non-medical reasons, and while it can be tempting because the last weeks of pregnancy seem to drag on forever, it's generally safer for mom and baby to wait until labor begins naturally.

Tuesday, June 1, 2010

Mother's Advocate videos: Day 1

This video is the first in a series that I will be posting this week. A large part of having a satisfying birth experience, I think, is being prepared.

Choosing a healthcare provider that is truly supportive of your choices is an important step that the video talks about. Personally, I've changed caregivers at 28 weeks along (baby #2) and 38 weeks along (baby #4) so that I could know I had someone who would help me have the birth I wanted while taking the best care of me and the baby.