Archive for the ‘Induction & Augmentation’ Category

A Message About Preeclampsia to Every Mother

Wednesday, June 4th, 2014

If your care provider is seeing a slight increase in your BP, a bit of protein in your urine, and asks you questions about headaches, swelling in your hands and face, pain under your ribs on the right, and if you’ve been seeing spots, they may tell you that you are turning preeclamptic. The Preeclampsia Foundation website can help clarify a lot of what they are telling you, and give you some tools to partner with your care provider in making sure of your diagnosis. Before you can proceed, having a good understanding of what you are facing is important for you and your baby’s health. A preeclampsia diagnosis is nothing to sneeze at, and therefore, it behooves you to learn what you can in order to participate fully in your care, and to make decisions based on information and instincts, rather than fear.

However, it is important to note that, if you do have preeclampsia, you are in a situation where the benefits of certain interventions (such as induction or occasionally cesarean section) very likely outweigh the risks of waiting it out. Preeclampsia doesn’t play fair. It is imperative that you speak clearly with your provider, and make sure you understand why they are suggesting certain procedures. Even if they are necessary, they can be hard to take in if you were planning an unmedicated vaginal birth. Knowing really is half the battle in this case. Do not be afraid to learn about preeclampsia, learn about the way your care provider treats it, and walk forward in confident awareness of the power you still have to choose rightly for you and your baby.

Some things to consider if your blood pressure slightly elevated during only one prenatal visit, and in the absence of other symptoms:

  • What is your stress level like?
  • Have you been sick lately?
  • Are you dehydrated?

Some questions to ask if you have more indicators and/or symptoms:

  • “Am I being diagnosed with preeclampsia, or are these numbers borderline?”
  • “Could this be pregnancy-induced hypertension? If so, how do you normally treat it? Can it lead to preeclampsia?”
  • “What other symptoms might come to light if it is preeclampsia?”
  • “Do I have the option of monitoring BP at home, and being checked every couple of days, or does this need to be taken care of now?”
  • “Is the protein in my urine shown via a reagent strip, and if so, can we double-check it with a 24 hour catch?”
  • “What are my options for induction if it becomes necessary? What are the benefits/risks/alternatives of each method? Which do you prefer, and why?”
  • “How soon do you typically decide to move on to a cesarean section if the induction does not work?”

Preeclampsia is not the end of the world, though it is serious. It is just one of several curve balls that get thrown at some women. It is not something that we currently know how to prevent with any degree of scientific certainty. We have a lot of ideas of what seems to help, but nothing we can hang our hats on just yet. One thing that I think is so important to understand is that we can do everything “right,” have a textbook healthy pregnancy, and still end up with preeclampsia or other problems. We are never guaranteed a “good” outcome when it comes to anything in life, and we should not expect our births to be any different.

What matters most is to do the best we can with what we have, and to be flexible when we are handed something unpleasant, difficult, or even downright terrifying. We face our fears and challenges head-on, and make the best decisions we can within our circumstances. We do not lose our power just because of a medical diagnosis. We just lose a few options we otherwise would have had. Never be afraid to ask your care provider, “Why?” The more you understand, the less scary it will be for you, and the better you will be able to process your birth after the fact.

Preeclampsia or no, your birth is still your birth. You are already a good mother. You can do this.

What do you know about preeclampsia? Where did you get your information? Have you had preeclampsia before? What was your experience with it? What did you learn from it? What advice would you give to someone facing a similar situation? Share your story in the comments…

Grace & Peace,
Tiffany

 

7 Symptoms Every Pregnant Woman Should Know

Monday, May 19th, 2014

Pregnancy is weird. There is no denying that. It often comes with all kinds of odd symptoms as the hormones of pregnancy do not limit their effect to the uterus and growing baby. Everything from morning sickness to hemorrhoids to indigestion can be a normal part of pregnancy. These things are not often a cause for concern, but sometimes, these symptoms wander outside the range of normal, and it’s important to understand what that looks like.

There is a reason your care provider has you pee in a cup, takes your blood pressure, and asks about headaches, vision changes, and other symptoms. It’s best not to stay in the dark about why.

I don’t share this information to scare you, or to make you paranoid, but to bring a sense of awareness. When in doubt, it never hurts to call your provider. Peace of mind and good health are more important than feeling a little foolish. Take a minute to watch this video, and just tuck it away in an easily accessible corner of your mind.

Grace & Peace,
Tiffany

Birthy Weekend Links

Saturday, September 7th, 2013

This weekend is coming up fast! What plans do you have? I have family coming in for a five-day visit, I’m on call for a midwife, and I’m trying to put together some bouquets for my sister’s upcoming wedding. In the meantime, here are a few things worth reading this weekend.

Interested in reading more? “Like” my Facebook page, since I tend to share a lot more of these on my Facebook page, almost daily!

Happy weekending to you!

Grace & Peace,
Tiffany

Induction is a Grey Area: How to use medical procedures to your benefit.

Thursday, February 23rd, 2012

Image from PregnancyBest.com

If you are facing an induction because you are approaching the 40-week mark, and your care provider does not want you to go past your EDD, you have more than one option available to you. This is not an all-or-nothing proposition. The burden of proof for induction, no matter the reason, lies with your care provider. It is their prerogative to make sure you understand clearly any medical concerns.

If there are none, as in the case of induction for postdates, a Biophysical Profile (BPP) might be a great tool you can use to your (and your baby’s) advantage.

Present the option as a compromise to your care provider. State that you are uncomfortable with induction for a non-medical reason. Agree to come in as often as they want you to, in order to do a BPP. Agree that if your score is a 6 or less, that you will be open to discussing induction.

A BPP score of 6 is considered to be borderline, so you still have room to compromise even then. Get a second opinion. Keep asking questions until you feel satisfied that you have enough information to make a fully informed decision. This means that you understand the benefits, risks, and alternatives available to you in your particular case.

One quick tip I give all my clients: Never make your final decision with your care provider in the room. You and your partner should be left alone. If you are not, it is your right to request that you be given privacy to discuss it. If possible, take 24 hours to decide. Then, once you know what you want to do, make your decision together, and be willing to accept any consequences that may result from it – good or bad.

Remember, you can only be induced if you show up. I strongly urge you that, if you are inclined to showing up for an induction, please make sure you feel very certain of the real reason, and that you are at peace with it.

If you were induced for postdates, and there were no other indications, was the BPP made available to you? What questions would you ask your provider in this particular scenario? What other compromises could you make with your CP in the case of a non-medical induction discussion?

Grace & Peace,
Tiffany

There’s more to Pitocin…

Friday, April 8th, 2011

First, read the following link, then come on back. Go ahead. I’ll wait.

Pitocin’s Untold Impact ~ Birth Faith

Pitocin – like any other drug – is a tool, morally neutral, with its own proper and improper uses. This post examines some emerging evidence of the role oxytocin plays in our lives. How synthetic oxytocin may hinder or help that is still being studied, but what’s coming out is like a big red flag that reads: “PROCEED WITH CAUTION!”

Never assume a drug is needed, based solely on someone’s say-so, and never assume the reverse. Examine your own case, have an open conversation with your CP, and listen to your instincts.

Pitocin might very well be needed, but that does not mean you should use it without knowing the risks, benefits, or consequences that may go along with it. Knowing those things will equip you to understand more fully what’s going on, as well as alert you to watch for long-term consequences, and may help you narrow down any issues you may have later.

It’s a tool – use it wisely, and own it. No apologies necessary for either road you choose, as long as you’re paying attention to the signs on the way!

Weekend Linkityness

Saturday, September 20th, 2008

Birth & Bonding ~ The Birth Ecology Project.
If you don’t see the article right away, scroll down…and down some more. It’s there. I promise.

Gross Oversight: Cytotec Not on FDA’s Warning List ~ The Trial of Labor
If you read only one link this weekend – this one is it if you’re pregnant and considering induction using Cytotec (or misoprostal).

Please Welcome…My Mommy ~ One Thing
Jenni’s mom shares the story of her birth – in the most winning and winsome style. I love it!

Sorry I don’t have more for you…but what I have is pretty dang good. Enjoy!

Small Pitocin Study

Friday, August 1st, 2008

**UPDATED** in response to Susan’s comment. You’re right, this small study was conducted for a doctorate thesis, I believe. It in no way encompasses the size and scope of an “official” medical study. It was posted on my doula boards, and I found it interesting, and wanted to share it with my readers. I did find a link to her actual study online – along with a downloadable PDF copy.

I’m sorry I couldn’t provide more for you. However, as I said, I don’t treat this study as something authoritative. Just interesting, and I think it merits some follow-up that is authoritative and farther-reaching than this student could provide.

Here is the link for you: SUMMARY OF FINDINGS OF THE STUDY. I hope this helps – even if it just lets you know the official source. 🙂

Thank you for your question!

The Relationship between Artificial Oxytocin (Pitocin) Use at Birth for Labor Induction or Augmentation and the Psychosocial Functioning of Three-year-olds

SUMMARY OF FINDINGS OF THE STUDY
Claire L. Winstone, Ph.D.

The focus of my dissertation research study was, as you can see by the above title, an exploration of whether there is any relationship between the use of Pitocin (artificial oxytocin) to start or speed up labor, and the way children born with its use function individually and in their relationships when they are three years old. I was interested in Pitocin use because what I read suggested that around two-thirds of inductions are now for non-medical reasons, but there wasn’t a lot of research to tell us whether there were any specific consequences to the child of this use.

Before starting this research I first interviewed six therapists who work with babies, children, and adults to resolve issues arising from challenging prenatal or birth experiences. All the therapists had worked with clients who had been born with the use of Pitocin. The therapists told me what they had observed and learned about their clients and the role they thought Pitocin played in their functioning. I performed a content analysis on the interview transcripts, and about two years later, had a long list of “items” that eventually became the raw material for a survey to be conducted with mothers of three-year-old children. I sent this list to the six therapists with a voting form, and they helped me select which items best represented the various areas of functioning about which I planned to ask the mothers.

Eventually, this list became the survey you were invited to complete. Ultimately, I had 498 completed surveys that could be analyzed to see if Pitocin use appeared to be related to a difference in how three-year-olds functioned. The following is a summary of the findings that were statistically significant.

1. Receiving Pitocin resulted in more negative recollections of labor and delivery, suggesting that mothers who received it had a more challenging experience than those who didn’t. However, there was a similar finding for the use of epidural anesthesia and for pain medication, both of which tend either to precede or follow the use of Pitocin.

2. Mothers who received Pitocin spent less time with their babies in the first hour after delivery, and were less likely to feed their babies exclusively at the breast in the first six months. In other words, babies who were born without Pitocin were more likely to be fed exclusively at the breast in the first six months than those born with Pitocin

3. Two factors distinguished children born with Pitocin from those born without Pitocin.

The first was called “Assertiveness” , which describes a socially appropriate way that babies and children communicate their need for help and comfort when they are feeling uncomfortable or unsafe. Typically, crying, using facial expressions and physical gestures, and later, verbalizing their thoughts and feelings, elicits helpful responses from parents, who try to identify and meet the need the baby or child is expressing. However, babies born with Pitocin, whose mothers reported having had a more challenging time during labor and delivery, appear to have a higher need to be assertive because they seem to experience more discomfort, but are apparently less effective in asserting their needs and getting them met when they feel unsafe or uncomfortable.

The second factor was called “Need to Control Environment” and this summarizes what seems to be a higher level of discomfort or insecurity, particularly in response to “outside-in” influences (e.g., reacting to food with digestive problems or being picky eaters; problems coping with other people’s timing and structure, refusing help from others) and increased or exaggerated efforts to control their environment, resulting in behaviors that may be more challenging to their mothers/family. There appears to be some continuity of effects between infancy and age three: for example, children who were described as picky eaters, or as having digestive problems at three, were likely to have been colicky, fussy babies. Interestingly, the hormone oxytocin is very involved in the digestive process: it plays a role in the production of digestive enzymes and as we enjoy our meal, in a positive feedback loop, we produce more oxytocin.

It may be that a process described as “hormonal imprinting”, identified in a considerable number of animal studies since the 1970s, is the mechanism that accounts for these differences between children exposed to Pitocin and those who were not. Using Pitocin to initiate labor may “flood” the available oxytocin receptors in mother and baby, apparently affecting children’s internal comfort levels and how they interact with others, although how this takes place in the babies has not yet been studied. Since both mother and baby receive Pitocin during labor and delivery, it is as yet unclear to what degree each contributes to challenges in their mutual relationship.

Claire L. Winstone, Ph.D.
Santa Barbara Graduate Institute
July 2008

Let the Baby Decide: The Case against Inducing Labor

Sunday, May 18th, 2008

An article in Mothering Magazine.
By Nancy Griffin
Issue 105, March/April 2001

Why induce labor?
“According to ACOG, “Induction of labor is indicated when the benefits to either the mother or fetus outweigh those of continuing the pregnancy.”30 A very small number of babies (a typical estimate would be less than Caldeyo-Barcia’s 3 percent, mentioned above) actually need to be induced for medical reasons. Another 3 to 12 percent seem to want to drive their mothers crazy and hang out inside that wonderful, warm, loving womb. No one knows why these suspected “postmature” babies choose not to make an appearance exactly when those of us on the outside want them to.”

Read the rest of this article. Seriously…go read it.