Archive for the ‘induction’ Category

Pitocin – Be aware!

Saturday, July 11th, 2009

In recent days there has been much chatter in the birth and consumer worlds about the use or rather misuse of the synthetic oxytocin drug Pitocin (ICAN, unnecesarean, nursingbirth, daytondailynews).

Pitocin is used very commonly in the United States before labor to induce, during labor to augment the process and post birth for the purpose of eliminating or preventing  hemorrhage. Women are told that it is just like the oxytocin she produces, it is a way to mimic natural labor, it is no big deal, etc.  Clearly that is not the case.  Unfortunately women are rarely if at all informed of the manufacturer’s protocol’s for use or the documented risks and  consequences to her and her baby as seen here – pitocinKingPharmPamphlet.

For a drug this powerful to be used routinely for  non-medically indicated induction and unnecessary labor augmentation is frankly terrifying and unethical.  How many complications go unreported or under reported that are directly attributed to such liberal Pitocin use? The thought is staggering.  My heart aches and sobs as there are thousands of women and babies suffering needlessly every minute, every hour, every day and every year.  The advocate in me raises a fist and grabs a bullhorn. Please spread the truth.

The many women who come out of birth terrified and traumatized.  They say how painful, how out of control, how trapped in bed, how unable to cope without pain medication, how they fear for another labor, how they don’t ever want to go through that again and so on.  Next time you hear that ask her if she was induced or augmented with Pitocin.  I think you will be astounded by how many will say yes and how many will give an account of the cascade of interventions that came with it.

Women I believe overall say yes to induction and augmentation because they have no idea of the true risk involved, and of the deep held ideal that no care provider or staff would recommend or allow any procedure (yes it is a procedure) that could harm a woman and a baby unless the benefit greatly outweighed the risk.  I do not believe that a care provider or staff member is trying to do harm, but more the realistic function that there is another medication to fix it, a protocol to manage it or the go to cesarean option to handle the pit-to-distress syndrome.

Every pregnant woman must find out how her care provider uses Pitocin with his or her patients.  She needs to inquire with the birth facility as to normal protocols surrounding this medication.

Be aware.  Be informed.  A decision only can be made well when the playing field is leveled.

Childbirth Education – Think outside the big box location

Thursday, November 29th, 2007

So let’s chat about childbirth education. Of the reported 30% of expecting parents who attend childbirth classes the majority go to the hospital where the birth is planned instead of seeking out independent options. I want to challenge you to think about how strange that is. Does it make sense that the information presented will REALLY be balanced, unbiased and evidence-based? Many protocols and practices used during labor and delivery in the hospital are designed as a one size fits all, no suited to each individual mom and baby. More importantly, they are not designed to suit the usual low-risk mom and baby (the majority of moms and babies are normal and low-risk), but can actually make a mom and baby appear or become high-risk. Some refer to hospital classes as “good patient preparation” classes because of lack of inclusive information. I will admit, that all hospitals do not offer education in this manner, however, in my experience and research many sadly do.

If a car salesman tried to sell you a car and actually insisted you purchase the specific color, make and model he/she decides for you, would you buy it? You would hopefully say no thank you and leave. How dare some one make such a huge decision for you. How long do you research a piece of electronics or a computer, even a cell phone plane before deciding? Even the pair of shoes you are wearing. Did you have to try on several before finding the right pair?

So why not think outside the big box, one size fits all class? Every mom, baby and partner deserve to know the wisdom of birth, understand what is normal and how to stay that way, when the abnormal happens what to do and be a skilled consumer.

There is no re-do here. This time is too important to leave to chance and inadequate education.

This is at the essence of why I teach my own childbirth classes at a location outside the hospital. I am able to freely give full spectrum information without restriction, bias or without the fear of losing my position.

Your birth matters to both you and your baby, to your future fertility, to your confidence as a mother

Below is a list of options available to families all across the US and variations in other countries as well (if if any class types have been overlooked, please let me know and I will add it).

There are many other great ways to find a class that suits you.

Here’s to finding the perfect fit and gestating in peace.

Desirre

Individual fit: Who and where you choose during pregnancy and childbirth matter.

Sunday, November 25th, 2007

Picture this: An expectant mother is preparing for the birth of her baby. She chooses the care provider her friend, co-worker or family member recommended, she is reading the most popular books on pregnancy and birth (she doesn’t know there are any others to choose from – everyone is reading these), she cannot help herself as she watches hour upon hour of those baby and birth shows on t.v., people tell her their birth stories and to just get the epidural (after watching those birth shows and hearing THOSE stories she is beginning to think it might just be a good idea). Right now, she is pretty sure she doesn’t want to be induced (she heard it hurts more, but knowing when the baby will come is appealing) or have a cesarean but other than that she is leaving it up to her care provider.

Now she starts her childbirth class. This class is based on normal birth and evidence-based practices. Hm those books she was given are SO different than what the instructor says during class. The instructor doesn’t even recommend those books but a host of other books and websites. She begins to wonder what her care provider really thinks and believes about birth. Also, what birth philosophy and practices her chosen birth location has.

I have written a list on choosing a care provider and birth location that is right for you. This is too important to make decisions without extra thoughtfulness and investigation. The key to this information is remembering you are the one purchasing a service. Essentially you are hiring a catcher with medical expertise and renting a room to birth your baby (if you are going to the hospital or birth center).

Choosing the place of birth for your baby – It is incredibly important that you understand where you fit best prior to choosing where to birth your baby. Take hospital and/or birth center tour, call and talk to L&D floor, get facts on home birth by talking to home birth midwives, other moms who have had home births, online and in books.

  • Does the location offer what is most important to you (tubs, birth balls, wearing own clothing, intermittent monitoring, etc.)?
  • What are standard protocols that are followed?
  • Does location routinely use methods that turn a low risk mom and baby into high risk patients?
  • Are waterbirths available?
  • Are birthing stools or non-reclined pushing and delivery positions encouraged?
  • What is the no/low intervention rate?
  • What is the epidural rate?
  • What is the cesarean rate? Does the hospital support VBAC’s?
  • Are mom and baby friendly practices used? (no routine interventions, no separation of mom and baby, breastfeeding is the norm, movement in labor is utilized, etc.)

Points to Ponder afterward

  • Will I be able to have the type of birth I truly desire?
  • What location will I ultimately feel most comfortable in?
  • What location is ultimately safest for my specific needs (I am currently low-risk or high risk)?
  • Is insurance or lack of it the reason I am choosing the location?
  • Do I have realistic expectations for the location?
  • Am I willing to take responsibility for my birth in the location?
  • Is staff open to working with a doula?
  • Is staff willing to work with natural childbirth practices?
  • Are there any compelling reasons to choose one location over another?

Choosing your care provider – Use this as a template for the interview process or to be certain you are of the same philosophy and belief system.

  • What is his/her birth philosophy?
  • What is philosophy of pregnancy?
  • Has provider seen normal labor and birth? How often?
  • What percentage of patients have medicalized births?
  • How is the “due date” approached? When is “overdue”?
  • Will you answer questions over the phone?
  • How much time will you spend with me during each appointment?
  • What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why?
  • Do I need a childbirth class? Breastfeeding class?
    o Are there restrictions on the type of childbirth or breastfeeding class? If so, what and why?
  • What routine tests are utilized during pregnancy? What if I decline these tests?
  • What are routine intervention rates? (IV, AROM, continuous monitoring, etc.) Cesarean rate? VBAC rate?
  • Induction rate? What induction methods are used?
  • Is natural, normal labor and birth supported?
  • What positions is care provider comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing?
  • If I choose an epidural, when can I get it or when is it too late?
  • How often is episiotomy used?
  • When would forceps/vacuum be used? Which method is CP comfortable with?
  • What about a birth plan? Will desires be put into my file at the hospital so the nurse and/or back-up will know what has been agreed to?
  • Are there any protocols that are non-negotiable?
  • What if I choose to decline something after careful consideration?
  • Is an on call rotation utilized or does CP attend all own patients? If there are partners or an on call rotation, do EACH of the others share in the same birth philosophy and approach to birth?

Points to ponder afterward

  • Did you feel immediately comfortable at the interview?
  • Were or are questions specifically answered or is the answer “only when necessary” without additional information unless pressed?
  • Was or is care provider willing to answer questions in detail without being annoyed?
  • If already with a CP, do you feel comfortable and heard at each appointment?
  • Is choosing your care provider based on your insurance or lack of insurance?
  • What are you willing to do in order to have the birth you really desire? Birth location?
  • How much responsibility are you willing to take for the health care decisions for you and your baby?

Cesarean Avoidance – Tips For Every Woman

Wednesday, November 21st, 2007

Yes you DO want to avoid a cesarean whenever possible. Cesarean is MAJOR surgery. It is not just another way to give birth. Both women and babies are well designed to give birth often never needing intervention of any type.

Cesarean can be a life-saving technique and used well for some serious medical conditions, including but may not be limited to placenta previa, HELLP syndrome, uterine rupture, placental abruption, cord prolapse, some breech presentations, true fetal distress, vasa previa and high order multiples.

Approximately 50-67% or more of all cesarean surgeries performed in the U.S. are likely unnecessary or become “necessary” from iatrogenic influences (non-medical inductions, AROM, pitocin augmentation, epidural or spinal anesthesia, “fetal distress”, suspected big baby, lack of mobility, continuous fetal monitoring, pushing positions and/or technique).

Here are some tips to help you avoid a cesarean and have a positive vaginal birth.

  • Get educated: Book to start with – The Thinking Woman’s Guide To A Better Birth by Henci Goer, Ina May’s Guide to Childbirth by Ina May Gaskin, The Official Lamaze Guide. Giving Birth with Confidence by Lothian and DeVries. Seek out websites that use evidence-based information and normal birth practice information. TURN off the t.v. from the dramatic birthing shows unless you watch with a discerning eye to figure out what could be done differently and why. Seek out local resources such as La Leche League, Birth Network, Birth Circles and/or a local ICAN chapter to learn from other women. Take a childbirth class that is not a good patient preparation class. Take an independent evidence-based class that gives you tried and true techniques along with the communication skills to use your consumer voice. Study and learn about your rights as a pregnant woman, informed consent/refusal and all the usual interventions and medications (induction, augmentation, AROM, epidural, monitoring, etc.).
  • Interview Several Care Providers: You want to find out what the raw data is for inductions, interventions, epidurals, episiotomy, cesareans, VBAC’s and so on. It is important to get at the core philosophy of the care provider. Email me at desirre@birthingtouch.com to receive my handout on this.
  • Interview several and hire a Doula: You want a doula who will fit into your philosophy of birth and labor/delivery needs. One size does not fit all.
  • Use normal birth practices: Stay home as long as possible in labor (if having an away from home birth), choose a care provider who supports and believes in you, use a variety of natural coping techniques, opt out of routine induction, opt out of continuous monitoring unless high risk, opt out of routine augmentation, opt out of routine epidural or narcotic use, opt out of routine pushing position, limit vaginal exams, use mobility, TRUST yourself, LISTEN to your body and baby, accept responsibility for your decisions, BE confident that you are designed for this task.

I hope this has given you a jumping point to go out and birth!

Happy Thanksgiving.

Desirre

http://www.cdc.gov/nchs/data/hestat/prelimbirths05_tables.pdf#1

http://www.ican-online.org/

http://www.lamaze.org/Default.aspx?tabid=171

http://www.birthingtouch.com/

http://www.childbirthconnection.org/

http://www.hencigoer.com/