Archive for the ‘Other Interventions.’ Category

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

Weekend Update

Friday, June 12th, 2009

Weekend Birth Linkage

Friday, October 10th, 2008

Welcome to my new Birth In Joy site! Please pardon the plainness, and lack of links, as I am hoping to soon invest in a professional transferring all my content from the Blogger site to this one. I have a sluggish start ahead of me, and I hope you will be patient with me as I make this transition. Here are a few links to tide you over until the next time we meet!

Delivery Method Affects Brain Response to Baby’s Cry ~ By: Tara Parker-Pope, NY Times Health

Why Babies Should Never Sleep Alone ~ A review of the co-sleeping controversy in relation to SIDS, bedsharing, and breastfeeding. By: James J. McKenna and Thomas Dade

High-Tech Interventions Deliver Huge Childbirth Bill ~ By: Rita Rubin, USA Toay. (a.k.a: One more reason to consider having a homebirth.)

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

GBS & the Use of Antibiotics During Labor & Delivery.

Thursday, July 3rd, 2008

“While many studies have found that giving antibiotics during labor to women who test positive for GBS decreases the rate of GBS infection among newborns, research is beginning to show that this benefit is being outweighed by increases in other forms of infection.”

“A study of 43 newborns with blood infections caused by GBS and other bacteria found that, when the mothers of the ill newborns had been given antibiotics during labor, 88 to 91 percent of the infants’ infections were resistant to antibiotics. It is unlikely to be a coincidence that the drugs to which the bacteria showed resistance were the same antibiotics that had been administered during labor.24 For the newborns who had developed blood infections without exposure to antibiotics during labor and delivery, only 18 to 20 percent of their infections were resistant to antibiotics.”

“Preterm labor (i.e., labor before 37 weeks) is a well-accepted risk factor for transmission of GBS to the infant during labor and delivery. Due to the larger risk of transmitting GBS to a premature baby during delivery, most women who go into early labor will opt to receive IV antibiotics during their labor. However, infants born prematurely are at a greater risk from super-bugs caused by the very antibiotics that are supposed to be reducing their risk of infection. Severe complications for the babies, even deaths, have occurred when women whose waters broke before 37 weeks were given antibiotics to prevent transmission of GBS to their newborns. “

“Given the frightening results of these studies, what is a woman to do if she tests positive for GBS during her pregnancy? A closer look at the real risks of transmission, a frank talk with her provider of prenatal care, and a consideration of alternatives for eradicating GBS are all good places to start.”

“It should be noted that antibiotics such as penicillin kill GBS as well as other bacteria that might cause a newborn to become ill. Currently, the use of penicillin during labor may be a case in which the benefits outweigh the risks, depending on your individual risk factors for passing GBS on to your baby. However, it was only a few years ago that the same could have been said about other antibiotics. Ampicillin and amoxicillin have been rendered virtually useless for treating GBS by their prior overuse in laboring women in an effort to prevent GBS infection in newborns. How long will it be before penicillin, too, becomes useless in the battle to prevent GBS infections?”

“Ultimately, it is the pregnant woman herself who will have to decide what is right for her and her baby. Deciding to follow the recommendations of ACOG and the CDC is not necessarily the wrong choice, as long as a woman is adequately informed of the risks that come with antibiotic use. But none of us should blindly follow recommendations to interfere with the natural birth process without taking a good look at the risks, as well as the benefits, of doing so.” (Emphasis mine.)

Excerpts from “Treating Group B Strep
By Christa Novelli Published 08/31/2005 Pregnancy, Birth and Newborn Care