Posts Tagged ‘induction’

Scavenger Hunt Contest

Monday, December 3rd, 2012

Preparing for Birth is having an online scavenger hunt to ring in December.

 

You could win this cute pocket diaper.

 

Here is the scavenger hunt:

Answer:

1)      How many births has Desirre Andrews attended?

2)      Name a doula that is working through Preparing For Birth?

3)      How many on average gel capped pills can be made from a placenta?

4)      What breast pump brand does Preparing for Birth have for sale?

 

Answer these and provide a link to the source:  

5)      What is the most common risk of induction?

6)      What is an evidence based reason for induction?

7)      What is the Bishop Score used for?

8)      What are Daniel Berwick’s three principals of patient centered care?

 

Find:

9)      A picture of a child nursing in a funny position.

10)   A picture of artwork that’s at least 100 years old depicting a woman in labor.

 

Bonus Questions:

1)      What is your favorite pregnancy or childbirth related blog?

2)      What is your favorite pregnancy or childbirth related book?

Send your entry to nichole@prepforbirth.com by 9pm Wednesday December 5th.

The winner will be announced Thursday, December 6, 2012, and must be able to pick up the prize in person. Everyone who enters will get a coupon for a free birth or postpartum plan session with one of the doulas from Preparing For Birth.

Know Your Score – Before an Induction

Wednesday, March 23rd, 2011

Knowing your Bishop’s score prior to agreeing to an induction when not medically necessary or setting the stage for a medically necessary induction can make a great difference in expectations, additional interventions and understanding for the process as a whole.  Knowing your score can help you determine the type of induction or whether or not to be induced at all.
Your score is based on a vaginal exam that takes into consideration the areas listed in the chart below.


Dilation, Effacement, Consistency and Position all have to do with your cervix. Station is telling where the presenting part of baby is in relation to the ischial spines. (sitz bones).

Are you a good candidate for induction based on your score? Do you need a ripener? Are you a VBAC mother?  What other factors are working in your favor or against success?
Induction is not an easy or guaranteed process. You can see the criteria toward success is telling even without discussing the additional risks leading to additional interventions, medications and/or cesarean.

Additional links and information on induction can be found in this previous post http://prepforbirth.com/2009/08/12/preparing-for-labor-induction/.

Rethinking the nature of intervention in childbirth

Saturday, January 16th, 2010

There is much awareness and conversation of what the routine interventions are that can occur during the labor and birth process within the hospital environment.  These interventions can include induction, augmentation with Pitocin, epidural, or cesarean. In all my professional and personal roles, I am privy to a great amount of pregnancy and birth stories. Within these experiences there are many “silent” yet obvious interventions that are hidden in plain sight under the guise of protocol, practice and societal expectation.

My current list of hidden in plain sight interventions in no particular order that can make a difference on how a woman labors and ultimately delivers her baby is below.

  • The uniform -Asking and expecting the mother to give up her clothes for the hospital gown.
  • Who’s on first? – If care provider is part of a large practice or on-call group a woman may have never met or have any knowledge of the person who’s practice style and philosophy is helping to guide and steer her labor and delivery. On-call CP may or may not adhere to the birth plan the laboring woman worked out with her own CP.
  • On a short leash – Continuous monitoring even if she is not high risk, medicated, or being induced/augmented.
  • The big drag around – Requiring IV running with absence of medical need.
  • Staying put – Asking or requiring the laboring woman to stay in bed for ease of staff without medical need.
  • Ice chips and Jello – Disallowing snacks and sometimes even actual water even though labor is hard work.
  • The marketing tool – Disallowing the laboring woman to get into the touted tubs or showers since it isn’t convenient for staff and she will not want to get out.
  • One is enough – Limiting the amount or type of support persons a woman is allowed to have with her.
  • I know more than you – Treating the laboring woman as if she knows nothing or shouldn’t know anything.
  • If you don’t… – Instead of giving informed consent and refusal, telling only what bad could, maybe happen.
  • Attitude and atmosphere – Negative, non-listening, lacking compassion, leaving the door open, ignoring requests, and the like when a woman is laboring.
  • Only if you ask – Though some wonderful practices are in place, they are only offered if a laboring woman or postpartum mother ask/insist on it.
  • Bait and switch – The official tour of labor and delivery and the reality of labor and delivery don’t fit together.
  • New with bells and whistles – The pretty with all the fancy bells and whistles like wi-fi, flat screen tv’s, etc. have to be paid for somehow. Because of this investigate the intervention rates there.
  • Routine vaginal exams – By and large VE’s are very subjective and can vary greatly between one person to the next on how they score a VE. This variation can deeply affect the course of a woman’s labor and delivery.  Women birthing in the hospital really only “need” a VE upon entrance for assessment of where she is in labor, if she desires an epidural/IV narcotics, if she is having a very prolonged labor, or if she feels pushy.
  • Pushing the epidural – When a woman is moving, moaning, making noise or just doing her thing in labor and it causes the staff discomfort or worry.  It could even be that anesthesiologist is going in to surgery and it can only happen now.

Simply because a societal norm is birthing at the hospital, as well as, what routinely goes on there, doesn’t mean the hidden in plain sight interventions are wise or harmless.

My goal here is to give pause and broader thinking to what intervention means for labor and delivery as another tool in planning and preparing for childbirth with eyes wide open.

Preparing For Birth: 35+ and Pregnant

Wednesday, September 16th, 2009

Hourglass

The disturbing trend in treating ALL  “advanced maternal age”  mothers (over 35 at the time of impending birth) high risk continues to grow despite lack of evidence to do so.

My original post from 3.5 years ago still rings true today.

They are being subject to weekly Biophysical profiles or Fetal Non-stress tests tests that are normally reserved only for high-risk mothers and babies from as early as 32 weeks in pregnancy.  On top of the scans, these mothers are often pressured to agree to an early delivery of their babies by means of labor induction or cesarean even without other risk associations.  This is growing more and more prevalent especially for women over 35 who are first time mothers.

I have heard even from women that at their first OB appointment they are being told they will be induced at 39 weeks as a standard of practice and expectation for signing on with said provider.  The seed of fear and worry is being planted that their growing baby will die if the pregnancy goes to 40 weeks or longer.  What a way to start out a provider/mother relationship.  I would call that a red flag of immense proportion.

So what really is the big deal with “old” mothers?  This study Advanced Maternal Age Morbidity and Mortality correlates various medical issues with “AMA” mothers though the biggest hot button is an elevated yet unknown cause of perinatal death.  This statement alone has caused a huge shift in the way these mothers are viewed regardless of  overall pregnancy health and absence of any known risk associations. ACOG’s February 2009  Managing Stillbirths maintains there is a risk to older mothers with no explanation as to why there is a risk, what the percentage of  risk increase is or any prevention protocols.  Seems dodgy since the other groups noted in the bulletin have all the data included.

There are some serious problems with any practitioner taking this study and applying it across the board to “AMA” women.  The study even says so much, “It is important to note that the findings of this study may not be generalized to every advanced-maternal-age obstetric patient in the United States. Although the FASTER trial patient population was unselected, meaning that patients were not excluded based on any confounding factors such as race, parity, BMI, education, marital status, smoking, pre-existing medical conditions, previous adverse pregnancy outcomes, and use of assisted reproductive care, there may have been significant patient or provider self-selection.” So the population could have been skewed from the get go by provider or patient selection, along with the fact that it seems the only point of homogeneity is present in that most of the women were Caucasian.  Throw all these women in a pot and see what happens?  Next step is to make protocols and change practice style upon weak findings?

The study also shows an increased risk for cesarean by “AMA” mothers.  “As with prior literature, this study demonstrated that women aged 40 years and older are at increased risk for cesarean delivery. Older women may be at increased risk for abnormalities of the course of labor, perhaps secondary to the physiology of aging. It is possible that decreased myometrial efficiency occurs with aging. Nonetheless, maternal age alone may be a factor influencing physician decision making. It is uncertain whether the increased rates of cesarean delivery are due to a real increase in the prevalence of obstetric complications or whether there is a component of iatrogenic intervention secondary to both physician and patient attitudes toward pregnancy in this older patient population.” Very interesting. So “old” women are perceived as being unable or problematic so they have less successful vaginal birth outcomes. Now that is a self-fulfilling practice style with a huge dose of ageism thrown in.  I also wonder what the cesarean rate in this age grouping is going to be due to these protocols.

Let’s get to the perinatal and neonatal death risks.  The study says: “Studies regarding an increased risk for perinatal mortality in women of advanced maternal age have been controversial. In this study, the increased risk of perinatal mortality was not statistically significant for patients aged 35–39 years (adjOR 1.1). Age 40 years and older was associated with a statistically significant increased risk of perinatal loss (adjOR 2.2). There were only 119 stillbirths and 37 neonatal demises in total. As a result, we could not draw any meaningful conclusions about the etiology or timing of perinatal mortality in women of advancing maternal age. The reason that advanced-maternal-age patients may be at increased risk of perinatal mortality is unknown. The failure of uterine vasculature to adapt to the increased hemodynamic demands of pregnancy as women age is a proposed explanation. So in conclusion, we have no idea why this might occur and have no way of counseling “AMA” mothers to lower the risk especially those over 40. Another noteworthy thought is that this study had 79% under 34 year old women, 17% 35-39 year old women, and only 4% women over aged 40.  So with such a small grouping ALL women considered “AMA” are being put under very heavy handed protocols to delivery their babies in the 39th week of gestation.

In closing, I find it difficult to believe that anyone who reads this study would change practice style because of it and move pregnant patients who are otherwise maintaining a healthy pregnancy without risk associations to a high risk model of care. Amazingly the study itself says the same thing, “In summary, the majority of women of advanced maternal age deliver at term without maternal or perinatal adverse outcomes.” And, “The role of routine antenatal surveillance in women aged 40 years and older requires further investigation because these women seem to be at increased risk for perinatal mortality, including stillbirth. Although the likelihood of adverse outcomes increases along with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.”

Couldn’t have said it better myself.

Since the original posting – – – instead of women being told they must be induced in the 39th week they are now being “offered” non-medical, cesareans as a first course of action.  This sort of pressure is not evidence-based or even medically ethical in my opinion.

Preparing For Birth: Labor Induction Myths

Friday, September 11th, 2009

It never ceases to amaze me why women are induced for labor.   I have compiled a list of commonly heard “reason” for an induction occurring.  Interestingly none among them is true.  The true reasons for induction is a very short list (shown at the end of the post) and only a small percentage of women will fall into those categories.  So all you pregnant mamas out there, induction beware because you may have something listed below said to you.

Compilation of “reasons” for induction:

  • My doctor says I have a small vagina.
  • My husband can’t miss any school or he gets kicked out (heard from both Police Academy AND Fire Academy wives).
  • I have already met my deductible for my insurance this year. Don’t want to have to start over again.
  • I want the tax deduction this year.
  • Because my doctor is going out of town.
  • Anesthesia allergy:  She ended up with an epidural, and then a c-section.
  • You are an older mother and your baby will die if you are not delivered by 39 weeks.
  • You are very small and there is no way you can birth a baby past 40 weeks or 7 lbs.
  • Your feet are very small.
  • Your amniotic level is really low. Only an 8 AFI at 41 weeks.
  • doc: “your first labor was pretty fast so let’s go ahead and induce you so you don’t end up having the baby on the highway on your way in”
  • I was told induction was recommended at 41 weeks because the placenta starts to deteriorate and stops working. Tell it to my 41 +4 day baby. I guess she was living on borrowed time those 4 extra days.
  • Doc to mom “I am going on vacation and you want me there for sure for your delivery!” Mom is 39 weeks.
  • To avoid a cesarean.
  • To avoid an epidural.
  • The pitocin is JUST like you make so it makes no difference.
  • It is completely safe.
  • You have a 50 minute drive to the hospital – it’ll save you the stress of worrying about making it in time. (First time mom)
  • My family is coming from out of town and I want to know when to tell them to be here.
  • I’m GBS positive and they want to make sure they get all of my antibiotics administered before I deliver…
  • It is a holiday weekend.
  • Baby is getting too big!
  • Because my husband works 30 minutes away and if I have a fast labor he might not make it in time!
  • Because I’m going to have a ‘huge’ 8 lb. baby.
  • Because I’m a teacher and I want as much time as possible with the baby so I’ll get induced earlier in the summer….
  • Because after 37 weeks, there is no benefit to staying in–the baby doesn’t do anything except gain weight (that one from a doctor!)
  • Low-fluid levels.
  • Way too far past your expiration, I mean “estimated due date.”
  • Too big for gestation.
  • Too SMALL for gestation.
  • Because you are so tired.
  • Because you look miserable.
  • Vacation times not congruent with labor patterns.
  • So you can pick your baby’s birthday.
  • So you can plan ahead.
  • Because it is more convenient.
  • Since you are planning the epidural anyway.
  • Because it is easier.
  • Because there is no risk.

Mother beware!  There are only truly a small amount of reasons evidence shows for an induction to take place.

  • Uterine infection
  • True pre-eclampsia
  • Prolonged rupture of membranes (longer than 48-72 hours)
  • True labor dystocia
  • Post dates past 42 weeks*
  • diabetes (gestational included) if compromising fetal or maternal health

Without the true need for induction the likelihood of cesarean nearly doubles.  Some of the risks or consequences of any induction include:  more need for an epidural, overly strong contractions, failure of induction, distressed baby, distressed mother, placental abruption, continuous monitoring, lack of mobility, the feeling of illness, longer labor, very fast labor, traumatic labor and delivery, and IV fluids.

In the event the word induction is brought up, the mother needs to be aware of the common yet myth filled reasons behind it and that it is alright to say no.  The mother ultimately is responsible for the outcomes.  She and her baby have to live with the results.  Waiting for baby to press start in the absence of medical need for induction, is nearly always the best way to go for mom and baby.

*If a woman knows exactly when she conceived and estimated due date is not solely based on ultrasound and guessing, fits the “average” menstrual and ovulation cycle length, and if she does not have a family history of post 42 weels and beyond pregnancies this can be reasonable.