Tuesday, June 15, 2010

No Induction is Normal

By Carla Hartley,
Founder Ancient Art Midwifery Institute (1981) and Trust Birth (2005)

chart from Birth International
(click to view larger)



There are many conversations going on everywhere I look about due dates, postdates, induction, "natural" induction. There is only one safe way that labor should start and that is for the baby to do it.

How I wish that everyone would wait for their baby to begin labor when s/he is ready, and not before. What makes us think that we can begin to comprehend all the intricacies of that incredible mother-baby dance? I am convinced that we are messing with things "way above our pay grade" when we try to start something that is not ready to be started...or something that has already started in exactly the manner, and at exactly the pace, it is supposed to be going, and then we screw up the timing - get things off track - and make it harder for everything to get back on track.

I am very concerned about the number of women I talk to who do not realize that their birth became a medical event the minute that someone decided that the baby was not doing her job and somebody else needed to tell her that it was time to get out!

Don't let anyone give your baby an eviction notice and don't believe that you need to either.

With every fiber of my being, I believe that those last few days and hours when the baby and mother are essentially ONE are more precious than we could possibly imagine. It is during this time that conversations are taking place that are as important as any other event that will take place after mom and baby have separated physically and baby has an official birth day.

As Sheila Kitzinger states, babies cannot tell time. They do not know anything about calendars.

One of my kids, however, disagreed. When he was about three years old he told me that he did in fact know that he was getting out early and that it was his decision. (Sam was born almost a month before his "EDD.") Sam explained that he decided to get out early because he was bored. As serious as a three year old could be, expressing great annoyance and disappointment with me as his mom, he asked why I didn't swallow a truck or something for him to play with?! For if I had only done that one thing, he would have stayed in longer.

Who am I to question that kind of logic?

30 comments:

  1. Hee hee. If only we could swallow playthings to keep preemies in. ;-) What a sweet boy.

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  2. I've often considered myself "naturally induced" because my contractions started post-coitus... but maybe that doesn't count.

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  3. With my fourth and fifth sons, I went in and out of labor several times, dilating to a 5 or so, then shutting down. It was aggravating, but the babies came in their own good time.

    Last night, my fourth son told me, "I don't remember being born, but I know I didn't want to be. I was in there like this," showing me his hands pressing up above his head,"trying to keep from coming out!"

    He was the hardest birth I had. He was born in the sack. His head did not engage until I made it, be squatting and eliminating all of the room.

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  4. Sex won't bring on contractions leading to labor unless your baby is ready (in the vast majority of instances...barring preterm labor issues for some other reason). I have one disagreement with the article. I believe the moment your birth becomes a medical event is when you choose a medical practitioner to "deliver" your baby in a medical environment. At that very moment, no matter what else happens or doesn't happen in your pregnancy, the chips are stacked against a natural, physiological birth.

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  5. This comment has been removed by the author.

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  6. The key here is that it is sometimes, rarely, necessary. In your case, it sounds like it was, but for so many others it is merely a doc convenience or a 'protocol' not taking the individual response into account. And it is always abnormal, even if necessary to save a life.

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  7. My doctor made me get induced so she could go on vacation. i ended up with a 31 hour labor, had to get the pitocin drip (which meant epidural), and then problems with breastfeeding. but at least the whole situation caused me to research a lot and inspired me to become a birth doula :)

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  8. I and just about every normal birth proponent would testify to the fact that hospitals, inductions and C/S are important parts of maternity care. There are people that would die if these implements were not used. However, we ALL know how overly used they are. NO these things are not normal. YES they can and do cause harm, but they can and do save the lives of women and babies as well.

    We all know, no matter who you are, unless you are a complete idiot, that inductions and surgical births are done WAY too much.

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  9. I agreed to pitocin augmentation when I was a FTM because the staff had me all worried about how my water had been broken (spontaneously) for so long with only a little "progress", and it did send my son into distress (decels, passed meconium), although I delivered him vaginally. If I had it to do over, I would have kept waiting instead of agreeing to augmentation at that point.

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  10. My main beef is with practitioners who suggest induction to tired and uncomfortable 39 week pregnant women without even touching on the risks, or mentioning Bishop's scores.

    I met with a midwife on my due date for a check-up, and she said, "You're not in labor and don't appear close to going into labor, so let's schedule an induction for tomorrow." We got into a big argument about it, and then she made the appointment with the hospital after I said no, so I had to piss off some poor hospital scheduler who called me to confirm.

    I feel like these things happen all the time, as I know almost no women who go into labor spontaneously before about 39 weeks these days.

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  11. I was induced and it was definitely NOT by choice...pretty much it was get the baby out or I was going to die (i was pretty close to going into liver failure, having a seizure and lots of other fun things)...i still got a drug-free vaginal birth, but i can't see why anyone would ask for induction! it was awful..i was so exhausted when it was over i dont even remember the first few days of my daughter's life..i dont remember the first time she nursed, her first cry, none of it.

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  12. I was NEVER induced with my 3 babies and I had to say NO to the offer each time. There was no reason for an induction and my babies came when they were ready. Induction is obviously needed in some cases but all too often just a convenience which is VERY wrong.

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  13. I was induced with pitocin after my water broke but the contractions never started. I had 17 hours of labor followed by a c-section. The use of pitocin caused my daughter and I to have a fever which made the doctor think she had sepsis so she got IVs and antibiotics along with numerous blood draws, she was covered in bruises and it turned out their was no infection! All that unnecessary pain because of the pitocin:(

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  14. Just my humble 2 cents - The problem with birth discussions I see is the number of people who say "I did it and nothing bad happened so stop saying the consequences could be bad."

    I could easily say "My grandpa smoked his whole life and lived to be 93" (true story), or one could say "I've never used a seatbelt and I'm okay."

    That's not the point - there are increased risks, no matter what anyone's personal experience is.

    I had a great C-section and easy recovery, but that doesn't mean that I downplay the increased risk and difficult recovery that many women experience.

    OBs will rarely ever tell us the real risks, so we need to educate ourselves and each other.

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  15. I let them break my water when my labour stalled at 5cm (after about 6hrs), and I regret it each and every day. I reached 5cm with very minimal pain, my body was doing it easily in it's own time.

    But within 5 mins of the artificial rupture of my membranes I was vomiting and passing out from the sudden intensity of contractions. It was NOT normal!!!

    I ended up pretty much confined to the bed, which again slowed my progress. I pushed for 2.5hrs (mostly on my back because it was the only safe way with my fainting) and my daughter just would not crown. It resulted in a last minute spinal block, episiotomy and forceps. I earned a 3rd degree tear, became severely anemic (haemaglobin of 78) and needed a blood transfusion, which affected my milk supply. It took almost 5 days for my milk to come in, and I struggled to keep up with the demand of my 9lb 6oz baby before my milk eventually dried up at 6 weeks :(

    So yeah... it would be very unlikely that I will ever agree to an induction or labour augmentation again.

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  16. @maggie - totally agree. I was induced due to pre-e/liver probs. The induction led to all the side affects & comps in the diagram, but when my partner & I weighed up the risks there really was no other choice for us. I fought & struggled to breastfeed for months following. I absolutely advocate induction as a last resort.

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  17. NO ONE would argue inductions are not necessary at times. But if a medical issue arises that endangers mom/baby, that is NOT normal either, so why would that induction, while necessary, be called normal?? Come on!!

    I had a lovely VBAC with my second baby after turning down a request to induce for "pre-pre-eclampsia" by the OB and midwives at the birthing center. I couldn't believe they'd try to urge a VBAC mom to induce without a true medical reason. It was pretty upsetting!!

    Thankfully I went into prodromal labor a couple days later on my own, and had my healthy baby girl later that week at the local Naval hospital. Not once did I have high BP, proteinuria, swelling, or any other signs of pre-e! Lying, nasty wenches...grrrrrrr.

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  18. I have a question for the one who posted this article. I've read some other articles on this site about basing EDD using LMP. Do you think an EDD based on ovulation date has the same problems, or at least not as many, as LMP? My OB has never used my LMP (since he's an NFP doctor) when he figures my EDD, and I was actually a week "early" with my second from the date he gave me.

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  19. Every mom I know my age who's had a baby in a hospital has been induced.

    Every. Single. One.

    Their goals were all very different, but the results were similar.

    They either had:

    1. A c-section

    or

    2. A traumatic birth story.

    or

    3. Both

    None of them had any sort of compelling medical reason that I could decipher (your baby is HUGE... you're 39 weeks so it will be fine... your "fluid is low," a very popular but ambiguous one).

    Crazy. Avoiding induction will be my number one rec to parents in the Lamaze classes I'll start teaching in Aug.

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  20. I am another who was induced (41+5 days baby born at 41+6) who ended up with a c-section. My recovery was easy, and breastfeeding is still going well at 7 months PP. HOWEVER I wouldn't do that again, and will avoid induction at all costs (read: non-medically necessary induction) I wish now I had been strong enough to refuse the induction. But I was tired - not of being pregant really - but tired of going to work and answering endless, stupid questions with no answers. (When will he be born? How big is he? Are you working until delivery? You won't go into labor at work, will you? etc)

    as for the question of LMP vs. O dating . . .I think it is still an average, TBH. I think my EDD was at most 5 days off, based on Ovulation dating. I think he would have been born in the next week or two, had we not interfered. I think it has a lot to do with genetics. My mother carried me 43 weeks, and with 2 of her other 3 pregnancies was induced (stillbirth, breech(but turned via external manipulation)) the last ended as a c-section. My thinking is "back in the day" babies came in their own time, and generally were not forced or encouraged out without good reason. We should listen to our bodies and our babies more.

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  21. I was induced because I am a type 1 diabetic and the risks to the baby (and mother) increase after 40 wks. I tried to give birth as naturally as possible--the hospital staff were actually pretty great, and did not push a cesarean on me. But, on day 3 I was given Pitocin (which I would not wish on my worst enemy)and after 7 hours of grueling labor I got the epidural I planned to avoid. On day 4, I gave birth by cesarean to a healthy baby who had no issues breast feeding, even though my milk didn't come in for 4 days. I just wanted to say that I appreciate the people who have commented that although induction is overused and usually detrimental, that it can be necessary!!!

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  22. The last 5 friends of mine to give birth all got induced 1 day to 1 week after their "due date" and ended up with cesareans.

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  23. I had a unexpected ceaseran because the contractions were just too intense after being in labor for almost 48 hours. I went into the hospital Wednesday night and finally had my baby Friday. I was "2 weeks overdue" and with NO dialtion or contractions. I would have waited as long as I could to have the baby come down himself, but the doctors i saw told me the placenta was showing signs of wear and the amnotic fluid would start to decrease. I feel like maybe they just said that since the medical doctor practice i went to only lets u go as far as 42 weeks. I did everything I could to not be induced: prayer, walked around the mall, sex, spicey foods, u name it i tried to do it, but nothing. Then my "scheduled due date came" and they gave me cervadell which was a WASTE of time except it did start some contractions. It wasnt until Friday that I started getting really weak and tired that my doctor said i was finally dialted at a 5( this was at 6am). She ended up breaking my water...which i also think now was a mistake because i didnt dialte any further and the contractions were super intense because they also had me on Pitocine. Finally at around 4 pm i just couldnt do it anymore and desided to throw in the towel since i knew this baby had to come out soon since she broke my water. I was really upset and felt defeated because i didnt even consider a c-section before. I guess i was just scared my baby would die if i didnt get the induction. Now after the horrible expierence i went through, im afraid to have another baby because i dont want to go through all that again. i will probably find a midwife instead next time.

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  24. i'm with chelsea from way above. i HAD to be induced as a way to avoid c-section since my liver, central nervous system, and kidneys were failing. yeah pre-e and hellp syndrome is LOADS of fun. and i too avoided the epidural , though it was in my experience the most excruciating pain i've ever had. my daughter was born 6 yrs prior with no pain meds of any kind, and i felt awesome afterwards. with my youngest son, i felt like a mack truck had hit me a few times and i STILL have trouble remembering things about the birth and the first few days. unfortunately my youngest never did nurse (he was preemie and i guess the fake nipples did us in. he is 2 now and i still pump for him. :(

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  25. I had a induction and epidural for #1 and it wasn't really anything traumatic. (i had high bp throughout my pregnancy and OB decided to induce)

    I had a homebirth for #2 and it was a precipitous birth, from 2cm to pushing in an hour and a half. (no indication of high bp throughout my pregnancy)

    I had a second degree tear both times. First time I got an epidural and no pain while I got stitched. second time I only had local anesthesia and it hurt so bad than the birth itself.

    recovery wise, the second time it was worse. my body was shocked by the quick birth (i had hoped to hypnobirth both times, my doc had other plans with #1, my daughter had other plans second time around lol). I didn't remember it being that way with #1.

    looking back, I wouldn't do anything different both times! I chose a homebirth because I wanted my son to be there with me.

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  26. During my last pregnancy, the doctor was SO worried that my daughter would be oversized. I had a history of large babies and had full-blown gestation diabetes with this one. The diabetes was completely managed with diet, though.

    I agreed (in that late pregnancy "get this baby out" sort of mode) to the closest thing to a natural induction he could offer - having my membranes swept. This was done 2 weeks early and again 1 week early (based on EDD, anyway). My daughter was born within 24 hours of the 2nd sweep.

    I'm determined to not give in to "natural" induction this time around. I've even warned my doula to remind me that I do NOT want that, no matter how miserably pregnant I get. She attends my appointments, so if my will falters, I'm sure she'll help me remember.

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  27. I was induced at 11 days past my due date and did it completely un-medicated(aside from the pitocin to induce me obviously), I got no pain meds and just hummed through my contractions which helped me(but my throat was killing me after the fact lol). I had a small tear and breastfed me daughter soon after her birth, she did have latching problems due to me having flat nipples and no lactation consultant available so the nurse just gave me a nipple shield to nurse her, we are however at 18 months and still nursing strong! =]

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  28. I wasn't induced, but after 134 hours of active labor (DD was sunny-side up, so most of my labor was at home trying to get her flipped around, the last 28 hours of labor were in a hospital with a midwife) I opted for an epidural. I knew the risks involved, but I hadn't slept in four days and my body was actually slowing down due to lack of adequate rest. I ended up on pitocin about an hour after the epidural to augment the labor, because I had been dilated to a nine for 10 hours with no progress. It took so long, the midwife came in for one last "check" before briefing me on an emergency c-section, but thankfully I had finally dilated to a 10. They turned off the epidural and in twenty minutes I had my girl in my arms. We did have some difficulty latching at first, but that ended up being due to a tongue-tie. With some hard work on my part, and on my LO's part (we didn't snip her frenulum), the latch issue was corrected within a few days. I am thankful for my midwives, but the next one will definitely be at home!!

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  29. First of all I apologize for the novel lol. With all three of my children I went into labour naturally and all were hospital births. With my son (1st) they induced as my water had broke but was only 1cm dilated. I went 20 hours with only a shot of Demerol... at that point I was in so much pain we called for an Epidural. It took them 2 hours more to find the anesthesiologist. After full dilation, pushing on my back and pushing on my side he still wasn't coming... We ended up having a CS which was good... The top of his head was firmly stuck in my pelvis... At 9lbs 7ozs he was just too big for me. The major complaint I had was that while I was in recovery they gave him formula for his first two meals... without consulting me or my husband. That coupled with flat nipples and it was a fight to establish breastfeeding. With DD1 I was scheduled for a CS but spontaneously went into labour 3 days before that. The nurses were ready to send me home as they didn't think I was actually in labour. Finally a nurse huffily declared she was going to check me and probably send me home. I was 4cm dilated. She changed her tune quickly lol. They still offered me the CS or I could do what the doctor called Trial by Labour. We decided to try TBL. My doctor broke my water at that point and half an hour later she was born. And with DD2 my water broke at home just after I confirmed my doctor's appointment for the day, the ultrasound for the next day and the BBQ at my folks place later that evening... Had to call everyone back and cancel lol

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  30. Have to say, I had more of this in the diagram with my spontaneous unaugmented labour than with my 2 inductions. I didnt even *have* monitoring with my inductions. No FTP. No need for pain relief. All my problems were in my spontaneous labour. Im not saying this to be contradictory, Im saying it because it makes me one of the very, VERY lucky ones.

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