The Six Care Practices that Support Normal Birth (Part Three)

Posted on July 12, 2009. Filed under: Birth, Cesarean, Epidural, Lamaze 6 care practices, pitocin | Tags: , , , , |

In Part One and Part Two of this segment, I discussed why I believe in the six care practices and the first three of the care practices which include: labor begins on its own , freedom of movement throughout labor and continuous labor support. The six care practices that support normal birth are based on research and evidence based maternity care. This is the healthiest and safest way to have a baby in most cases. In a normal healthy pregnancy most women can and should deliver their babies vaginally and with few interventions. All this medicalization of labor and delivery is not only not necessary, it’s also causes problems.

The fourth care practice is no routine interventions.

No Routine Intervention

Routine interventions are anything that is done or not allowed at hospital that isn’t medically necessary. Evidence based maternity care through research has shown that these interventions are not only not necessary but can cause more harm than good when used routinely. Here is a list of the most common routine interventions.

Restriction on eating and drinking: Back in the day when women were knocked out with general anesthesia food and drink were not allowed in case the woman vomited and inhaled it. Rarely is general ever used any more but it’s still the policy at most hospitals. Women need food and drink to keep their bodies fueled and hydrated for the hard work of labor.

Use of IV fluids: Because of the restriction on drink, the IV fluids are given to keep the mom from getting dehydrated.  IV fluids are just not properly balanced in a way that gives the mom the energy she needs to labor. The intervention spiral tends to begin with the IV and it’s easy access to the vein and it also keeps you tethered and restricts movement.  The IV line does provide quick access to the vein in case of an emergency. One compromise is a heparin lock. It’s the little catheter that put in the vein and shut off without the IV line actually being connected.

Continuous electronic fetal monitoring:  In a normal low risk labor continuous EFM isn’t recommended. Intermittent monitoring, or 20 minutes out of every hour is just as beneficial. With intermittent monitoring the mom is allowed the freedom of movement. Continuous EFM increases the number of inventions without improving outcomes.

Speeding up labor: Artificial rupture of membranes and augmentation of labor:  Speeding up labor sounds pretty tempting but when the water is artifically ruptured (AROM) it increases the pain of the labor and removes the baby’s cusion to move around and get into a better position. Infection risks are increased and most hospitals have a time limit on how long the water can be broken before intervening.  Augmenting labor with pitocin can make labor go faster but it also interupts the normal flow of hormones and makes labor much more painful while increasing the risk of fetal distress.

Epidurals: Epidurals do take the pain away (most times) but can also cause a cascade of other interventions and problems. They increase the risk of an OP baby (sunny side up) because the pelvis is over relaxed and baby finds it harder to rotate and turn without the gravity because mom is stuck in bed. The risk of c section increases and the drugs do reach the baby potentially causing breastfeeding problems. Please see my post To Epidural or Not to Epidural for more details on the risks of epidurals.  There are many other ways to cope with labor. Preparing physically and mentally for labor, continuous labor support and avoiding routine interventions all help make labor an easier process.

Episiotomy: Routine episiotomy can be more harmful than tearing. Tears typically aren’t as bad as the cut would be and they heal faster. Episiotomy frequently causes more tearing and more pain. Avoiding epidurals and upright pushing positions reduce the risk of or need for episiotomy.

Medical need for interventions are occasionally necessary. Routine intervention should be avoided. Learning about the routine interventions and when they may become necessary and writing a birth plan can help reduce the chance of having routine interventions forced on a laboring woman. I think it is also very important for the partner to understand these procedures so that they can assist the mother as much as possible. Research is on the side of the mother when it comes to these routine interventions and discussing the written birth plan before the birth will help the labor go more smoothly.  Hiring a doula can also help keep routine interventions from being carried out as she can remind the mom of what the risks and benefits of the interventions are and of what her wants are.

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Going “Natural” and Being a “Hero”

Posted on July 8, 2009. Filed under: Epidural | Tags: , |

It makes me so mad when I hear women say “I am not one of those women who think I have to prove something and not get drugs.” Are they just trying to justify themselves with that? Do they think they have to defend their decision to use drugs in their birth? I have never had a client come to me and that she wants to go natural and the reasons for it are bragging rights. Quite frankly, I would rather hear the woman that says she thinks she is too wimpy to do it without an epidural. Then I can tell her how wrong she is and that she is completely capable of birthing her baby without an epidural because I have never met a woman that I thought couldn’t do it, that every woman has the strength and ability to do and that yes she may need help but she can totally and completely do it! I would tell her about a client of mine that is a girly girl and self admitted wimp that naturally birthed an OP baby after a HARD 36 hour labor and how she was happier with that birth experience than with her first epiduralized birth that included 25 hours of pitocin, 50 stitches from an episiotomy, a vaccum assisted birth, and a baby with meconium aspiration that spent 10 days in the NICU.

And while we are on it, going natural does not mean not having a c section. It means not using drugs or interventions although if you tell a couple of my med free moms that because they got an IV line they don’t count as having had a natural birth they might smack you for it. But really, if you are having a completely natural birth, you are not medicating, having an IV line, having an episiotomy or having any other routine intervention. You are just having your baby. If you are not having a c section then you are having a vaginal birth. It’s ok to say vagina or vaginal or vaginally. Really, it is.

But back to the whole hero thing…it just drives me nuts when I hear the whole “I don’t have to be a hero in the delivery room” bit. It has absolutely nothing to do with being a hero or with what anyone else thinks. Moms that come to me that want my help in having a natural birth do it because it is safer and healthier for both the mom and the baby. They want the natural experience of birthing their child with their body. They want to give their baby a gentle start without drugs in their systems. They want to minimize the risks of forceps and vacuum and cesareans. They want to minimize the risks of tearing because they have the ability to feel what is happening as it happens. They want to move during their labor and not be forced to push on their back. They want to reduce the risks of breastfeeding issues because having an epidural can cause latch problems for the baby. They do not want to run the risk of having pitocin because the epidural over relaxed their uteri. They understand that by having drugs they increase the risk of fetal distress and c section. They could care less about being a hero in the delivery room. I doubt any of them ever even had that thought.

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“Pit To Distress”

Posted on July 7, 2009. Filed under: Birth, Cesarean, pitocin | Tags: , , , , |

Yes this is a real term that is really used in hospitals. Now I have heard it all. “Pit to distress” is referring to administration of the maximum dosage of pitocin until the fetus is distressed and the mother needs a c section. I am not making this up. Go read about this for yourself here. If you think this would never happen to you, you may want to do some research. If you think this DID happen to you, please share your story.


Here is an L&D nurse weighing in on this topic. She confirms that it is in fact practiced and referred to as “pit to distress”.

Here is another spin on it from an L&D Nurse, just to get a different perspective.

Here is a link from VBAC Facts weighing in on “Pit to Distress”

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The Truth About Pitocin and Labor Induction

Posted on June 9, 2009. Filed under: pitocin, Pregnancy | Tags: , , , , , |

There is a difference between elective induction and medical induction. Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Reasons for medical induction include: fetal distress, pre-eclampsia, uterine infection, premature rupture of membranes and other situations where the health of the mother or baby are compromised by continuing the pregnancy. One in five pregnancies are induced in the U.S. with some hospitals reporting induction rates as high as 50%. The medical induction group appears to be in the minority, however, since the 1999 Green Journal review reported that as many as 3 out of 4 labor inductions were performed without an indicated risk. (I cannot link the article and it is 10 years old but I would be willing to bet the stats aren’t any better now as induction rates have increased). In short that means that 75% of induced pregnancies are not for medical reasons. Research has proven that elective inductions lead to higher c section rates.

I start this post discussing the differences between medical induction and elective induction because labor is often induced with a drug called Pitocin that is only approved for use in medical inductions. Pitocin is synthetic for of the hormone Oxytocin that the body releases to cause contractions. How does Pitocin play into the reasons for induction? Well, I am going to tell you but let’s start with some background info first.

Someone asked me the other day what the long term affects of Pitocin use where. I told her that it was unknown and I started thinking about Pitocin and everything that I know about it. Here’s what I knew…

It’s a chemical synthetic version of Oxytocin
It’s used for labor induction and postpartum hemorrhage
It causes contractions to be stronger, longer and closer together than normal, which leads to epidural use
It can hyperstimulate the uterus
It can cause fetal distress
It interferes with the normal flow of Oxytocin but does not replicate the emotional responses that Oxytocin create
It can cause uterine rupture

I decided that I should learn more about it as it is becoming more routinely used. Here’s what I found according to the package insert

In the mother it can cause:
Anaphylactic reaction
Premature ventricular contractions
Postpartum hemorrhage
Pelvic hematoma
Cardiac arrhythmia
Subarachnoid hemorrhage
Fatal afibrinogenemia
Hypertensive episodes
Rupture of the uterus

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug. Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.

For the baby it can cause:
Due to induced uterine motility:
Low Apgar scores at five minutes
Premature ventricular contractions and other arrhythmias
Neonatal jaundice
Permanent CNS or brain damage
Neonatal retinal hemorrhage
Fetal death
Neonatal seizures have been reported with the use of Pitocin.

These are the known short term affects of use. There have been no long term or controlled studies for long term affects. Due to this the package insert says this based on recommendations from the FDA:


Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefits-to-risks considerations, Pitocin is not indicated for elective induction of labor.

Now THIS I didn’t know. It is not even approved for use for elective induction! How many of you had routine pitocin administered in your labor? To ‘get things going’? To ‘get you over that hump’? How many of you were informed that it’s not approved for that? How many of your were told of all the risks associated with it’s use? How many of you weren’t even told it was being administered through your required routine IV?

When you think of risk vs benefit, and you are told that your baby is safer on the outside than on the inside then Pitocin induction is a risk that may not be as risky as not inducing. That makes perfect sense to me. Why would we subject ourselves and our babies to these risks for no reason other than being tired of being pregnant? Or being told that you might have a big baby? Which by the way, ACOG doesn’t even recommend induction for suspected microsomia because growth scans can be off by up to two pounds. Another common induction reason is that the pregnancy is past 40 weeks. What happened to 42 weeks before discussing induction?

Here’s what I suggest…

Learn as much as you can about induction if it’s being suggested. Learn the medical reasons and risk vs benefits of inducing or not. Find out your Bishop’s Score. The Bishop’s Score can help you understand your chances of having successful induction or failed induction. Learn about the natural induction methods and ways to get labor going. Sex and nipple stimultion and orgasms all cause the body to release oxytocin!

The c section rate in the U.S. is horrifying. Many of these unnecesarians are due to failed inductions. I haven’t discussed c sections and their risks yet but I will go ahead and leave you with this…

According to Mardsen Wagner’s interview in The Business of Being Born, he says that section rates in the 70’s in the U.S. were at 7%. It is now over 30% and no more babies are being saved than before. In fact, the U.S. ranks 28th in the WORLD for infant mortality. That means that 27 other modern countries have better out comes than the U.S. C section has become so routine in our country that most people don’t even understand the risks involved. I truly believe that the way to start lowering these incredibly high numbers is to stop the elective inductions.

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