“Induction of labor is like pushing a parked car up a hill. It requires a lot of help, hands and/or machine (tow truck). ”

There are many reasons a woman may be admitted to the hospital for an induction; past expected due date, pregnancy-induced hypertension, spontaneous rupture of membranes without labor and just because. As you can see most of these reasons are perfectly valid and are most likely for the best interest of the mother and baby. However, there are 2 reasons in particular I have seen take place for convenience or according to the doctors or hospital policy, not necessarily because the mother and baby were in any danger.

The Estimated Due Date Myth

Most women do not know when they ovulated, therefore conceived so the common method is based on your LMP (last menstrual period). The problem with this method  is you may have been told that you ovulate or are most fertile on day 14 of your menstrual cycle, mid-cycle or even 14 days before your period is expected. These are myths. While this may be the case for some women, it may not be true for you, even if your cycles are regular. Your own fertility pattern is unique to you and unless you observe and chart your cycles your estimated due date can be off by as much as 2-3 weeks.

When we are given a due date (even on the basis of it being just an estimate) we hold on to it as if it is in stone. We watch the calendar and check days off and the closer we get to it with no sign of labor starting we panic. Not to mention the annoying phone calls, emails and now texts from well meaning and loving family and friends asking, “Have you had the baby yet?” If you happen to have a doctor who has a vacation coming up or who “doesn’t like to see their patients so uncomfortable”, that’s a lot of pressure for an expectant mother.

“One of the biggest obstacles to natural birth is misunderstanding your "due date." A due date does not mean there is only one safe day for your baby to be born. It is meant to establish a range of time that your baby is mature and safe to be born. Because modern obstetrics narrows this to a specific day, unnecessary interventions, like inducing labor, come into practice.” Mothers Naturally

“Is this baby ever going to come?”

These words and thoughts may start to be uttered days before the estimated due date. But we have forgotten one thing, it’s an estimation.

Sometime we are literally evicting the baby before he/she is ready. There are many things that need to come together for true labor to begin. It is not just about jump starting contractions. When we begin to play with nature and its timing there is no wonder the snowball effect of interventions begin. It’s almost like our bodies are saying, “I wasn’t ready but since you are trying to make it happen you are going to have to finish it”. That is exactly what happens.

 “Pitocin is like normal contractions on steroids”

Oxytocin is a natural hormone produced by a woman's body that cause uterine contractions, when her body and baby are ready. Pitocin is the synthetic form of oxytocin. Pitocin is generally used in two ways: 1) to induce labor, and 2) to augment (speed up) labor. Pitocin is supposed to be used to induce labor or increase the strength or duration of contractions for the health of mother or baby.

Oxytocin, your body's natural hormone, is secreted in bursts. However, when you are given pitocin you are placed on a regulated intravenous pump, to regulate the amount of pitocin to a steady flow. Therefore, pitocin induced contractions are different from your body's natural contractions, in strength and effect. (For more detailed information on Pitocin FAQ )

This domino effect, I have unfortunately seen more than once, has a higher chance of ending with a c-section. The mother wonders; how did I get to this point, what went wrong, did my body fail me? I have been in these moments; it can break your heart to witness.

Are there times when inductions are needed? Absolutely, and when they are done during those times can give a mother and child the best outcome. However, similar to c-sections, it can be a matter of convenience and control and less about a woman’s ability to labor successfully on her own.  “In a well-nourished, low risk pregnancy it is normal for your baby to be born between 37 and 42 weeks gestation*. Many natural events take place within your body during the last weeks of pregnancy to prepare you for labor. Allow time for the natural process to occur.”

I would like to encourage mothers to-be and their providers to 1) allow nature to take its course which will require some patience, 2) if assistance is needed to consider all the options, pros and cons of induction, 3) consider alternatives to start and augment labor.

To induce labor:

• Walking
• Nipple Stimulation
• Intercourse (Only if the bag of water is intact.)
• Enemas
• Castor Oil

Augmenting Labor:

• Walking
• Change positions
• Avoid exhaustion
• Nipple stimulation
• Employ a professional labor support person

Do not be afraid or intimated.

Ask questions about what is being suggested. Ask why, are there any alternatives and what are the pros and cons. When we want someone to do something we tend to glorify the benefits and downplay the risks. This is a time you want to know (equally) both sides of the coin. If your doctor seems impatient or acts as if your questions are stupid or annoying (I’ve seen it) in the middle of labor (especially an induced one) is not the best time to address your concerns. You may feel vulnerable, afraid and as if you do not have any choices, or that you can’t make the right one.

 

Resources:

Childbirth.org

The Doula Book

mothersnaturally.com

I avoided cavities during the sugar crazed adolescent years, late night snacks while studying during college and the sweet tooth I developed when joining co-workers for lunches that always ended with a decadent dessert. Yes, I was pretty proud of my choppers only to have my streak end with my second pregnancy.  

I try to always see my dentist every 6 months to keep my pearly whites healthy. My visit was near the end of my pregnancy when I learned that I had not, one, but four cavities (two on each side that mirrored each other). I was horrified (I really was). Immediately I started to figure out the culprit. I had severe morning sickness that lasted almost to my seventh month. I was on a prescribed medication to keep food down and I had concocted a drink mixture of part Gatorade, part water, and ice to prevent dehydration. Sipping on this all day couldn’t have helped but I later learned that if you're a woman, your hormones can have a big effect on your oral health at different times in your life — puberty, menses, pregnancy, and menopause all have an impact.  

Apparently it is very important to be conscious of your dental health during pregnancy.  

According to EverydayHealth.com “Any infection, including periodontal infection, can cause problems in pregnancy. Studies show that pregnant women with periodontitis are seven times more likely to give birth prematurely or have an undersized baby. Women can also lose much of their calcium to the developing baby during pregnancy, and that can lead to tooth loss.”

Certain oral health conditions affect pregnant women in particular. These include:

Bleeding gums. During puberty, increased levels of female hormones cause an increase in blood supply to your gums and can affect your gum health. This can lead to greater sensitivity and more inflammation from food particles and plaque. Similar responses can occur during menstruation, when taking oral contraceptives, and during pregnancy. Gums may become swollen and bleed easily.

Gingivitis and periodontitis. Gum disease is also more common during periods of high female hormone exposure. Up to 75 percent of women get gingivitis during pregnancy, usually between the third and eighth months.  

All women should follow these basic guidelines to maintain the health of their teeth and gums (especially during pregnancy):

• Brush your teeth with a toothpaste containing fluoride at least twice a day.
• Floss at least once a day.
• Eat a well-balanced diet.
• See your dentist regularly.
• Ask your dentist to recommend a good antimicrobial mouth rinse.

·         If you're pregnant, make sure your diet contains enough vitamins, proteins, and calcium.  

Another thing to consider is if you aren’t pregnant but are planning to be, it is a great idea to try to get any dental work, routine or special x-rays, etc. donw before you have a little peanut in the oven. A dental check up pre-pregnancy or early on may ensure that your mouth stays healthy. Also, inquire about whether frequent visits during your pregnancy may be necessary.

Pregnancy can make your gums bleed and swell; you may want to switch to a softer tooth brush during this time.

Don’t forget to see your dentist after you’ve had your little one. The months following a birth can wreak havoc on your teeth with all of the hormone changes and fatigue (meaning you may skip your daily routine).

You don’t have to be a dental hygiene fanatic when you’re pregnant, just try not to skip on brushing and flossing.

Dental health is often the last thing on an expectant moms list of to do’s and concerns. You’re doing great already, just being aware of things will cause us to make any necessary changes for our health and baby.

~You’re wonderfully made!

Last week my husband and I learned that the baby whose fall arrival we had so anxiously anticipated will not be. The process was all too familiar as we had just experienced it for the first time earlier this year. It was hard to be optimistic as we noticed the same pattern as our first loss. You notice some spotting, or maybe bleeding with or without  cramping and make the alarmed call to the doctor (or nurse) who tries to reassure you that it is not uncommon in the first trimester to have some bleeding. Their advice; try to relax, put your feet up, get some rest and try not to worry. Something doesn’t feel right, not just with your body but in your spirit. By the time you see your doctor you already know in your heart but it stings all the same to hear that what you are experiencing is most likely the end of your pregnancy. They run tests to be sure and tell you not to give up. Your symptoms are fading along with all of your hopes and dreams. All optimism is lost as you learn that the “pregnancy wasn’t progressing” or has ended.

“Miscarriage is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage…Most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed about miscarriage, in the unfortunate event that you find yourself or someone you know faced with one.” American Pregnancy Association

This is a loss, a real loss. Whether you had just conceived (chemical pregnancy), in your first trimester (miscarriage) or were in a later stage in your pregnancy (stillborn) the loss is as real as having had a newborn baby in your arms and to later lose them.

With every loss there is a grieving period. The length of the grieving doesn’t necessary depend on how far along a woman may have been and every woman will grieve in different ways as well. One thing that they will all share is the different stages of grief.

Stages of Grief:

·         Denial

·         Anger

·         Guilt

·         Bargaining

·         Acceptance

“A miscarriage takes away the pure innocence of pregnancy”. I read this comment on a pregnancy loss website the other night. The young lady who wrote it pretty much summed up how other women (including myself) may describe the emotional aftershock of a pregnancy loss.  This short sentence says so much and I didn’t understand it until I experienced it myself.

Instead of the heart racing excitement that once was, future pregnancies will be held frigidly in the heart. The “I won’t get excited until after the safe zone (first trimester)” technique will be applied for self protection. Every twinge, spot or loss of symptoms will be cause for anxiety. Fear lingers and every ultrasound appointment ends with a sigh of relief.  Between each doctors visit it feels as if you have been holding your breath since the last. Some may (try) to with hold any love toward the new babe as to lessen the impact of a potential loss. As if we can really do that. Yes, it is true that a mother and a baby are two individuals but as soon as we see the little “+” sign or “pregnant”, or the doctor confirms what your womanly intuition told you, you are hooked. From that moment the heart strings become entangled to this little one.

It’s not that the mother who hasn’t had a loss doesn’t experience some level of anxiety. On the contraire, when I was pregnant with my two daughters who are 3 and 12 years old now, both times I was so afraid of miscarrying them. I pretty much walked around as if I was holding china that I was afraid would easily break. What I am describing above is different. A previous miscarriage can almost rob the joy expectation of being pregnant from a woman.

Ironically enough after our news I have been contacted by two new potential clients for doula services. My daughter asked me if I was going to be okay with my two deliveries I have coming up in the next few weeks. She’s also observed me still researching and practicing my doula skills in between minor melt downs when the reality of what we are experiencing hits me like a tsunami. It’s a fair question that I didn’t mind her asking. The truth is, I’m not sure how I will feel in the next few weeks, next few months or due dates. When you consider that each month a woman has only a 20% chance of conceiving (who is purposely trying) it is pretty amazing. The fact that there is a about a 24 hour timeframe for a sperm to meet the egg and the uterine environment has to be just right, I still believe that every conception and birth is a miracle. I attended a birth a week after our first loss and it was almost therapeutic to take my mind off of myself and our loss and give someone else 100% to help them to bring forth their miracle.

 

(Authors note: This post was really written to encourage women out there who have and who will experience a pregnancy loss but also those who aren’t sure how to comfort them.)

Websites:

http://pregnancyloss.info/

http://www.americanpregnancy.org/pregnancyloss/mcsupportingothers.html

Books:

Empty Cradle, Broken Heart

Pregnancy After a Loss: A Guide to Pregnancy After a Miscarriage, Stillbirth, or Infant Death

Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss

A Silent Sorrow: Pregnancy Loss - Guidance and Support for You and Your Family

Grieving the Child I Never Knew

Something Happened: 
A book for children and parents who have experienced pregnancy loss.

We Were Gonna Have a Baby, But We Had an Angel Instead by Pat Schwiebert. 

 

"It is often claimed that traumatic events are repressed, yet it appears that the trauma more often strengthens memories due to heightened emotional or physical sensations.[1]" A classic visual image of repression is the image of one trying to hold a tennis ball under water. All of your physical and mental energy is focused on keeping that ball down and as soon as it is released it resurfaces. The same is similar for memories, events, habits, etc. that we try to submerge in our thought lives. Often these memories resurface like the tennis ball and usually when we least expect it.

For years due to public awareness we are more educated on how abuse on children, adolescents and later on adulthood. "The effects of sexual abuse extend far beyond childhood. Sexual abuse robs children of their childhood and creates a loss of trust, feelings of guilt and self-abusive behavior. It can lead to antisocial behavior, depression, identity confusion, loss of self-esteem and other serious emotional problems. It can also lead to difficulty with intimate relationships later in life." [2] (My emphasis).

One in four women is estimated to have been sexually assaulted at least once in her life. This statistic is derived from two large-scale national studies that show the incidence of childhood sexual abuse to be 27%, with a further 17.6% of women reporting adult rape (attempted or completed), half of whom were also survivors of childhood sexual abuse.[3] That is quite sobering especially if you are hearing this while sitting in a room with a group of women. The effects of sexual or child abuse has on a women during her childbearing years, especially during labor and delivery has been overlooked, however awareness is starting to be raised. Unfortunately, because it wasn’t often discussed during prenatal visits or during childbirth education (or the woman does not feel safe to discuss it or has repressed it so deep) the doctor, midwife, nurses, and labor companions assume that the expectant mother couldn’t handle child birth and are labeled as such. Because of this their specific needs and concerns are not addressed.

If you have given birth to a child you can attest to the fact that it is one of the most vulnerable times you will ever experience in your life. The double-sided coin is that to possess complete control during the process a woman must give up complete control. She must trust and work with her body, baby and the process. The end result is the same for all women as it has been since the beginning of time, a baby will be born. However, the difference in how that mother receives that baby can range depending on the circumstances. If not handled correctly instead of feeling empowered and confident as a woman, new mothers are often left having to relive traumatic experiences and feeling victimized all over again.

With the above stats it is more likely than not that I will come across more and more clients who have experienced some sort of sexual abuse trauma. I am fully aware of my scope of practice and that I am not a therapist or counselor, but it doesn’t release me from the responsibility of being aware of how a mother is reacting to pregnancy, labor, delivery, post-partum and motherhood. During prenatal visits I try to build a relationship with all my clients by educating them as well as spending time learning about their experiences and expectations. Sometimes the subject may come up during our visits; other times intuition and experience will be my guide. During labor and delivery I am to adapt my response to these mothers so that I may not cause further harm. I need to be mindful of words used that can encourage your average mom but can make a survivor mom completely withdraw or become defensive. A touch that can sooth and comfort most women may send a survivor mom into a cocoon or worst have her completely shut down prolonging her labor.

With all of the literature, education, training for professionals and counseling for survivors have become available as awareness for this subject continues to bring healing to women and mothers. I admit that I am still resolving to learn more so that I may better assist and be a better and comfort and support to survivors of abuse.

Resources

References:

1. ·  ^ NPR: Why It's Hard to Admit to Being Wrong

2.      Besharov, D. J. (1994). Responding to child sexual abuse: The need for a balanced approach. In R.E. Behrman (Ed.), The future of children, 3 & 4, 135-155. Los Altos, CA: The Center for the Future of Children, The David and Lucile Packard Foundation.

Bottoms, B., & Epstein, M. (1998). Memories of childhood sexual abuse: A survey of young adults. Child Abuse & Neglect, 22(12), 1217-1238.

U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. (2007). Child maltreatment 2005. Washington, DC: U.S. Government Printing Office.

3.      National Research Council. 1993. Understanding Child Abuse and Neglect. Washington, D.C.: National Academy Press; Tjaden, P., and N. Thoennes. 2000. Full Report of the Prevalence, Incidence, and Consequences of Violence against Women: Findings from the National Violence against Women Survey. National Institute of Justice: NCJ 183781. (www.ncjrs.gov/pdffiles1/nij/183781.pdf)

 

In my last post I spoke of the possible influences that affect the way women and society view childbirth. In this post I would like to help from a different angle. We’ve heard that knowledge is power. I wonder if we’ve really grasped the meaning of this, or is it just another inspiring quote. One way to combat fear head on is to know your enemy or the perceived enemy in most cases.

I am going to use a job interview as an example of having fear and anxiety about the unknown and methods to overcome them
that can be applied to childbirth. When you are interviewing for a job it is not uncommon to begin to have some anxiety about
the interview itself and the outcome. Sometimes we begin to play in our mind all the negative possibilities that can take
place only paralyzing us all the more. There are several books and websites dedicated to preparing potential job hunters for
their interviews. One in particular allbusiness.com has helped me compile this list which I will apply towards childbirth.

1) Do your homework.  Although childbirth is a natural process which a woman’s body is designed to achieve most people do not understand the physiological, psychological and emotional components that go along with it. Childbirth classes help expectant parents learn about and prepare for labor and birth. There are several kinds to choose from. In childbirth classes you will learn about the labor and delivery process, how your body is working with you (not against you), ways to manage pain and other information that will help you feel more comfortable about the process and knowing what to expect. Research them as much as you can to become familiar with each technique until you find an course that seems right for you.

2) Know where you’re going. Are you having a home birth, birth center, or giving birth at a hospital? Will your health care provider be an obstetrician, a midwife or your family practitioner? Each option has their strengths and weaknesses and it is best to know beforehand who you’d like to be involved with the delivery of your child.   

 

3) Look the part. Well, your body is already taking care of this one. I would add that it is not only important to take care of yourself physically during this time but your overall well being is important as well. If you exercised before baby keep at it (with doctors guidance). In fact, if you abruptly stop your routines it may cause some stress and anxiety.  If you did not exercise regular before baby, I don't believe doctors recommend starting up a program, but Pilate's, walking, stretching, etc. not only benefit you but baby as well.  There are (thank God) a lot of great maternity clothing now. Have fun, enjoy this time, get a massage, a facial, be pampered. This is your time, in a few months it wont be so much.

4) Rehearse beforehand. Is there a breathing technique or hypno birthing method you would like to use? Most people make the mistake of skimping on the practicing; they figure they can wing it. The problem is with most methods and techniques they benefit you the most with when you put in the work before labor starts. Many times someone will try something and say it didn’t work,  in reality they really didn’t commit to learning it completely. What are some ways you relax, distress? This is the time to practice some comfort measures to see what helps and what would irritate the daylights out of you.


5) Secure your references. Build your support system. Women who labor and deliver alone tend to have less than ideal birth experience. When I say alone, keep in mind that most obstetricians are either taking care of several patients at one time, and most only want to be called to come in when delivery is very near. Most labor and delivery nurses chose that profession because of their sincere desire to serve and comfort women during their most vulnerable time. Unfortunately they also juggle several patients and have to follow procedures and monitors which keep them from the one on one experience with expectant mothers. Midwives can vary depending on if it’s a hospital, home or birth center delivery. They can be more attentive to the laboring mother but as delivery become closer their role rightfully changes from solely nurturing the mother to making sure that a safe delivery is the end result. Whether it’s your best friend, your partner, mother or doula, you will want to consider who you will want with you as each person brings along their experience, fears, and expectations which can positively or negatively influence your birth experience.


6) Arrive early. Or maybe not. Most women (and the fathers-to-be) have anxiety about her water possibly breaking at the movies or trying to determine if she’s having real contractions, Braxton hicks or gas. You will want to discuss with your caregiver at what point you should contact them and head to the hospital, birth center, or should expect them to come over if you are having a home birth. Often women have reported being in labor and rushing to the hospital only to have labor slow down or stop, and this may be due the change in environment, paper work, unfamiliar faces, etc. Whatever the plan is make sure you have it and contact numbers close by and that your support person(s) have access to it a well. Also, taking a tour of the hospital before, finding out their procedures for admitting, labor, delivery and recovery is a good idea.

7) Bring necessary documentation.  Make a checklist of everything you will need to bring to the hospital. Toiletries, music, comfort and focus items to name a few. Consider getting a new robe, a new night gown as a gift for yourself, any medications you take, journal, camera, whatever you can think of. This is helping you to be proactive. Being unprepared can caused unnecessary stress to an already potentially stressful situation.

8) Sell yourself. You have to advocate for yourself. This is your birth experience. Work with your doctor, midwife or doula about the benefits of a birth plan. The great thing about creating a birth plan is it causes you to learn about the pros and cons of interventions, how you would like to handle situations as they arise, etc. The process of creating a birth plan empowers you to take responsibility for your birth experience and may ease some fears of the unknown by leading you to search for more knowledge to make informed decisions. Don’t forget to present a copy to your doctor and discuss it with him and also the nursing staff when you are admitted. Be advised that like weddings, things do not always go as planned. Your birth experience may not go exactly as planned but you will have the information to discuss any changes so that you can make an informed decision that you can live with.

9 Don’t neglect to ask questions. It doesn’t matter if it’s your first baby or fifth, there are no dumb questions. If your doctor or midwife responds impatiently or negatively to your questions, it may be time to look for a new one. If you are hiring a doula she can be a wealth of information and resourceful as well. Connect with mothers who have succeeded with the birth plan you desire. Another warning: stay away from people who only want to tell you horror stories. You’d be surprised (especially as an expectant mom) how things stick to you. Before you know it, you’re staring at the ceiling at 3 am wondering if you will have a 46 hour labor that will end up in a c-section because you were so exhausted and you had a small pelvis and the baby’s shoulder got stuck and they ran out of cranberry juice!


10) Follow up. After your delivery it can be helpful to find out from those involved what they experienced. As you mentally are revisiting your birth experience (journaling is great too) their feedback can help fill in the gaps of things that were missing from your story. It’s not uncommon to hear about things that happened that you didn’t notice because you were so focused and tuned in to your body.

 Please keep this in mind: Every birth will be a different experience. Your level of enjoyment with each experience will be determined on how prepared you are for the journey. Knowledge is power. You will have the power to allow your fears to influence your birth experience or to face them head on and use them to push you to the birth you’ve always wanted.