One of my very favorite blogs I go to for timely, relevant, and well researched information is the Lamaze International Blog, Science and Sensibility written and monitored by Amy Romano. I was excited to have an opportunity to submit a piece I had written a few months ago for their recent Healthy Birth Blog Carnival. This particular carnival focused on the Lamaze Healthy Practice #1… letting labor begin on its own.
I wrote my original submission, as a critique of the newest ACOG Induction Practice Bulletin. I updated it a bit for submission to the carnival and today Amy put together a post that categorizes and discusses the many submissions. Soooo…. If you want to know something about allowing labor to start on its own and the perils of induction, head on over to Science and Sensibility. While you are there, be sure to click on a few of the featured articles.
To watch a real account of the drama that can ensue when a woman is essentially “forced” into an unnecessary induction check out this video where Lindsey Meehleis shares her powerful story. Stay around to the end of the video and see how her experiences transformed her from an uneducated consumer, to a powerful woman’s advocate and successful HBACer { HBAC – Home Birth After Cesarean} Enjoy!!
If you are pregnant, be patient, and demand your health care providers be patient or tell you WHY its so important for you to be induced today. Don’t fall for the “your baby is too big line.” There are MANY stories out there, including Lindseys that prove that wrong. Do your research, ask questions… your body and baby knows when it’s time to birth. Let your labor to begin its own. Your birthing experience depends on it!
In Birth and Love
Nicole
As an LD nurse, I get really frustrated when I hear that women are being induced for babies are too big ( I think this mostly comes from the fact I am pretty little myself and had pretty big babies). What I’m wondering though, is about what percentage of babies are really too big?
I had one lady that did everything right in her labor and yet ended up with the diagnosis of cpd and was sectioned. She pretty much stopped laboring and 8cm. The doctor was really good about letting her continue to try also. She was at an 8 for almost 12 hours. I hate to label her as cpd, though, because I have seen so many successful vbacs. Yet, I didn’t know how to help her through this emotionally. How do you deal with these sorts of situations so that the mom doesn’t feel like she just doesn’t work? Thanks.
Hi Rachel. That’s a great question and I think just like with pregnancy, labor and birth in general the what to do and how to help willl be different in every situation and for every woman. Lets look at CPD. While it is often used as a diagnosis and a reason for a cesarean section, TRUE CPD is VERY rare. If we listen to the stories of countless women who were diagnosed with CPD and had a c/section and then went on to VBAC successfully a LARGER baby we can see that CPD is most often a misdiagnoses. There are many things that can affect the progress of a woman’s labor. You mention that your patient did “everything right.” Was she unmedicated and listening to her body’s cues of how to move during her contractions. Was she eating/drinking. You also say that “She pretty much stopped laboring at 8cm” Does that mean she stopped contracting or stopped dialating. Was her body fatigued and she needed some nutrients or a nap. Did she need a little nipple stimulation to bring about stronger contractions. Did she feel safe and secure in her environment. Was she surrounded by a supportive birth team or was her birth environment stressful. Was she able to work through/with her contractions or did she get to transition and begin to drown under the wave of each surge of pain. Was she truly ready to birth her baby or was she apprehensive. Was the baby’s head acynclitic, was there a compound presentation. You may never know the answers to these questions and yet these answers could very well tell us what happened to this patient at 8cm.
Here’s an example… I have a friend who’s daughter had a baby 4 weeks ago. Her daughter labored rapidly until 7/8CM. At that time, things slowed down and it was 12 hours before she birthed her baby. When I spoke with my friend about it, we realized her daugher was waiting for her to return from a road trip she had made a day before. She declined Pitocin, she took a nap and basically stopped her own labor until her mother (my friend) arrived at her bedside. As soon as she arrived, the contractions restarted and she birthed her baby a few hours later.
So how do I deal with this situation? One of the things I do first is remind the woman how stong she is. I tell her repeatedly that she is strong, she is a fighter, she is phenomenal. I encourage her with positive adjectives that convey strength and power. I am careful not to overdo it so that I don’t sound fake or patronizing. I let her know that there are MANY reasons why this is happening and unfortunatley when it comes to labor and delivery we don’t always know WHY. I tell them I KNOW this is not a great answer. I am supportive to thier response and provide honest answers to their questions.
Emotionally, as it gets to the time that the c/section is actually “called” I will say to her “I know this is not how you wanted you wanted to birth your baby” I will often do what I call the “Nursing 101 Pause” and allow her an opportunity to say something ANYthing. I include the husband/partner/FOB if they are there. Depending on her response, I will say “I want you to know you are sooooo strong and you have been so wonderful today/tonight… and its okay to be angry/sad/to cry/to be mad etc” What ever seems appropriate for that particular patient. If they are a praying family I will ask them if they need a moment to pray. If possible I try to get to this BEFORE the cesarean is actually “called” so they do not feel so rushed. I will prepare them for the rapid movment that will take place from calling the surgery to the delivery of the infant. I will give them a run down of what is going to happen and answer questions. This gives them an opportunity to work through some of the immediate emotions.
For many women, the emotional healing from a cesarean birth can take longer than the physical healing. Often the pain they feel is not simply about the cesarean but includes events and what they may feel are missed opportunities throughout the day. I think the more compassionated we can be as their labor nurses, throughout the entire process, the more we can help them work through that pain. What we say and do on admission is just as important as what we say and do on the way to the OR. I hope this helps a little. Thanks for reading and thanks for your question.
Nicole, I’m curious: Why do doctors even bother doing sizing ultrasounds? The OB who delivered my daughter didn’t do them routinely, and the midwives who will be delivering my current baby don’t do them either — even though my daughter was 9 lbs 7 oz (and they know it) and so I’m assuming this one will be big too.
My midwives said that ultrasounds can be off by up to 2 lbs in either direction, and besides, there’s really no way to know whether a baby is “too big” short of giving vaginal delivery a try. Makes sense to me. So why do so many doctors insist not only on doing sizing ultrasounds but also on making medical decisions (such as inducing) based on them?
There are a couple of reasons that a physician may do a sizing ultrasound. ONE…. when doing abdominal measurements during a routine prenatal visit things seem off (i.e you are measuring much smaller or much larger than expected). An estimated fetal weight may be obtained to see if the baby is growing adequately. These definitely can be off by a couple of pounds as your midwife explained but in this situation, decisions are not made on one ultrasound. They will usually do a few ultrasounds to measure interval growth to be sure that your baby is growing from month to month. They will also be looking at other things as it relates to the health of the baby i.e. amount of amniotic fluid and health of the placenta.
TWO… and the issue that you are talking about is … in my personal opinion… they do sizing ultrasounds so they can tell you that you are at risk of having a big baby to scare you into an induction. There really is no other explanation. Practitioner hands cannot accurately predict baby birth weight. Ultrasounds cannot accurately predict baby birth weight and even if we had an adequate way to predict baby birth weight your midwife is absolutely right. There is no way to determine if a woman will be able to birth her baby based on an estimated weight alone. She has to be given what we call a TRUE trial of labor and that does NOT include labor that is induced. What happens with/after/during an induction is not proof of what would happen with a normal spontaneous labor. There are so many other things at play. AND…. there are many women who have an induction and subsequent cesarean for a first baby that is say 9#2ounces and go on to have a later VBAC (Vaginal Birth After Cesarean) with a newborn weight of 9# 10ounces.
The bottom line it this… sizing ultrasounds to determine if a baby is “too big” is a waste of money, time, and energy. Inductions are done for a lot of reasons and one of them is definitely convenience. Not that it is more convenient for the mother but more convenient for the provider. So why do they do sizing ultrasounds… so they can say your baby is getting “too big” and they can convince you to have an induction for their personal convenience. Its ashame. And its true.
Oooppsss…. I almost forgot another reason… MONEY!!! If they can bill for it… they are more likely to do it. If insurance companies stopped paying for them they would stop doing them!
Thanks Nicole. That’s exactly what I suspected, but hey, I’m not a medical professional, so I didn’t know if there was some actual medical reason that I might be missing.
This topic actually came up today in a discussion with a friend. I told her that I had already gone over a couple of L&D issues that are REALLY important to me with my midwives — I started at my very first appointment, at 7 weeks! If they insist on something that I absolutely do not want, I want to find that out sooner rather than later so I can switch providers!
Anyway, sizing ultrasounds are something I’m very much against, because I do suspect that I’m going to have another big baby, I’m a little scared of HOW big, and the last thing I need is a stupid ultrasound predicting an 12-pound baby, or even (accurately) predicting a 10-pound baby, and then having THAT in the back of my head during labor.
Anyway. My friend said, “Yeah, they did a sizing ultrasound for me. It was off by a pound. My doctor said that it was more for her than for me. She also said that she’s having more and more trouble getting insurance to cover those ultrasounds, so she has to come up with reasons to do them. But she had no problems with me because I was advanced maternal age.”
Well alrighty then. Good that insurance is being pickier about what they’re covering… but shouldn’t that doctor take the hint that maybe she’s having trouble getting them covered for a reason?
My friend’s baby was reasonably sized, and anyway, she went into labor on her own before her due date. So in the end, the ultrasound didn’t affect things, thank goodness… I know not everyone is so lucky.
As usual, great advice that empowers!
THANK YOU Tracy!!