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Induction of Labor Associated with 67% Increased Risk of C-Section

Posted by on March 9, 2012 1 Comment

My epidural from the horrible birth of my son in 2001

Natural birth has been at the foundations of  Everything Birth from its conception. It began in 2001 as a small resource center offering natural birth classes and workshops.   Everything Birth’s owner, Crystal White, wrote, “My first child was born in 1997, and at the time I was still contemplating grad school and what direction my career should take. The more research I did on birth, intervention, and the unbelievably high cesarean rate in the US, I knew that somehow I wanted my career to be involved with birth.”  The year Everything Birth, Inc. was born was also the year my own son was born in a hospital. His birth experience was very traumatic given I was induced and the threat of cesarean section loomed over me the entire time with “gentle reminders” from the OB that my window of time for delivering naturally was running out.

As the years passed, the midwifery movement has grown and we have seen the occasional study stressing the increased safety of  a midwife assisted childbirth over a hospitalized childbirth. Over the years, I have often wished that these studies had been available just a few years sooner. I felt that same way as I read the most recent study on the risks of unneeded inductions of labor.

This month, a very important childbirth study was published in  the journal Acta Obstetricia et Gynecologica Scandinavica. Led by Rosalie Grivell, BSc, BMBS, FRANZCOG, of the University of Adelaide’s Robinson Institute, this childbirth study has the potential to dramatically change the way society views childbirth. A summary of the study, which included 28,626 pregnant women was highlighted in the research magazine Science Daily. It seems science is catching on to what midwives and birth doulas have been insisting. Science daily reported that the “induction of labor at term in the absence of maternal or fetal indications increases the risk of cesarean section and other postpartum complications for the woman, as well as neonatal complications.”

  • Induction of labor for non-recognized indications was associated with a 67% increased relative risk of cesarean section.
  • Induction of labor for non-recognized indications was associated with a 64% increased relative risk of infants needing NICU care.
  • Induction of labor for non-recognized indications was associated with a 44% increased relative risk of infants needing intensive care treatment.

In addition to those findings, the study found that for the best maternal health outcomes and the lowest risk of mothers needing an epidural or spinal analgesia occurred with birth at or after 41 weeks’ gestation. We discussed the reasons for this in a previous post called The Due Date Debacle.  More than just the implications this study will eventually have on hospital births, I feel that this childbirth study stands to provide an enormous amount of information to help women with healthy pregnancies subside any culturally induced fears about choosing a midwife to handle the birth of their child.

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Birth Perception.

Posted by on June 30, 2010 1 Comment

When I tell my birth story to some people they just can’t believe that I carried twins for 37 weeks thinking there was only one baby in there.  They ask “weren’t you really big?”  No.  ”Couldn’t you feel a lot of movement?” Kind of.  But I had nothing to relate it to.

I just think I had a very healthy outlook on my pregnancy.  What I did not know, only helped me.  I trusted that my body would tell me if something were wrong.  My midwives would pick up the signals of  anything going bad.  Choosing not to have ultrasound or any excessive interventions was a choice I made.  All of the prenatal testing in the world would not change the fact that I was pregnant.  Negative results would only add stress to my pregnancy.  As long as there was a heartbeat and I was feeling healthy that was all that mattered to me.  My pregnancy would continue and if there was a road block then we would deal with it when it came up.

Looking back, had I read any of the books about twin pregnancy, I probably would have been on bed rest at 32 weeks like most of them suggest.  Instead, I was swimming and walking everyday up until my 37th week.  My perception was that I was carrying a singleton, and that is what my pregnancy presented itself as.  My mind did not fear anything twin related because it had no idea that was even a possibility.  Was I scared to give birth for the first time?  Certainly.  But I addressed my fears and ackowledged them all.

The two weeks from when we discovered the twins to when I had the cesarean, were stressful.  I will not deny that.  I was just waiting for labor.  Full term for twins is 35 weeks.  Why was my body not going into labor?  I will never know the answer to that question.  All I can think is that my visualizations and birth affirmations worked.  They kept my fearful mind at bay and my body went along with perception that all was good and healthy.  I just happened to get two for one that time.

Affirmations can be so empowering.

My body knows how to birth my baby.

My baby knows how to be born.

I relax and fully turn my birthing over to nature.

I am safe even though I may be scared.

I put all fear aside and welcome my baby with happiness and joy.

Bless,

Jess

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Do Your Research.

Posted by on June 17, 2010 2 Comments

I am not a sheep.  I do not just do things because everyone else is doing it.  I guess that is why when I got pregnant I needed to know everything I could learn about what I was going to experience.  After scouring through book after book, I realized that my best chance at having an intervention free birth was going to be at my home or a birth center.

If you have been reading this blog for a while you will know that my first birth did not wind up at home, but in the hospital.  I am thankful that the medical assistance was there when I needed it, but when it came time to have my next birth, I went back to the homebirth plan.  Why, because I did my research.  I didn’t want to have another cesarean just because I had one the first time.  And according to the statistics at the hospitals where I lived, that was most likely what was going to happen.

Here are a few book titles that I think are essential reading if you just found out you are pregnant, or if you just want to read up on this topic.

Ina May’s Guide to Childbirth,

by Ina May Gaskin.

Discover the proven wisdom that has guided thousands of women through childbirth with more confidence, less pain, and little or no medical intervention.

The Thinking Woman’s Guide to Better Birth

by Henci Goer

Certified Lamaze instructor and activist Henci Goer brings women the carefully researched facts they’ll want to have–the complete rundown on modern pregnancy and childbirth.

Gentle Birth Choices: Book with DVD

by Barbara Harper

”Should I give birth at home, in a birth center, or in a hospital? Should I see a midwife or an obstetrician for prenatal care? What approach to pain relief should I use during labor? How does a waterbirth work?”

Expectant parents are faced with a daunting array of choices to make about prenatal care, labor, and birth. InGentle Birth ChoicesBarbara Harper, renowned childbirth advocate, nurse, midwife, and mother of three, explains all the available choices and shows how to plan a truly meaningful, family-centered birth experience. She dispels the medical myths that so often shift control of birth away from women and reimagines birth without fear or violence and with minimal pain. Harper reveals the abundant range of gentle birth approaches, including:

•giving birth in an independent birth center, at home, or in a hospital birthing room
•finding a primary caregiver who shares your philosophy of birth
•deciding how to best use current technologies

She also provides practical advice for couples wishing to explore options such as hiring a doula or laboring in water to avoid the unwanted effects of drugs and epidurals.

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Change in Plans.

Posted by on May 24, 2010 1 Comment

My birth plan was thrown out the window as soon as we were risked out of home birth at 39 weeks.  I thought we had everything in place.  Even though we found out we were having twins when I was 37 weeks, our midwife assisted  home water birth was still the plan.  Until……I just never went into labor and the second ultrasound revealed twin b was breech and cord wrapped.  At 39 weeks and no signs of labor plus a heatwave we were having, we needed to make some decisions.

We were offered two choices.  The first was to go home and wait for labor to start(it was 106 degrees that day), go to the emergency room and get doctor dujour.  Whoever was working that day may or may not let me labor and attempt vaginal delivery.  Most likley twin b was going to be a cesarean delivery.   The second choice was to go strait to the hospital and have a cesarean with the on call doctor who my midwife was familiar with.

Not having to recover from a vaginal and a cesarean delivery with twins to nurse and care for won out. We called our families and headed over to the air conditioned hospital.  I just knew I was making the right choice for everyone involved babies included.  I was dissapointed that my birth plan was not fulfilled, but no matter the circumstances I was overjoyed the moment my babies were out.  There is no better moment in life.

The lesson learned was that you can have the most comprehensive birth plan on the books, but you need to be willing to go with the flow.  I am appalled at the high cesarean rate in this country and never in my wildest dreams imagined I would head down that road, but when life happened and I hopped in that car I was glad that the mechanics were ready at the shop.

Three years later I had the opportunity to have a pregnancy that ended the way I envisioned.  I had the midwife assisted water home birth.  Only this time it was a HBAC.  Home birth after cesarean.  This experience was so empowering, but no more special than the first.

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Everything Breech.

Posted by on May 16, 2010 Leave a Comment

Part of the reason I was risked out of the homebirth of my first pregnancy was because one of my twins was breech and twisted in the umbilical cord.  When we went in to see the OB he told us that if I went home to wait for natural labor I would end up in the emergency room and I would get doctor du jour.  I would or would not be allowed to try a vaginal delivery with twin A, but twin B would most likely need to be delivered by cesarean.  Our reasoning for going in to have the cesarean that afternoon was so I would not have to recover from vaginal and cesarean delivery and have twins to nurse and care for all at once.  This was all a major diversion from any birth plan I had ever imagined.

The OB told us that there are so few doctors willing to even attempt a breech delivery that the art of breech delivery is dying out.  None of the young doctors are getting to see breech delivery so they are reluctant to do them as well.   Not all breech babies need to be delivered cesarean.  Go here to read 17 ways to turn your breech baby.

The medical professional’s reluctance to deliver the breech baby is well founded. Based upon their experience, this delivery is fraught with danger. How can we expect a physician to handle the unusual delivery when he has not been trained to allow the normal delivery?

Indeed, complications may ensue in the process of labor and delivery, and in no way do I wish to disallow them. Yet I believe that many of these complications may be avoided with competent knowledge of the mechanics of the breech labor and appropriate delivery technique.

Physiological reasons for breech presentation:

  • Prematurity
  • Placenta previa
  • Hydrocephalus
  • Multiparity
  • Hydramnios
  • Uterine abnormality
  • Tumors or fibroids
  • Multiple gestation

Other than these obvious physiological reasons for breech presentation, I believe the baby chooses the position that is most comfortable and that will guard him against oxygen deprivation. For example, I have delivered three breech babies who had complete knots in the cord. If they had been born vertex, they may have suffered hypoxia or been stillborn. Also, it is not unusual to find that the placenta, though not a previa, is somewhat low-lying (most often delivering Duncan), which leads me to wonder if the baby assumes the breech position to avoid the greater weight of his head pressing against the placental site, thereby reducing oxygen flow.

When considering a vaginal breech delivery, it is imperative that the mother is emotionally stable, has a high degree of confidence in her body as well as in her midwife, and has a high degree of motivation. In attempting breech delivery, excellent communication and cooperation between the mother and her birth attendant are crucial. Allow extra time for a careful discussion with the parents so they will know what to expect.

— Valerie El Halta
Excerpted from “Normalizing the Breech Delivery,” Midwifery Today, Issue 38
Order the back issue
Order the video Normalizing the Breech Delivery

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