Do I Really Need to be Induced? Resources for Informed Decisions

Responses to the 2006 Listening to Mothers II survey indicate that about 35% of birthing women in the US are having their labors induced by their caregivers. Considering the risks of induction, it is helpful for pregnant women to know which cases usually truly warrant induction and which ones usually don't. I hope that if you are faced with induction, these resources can be helpful to you in figuring out whether or not induction is necessary in your case, taking into account your individual health situation.

There are people out there who know what they're talking about more than your student doula/prospective childbirth educator. I've decided instead of writing about this myself, to provide a list of links to various resources available for information on this topic. I have tried to offer multiple perspectives by including links to many types of sources, including research information, statements from professional organizations, care provider opinions, and consumer-oriented information. If you find a link that you feel would be helpful to include in this list, feel free to let me know in the comments.

Suspected Fetal Macrosomia ("The Baby is Too Big")

• Induction of labor for suspected fetal macrosomia (Cochrane Review)




• ACOG Issues Guidelines on Fetal Macrosomia (American Family Physican)




• Big Baby Bull (by Sheridan of Enjoy Birth)




• "is my baby too big?" (Charis Birth Support)

Post Dates Pregnancy (Being "Overdue")

• A Timely Birth by Gail Hart (Midwifery Today)




• The Lie of the EDD: Why Your Due Date Isn't When You Think by Misha Safranski(Associated Content)




• Induction of labor for improving outcomes for women at or beyond term (Cochrane Review)




• Induction of labor: balancing risks--Midwife Thinking's Blog




• Postdates - from Ronnie Falcao's Midwife Archives

Oligohydramnios (Low Amniotic Fluid)

• Oligohydramnios: Too Little Amniotic Fluid - March of Dimes




• Birth Sense: Low Amniotic Fluid: A Cause for Panic? (original post has become unavailable, but I found the text reposted on another site)




• Gloria Lemay: Low Amniotic Fluid. . . I don't think so




• Amniotic fluid index versus single deepest pocket as a screening test for preventing adverse pregnancy outcome (Cochrane Review)

Prelabor Rupture of Membranes (Your Water Breaks and You're Not in Active Labor)

• Planned early birth versus expectant management (waiting) for prelabor rupture of membranes at term (Cochrane Review)




• Pre-labor rupture of membranes: impatience and risk--Midwife Thinking's Blog




• Prelabor Rupture of Membranes--PROM--from Ronnie Falcao's Midwife Archives

Hypertension, Pre-eclampsia, Eclampsia and HELLP (issues involving high blood pressure)

• High Blood Pressure During Pregnancy - March of Dimes




• Preeclampsia Causes, Symptoms, Diagnosis, and Treatment by eMedicineHealth.com




• Pregnancy-Induced Hypertension - from Ronnie Falco's Midwife Archives

Placental Insufficiency and IUGR (placenta not working properly, baby not growing)

• Placental Insufficiency Medical Information - medicineonline.com




• Intrauterine growth restriction (IUGR) --BabyCenter




• Intrauterine growth restirction -- Familydoctor.org

Why Natural Childirth is Not Important

My goal is not for everyone to have a natural birth. Of course I believe that, in cases where everything is going smoothly, mothers and babies will be safest if medical intervention is avoided. However, there are times when things go wrong, making intervention necessary (though it is important to remember that not everyone's definition of "necessary" is the same). Holding an intervention-free birth up as The Ideal Birth sets a woman up for failure if complications occur, which is something she has no control over.

I recently followed an online discussion among student doulas about the use of the term "cesarean birth." Some women wanted cesareans to be recognized as births and some women felt that a cesarean is never a birth because it removes the mother from physically participating in the birth process--since birthing is a verb, and a women having a cesarean is not acting, but being acted upon, it can't be a birth. This lead me to re-examine my definition of what birthing entails.

What does it mean to give birth?

When we use to birth as a verb, we are usually intentionally distinguishing to birth from the more traditional to deliver. In the sentence, "The woman birthed her baby into the midwife's hands," the woman is the subject, actively performing the verb. However, if we were to say "The midwife delivered the woman's baby," the midwife becomes the subject of the sentence, implying that delivery is something the care provider does and not the woman. Yes, words really do have power. Once could say one of the purposes of birth education and advocacy is to help women be empowered to birth their babies instead of having them delivered.

It is true that part of the power of an unplugged birth is that women's bodies are in control and not the machines. A birth without immobilizing pain medication, in which the mother can use positions that are comfortable to her, is truely birth in which the mother is "active." But is natural childbirth the only birthing?

If a woman becomes exhausted and decides she wants an epidural to help her relax and get some rest and goes on to push her baby out, we still call it a birth, even though she needed the help of medical professionals and drugs. Some would say, "Of course it was a birth, it was vaginal." But what if that same mother has her labor slow down and needs pitocin to keep her contractions going and isn't able to push effectively with the epidural and chooses to have the doctor use a vacuum? Is the mother still birthing the baby? Is that really much different from a mother choosing to have the doctor perform a cesarean when the mother feels it is medically necessary?

To birth refers to what a mother does to bring her child from her womb into the outside world. Now, does her body have to do this all by itself in order for her to participate in the process? Not necessarily. I believe birthing can be about more than just he limited definition of pushing your baby out. Being actively involved in your birth can also include deciding that your body needs help from a professional, medications, instruments, or yes, even surgery, to bring your baby into the world. In such cases, the birthing is not in the pushing, the birthing is in the choices. I believe that if it is the woman's choice to have a cesarean--she actively decides that enlisting surgical help is the best way for her baby to come into the world, then she is still giving birth.

Natural childbirth is not important. A woman being involved in the decisions about the medical care of her and her baby--that is what is important. Helping women avoid feeling assaulted because they were not involved in what happened during their births--that is the goal. What I do--this blog, becoming, a doula and childbirth educator--that is what it is all about.

the Women in the Scriptures blog is having a giveaway

Visit Women in the Scriptures to see how you can enter to win some really cool prizes. The blogger, Heatherlady, is a collaborator on the book, The Gift of Giving Life. She is a mother and a doula. Her posts explore the lives of scriptural women in depth and she also writes quite a bit about birth.

Marwa's Hypnobabies Birth Story--a must read!

Check out Marwa's Birth Story on the Hypnobabies Blog. Her story is just full of surprises!

We are Daughters: my guest post at the Gift of Giving Life

Clicking on the title of this post will take you to a guest post I wrote for The Gift of Giving Life called We Are Daughters: Preparing Young Women for Pregnancy and Childbirth about how key parts of the Young Women program in the LDS church apply to pregnancy and birth. The story behind the post is quite amazing. Felice (aka Mother Earth) and I both feel that this is something that should be shared with Young Women, so please share it with the Young Women or Young Women leaders you know.

Passing knowledge on to the next generation

Photo by Jordan Gillespie.

This is a photo of four generations of women (left to right: my daughter, me, my mother, and my grandmother) taken at my grandparents' 50th wedding Anniversary this summer.

I've been thinking about how sometimes our choices impact future generations. There has been a lot of talk about circumcision lately, due to reports that the circumcision rate has dropped drastically over the past four years. The vulnerability of circumcised men is one of the reasons that circumcision has been perpetuated from generation to generation in America.

Interestingly, both my husband's and my parents, having children in the '80s when the circumcision rates in the U.S. were somewhere around 80%, broke with this particular tradition. After recently reading an article that discussed how circumcision affects sexuality, I feel that I am lucky that my mother-in-law chose to stick with what was normal in the culture she grew up in, regardless of the culture she was living in at the time. My in-laws' decision made the decision to keep our son intact very easy. The more people stop circumcision in their own families, the faster the custom of non-religious routine infant circumcision will end, since circumcised adult males are some of the biggest propagators of circumcision myths, (for reasons explained in the piece on vulnerability linked above).

I've been thinking about other things mothers can do to benefit future generations. My own mother had a beautiful birth journey. Her first was born by induction for term PROM (sound familiar?) with an epidural and forceps. She had hoped to avoid interventions because she didn't have health insurance, but she was birthing at a hospital and with a doctor both still known for being very medical model (and her doctor was still praciting when I had my daughter in that same town, though I went to a different hospital). Her other three she was able to have less medicalized experiences, using shots of narcotics for two of them and having a drug free birth with her fourth and final birth. Her two youngest were caught by nurse-midwives.

I did not know any of this until I was about 7 to 8 months pregnant with my first and told my parents I had decided I wanted a natural birth and was considering switching to a group of nurse-midwives. My mom had never mentioned her birth experiences to me. I never knew she'd had a bad experience with an induction and epidural or that she had a natural birth. I would have been nice to have grown up knowing that natural childbirth was not something to be feared, that there were women who still "do" natural childbirth, and my mother is one of them. I don't begrudge the journey I've taken myself, it is part of what feeds my fire, but I have a dream for my own children.

My dream is that my daughter (and any sisters that may come along) will grow up knowing that birth is not something she needs to fear--I hope she will know that her experiences giving birth matter, that birth can be a special experience for a woman. I hope that she will respect the amazing power her body to create life, and to celebrate it.

I hope my son (and any brothers that may come along) will understand the importance of supporting his future wife's intuition and helping her find her inner strength in her preparation for the births of their children

"Mothers who have fears also hand down fearful attitudes about birth to daughters--and to every other woman who will listen. But each woman who gains the confidence to birth as unhindered or freely as her biological circumstances will allow--she will go on to encourage her sisters and daughters with birth words and images which resound with all the potential strength and beauty of birth." --Jan Tritten

If not my children, perhaps my grandchildren, will live in a world where fear of birth is not the dominant attitude; a society where the medical world provides support and back-up for the natural process of childbirth; a world where all women are confident in their ability to give birth.


(to learn more about circumcision and intact males, see birthnaturally.org's consumer information on circumcision and peaceful parenting's prepuce and circumcision resources)

Nursing in Public at the Space Needle

This is me breastfeeding my son on a bench on the outer observation deck at the top of the Space Needle during our Seattle trip last weekend. I love everything about this picture--the lighting, my facial expression, his little hand holding the neckline of my shirt...

Ironically, the sign in all the doors going to is deck say noy to bring food or drink out there. :)

What's the most interesting place you've nursed a baby?

Did someone say something to you that had an impact on your birth?

One of the important messages taught in hypnosis for childbirth is that words have power. The President and Vice President of Hypnobabies are creating a presentation for the birth mega conference put on by Lamaze and ICEA about how things care providers say influence women during pregnancy and birth, and they need your personal examples. Here is the original request from Kerry Tuschhoff, in her words:

Hi Everyone,

First of all, just a reminder that Kerry and Carole are speaking at the"Uniting for the Future of Birth" Mega Conference in Milwaukee in early October! http://www.futureofbirthconference.org/ Our session is called, TheTransformative Language of Birth and will allow us to teach birthprofessionals how to alter their thinking and use positive wording which canpositively affect birth outcomes. Please post and e-mail this to EVERYONE!

Since our session at the Mega Conference is all about helping birthprofessionals learn positive language that is extremely helpful to all pregnant and birthing moms, we would like to ask for everyone's input! Thisincludes moms and birth care professionals.Please call our toll-free hotline at 800-350-2204 and complete any or all ofthe following:

"When I was pregnant my (caregiver) said ...to me and then I felt....aboutchildbirth". (Doulas, doctors, midwives, nurses; any caregiver)

"My birth was awesome (or whatever adjective you'd like to use) because my(caregiver) said..."

"My birth was going very well (or however you'd like to describe it) until my (caregiver said ..."

If you are a birth professional, you can complete the following:

"I attended a birth where a (medical caregiver) said....to the birthing momand it changed....in her birth experience (explain what happened, positiveor negative).

Please forward this to anyone who would like t be part of the process ofchanging birth language. Thanks so much for helping us educate birth careprofessionals how to become more positive and effective!

Kerry

Kerry Tuschhoff, HCHI, CHt, CI

I think I have some things I can share. During my son's birth my OB said both some wonderful things and one or two things that could have been said in better ways ("Try not to push" was a big one for me) If you have an experience, whether it was related to a birth with hypnosis or not, they would love to hear from you.