Should You Get Induced? - Part 2

This is the second video in a series about induction. Click here to watch the first video.

Induction Information - Should You Get Induced? Part 1

Favorite Recent Pregnancy/Birth Links

I post a lot of web links on my Mamas and Babies facebook fan page, but I often forget to pass the information on here. I think it's important to share as much information as possible, so I'm bringing you some of my recent favorite web links related to pregnancy and birth.

These are in no particular order:

• The Unnecesarean: U.S. Cesaren Rate Reaches Record High, Rises for 13th Consecutive Year - The Cesarean rate for 2009 was 32.9%, up from 32.3% in 2008. The rate continues to climb despite cesarean birth carrying greater risks to mothers and babies in comparison to vaginal birth.
• As early elective births increase so do health risks for mother, child - Babies are being born earlier than they were 10 years ago, thanks to elective inductions and scheduled c-sections. This carries multiple serious risks to mothers and babies. Do you know what the risks of delivering even a week early could be?
• Motherhood: Induced and Seduced: The Dangers of Cytotec - A drug commonly used for labor induction which hasn't even been approved for such use by the FDA, and it carries great risks with it. Why is it used so often? It's cheap.
• C-sections up, overall births down in 2008 - As the cesarean rate increases, the overall birth rate drops? Why do you think this is?
• Pre-Holiday Induction of Labor Without Medical Indication - Some striking statistics about labor patterns through the major holidays of the year. Some food for thought when your doctor or midwife suggests scheduling your child's birth.
• Early skin-to-skin contact after birth: the more the better - A post from Stand and Deliver covering a recent study proving the increased effectiveness of early skin-to-skin contact within the first 3 hours of birth. The more contact, the better the results. 
• A proactive approach to breastfeeding - Another post from Stand and Deliver, about approaching breastfeeding prepared. Taking a proactive stance rather than reactive. Especially good information for first-time mothers or those planning to breastfeed for the first time.
• Everything you ever wondered about breastfeeding during pregnancy, but didn't want to ask... - A straight-forward FAQ style blog post about breastfeeding while pregnant and tandem nursing, from a mom who's been doing it for years.

Happy surfing!

What Triggers Spontaneous Labor?

Yet more proof that nature knows best, and why it's generally best to avoid induction and wait for labor to start spontaneously.

As published on Science Blog

Fetal lungs provide a signal initiating labor, UT Southwestern researchers find

Dr. Carole Mendelson, Dr. Jennifer Condon and Dr. Pancharatnam Jeyasuria have found evidence that a substance secreted by the lungs of a developing fetus contains the key signal that initiates labor.

DALLAS – March 22, 2004 – A protein released from the lungs of a developing mouse fetus initiates a cascade of chemical events leading to the mother's initiation of labor, researchers at UT Southwestern Medical Center at Dallas have found.

The research, which has implications for humans, marks the first time a link between a specific fetal lung protein and labor has been identified, said Dr. Carole Mendelson, professor of biochemistry and obstetrics and gynecology and senior author of the study. The paper appears in an upcoming issue of the Proceedings of the National Academy of Sciences and is currently available online.

The initiation of term labor is carefully timed to begin only after the embryo is sufficiently mature to survive outside the womb. Previous studies suggested that the signal for labor in humans may arise from the fetus, but the nature of the signal and actual mechanism was unclear, Dr. Mendelson said.

In their study, UT Southwestern researchers found evidence that a substance secreted by the lungs of a developing fetus contains the key signal that initiates labor. The substance, called surfactant, is essential for normal breathing outside the womb.

"We found that a protein within lung surfactant serves as a hormone of labor that signals to the mother's uterus when the fetal lungs are sufficiently mature to withstand the critical transition to air breathing," Dr. Mendelson said.

"No one really understands what causes normal or preterm labor. There may be several chemical pathways that lead to labor, but we think that this surfactant protein, which is also produced by the fetal lung in humans, may be the first hormonal signal for labor," said Dr. Mendelson, who is co-director of the North Texas March of Dimes Birth Defects Center at UT Southwestern.

In humans the signaling protein, called surfactant protein A, or SP-A, also helps immune cells, called macrophages, fight off infections in the lungs of children and adults by gobbling up bacteria, viruses and fungi that infiltrate the lung airway.

"Women who go into preterm labor frequently have an infection of the membranes that surround the fetus, and the number of macrophages in the wall of the uterus increases with the initiation of preterm labor. When women go into labor at term, they also have an increase in macrophages in the uterus," Dr. Mendelson said.

This led the researchers to investigate whether there was a connection between what happens during normal labor at term and in infected mothers who go into early labor.

"This also raised the question: If bacterial infection can cause increased macrophage infiltration of the uterus in preterm labor, what is the signal for the enhanced macrophage migration to the uterus at term?" Dr. Mendelson said.

In mice, the developing fetal lung starts producing SP-A at 17 days gestation; full-term delivery occurs at 19 days. The developing human fetus starts producing SP-A in increasing amounts after 30 to 32 weeks of a 40-week normal gestation, at which time the baby's lungs are essentially developed. As the fetus "breathes" amniotic fluid in the womb, the protein is released into the fluid.

"The SP-A protein binds to macrophages in the amniotic fluid, macrophages that come from the fetus itself," said Dr. Jennifer Condon, a postdoctoral researcher in biochemistry and the study's lead author.

The macrophages, "activated" by the protein, make their way through the amniotic fluid to the wall of the uterus. Once embedded there, they produce a chemical that stimulates an inflammatory response in the uterus, ultimately leading to labor.

The researchers also found that injecting a pregnant mouse with SP-A before day 17 of the pregnancy caused the mouse to deliver early. Injection of pregnant mice with an antibody that blocks SP-A function caused them to deliver late.

Identifying the receptors on the macrophages to which the SP-A protein binds will be the next step, Dr. Mendelson said.

"We think that bacteria may be binding to the same receptor on the macrophages to cause preterm labor in women. The bacteria mimic the function of SP-A, initiating the chemical reactions that lead to premature labor. If we knew more about this receptor on amniotic fluid macrophages, we may be able to design therapies or inhibitors to block preterm labor," she said.

Other researchers participating in the study were Dr. Pancharatnam Jeyasuria, a research fellow in internal medicine and former fellow Julie Faust, now a medical student at Texas A&M University.

The research was funded in part by the National Institutes of Health and the Texas Higher Education Coordinating Board.

Hospital Bans Early Elective Births, Resulting in Fewer Surgeries and Healthier Babies

Hospital cuts C-section rate, leading to healthier babies

As published on fiercehealth.com

June 16 might seem like a great day to give birth, but planning a C-section, or being talked into it for convenience (of either the patient or the physician) may be bad for the baby. Tallahassee Memorial Hospital has decreased the number of preterm births--and thus admissions to neonatal intensive care units and infants with health problems--by cutting elective induction and C-sections over the last three years.

The hospital saw early delivery rates go from 44 percent to less than 37 percent. The statewide rate is 38 percent and has gone up yearly for the last few years; the national rate is 32 percent. The hospital has also reduced first time delivery C-sections from 22 to 15 percent--compared to 25 percent for Florida as a whole. A rate under 20 percent is considered good by childbirth advocates.

Many obstetricians think that deliveries in the 37th or 38th weeks are fine since they don't usually involve serious complications for the infants. They allow both patient and physician more control over their schedules, and inductions can allow physicians to see more patients in a day. But emerging research indicates that any birth before 39 weeks involves potential problems, including respiratory distress. The later the delivery, the fewer admissions of newborns to intensive care, and there is no increase in mortality by waiting until 39 weeks to induce or schedule a C-section.

The Tallahassee Memorial program was the brainchild of a neonatologist who saw a relationship between the sick babies he cared for and how many were delivered by elective inductions or C-sections. Now, physicians can't schedule deliveries before 39 weeks without a medical reason.

The hospital also recommends that physicians not induce until a woman's Bishop's scale score--related to fetal position and cervical dilation--indicates she's ready. Noncompliant physicians get reminders, and the hospital has few outliers among their obstetricians.

Other hospitals should take note: In April, The Joint Commission asked hospitals to start collecting data on prenatal care, including the numbers of near-term deliveries and first-time C-sections in mothers at low risk. It will soon set target rates for hospitals based on their data.

This is a great example of what a huge impact hospital policy can have on the health of its mothers and babies. It's important to ask questions and find out what the policies are at your hospital of choice.

The Real Risks of Pitocin

This article has been going around the internet like wildfire! I've read a lot about pitocin, but I never realized everything that was involved with its routine use, or the real risks. All expectant parents need this information.

"Pitocin – a very useful drug that improved obstetrics and gave us options to help women in ways we weren’t able to before!

"Pitocin – a very seductive drug that changed obstetrics, increasing risks to mothers and babies in ways that are often not even taken into consideration.

"Both of these statements are true – how can that be? I will do my best to explain this complex issue in a simple and straight forward way. Be warned…much of what you are about to read will probably be new to you because these are the things that aren’t being talked about!"

"Pitocin is a drug used to induce or augment labors here in the US. It is most often given via IV infusion, although immediately postpartum if an IV isn’t already in place it may be given as an intramuscular injection. It was created for the first time in 1953 and became available just 2 years later. Mothering magazine writes, “A survey by Robbie Davis-Floyd, a cultural anthropologist at the University of Texas, found that 81 percent of women in US hospitals receive Pitocin either to induce or augment their labors.” It has been said that only 3% medically require it." (emphasis mine)

I could copy the entire article into this post, but it would be better for you to read it at the source. Please read this important article about the real risks of pitocin:

Pit of Despair

Baby Birds and Birth

I had a dream in which I had some eggs, and in one of them grew a baby bird. I noticed cracks in the egg and I helped the little bird by opening the cracks and getting it out of the shell. But, since I had opened the egg prematurely the baby bird was weak and unable to even stand on its own feet. It would have to live in captivity its whole life to be cared for. It was a beautiful bird with fluffy bright blue feathers. I wondered if it would ever be able to fly.

After I woke up I couldn't get the image of this helpless baby bird out of my mind. The dream was so vivid, that for hours after waking I could still see the blue baby bird and feel it's soft warm body in my hands. I couldn't help but think how it's the same with human babies.

In modern obstetrics, labor is often induced or augmented artificially, for many reasons. Sometimes the medical intervention is necessary, but many times it's simply for convenience to "help get this baby out" or for scheduling purposes for the parents and/or care givers.

I know first-hand how it feels to be 9 months pregnant and so ready to be done with pregnancy. So ready to get the baby out and be able to hold it in my arms. The longing for the discomfort and awkwardness of pregnancy to end, and to start the next chapter of life with my new little one. The feelings are real, and they help us to be ready for labor when it comes.

The danger comes when labor is forced or coerced before the baby is ready. Many times babies who are induced prior to 40 weeks, even if they're considered "full term" at 36 or 37 weeks will still need assistance with breathing, feeding and basic survival in the neonatal intensive care unit. Should our goal be to get the baby out and support it in the NICU to survive, or should we focus instead on letting the baby come when it's ready and able to breathe and feed successfully without medical support?

"In his classic book Husband-Coached Childbirth, Robert Bradley, MD, compares the arrival of human babies by nature's schedule to fruit ripening on a tree. Some apples ripen early, some late, but most show up right in season. Along with Grantley Dick-Read, the father of what we now call 'natural childbirth,' Bradley advocated relaxation, trusting nature, and allowing babies to show up when nature intended."

One hospital prohibited elective inductions prior to 38 weeks. As a result, there was a drop of over 40% in newborns being admitted to the NICU. There was also a drop in the number of c-sections being done.

The concept of nature knowing best also applies to c-sections. When a baby endures labor contractions, the compression from the contractions press on the baby's lungs, preparing them for breathing on its own. Newborns delivered by c-section are more likely to have respiratory problems and require breathing support and admission to the NICU. Babies born by elective c-section may also be at an increased risk for SIDS because of the associated problems with breathing and sleep apnea.

Elective inductions and scheduled cesarean sections have become commonplace in our modern society. This poses greater risk to both mothers and babies.

You would never break open a chick's egg to get it out faster knowing that as a result it would be too weak to survive. Why would you do the same thing to your own baby?

"Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn't dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line."

- Gloria Lemay

Here are some other posts about labor induction:

Labor Induction Overused and Puts Mothers and Babies At Risk

New Moms at Risk: Maternal Death Rates Increasing

12 Questions to Ask BEFORE Being Induced for Labor

Preparing for Labor

Inductions - Your Just About Complete Guide

12 questions you shoud ask BEFORE you are laying in a a hospital bed hooked to an IV, monitor and Blood Pressure cuff!

1. Why are you being induced? Are you overdue or are their some health concerns?
2. Would they be opposed to following the ACOG's stanadards and monitoring you till 42 weeks then inducing?
3. How favorable is your cervix? This can affect how they induce and how likely the induction is to be successful. Ask for your Bishop's Score.
4. How do they plan to induce? Are they going to use a cervical ripener to soften your cervix? Are they going to go right to Pitocin? The answers should be tailored to how favorable your cervix is.
5. Ask what they would do if you don't go into labor? Do they send you home and wait it out? How do they manage things?
6. Will they let you eat and drink?
7. Will they let you move about, use water, change positions...?
8. Do they require continuous monitoring or do they do intermittent?
9. Can you have pain meds? When can you have them? What narcotics do they have standard orders for? What dose? Is there a cut off point to recieving painmedications (if you are 8+cm, will you be able to get anything?)
10. If labor is progressing well can we turn OFF the pitocin for a while and see if my body will take over? I would like to have the opprotunity to have the kind of contractions that are perfect for my body and I would like to be able to get off of the monitor for a while so I can walk and change positions easily. I know that this will help ensure proper fetal alignment, more so than laboring in bed. What reasons are there that I couldn't have the pitocin turned off?
11. Is there a time limit on my induction before it is considered a failed induction or turns into a c-section? Do you follow active management? Do I have to progress Xcm in X amount of time? If I am well and the baby is well, can we take it slow and steady instead?
12. Can I decline having my amniotic sac ruptured as part of the induction process? I know that I can reconsider later, like if I get stuck at 8cm for a few hours, but as a matter of routine I would rather not have it ruptured. I worry about the added stress baby could face with the pitocin contractions if they don't have the benefit of the cushion. Fetal malpresentation, cord prolapse and cord compression are other concerns, as well as infection.

For more in-depth information about preparing for labor and the risks involved with labor induction, please click here.

Labor Induction Overused and Puts Mothers and Babies at Risk

My labor was induced with pitocin for the first 2 of my 5 children. After my second child was born I made the conscious decision that I didn't want to be induced again. I didn't like being hooked up to the IV and monitors for the entire labor and being confined to bed, as well as the lack of control over the process of birth itself. I felt that induction was unnatural, and I wanted to see what my body could do on its own with no medical induction or augmentation. That decision played a big part in my birthing journey, which has helped me learn to honor, work with, and trust my body, and has given me greater confidence in myself and faith in the natural order of life.

"In his classic book Husband-Coached Childbirth, Robert Bradley, MD, compares the arrival of human babies by nature's schedule to fruit ripening on a tree. Some apples ripen early, some late, but most show up right in season. Along with Grantley Dick-Read, the father of what we now call 'natural childbirth,' Bradley advocated relaxation, trusting nature, and allowing babies to show up when nature intended."

Let The Baby Decide: The Case Against Inducing Labor

This article goes into great detail in explaining the medical and cultural reasons and ramifications of inducing labor, and it touches on some of the same reasons I chose not to be medically induced again. There are so many reasons women and their care givers choose medical induction, and I think that expectant couples should understand the risks involved with those choices so they can make an active, informed choice in their own care.