Induction Doubles Risk of Cesarean

Ok, so if you’re going into a hospital that has a 30% cesarean rate, and you go in for an induction, does that make your chances of a cesarean go up to 60%? Probably not, but it did make me ponder. SO many of the induction I hear about from friends, relatives, etc. end in a cesarean. To say that half of them do is not a stretch.

CONCLUSION: Labor induction is significantly associated with a cesarean delivery among nulliparous women at term for those with and without medical or obstetric complications. Reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population.

LEVEL OF EVIDENCE: II

(C) 2010 The American College of Obstetricians and Gynecologists

Here is the article just published with these stats:

Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term

Ehrenthal, Deborah B.; Jiang, Xiaozhang; Strobino, Donna M.

Obstetrics & Gynecology. 116(1):35-42, July 2010.

doi: 10.1097/AOG.0b013e3181e10c5c

Sonogram: The New Crystal Ball?

I am So frustrated at the amount of misinformation put out there as FACT soley for the convenience of the provider! Grrrr!!!!! Some OB’s do it, some GP’s do it, some midwives do it, heck as far my experience shows some DENTISTS do it.

There was recently a comment made on my Castor Oil post from a woman who was told she was too small and couldn’t go to 38 weeks or her “uterus would rip open”. Baby was just TOO TOO big. Even if the poster got some of the semantics wrong (probably is her pelvis they are talking about not her uterus) the arguments for induction just amaze me. Of course I did not offer he any advice as to induction.

My local hospital routinely does inductions at 37 weeks. 37 WEEKS! Yeah. Ludicrous.

The main reason given to women for inductions and even cesareans is the “big baby” argument. And we have these wonderful things called sonograms to “prove” they are too big to “fit” through your pelvis. Please. Do they think we are stupid? Ignorant perhaps, but we are not STUPID.

Here is a lovely blog post by the fantastic “Unnecessarian” on sonograms and estimated size and due dates. Sonograms can be off as much as a pound either way and 2 weeks +/- for due date predictions! So if the sonogram says you are ok for an induction at 37 weeks (by the sonogram) and you induce and it’s off by 2 weeks guess whatcha get? A baby at 35 weeks with respiratory issues, breastfeeding challenges, and a myriad of other psychological implications the likes of which we have NO CLUE about yet.

And the weight predictions are just fantastical. The stuff of Harry Potter and traveling circus acts. There is some science there – just enough to be dangerous. Sure. Gaze into the sonogram screen and see your future: induction + pitocin + epidural = surgical birth.

And let me tell ya from experience: a 2nd degree tear is alot easier to heal from than a 10″ wound on your belly complete with scar tissue and a spinal headache for dessert.

Canadian study supports safety of planned homebirth

This ia really exciting. The study found HERE compares not only planned homebirth vs. planned hospital birth but also throws in planned hospital birth with both physician AND midwife. I often hear, “Well, I had a midwife in the hospital. That’s about the same as a homebirth.” No, it isn’t and here is the support for that position.

Not only are the planned homebirth outcomes better ACROSS THE BOARD, but they are bett with a homebirth midwife vs. a hospital midwife. Really cool info to have when asking or arguing for the safety of planned homebirth. (This booklet from Molly also has some great talking points in it!)

🙂

This just made my day. The canadian system has it’s caveats, no doubt, but the overall theme is that planned homebirth is SAFE with a trained midwife. I could do without the “registered” midwife thrown in there because I think it undervalues the work and safety of trained midwives who refuse to register (and there are many many GOOD reasons to not register). Of course they could not participate in the study and I doubt they were asked to. Afterall, who are they and WHERE are they? That, of course, is a question for another day. 🙂

Off-label drug use

I understand that the off-label use of pharmaceuticals is a normal occurrence in the medical world. I get that. What’s not cool is that this is done in maternity care as well with dire consequences.

I’m not talking about the random, “uh-oh”, I’m referring instead to the drug company themselves issuing statements saying “We do not endorse the use of this product for any use other than that described on the label.” Yeah, they’re probably just covering their b*tts but still. They said it. Yet it happens everyday in the labor and delivery department of nearly every hospital in the country. It has become so commonplace to induce labor that not only have we stopped wondering how/if this affects the baby or the mother we have now started grabbing whatever drugs we can find that give us “a better induction outcome”.

Hrrumph.

Bishop’s score be damned. God created women’s body to birth. With consideration made for the odd-one-out with pituitary damage or other disorders that truly make her body hold onto her baby long past safely, using drugs to begin labor before the body begins to open up on it’s own is risky risky risky.

Births are kindof like bowel movements. They happen on their own. Can’t plan ’em, can’t stop ’em, can’t hurry them along. Bowel movements happen (errr… I can’t help but think of a certain bumper sticker I’ve seen alot of right now).

Birth HAPPENS as well. Babies are born when it is TIME. If we have accepted that every other body system has knowledge to know when to open and release, then why can’t we accept the body’s wisdom in birthing when it is time?

You might have had a Cytotec induction. And so did your sister, your friend, aunt, daughter’s 2nd grade teacher… and all went well. On the surface perhaps. But what did it do to that baby’s emotional/psychological health to be so rudely pushed into the world before he/she was ready to come? And what about the women reading this who is a victim of a cytotec induction who is grieving the loss of her womb? Suddenly hurrying a baby out seems less important when faced with an emergency cesarean to save your baby’s life and a hysterectomy to save yours.

All from a couple of tidy white pills manufactured to treat ulcers. Who’da thunk?

Who’da thunk it?

A WOW news release on MedLine this morning regarding the safety of planned homebirths. Get this:

All of the outcomes studied occurred with comparable frequency in the planned home and hospital birth groups. These included intrapartum death (0.03% vs. 0.04%), intrapartum and neonatal death within 24 hours of birth (0.05% vs. 0.05%), intrapartum and neonatal death within 7 days (0.06% vs. 0.07%), and neonatal admission to an intensive care unit (0.17% vs. 0.20%).

[My note: actually, the numbers show slightly better outcomes at home. 😉 ]
“As far as we know, this is the largest study into the safety of home births,” the authors note. The findings, they conclude, indicate that with proper services in place, home births are just as safe as hospital births for  low-risk women.  ~ BJOG 2009;116:1177-1184

NOw of course this is a “foreign” publication (British Journal of Gynecology) so I don’t know how much credibility it will get here in the trenches, but WOW. Very cool that the news is getting out there to US med students and physicians!

Only if…

“It’s a numbers thing,” says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. “You don’t get sued for doing a C-section. You get sued for not doing a C-section.”

I’ve seen this quote before, but it never quite made me as angry as it did this morning when I was reading it in the context of THIS TIME MAGAZINE ARTICLE. This California mom has to drive 100 miles to have the chance for a VBAC. Give me a break!

I understand liability, I truly do, and I understand that to continue offering care for the majority of patients, one must sometimes eliminate care for the minority. But hey. This is ridiculous. As a VBAC mom myself, I would have to drive at least 100 miles and then only have “permission” for a “trial of labor” within a very small window of opportunity. “Only if” my incision was of type A, “Only if “ my bag of waters hadn’t been broken more than 12 hours, “Only if” the baby was in a perfect position (by obstetrical definitions), “Only if” the labor didn’t last more than X number of hours, “Only” if it progresses well, “Only” if I would have continuous fetal monitoring, “Only if………”

By the time all of the restrictions had been placed on me I’d have a better chance of delivering my baby vaginally in a snow storm in the middle of April. Yeah, it happens, but rarely. Birth was not meant to be a 3-ring circus with planned events and bright lights.

This mom, in the Time article, said her biggest fear was the drive and that she might not make it to the hospital.

If only… she gets that lucky. It might be her best chance at a natural birth.

Well Said Mr. Jefferson!

“I know of no safe depository of the ultimate powers of the society but the people themselves;                                                   and if we think them not enlightened enough to exercise their control with a wholesome discretion,                                      the remedy is not to take it from them, but to inform their discretion by education.”    ~Thomas Jefferson

Well said. Very well said. The ACOG could use a bit of this advice. Constantly trying to “save” women from themselves, it absolutely enrages me that many will perform abortions under the argument of “It’s your body.” but will refuse VBAC’s, natural labors, laboring without intervention, denying women their birthing rights. And they do this in such a sneaky way. It’s unlawful for them, speaking broadly, to outright deny you services. You have rights you know. But if your decision/wishes conflict with the OB, then by golly, you can take your “rights” elsewhere. They simply write you a letter and dismiss you from their care. This is how they monopolize the childbirth experience and make it about their decisions and not ours.

When will we, birthing women with daughters who will be birthing women someday, stand up and LEARN the truth about birth and begin telling others about it? As usual, an educated mind is a healthy one and the future of birth depends on what we do TODAY to impact the birth culture.