Q: What do you recommend for your doula clients who are planning for a natural (physiological) childbirth?
A: Avoid the unnecessary induction.
The clients who hire me to be their doula are looking to have a natural (unmedicated) physiological birth experience and are committed to avoiding an unnecessary induction.
The Medically Necessary Induction vs. The Medically Managed Induction
It can become a bit tricky to discern between the usual protocols for medical management of birth and individualized medical advice when doctors tell my clients that their babies are too big to possibly fit through their big American pelvises, their baby’s amniotic fluid looks to low and they are drying up in there, or the baby may suddenly die as a result of passing the due date. Plans to induce are frequently discussed before the baby’s due date and those plans are often executed at 40 weeks and 1 day in the medical model of obstetrics and nurse-midwifery.
Why so many inductions?
It’s a totally new phenomenon to chemically push a baby out of the womb. Are we to believe that women are incapable of having babies if doctors don’t give them a pharmacy full of drugs to start labor? That at some point in the last 60 years, almost half of the females in human species are incapable of reproducing without chemical intervention? If that’s true, then that’s a very sudden and severe threat to our existence, don’t you think?
It seems more realistic that American society has gotten caught up with the false notion that more intervention means better maternal-fetal care. Meanwhile, Cuba, Malaysia, and Portugal do less and do it better. In fact, the US ranks 39th in global maternal health. Perhaps this medical management of birth isn’t good for babies after all?
Induction has no business in natural childbirth. The mere fact that you are forcing the baby to be born before it is ready to be born is, by definition, unnatural. To pursue an induction and a natural childbirth is oxymoronic.
So how do inductions lead to cesarean births?
Well, to begin with, an intravenous (IV) drip of fluids and Pitocin is placed in one arm. The fluids, while necessary due to the anti-diuretic properties of Pitocin, are associated with early newborn weight loss. Now one arm is kind of immobile and there are stress hormones rushing as a response to a needle and foreign object being inserted into your skin.
Pitocin is noted to cause low blood pressure, and so therefore, requires frequent blood pressure monitoring. A blood pressure cuff will be placed on the other arm (the arm without an IV in it) and left there to electronically monitor regularly.
Continuous electronic fetal monitoring is required, which measures the strength and duration of your contractions along with the baby’s heartbeat. Two plastic discs will be placed on your abdomen with elastic straps attaching them to your body. With an IV in one arm, a blood pressure cuff on the other, and two abdominal monitors, you are in bed for a while.
It’s not likely the hospital staff are going to allow you to get up and walk around or be in the tub. This is a problem for laboring women, who need the freedom to move as their body needs to move during labor. Even if you are allowed to, it is a burdensome chore that most women seem to avoid. Most women report feeling really ‘strapped down’ with an induction.
An epidural is added to this package of interventions that come along with labor induction, because the Pitocin makes the contractions unbearable for most women.
Along with the epidural comes also the placement of an urinary catheter (a tube is inserted into your urethra and placed into your bladder to collect urine), which further limits your ability to move about, which is crucial in a physiological (natural, vaginal) birth. To learn more about epidurals, please read the article on Science & Sensibility: Straight Talk on Epidurals for Labor and Pain Management for Women in Labor: A Research Review. It’s also worth noting the correlation between epidurals in labor and breastfeeding problems.
Further, inductions put you on the hospital’s time clock. Once you start, you had better have your baby and have it quickly and on their schedule, because any variation from the Friedman’s curve and you could be cut open for failure to progress. Of course, to assess your progress means you’ll be given a lot of vaginal/cervical exams and each of those increases your risk for infection. If they break your water, another common induction intervention, you have 12 hours before you can add on some antibiotics to this birth plan, too… tick tock.
Finally, let’s talk about “Pit to Distress“, which is really the culmination of all of these interventions leading to results in electronic fetal monitoring that cause concern for the well-being of the baby that leads to an immediate cesarean. With an epidural already in place, the doctor easily recommends an emergency cesarean.
Do the right thing for yourself and for your baby. It really does matter how your baby is born. Inform yourself. Demand to be treated as individuals. You and your baby deserve better than if-then-else protocols that are created by administrators and litigators who have their own interests at heart, not yours and your baby’s. I encourage you to research labor inductions, epidurals, and cesareans for yourself. Knowledge is power.
The Bottom Line
“Is the mother doing ok? Is the baby doing ok? Then let’s wait another day,” needs to be the mantra of the pregnant woman who facing pressure to induce. If there is no reason to force the baby out, then let her be. Inductions are contraindicated in most cases if the goal is a physiologic birth. A natural birth is best achieved with a natural labor.
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Today, I’d like to get back to basics. For me, Human Rights in Childbirth (HRiC) means that birthing women have the right to choose where, when, and with whom they will have their baby. I realized the other day that I’m writing with the assumption that my audience even knows that midwives exist, let alone the various types of midwives or the laws that apply to midwives. With this in mind, I am going back to the start and define/distinguish the various options that pregnant women have when considering with whom to give birth.