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Birth stories: About our culture of induction

Trumandaddyfirstpic_200After my successful VBAC, Rebecca wondered if Pitocin could possibly be a cause of our country's high c-section rate. That got me thinking, and as I'm doing research for a book I'm pitching on pregnancy, last night I came across two really interesting recent books: Pushed: The Painful Truth about Childbirth and Modern Maternity Care and Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First. Amazon had several pages from Pushed in its little 'inside-the-book' feature and I was struck when reading about one hospital in Florida whose power went out during Hurricane Charley.

The labor & delivery ward changed its policies and cancelled all inductions. Mothers were sent home unless they were in active labor. No one got Pitocin, no one's water was broken, and epidurals were contraindicated. Their c-section rate went down to almost zero, and even first-time mothers had quick and relatively easy labors. What's more (here's a shocker, haha), the births were evenly distributed between day and night, weekday and weekend (did you know that more births happen on Tuesdays than any other day in the U.S.?). Even fetal distress and interventions after birth dropped to almost nothing.

Essentially, the lesson seems to be that induction is the enemy of a relatively easy birth, and what's more: a healthy baby. Most of the nurses who worked the Hurricane Charley shifts at that Florida hospital have quit and a few are campaigning for changes in the 'induction culture' of birth in the U.S. While it's certainly not true that Pitocin causes c-sections, it could be a major contributor to our unusually high c-section rate. It's anecdotally true for me: I had a bunch of Pitocin in each of my two c-sections, but none in my vaginal birth. I'll continue to do research because it interests me (and Rebecca, let me know what you find) -- but in the meantime, I'd love to hear your stories.

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Both my labors 'started' with my water breaking.

For my first, I was GBS positive, and the admitting nurse checked me for dilation. That, my doctor said, was what 'started the clock' against risking infection. At that point, I had no discernible contractions and was dilated not at all, but pitocin was started. The 'pit' drip was amped up through the next 24 hours, but my contractions were erratic and not terribly productive. I got an epidural 24 hours after I checked in, and two hours later was still dilated only 5 CM. So I had a c-section, because it had been 26 hours since I had the first digital exam, and about 36 since my water had broken, and I was just not progressing. I hold no ill will toward the doctor or the hospital. I don't know what the outcome would have been otherwise.

With my second birth, my water broke again, but by the time I arrived at the hospital my contractions were steady and painful. I was not GBS positive this time. I had no pitocin, but did get an epidural about 6 hours after I was admitted, when I was 7 cm dilated. I had a successful VBAC. Total labor: 13 hours from water breaking to new baby. I don't know if it was the lack of pitocin that made the difference, but I sure wanted to avoid it if I could.

wow, i'm feeling very lucky. all the pitocin, none of the c-section. next time, home-birth. just in case.

Wow, I feel lucky too. I've had two inductions with pitocin; both resulting in manageable labor and a vaginal birth.

I posted about my experience a bit on Sarah's previous post, but I'm also skeptical about pitocin. I just got back from the doctor...I'm due in 3 weeks...I'm currently 3-4 cm dialated and around 60% effaced and really hoping that I go into labor on my own within the next 2 weeks. She's offered to schedule an induction for 2 weeks from today, but said it's also very much my choice, unless she sees a problem with the baby. I really want to go into labor on my own, but I fear if I'm still pregnant in 2 weeks I'll have a tough decision on my hands...

In my case, pitocin really put my body into high gear and I think it led to an unusually quick labor and delivery, (4 hours) and a very long and painful recovery. Sometimes people seem impressed that I had such a quick labor, and that I had a baby without the epidural, but I regularly tell them I could have used that epidural for the 24-48 hours AFTER delivery! I dont want to do that again if I dont have to. I have a lot of respect for the female body, and believe that if you give it the chance, it will do what it was built to do on it's own.

I had a c-section, but Maggie was a preemie at 33 weeks. She would not have tolerated a vaginal birth, and, I was told, my cervix wasn't "ripe" enough. She was early because I had pregnancy induced hypertention that escalated to pre-eclampsia. I'm one of those who is incredibly grateful for medicine and medical advances. Pre-eclampsia is one of those things where the death rate is 95% for both mom and babe if untreated, but practically 0% for those treated. I would never, ever in a million years have a baby at home, even if the pregnancy was healthy. But, that's just me.

For my first, no pitocin but an epidural. For my last two pitocin and epidurals. I think pitocin does make labor more abrupt and painful, but at the same time--most of my relatives (cousins and sisters) have had pitocin and none of us have needed c-sections. Of course, that is ancedotal evidence, but I say, discuss it with your doctor and only do it if they are reasons. In my case, I had gestational diabetes and signs of fetal stress. My sister just never went into labor--3 weeks overdue and huge babies each time.

very interesting stuff, and the hurricane evidence you cited is pretty powerful. I believe it is mostly agreed that for whatever the many reasons, we have a csection rate that far exceeds what "mother nature" would naturally produce - ie - births that truly could not happen without intervention. Regardless of talk that women (and children) used to die in childbirth (hello - they still do!) we did not have a 30-40% failure rate prior to csections.

I also wanted to add that I believe that other forms of induction can "promote" chance of csection. I ended up with an undesired csection for many reasons, but I fault the induction with c-gel as the biggest problem. My belief (and midwives would agree) is that the c-gel produced a non-natural, erratic, and ineffective labor - which resulted in the end with csection. I also had Pit (and all the rest of the interventions after 24 hours of little progress) and nothing happened - baby just got more stuck.
I'm 3 months away from next baby, and this time trying for a home birth. If I end up transporting to hospital for medical intervention or csection - at least I will know I gave it a fair chance.

Feelin' lucky as well! I was induced with Ella because my water broke and nothing happened. It did somewhat feel like I had been hit by a freight train (as it did without the pit for baby #2!), but I had her quickly w/out an epidural(I wanted one, but it progressed to quickly) and without any issues.

I feel a little odd here but three days of pitocin and no labor what-so-ever. I had pregnancy induced hypertension that was trending towards preeclampsia, which was discovered about three days before my due date. We decided to do the induction because of the situation but three days later I hadn't gone into labor at all, not even enough to break my water. C-section scheduled for the next day as the medical situation wasn't looking any better and baby needed to be born. So, I had never heard of pitocin not doing anything, but there you go. And as an aside, I loved your VBAC story, Sarah. I wonder as you compare your three recoveries if there aren't times you've been wishing for that C-section! Hang in there.

I feel really lucky. I have 3 children (currently preggers with number 4): #1 and #3 were induced using pitocin and had vaginal deliveries and #2 was the dream delivery of everything just happened on its own. I'm hoping for another easy delivery with #4 (due the 17th of Aug, but can happen anytime). In all 3 deliveries I had a wonderful short stay of the mandatory 24 hours in the hospital. All of my children were past their due dates and arrived healthy.

I had pitocin with all three of my babies. I had long, frustrating deliveries, but apparently my body just wasn't in birthing mode quite yet. Problem was, my babies were all big - with the last one at 11 lbs, 5 oz. As much as I think the pit made it a harder, more difficult labor, I am thankful that I was able to deliver all three vaginally because the pit eventually got us going.

i think this is another great example of how every woman's body and every birth experience is different, even if the paths/decisions/plans may start out the same. with #1 i was given pitocin after a long while of stalled labor, but i never felt the freight train feeling others have mentioned after the pitocin started. my contractions just seemed to speed up at a normal pace. i had a great vaginal delivery with #1, and with baby #2. with #2, i was scheduled for an induction (a choice we made for several health reasons) but baby decided that she was going to come on her own the day i was scheduled to be induced. right before they started the pitocin, the nurse noticed my contractions picking up intensity and then my water broke.

No birth story... but some food for thought in your research:

A friend of mine is a labor & delivery nurse and has worked both in the Deep South and in the PacNW. She said the standard of care in the South is very different and the common practice for nurses was to give Pitocin to every woman who arrived at the delivery room... even if they were already in labor. Naturally, that led to more epidurals... etc., etc.

I definitely think pitocin and c-sections have their place but are overused in some cases. For me, without the use of pitocin, I probably would be highly discouraged from having children because I am diabetic. Diabetics are encouraged to deliver their babies early because of the risk of fetal death in the last 2-3 weeks of pregnancy. I was induced at 37 weeks with pitocin and meso. I labored for 10 hours and had a vaginal delivery. I know that their is a lot of discussion about birthing options, but I am glad we have so many options available to us in this age. A fair percentage of women did die during childbirth before the advent of modern medicine, including the c-section and pitocin. The maternal death rate in the US is 17 (in 100,000). At the beginning of the 20th century, the maternal death rate was 1 in 100.

When I was pregnant our first daughter, our OB was Judith Gershowitz, who was once declared "Best OB/GYN in New York City" (wish I could find a link to that "best of list, 2000" but I can't). I was excited that she'd be delivering our first daughter.

On the day I was in labor, a few hours into it, I went to her office. I was about 4-5 cm dilated, and contractions were strong -- and getting stronger. It was about noon. Dr. Gershowitz suggested I head home, gather my bags, and meet her at the hospital. She said she could give me some pitocin and we could "have this baby by dinnertime."

I let her know that I wanted to see how my labor progressed naturally. I didn't see any reason for us to induce it further at this time; it was 3 days before my due date. I was also waiting for all my support to come to my side: my husband was in a conference all day (of course, he'd leave to be with me if the time was NOW), my husband's parents were still in transit from upstate to the city, my parents were trying to hop a flight from SFO to JFK. Aside from the fact that my body was apparently not ready yet to deliver, I was also not emotionally ready.

Anyway, when I objected to her suggestion, her response was haughty: "Don't call me at midnight when you're ready to have this baby" or something like that. I was one very distraught first-time mama at the treatment I was getting by NYC's finest obstetrician.

In the end, I lost my mucous plug at midnight that night and called her (Ha!). I went into the hospital pretty much 10cm dilated. I stalled. After about 4 or 5 hours of laboring without progress, the Doc told me again that I should have some pitocin. I agreed. I think she muttered under her breath that I should have done it the afternoon before and saved us all this time.

The pitocin did the trick, but I'm glad I waited. My mom landed and rushed into the delivery room about 15 minutes before Philly was born.

I occassionally wonder whether I could have continued and labored without the pitocin, but *shrug*....

I also delivered in Manhattan, and chose to work with a team of midwives from an affordable clinic. They all advised me to stay at home until I'm completely ready to have the baby. So I did, and almost had the tyke at home. Once at hospital, the midwife really had to keep the doctor/nurse out of my way so I could have the baby. I had a relatively quick labor (10 hours) which was powerful enough to let the endorphins go crazy to control the pain, and it was all natural. The birth was so spectacular, with both of us so awake, that I became a serious advocate for natural birthing. I would only work with midwives again. They really prepared me for what to expect and moreso how to listen to my body, and how to trust my body to do the work. The experience was incredibly primal, and I felt linked to women thousands of years before now.

I'm saddened that the process is currently in the hands of doctors, hospitals, and medicine. Even tho I'd been petrified of labor beforehand, and birthing too, I do think the current hospital trend seems to instill fear in women, and of course tries to hurry us in + out of there, while negating the beauty of the event. I know if I'd gone to the hospital earlier, that I wouldn't have felt comfortable enough to labor in my own (animalistic!) way, and pitocin would have just been the beginning.

regarding the statistics on the maternal death rate, a LOT of other things have changed in medicine during the last century besides the use of pitocin and c-section... I'm not an expert on the subject, but I'm not convinced that statistic is really valid support for the way things are done in hospitals now.

I was admitted to the hospital after my water broke even though I was barely contracting and immediately started to be pressured toward induction, even though there was no sign of fetal distress or infection. after a couple days we gave in and started pitocin and labor was excruciating and exhausting, and the doctors kept pushing for further interventions because they felt I wasn't progressing "fast enough". I resisted because it was pretty clear that road was headed toward a c-section and eventually had my daughter vaginally with NO complications. I do wish that I hadn't given in and started pitocin because I believe my body would have been able to deal better with the stress of labor on its own timeline. we're going for a home birth with the next one.

I should probably add the story of my second birth, which was here in Portland at Emanuel Hospital. We went to the hospital at about 4 or 5 cm, and the nurses suggested I walk around and let labor progress more. They didn't want to hook me up that early and they wanted to see if labor could progress naturally. I appreciated that.

I took brisk walks with my mom and my mother-in-law, and we had a fun day laboring. We went back about 5 or 6 hours later, and I delivered the baby a few hours after I checked in. I had a little anxiety that my labor would stall like it did the first time and they would try to push the pitocin again, but Tati was born before the day was over and the delivery was pitocin-free.

I've given birth twice: once, in Nashville, with traditional, conservative OBs and once in Portland with midwives. Both times I attempted natural, no intervention labor and birth. The progression of the labors was very similar. The outcome was very different. With the doctors, they knew I wanted a natural birth, so they pretty much left me alone. They rarely checked my progression during labor, and after transition when I had about had it with the whole birth thing, they refused to break my water even though I begged. I didn't even have a hep lock. It was a difficult birth (3.5 hours of pushing!) but no interventions whatsoever.

Contrast that with my labor and birth with the midwives here, and they pushed just about every intervention on me, and it all just made things worse. By the time I finally convinced them to leave me alone and to schedule a c-section, I had lost all trust in them that they could take care of me and to watch out for the safety of my baby. After 24 hours of labor, my son's heartbeat was changing, and even though the midwife kept assuring me that it was normal, I knew for certain that it was the beginning of a more serious downturn. I am glad I avoided an emergency c-section. I know that my experiences are not indicative of all OBs and midwives, but I know I'll never be able to trust this group of midwives again, even for annual gyn care.

With my first, because I had gestational diabetes, about two weeks before I was due, my doc did a membrane sweep to get things going. It took a few days, but after my water broke, I went to the hospital. I was induced since after 5 hours there was absolutely no progression. Even after the induction, it took about another 5 hours and many increased dosages to get things going. But when it did, I labored and had the baby within four hours. It was fast, and mostly furious. I didn't have an epidural because by the time I asked for one, it was too late. I didn't expect the intensity, and I admit it was a bit traumatic. That and dealing with Nurse Ratchett (the afterbirth nurse).

With number 2, it was a text book birth. I labored at home (even went to a birthday party) for about 5 hours before arriving at the hospital. By the time I arrived, the contractions were strong enough to be annoying. I delivered a couple of hours later, but the intensity did not compare to the first and my recovery was much quicker. In my case, I do believe that pitocin had a negative affect on my first birthing experience.

I'm sort of amazed at how many women are induced in the US. I have a homebirth practice where we cannot induce labor (other than in natural, benign ways like suggesting long walks, intercourse, spicy foods, accupuncture) and rarely see any problem with letting spontaneous labor begin - even as long as 43 weeks (which is rare). Our experience is that most women will have their first baby by 41 1/2 weeks spontaneously. I've had many go past 42 weeks (while monitoring both mom and baby's well-being to make sure that the placenta is doing it's job) and have wonderful outcomes. Though inconvenient and uncomfortable (not only for the pregnant woman and her family, but the care provider who may becoming impatient) it is considered normal to stay pregnant past 42 weeks. Neonatal outcomes in many countries that rarely induce are often better than in the U.S.

Additionally, confidence in one's body to know how (and when) to birth can be a fundamental boost to a woman's trust in her abilities which may be useful in the much harder task of parenting.

I now have a compare/contrast story of my own...I just delivered my 2nd son at Good Sam a few nights ago!

In my earlier posts I've mentioned my intense/fast labor with pitocin and my anxiety about being induced on this 2nd pregnancy...On Friday night my water broke at 10PM with no contractions...we headed to the hospital on advice from the doctor. They confirmed that my water had broken and admitted me; I was already nervous they'd push pitocin right away. The nurses said that if, by morning I had not started having contractions on my own, the doctor would probably start pushing an induction. Well, long story short, by 12:30 contractions started, by 2:30 they were consistent and strong. By 3:30 I was seriously considering an epidural (!) but wanted to try to stick it out. By 4:10 I was fully dialated and ready to push. Henrik was born about 1/2 hour later.

I have to say, having done it both ways, that my labors were virtually exactly the same, and followed pretty much the same timeline too. With the only exception being that this time, my contractions slowed slightly once I was fully dialated which turned out to be kind of nice--I was able to truly catch my breath in between contractions and really get myself organized to push hard and efficiently. Whereas with my first, I dont believe they turned the pitocin down/off once I started pushing, and my contractions were coming every 30 sec to 1 min, so I pushed straight through with very few breaks--it was very hard on me and I believe led to a long, hard recovery.

Congrats Leah!!! That is wonderful news.

I had two homebirths, pretty straightfoward, so I don't have a personal pitocin story. I do believe that not only in our society, but in many other countries as well, the c-section rate is reaching unhealthy high numbers. I wanted to put some info out there to everyone who is interested in the topic and wanting to learn more in a local setting. There will be a conference the last weekend of September here in Portland: http://www.gentlebirthworld.com/mc/page.do along with a free Expo geared toward parents: http://www.freebabyexpo.com/. You'll probably start to see ads for this later this month, but it seemed appropriate to this discussion.

Interesting that labor often stalls once we go to the hospital. Same thing happened to me and to my mother. As my midwife (who delivered my second baby at home) said: "If a cat is laboring in a quiet place and you suddenly move her to another location -- one with noise, lights, activity -- her labor will stall."

Regarding pitocin, she said: "Pitocin contractions are like a knife, natural contractions are like a spoon." So true for me. Epidural followed the pitocin, which led to a very long pushing session; thankfully no other interventions.

My second birth was similar in that my water broke hours before contractions, but my midwives kept me fed and hydrated. When they told me to get into the birthing tub to start pushing, I could not believe it; thought I had hours to go to reach the pain level I felt w/in just minutes of the pitocin drip (for baby #1).

Having said this, I believe medical interventions are a blessing at times, and I fully respect every woman's choice to labor/birth as she desires.

I was supposed to have a home birth, but weirdness with my dates (I was 3+ weeks late, but I thought that was debatable) and a bad biophysical profile had me in the hospital the next day for induction.
I felt extremely lucky that my midwives were with me every step of the way, advocating for me when my husband and I couldn't seem to get our wishes across. Having their calming presence before and during labor and after, even though I wasn't at home, was a great thing.
I sat with a pitocin drip for 8 hours and nothing happening whatsoever, The next day I had about 4 hours of pitocin before labor finally kicked in. It was really rough, but I managed without drugs and was able to birth vaginally my 9 lb boy.

I was induced. The day before my due date. My doctor and I made the decision after careful consideration and discussion. I won't go into why we opted for it but it was the best thing for me.

Not only did I have a completely easy vaginal birth, but my labor was a short 3 hours and I pushed 3 times for a total of 15 minutes, no episiotomy and only a small tear. This was my first pregnancy too.

One of the things my doctor did say, was that my body was already making progress towards childbirth (she actually thought I'd go into labor prior to the induction). I asked about the horror stories I'd heard and she said that those usually happened when a woman's body was not dilating, etc.

I'm all for educating women about their choices, whether it be induction or natural, formula or BFing but I don't like the idea of dictating one or the other (or using scare tactics, for that matter). It's a slippery slope when you start taking away choices.

I guess I should add that following the induced birth, I had very little pain (I took the first 2 Ibuprofen but after that, nothing).

One thing I do think women need more education on is the benefits of exercise and maintaining a healthy weight before and during pregnancy. I regularly exercise and I think it's one of the reasons my labor was so easy, in addition to my very fast healing time.

I would have to respectfully disagree with the above comment. Sometimes, it seems, it just doesn't matter how good of shape you may be in. As someone who has always exercised regularly and ended up having extremely LONG and complicated births (c-section, etc.), my labors were far from easy. I have friends who are "overweight" (as they themselves put it) and have never been into regular exercise, and had amazingly fast and easy labors!

With my first son, my water broke on a Friday night, but no contractions. I actually waited until after the episode of Seinfield was over before I called my midwife (much to dh's chagrin). My midwife said unless contractions started, or something didn't feel right, to come in to the hospital the following morning. Saturday morning DH and I got up, went to the bank, stopped by Starbucks, called our parents and headed out to the hospital, which was about an hour away.

I hung out in the hospital all day Saturday. By the time Saturday Night Live started (exactly 24 hours after my water broke), I still hadn't had any contractions, so I was started on pitocin. By about 3am the contractions were painful enough--and I was exhausted--that I asked for something to take the edge off. I was given demerol, which made me a complete b*tch, but I was able to rest between contractions.

I started pushing at about 5am, and after 3 or 4 very determined pushes, Elijah was born at 5:17.

With my 2nd--it was a blur. He was over 2 weeks late. I had tried the walking, the spicy foods, intercourse, the riding in a car on a bumpy street (hey--I was desperate), and eventually went in for a very uncomfortable membrane sweep. Which totally didn't work. Finally on the 15th day of being overdue (this too, was after they had changed my due date from the 5th, to the 15th when I was about 8 mos. along), I went in to get induced. I spent the night in the hospital, with the plan of getting induced super-early in the am.

About an hour or so before they were going to start the pit, my contractions started. It was a slow progression, until about 6 cm (I had entered the hospital at 3 cm), when all of a sudden it was just horrible--much worse than with my first. But I stuck it out, and by 11am--after about 8 hours of contractions--Gideon was born.

With both boys I had midwives, and during my recovery stays, both times the nurses were joking about how I must have had midwives, not doctors, because I was the only one walking around post-delivery. I don't think I even took any tylenol post-babies.

I am due to have #3 in about 6 weeks--my first baby not born in NY. We'll see how it goes.

I really wonder about the 42 week stigma. According to m health provider, I am approaching 42 weeks (I think they are 3 days ahead of my actual due date). They are terrified of letting a woman go 42 weeks. I understand that there can be placental breakdown, but I wonder if NST testing would be ok? Does anyone know of any studies on this? I agreed to schedule an induction anyway, and am just hoping my baby will come out before next Wednesday because I don't like any of my induction options! (Pitocin or AROM)

If you are able to eat well still, I don't see the issue. The placenta is not a time bomb that goes off at a certain point, its meant to do its job to nourish the baby with your help eating all the proteins,veggies and fats you can.

I love this article..

http://www.mothering.com/pregnancy-birth/the-case-against-inducing-labor

And all that said, I have had two very quick, natural labors. No interventions of any kind. I did birth with a CNM at the hospital. My hubby and feel that covers all the bases. So I don't have any personal experience with epidurals, pitocin or even having to deal with an Iv while laboring. We did Bradley childbirth classes and the Brewer diet.

I was in a multi-car accident on the highway at 37 weeks and the force caused my water to break. After a couple of days of no labor I was induced with pitocin. It was a long hard labor with vaginal birth.

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