Spontaneous labour vs induction. JanetF - would like to hear your views

[Audrey]

Hi,

I had a long labour with my first baby and ended up having a epidural and ventouse delivery. I would ideally like to have a natural (drug free) birth this time, but am really scared of handling the pain. I feel that I will go so far and then cave in and want an epidural. My OB said that as second births are usually quick (approx 3 hours), if I think I would like an epi, that it would be better to be induced, so that the Anaesthetist(I think that is how you spell it) will be available. This sounds like a very neat and tidy way to have a baby. ie no guessing when it will hapen, no pain etc.

Is being induced a problem for the baby or are there any disadvantages as opposed to waiting for labour to occur naturally?

How do I find the courage to go drug free?

I would love to hear any opinions.

Thanks
Audrey

[Sarie]

I had two epi's with my first son and neither of them worked. So I only had gas to deliver him, it was a long labour and not very comfortable.
My second baby was induced, I found the gel being applied somewhat uncomfortable, but not painful. When the doctor broke my waters, that was painful, but when you consider what childbirth is - it's not meant to be easy. I only had minimal gas second time round, but I was up on my feet straight away.
I wouldn't look at being induced as something other than a last resort. I think you always want to try and get there on your own. I just have trouble getting started myself.
Just think that it is one day out of your life. I am the biggest chicken when it comes to pain. I shocked myself at how much I managed to cope with.
Good luck

[nemosmum]

[QUOTE=Audrey],Is being induced a problem for the baby or are there any disadvantages as opposed to waiting for labour to occur naturally?
How do I find the courage to go drug free?



I was induced at 12 days overdue and from what I know about the subject it can cause your baby to go into distress (which my baby did) causing them to poo in the womb (which my baby did) which is bad as if they swallow it can cause respirtory (sp) problems (which my baby did). DS wasnt breathing when he was delivered and had to be taken to the special care unit and kept there for two days. I also had an epi and an episiotomy which I have read is higher in women who are induced (but Im not an expert on the subject)
For me inducement was the only option (as far as I was told by my doctor and midwives) because I was 12 days late. I think its a very personal thing to choose to be induced- for me the up side of inducement was that (like you said) I knew when I was going to have my baby, labour was quick for me (6 hours) and I finally had my baby after waiting 42 weeks to meet him!

Re: the drug free thing I had drugs so I cant help you there :p

Good luck with what ever you decide :)

[JanetF]

Hi Audrey *waves*

you're asking about some really big things which require long conversations :) Let me try to summarise and suggest places for further information.

In the same way as we can't predict with any accuracy when our child will walk, talk or crawl, we can't predict how long they will need to gestate. Labour begins when babies are sufficiently developed to survive without their lifesupport system being permanently attached. The greatest cause of prematurity (and it's encumbent health problems for babies) is induction. For some reason, actually many complex reasons, the medical model (MM) which is the philosophy behind routine obstetric care, has decided that babies need to come out to a timetable. This is a recent trend in maternity services. Term is considered anywhere from 38-42 weeks and yet women who hire surgeons as primary carers, or are under the care of a hospital, are under pressure to induce as they near the end of their pregnancy. We know from oceans of studies that babies who are induced run the risk of serious short and longterm health benefits. It's not just induction, it's a whole factoryline, one-size-fits-all approach to medicine which causes problems to mothers and babies. Basically, babies who gestate as long as they need to, and are born undrugged are the healthiest babies with the healthiest physically and emotionally mothers. Birth is a normal physiological event which is why countries where midwifery care is norm have such superior outcomes to Australia and the US. It has also been since active management of labour was invented, that PTSD and PND have skyrocketed and PTSD from childbirth is now considered a serious mental illness.

Unless there are compelling reasons which mean that you or the baby would be seriously compromised by the pregnancy continuing, there is no need for induction. We tamper with the delicate safeguards and balances of labour and birth at the peril of mothers and babies.

Epidurals are a part of what we call the 'cascade of interventions." Loosely speaking, if you're induced, the pain is almost always unmanageable and requires chemical pain relief. So you have the epidural which ties you to the bed, means you have to have foetal monitoring, and in turn slows your labour down because you're not able to move but also commonly the drugs will stop the uterus contracting. So then you don't dilate to the hospital timetable and you're given Syntocinon. We know synthetic oxytocins cause foetal distress and so you either end up with a caesarean (60% of women who have epidurals end up with c-secs as a result) or an instrumental birth with it's risks of damage to the baby and massive potential for damage to the mother - particarly recto-vaginal fistulas and fecal incontinence. On top of that, the baby is often badly affected by the use of those strong drugs.

Once you really understand the full ramifications of how these interventions work, I think it takes a lot less courage to resist them ;) It's only logical, after all. Most of us are completely unaware of these possibilities when we're asked to decide about induction.

Choosing to achieve a normal physiological birth in a hospital is a complex path. But if you really decided you want to birth in a hospital, there are lots of things you can do to protect yourself and pursue the safest course of action for you and your baby. What the studies show us, is that the greatest deciding factor on the course and outcome of our births is the careprovider we choose. So if you choose a surgeon, you will be most likely to get surgery in some form or other, usually caesarean. Choosing evidence based care, means that you are a lot less likely to end up with unnecessary surgery because labours left to run their own course seldom need assistance but labours which are interfered in frequently require assistance.

The first thing I'd do in your shoes, is buy myself a copy of Henci Goer's "Thinking Woman's Guide to a Better Birth" which has lists of every possible intervention, the pros and cons and thousands of studies from which the evidence has been taken. I would also buy "Birthing from Within" which allows us to really delve into our emotional state around birth and make more nurturing choices for ourselves. I can give you a mass of info to read and share with your partner about how women achieve normal physiologcal birth but the greatest need is for emotional support. Most women reach a point in birth where they experience a crisis of confidence and start to verbalise a sense that they just can't do it any more. In a hospital, this is usually a signal to give the woman an epidural because (among other reasons) there are insufficient staff available to actually be with the woman and help her work through this normal stuff. In an evidence based situation, the woman and her partner would be held and supported in a safe and sacred space that would give the woman all the emotional support she needs to birth her baby. Offer hugs not drugs is a bit of a slogan to remember ;) It's really important to set up your birthing space so you are well supported because we need a lot more than our own internal resolve at times in birth.

Asking this question indicates that you're on a quest to take control of your own health care so that's an excellent thing. Just PM me for any help at all.
:)

[JanetF]

These are some articles on the importance of spontaneous labour and how inducing on dates alone is a dangerous path.

http://www.midwiferytoday.com/articles/timely.asp

A Timely Birth
by Gail Hart

http://www.birthlove.com/free/ten_month_mama.html

Birthlove’s 10 month mama page – extensive references.

Obstetric Myths Versus Research Realities

A link to a sample chapter.
Enjoy!

http://www.hencigoer.com/obmyth/index.html#obthink

Active Management of Labour

Marsden Wagner.

http://www.acegraphics.com.au/articles/wagner01.html

Lack of Scientific Evidence
Active management of labor, like other examples of medicalization of birth, lacks a scientific base. A WHO survey of routine obstetrical interventions found only 10 percent justified by scientific evidence (Fraser 1983c) Active management was started without any attempt to scientifically test the underlying assumptions nor to put the package of interventions to the acid test of a randomized control trial. More shocking is that, 25 years later, there is still not a single randomized controlled trial comparing the active management package with other methods of reducing cesarean section rates such as described above

Henci Goer on elective induction.
http://www.hencigoer.com/
Problems with inductions stem from two sources: the physiology of initiating labor and the side effects of the procedures and drugs. First, despite common belief that they can, obstetricians cannot switch labor on at will. Starting and intensifying labor involves a complex cascade of feedback mechanisms that mutually reinforce and limit each other. It is an elegant and delicate dance of hormones and other substances between the baby, who initiates and controls the process, and the mother. Dumping in oxytocin—with or without cervical ripening procedures—often won’t initiate progressive labor unless labor was on the verge of starting on its own. This is the main reason why studies consistently show that inducing labor, apart from the reason for induction, considerably increases the likelihood of cesarean section in first-time mothers.2,8-9,23,28,32,36,42,45 (Some studies have concluded otherwise. The reasons why are instructive and will be discussed in the next section.) (See Table.)
Second, all of the procedures and drugs used in inducing labor can have adverse effects.
• oxytocin (Pitocin, also called “Pit”):
o uterine hyperstimulation: Uterine hyperstimulation is a more common and serious problem with inductions than when using oxytocin to strengthen contractions in an already established labor because it takes higher contraction pressures to get and keep a labor going from a standing start.20 Of ten studies comparing hyperstimulation rates at two different oxytocin dosages, hyperstimulation rates ranged from 2% to 60% at the lower oxytocin dose, and six of the studies reported rates of 15% or more.14 At the higher dose, hyperstimulation rates ranged from 13% to 63%, and half reported that 25% or more of the women experienced hyperstimulation.
o fetal distress: Uterine hyperstimulation can cause fetal distress. Four studies reporting hyperstimulation rates also reported fetal distress rates.14 One reported an 8% rate at the lower dose; the rest reported rates ranging from 15% to 54%.
o low Apgar score: A separate study reported that induction increased the percentage of babies born in poor condition from 16% to 21%, doubling the odds after statistical adjustment for interdependent factors.21
o postpartum blood loss and neonatal jaundice.4-5,7,13,16,29,37 Blood loss and jaundice may relate to direct effects of oxytocin; increased use of IV fluids, especially IV fluids that don’t contain salts; or both.

[JanetF]

Here are some places with excellent info on the how but most importantly WHY we need normal phsyiological birth for mothers and babies.

Natural pain relief in labour

http://www.babycentre.co.uk/refcap/546717.html



Pain relief and home birth (useful in any situation though)

http://www.homebirth.org.uk/pain.htm



Comfort measures for labour – the most complete list I’ve ever seen, a must read!

http://www.gentlebirth.org/archives/comfort.html



Water birth stories

http://www.homebirth.org.uk/water.htm#birthstories



“The importance of relaxing by Grantley ****-Read MD

http://www.naturalchildbirth.org/ma...id=263&Itemid=3

http://radmid.demon.co.uk
From MIDWIFERY MATTERS, Summer 2000, Issue No. 85
Pain in Labour - Is it Insufferable?
By Margaret Jowitt

"Help - it hurts! ... get me the complementary therapies!" Andrea Robertson
http://www.acegraphics.com.au/articles/andrea21.html

"The Pain of Labour: A Feminist Issue" Andrea Robertson
http://www.acegraphics.com.au/articles/painlabour.html

"No gain without pain" Nicky Leap
http://www.acegraphics.com.au/articles/leap02.html


http://gentlebirth.org/Midwife/birthjoy.html

http://www.childbirthsolutions.com/...ssure/index.php

Dr Sarah Buckley on the hormones of labour - read the rest at the link.
http://www.sarahjbuckley.com/articles/ecstatic-birth.htm
Four major hormonal systems are active during labor and birth. These involve oxytocin, the hormone of love; endorphins, hormones of pleasure and transcendence; adrenaline and noradrenaline (epinephrine and norepinephrine), hormones of excitement; and prolactin, the mothering hormone. These systems are common to all mammals and originate deep in our mammalian or middle brain.

For birth to proceed optimally, this part of the brain must take precedence over the neocortex, or rational brain. This shift can be helped by an atmosphere of quiet and privacy with, for example, dim lighting and little conversation, and no expectation of rationality from the laboring woman. Under such conditions a woman intuitively will choose the movements, sounds, breathing, and positions that will birth her baby most easily. This is her genetic and hormonal blueprint.

All of these systems are adversely affected by current birth practices. Hospital environments and routines are not generally conducive to the shift in consciousness that giving birth naturally requires. A woman’s hormonal physiology is further disturbed by practices such as induction, the use of pain killers and epidurals, cesarean surgery, and separation of mother and baby after birth.

Medical risks of epidural anaesthesia during birth.
http://www.healing-arts.org/mehl-madrona/mmepidural.htm

[Sarie]

I've already posted this but if you haven't had a look. It's good to get both sides and this is good source of medical information relating to all things, in this case induction risks, can be found at the following site http://www.greenjournal.org/ A good site with peer reviewed scientific papers. Some of the results prove interesting reading.

[Audrey]

Thank you everyone for your replies. I am so touched that people out there put so much effort into helping others with their pregnancy concerns. I have a lot of reading to do!

I gave the subject some more thought overnight and feel that it seems morally wrong to induce labour unless there is a medical risk to Mother and /or baby. I really want to give my baby the best start in life.

I agree with support being the key to coping as I didn't really get any support with my first baby. DH first of all complained that I had to pick that night to go into labour after he had had such a bad day at work and then he spent most of the time asleep on a reclining chair. I rarely saw a nurse until I had the epidural. I also heard another woman screaming, 'help me, help me', which really frightened me. They told me later that there were a lot of emergencies that night. I was sitting in the shower alone and decided it was best to put everyone out of their misery and have an epidural. I must say, I felt no pain and had no complications from the epi. It seemed to make the experience much more pleasant, but afterwards I felt terrible about the bruise on my baby's head from the vacuum extraction and a sense of dissapointment that I didn't give birth to my baby, the Dr did it for me. I was also embarrassed and uncomfortable about the catheter. Of course I was so grateful that I had a beautiful, healthy baby and that was all that was important.

This time I still don't know what to do about getting support. I gave my DH heaps about how selfish he was and he promises to do better this time, but I still don't fully trust that he can provide the support I need. I looked into Doulas, but it is an extra expense that I can't afford and seems a bit over the top. I don't really know anyone who would want to be there with me as a support person and I think I would feel a bit uncomfortable asking. I just hope this time I get a better midwife. I will give this some more thought.

I love the line 'I need hugs not drugs'. I will use this one on my DH.

I have five weeks to go, so I am going to spend as much time as possible preparing myself. I will be heading off to the book store in my lunch break today.

Thanks again!
Audrey :)

[JanetF]

Hi Audrey,
student doulas often come for free so if you let me know where you are, I can look for you. In terms of the money and whether or not it's worth it, well given how unhappy you are with your last birth, can you afford to NOT have that support? As you say, you want to give your child the best possible start to life and that means a spontaneous, undrugged birth and I would be putting every possible effort into that.

The stuff about being grateful for a healthy baby, well who isn't happy that their baby is well? It's a completely separate issue from the mother's, and baby's, experience of birth. Birth is not a one day event. It's a journey which begins with conception, and continues for the rest of our lives. I run a group supporting women recovering from traumatic birth and for each one, their child's birth has echoed through their lives in ways both large and small for many years. And for the women I know who have had empowered births, where their needs were respected and they were emotionally supported, those women live on the high of that experience for many years and become invincible women! We all deserve to be supported and respected in birth, not just stuffed full of drugs which impact our capacity to birth, breastfeed and parent but make us easy to manage in the hospital/Obs' schedule.
http://www.birthpsychology.com/

An excellent book for your dh to learn how to be supportive is Penny Simkin's "The Birth Partner."

Let me know how I can help!
:)

[Audrey]

Hi JanetF,

I am in Brisbane if you have any information on student Doulas.

Audrey

[JanetF]

Try this.
Optimum Birth http://www.optimumbirth.com/
brisbane, gold coast & northern nsw regions ph: (07) 3409 4344

[Sarie]

Just make sure you do plenty of unbiased (either for or against) reading.

[JanetF]

More doulas here.
http://www.doularegister.com/queensland.htm

And some doula info :)

http://www.mother-care.ca/benefits.htm
Studies of Doulas and Their Impact on Families
A review by Cochrane (a prestigious international organization that prepares and keeps up-to-date systematic reviews in many areas of health and medicine) on the effect of "Continuous Support for Women During Childbirth*" has drawn astonishing conclusions. The primary objective of this review was to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support as compared to usual care.
Fifteen trials involving 12,791 women were included. After review and analysis of the data, the researchers offered the following synopsis: Continuous labor support reduces a woman's likelihood of having pain medications, increases her satisfaction and chances for 'spontaneous ' birth, and has no known risks. Supportive care during labor may involve emotional support, information and comfort measures. Such care may enhance normal labor processes and thus reduce need for obstetric intervention. The reviewer's offered the following conclusion: All women should have support throughout labor and birth.


The Benefits of Labour Doula Support:
Effects on Birth Outcomes:

Women request less pain medication and epidurals

There are fewer complications

Reduced chances of having a cesarean section

Reduced epidural or other painkiller use

Reduced use of artificial oxytocin to speed labour

Reduced duration of labour

Reduced use of forceps

Reduced use of vacuum extraction

Increased chance of spontaneous vaginal birth
Effects on the Mother:

Greater satisfaction with their childbirth, resulting in a more positive birth experience

More positive assessments of their babies

Reduced chances of maternal fever and infection

Mothers feel more secure

Mothers feel more in control

Reduced levels of anxiety

Reduced maternal bleeding following birth

Mothers have higher regard and increased sensitivity towards babies

Reduced incidence of postpartum depression
Effects on the Baby:

Babies have shorter hospital stays and fewer admissions to special care nurseries

Mothers are more affectionate to their babies postpartum

Reduced chances of health complications and hospitalizations of baby

Increased chances of successful breastfeeding

Found to be superior to Lamaze
Effects on the Health Care System:

The cost of obstetrical care is dramatically reduced

Women are pleased with the personalized care doulas offer

The Benefit of Continuous Support in Labor is Recognized by:

The Society of Obstetricians and Gynecologists of Canada

The World Health Organization

The Medical Leadership Council (an organization of over 1200 U.S. hospitals)


http://www.birthrites.org/
Statistics show that using a trained Doula can have the following results:
• Shorter labors
• Reduced need for pain medication
• Fewer episiotomies
• 50% reduction in C-Sections
• Improved neo-natal outcomes
• Better mother- infant interaction
• Greater satisfaction with the birth
• Reduction in the use Pitocin
• 40% reduction in the use of forceps
• 60% reduction in the request of epidurals and more

[JanetF]

Just make sure you do plenty of unbiased (either for or against) reading.

Couldn't put it better myself! Excellent advice for all life, really!
:D

[Sarie]

Couldn't put it better myself! Excellent advice for all life, really!
:D

That is why http://www.greenjournal.org/ is a great place to look. Look through a few, as it is easy to taked quotes and be biased in one direction or another. As my hubby is a scientist by trade he is big on researching...

[bubhub]

Local doula contact details also on the Bub Hub Directory at http://www.bubhub.com.au/servicesdoula.shtml

Hilary

[jaydensmum]

Hay Audrey, i dont think ill be able to help you very much since ive only had one baby. With my labour i had an induction because he was 10 days overdue. My labour was long too, it totalled 30 hours! :eek: I dont think that the induction was the reason that my labour went so long. I think the reasoning for the length was because he was posterior. The way i survived the labour was the knowing that he would of have to come out soon. Like i said in another thread, if you tell yourself that with every contraction you have, your one closer to seeing your baby! The facts have proven that the subsequent labours aren't as long as the 1st. I would love to have a spontaneous birth next time but i have no control over that. To me it felt weird walking into hospital without any pain and not having contractions and saying im here to have a baby! I wanted to go through the whole experience of ringing up my DP and saying its time and him flying around the corners to get me to the hospital! :D
I hope some of the others can help you with your questions better than what i have. Im sure no matter what way it happens you'll love the experience as it occurs.

jaydensmum

[blondenemesis]

I'm 5 days over with my 2nd baby - swollen feet the size of footballs (cracked & now bleeding), baseball mitts for hands, & a watermelon face. I can't walk more than 50 metres without shooting cramps up & down my legs, & the feeling that my whole gut is about to fall out. I've been having contractions for over a week now, which isn't fun - they start & stop, weak & strong.
Still, the DR says this is 'normal', & that as my blood pressure remains stable, I can keep coasting for at least another 2 weeks. This is the most hideous, horrible pregnancy that I could ever imagine. Sometimes when they talk about what's best for baby, they sometimes forget about the vessel.

[tickle]

It has been almost a year since this thread was started so I might just close it now. If you wish to start your own on a similar topic feel free.:)