Why does everyone get induced? What’s going on here?

Opinion piece here…As I’ve been on this journey of birth for a few years now, with my first son (born by cesarean in a hospital) and now awaiting the birth of my second son (planning to birth at home with a licensed midwife), I have been reading a lot and keeping my ears open to others’ experiences. I am not a “everyone should do home birth” kind of a person, I don’t know anyone who is. Nor am I judging women who choose elective induction. If that is something someone really wants, that is cool, I am pro the woman’s choice. BUT, I don’t think that women are actually given the full spectrum of information about elective induction which is the main problem AND it is being suggested by far too many medical professionals (mostly OB’s in hospitals) when, many times, it isn’t actually in the best interest of mother and baby. I think a lot less women would be saying “yes” to suggested inductions if they were given the whole picture. For example, a mother’s mental well being post baby is actually extremely important for one: the woman and two: the health of the baby. The whole “as long as you have a healthy baby, healthy mom” comment, is hardly ever referring to a woman’s postpartum health or just her mental/physical/spiritual health in general, or the baby’s. Studies show that emergency cesareans (which can rise from elective inductions) give a 15% higher chance for a woman to develop postpartum disorder. There is also the issue of clarifying when inductions are medically necessary versus elective. For example, the fear tactic of “your baby is big and you’re close to your due date so let’s induce” is NOT medically supported. (The ACOG finally just came out and admitted that ultrasounds can’t accurately predict a baby’s weight for example.)

I am just thinking of this today as literally within the past two days I’ve heard of two women I know being induced. One of which is getting induced the day after “40 weeks.” Now, to me… due dates are a joke. They aren’t accurate. A woman isn’t even considered “post term” until after 42 weeks and that is just a guideline of the ACOG. In some countries, it’s later. Unless there is a major medical reason to induce, it seems more logical to just let the body and baby go into labor when ready, so labor isn’t horrible for the mother. Induced labors in general are actually harder than spontaneous labors because the body is being forced into it. I have friends who shared with me how their kids went into distress once given pitocin. It was clear that the baby didn’t like the “force me out” method. My mom said once she was given the epidural that her labor stalled.

If someone doesn’t want a major abdominal surgery with all that comes with it (possibly not having skin to skin right away, possible problems nursing, possible problems with breathing for baby, a much higher likelihood of postpartum depression, etc.), one should really consider saying yes to any kind of induction method because of what’s called the “cascade of interventions.” Once this process is kickstarted, let’s say with being given some pitocin when the body has shown no signs or minimal signs of readiness, the woman is then typically put on a clock at that hospital for things to happen in a certain amount of time. She is also catapulted into a lot of pain (not the natural way of the body and brain chemistry working together) which leads to a need for an epidural, which can totally halt the progress of labor because a woman can not feel what is happening to intuitively breathe or push the baby down. NOT to mention, once given synthetic drugs to induce a woman is put on continuous fetal monitoring devices which also unnecessarily lead to more interventions and she is most likely stuck on her back in a bed which makes labor much harder and less efficient. (Please look at my resources page and this quick article with a caption below).

“The Listening to Mothers survey reported that almost 50% of the women surveyed had their labors induced (Declercq, Sakala, Corry, Applebaum, & Risher, 2002). Physicians are astonishingly up-front in discussing how much more efficient scheduled inductions (and scheduled cesareans) are. They claim that women will not have to worry about middle-of-the-night births and that hospital staffing and bed turnover can be better managed. Both physicians and women seem to be comfortable with “intervention-intensive” labor and birth.

Women are between a rock and a hard place. It is so easy to be seduced into believing that the baby is ready for birth. It is also frightening to hear the physician talk about a too-large baby or a possible medical problem. In the first instance, potential problems are brushed aside; in the second instance, problems are suggested where none are likely to exist. In both cases, pregnant women do not have the full information required for making a truly informed decision.

To make an informed decision—either informed consent or informed refusal—women need to know the value of waiting for labor to start on its own. The last days and weeks of pregnancy are vitally important for both the mother and her baby. The end of pregnancy is as miraculous as its beginning. It’s a lot easier to say “no” to induction if the mother knows the essential and amazing things that are happening to prepare her body and her baby for birth.” (“Saying No to Induction” The Journal of Perinatal Education by Judith A. Lothian, PhD, RN, LCCE, FACCE)

I remember with my first birth, the CNM saying, “Don’t worry, having the section at 39 weeks is perfectly fine. The baby is done developing.” In my gut, I had a problem with this. Although I accepted that most likely he wouldn’t turn at that point (he was frank breech), I felt it was not right to not let my body at least go into labor on it’s own and then go in for the cesarean, but I succumbed to the fear tactic and went with what they said “I had to do.” If you access the risks with either choice (c section scheduled without any indication of labor at 39 weeks vs let labor start then have the c section), I think it’s less risky go with the later and gives many benefits for baby and mother to allow body to at least start the process.

Now, that all said, with the info I have now I would’ve sought out an OB who delivered breech babies but I have also thought about how going into labor is usually better for the mom and baby. It’s not convenient for doctors or hospitals though.

If anyone out there is pregnant and hoping for a spontaneous labor with little to no interventions, I would highly suggest you ask your provider lots of questions very early and do your homework on the provider/institution in which you are planning to deliver as per their rates and policies (with a 50% induction rate going on and a 31% cesarean rate going on in the US… it is very clear that it’s actually harder for a woman to birth without interventions in hospitals than it is to have them.) Also, switch providers as many times as needed to find one that lines up with your beliefs and “gut.”

Finding the Balance. When is it too much info?

January 3, 2020. I am now 27 weeks pregnant with baby number two.

Around six weeks ago I filled out a questionnaire for my midwife which we will review this upcoming Tuesday. The first question was “What are your top fears about this pregnancy/birth?” I knew right away. 1. That this baby will also be breech and I will not have any choices (like my first) except to have a c section.

My first ended up in a cesarean section due to late finding of frank breech positioning and “low fluid” (I put this is parentheses because this is kinda in line with the whole “big baby” fiasco going on in maternal care, typically being an unnecessary (lack of evidence) cause for intervention. (see earlier posts about my first pregnancy and look up the ACOG’s new position on the big baby thing: stating that ultrasounds can’t accurately depict size. Yes. thank you for all the unnecessary surgeries due to your earlier position on it. lordie.). Sidetracked there… I now know SOOO much more about optimal fetal positioning and the need to look at pelvic alignment and balance and relaxing the ligaments surrounding the uterus to give baby optimal space to turn and the various ways to do that. (A topic that isn’t fully addressed in 10 min prenatal OB appointments or CNM hospital groups in my experience. They very lightly touch on things AFTER the less than optimal positioning presents itself. Teaching optimal fetal positioning and ways to prevent variations that aren’t medically supported usually isn’t a part of basic prenatal care in the first and second trimester especially. (Over my two pregnancies so far: I have experience seeing a top OB at a major “good hospital,” a CNM group with a smaller but good hospital, a private practice OB known to be “natural” and vbac friendly, and a regular midwife. By far, the midwife has been the most holistic and knowledgeable and presenting me with all my choices and giving me preventative care as opposed to “let’s fix this” afterwards.)

I’ve been seeing a regular chiro and then a Webster certified chiropractor since 7 weeks. We just started doing twice a week actually around 26 weeks. I have gone to acupuncture with a guy who specializes in pregnant women around three times so far and plan to continue every few weeks. I’m doing a handful of Spinning Babies exercises/stretches daily at home, such as the forward leaning inversion, and focus on just walking and caring for my toddler as my exercise. I’m seeing a supportive provider, a midwife. I joined ICAN and my local chapter. The more I learn, the more passionate I become about the need for changes to women’s rights and choices with maternal healthcare in the US.

Now… at what point is too much? or too much focus on this breech prevention? or wanting to become an activist as I am prepping for this birth?

Well… As I near third trimester, I think I’ve hit my self imposed limit of research for now. I just deleted the Facebook App from my phone so I don’t read posts so often from my support groups because I find it just makes me think about it more. In the last 6 weeks since I’ve answered that question about my fears, I’ve concluded that if I end up with the circumstance of baby presenting head up towards the end (like 35 weeks), that I would first try more things to turn (but not an ECV bc of prior experience) and seek out a vaginal breech provider who does attend home births if not and if he thought I qualified for a vaginal breech birth. (If an OB would attend my birth at a hospital near me I’d do that instead but they don’t exist where I live unfortunately. I’ve looked into it.). After all my fact finding, I now believe having a csection just because baby is breech is not usually a necessary csection. (sometimes it does necessitate one… but it’s not a black and white, always needing one.) My first baby never showed any signs of distress while in breech position at the end. I have felt that truth. It’s more a lack of skilled providers being “allowed” to attend the vaginal breech birth which is a recent phenomenon in our history. I think I would have a hard time consenting to something that some providers will do and others won’t. That lack of continuity makes me see it as a policy issue and not a health or safety issue, or what’s in the best interest of mom and baby. However, me dwelling on this limitation in our health care system keeps me in a “fight or flight” stance because I get angry. I know that being in fight or flight is ANTI optimal baby positioning and labor. It’s like me being in defense of the giant bear outside my cave when I am preparing for birth, the modern day threat: the healthcare system. It’s not what my mind or body needs. This also brings me to the conclusion that although I want to begin advocacy work for more options for breech birth as well as vbac and home birth in general, I think being in “fight or flight” with the system, as it gets me all riled up to think of our current state of options, isn’t the best for me while preparing for this next birth. I will jump on board more post birth to do my small part in making some changes. Even just sharing my experience now feels like a bit of a contribution.

So, I’ve done a LOT of gathering and now it’s time to have faith that baby will be head down and try my best to let go of the outcome. I will only do more research now when a new decision presents itself. I have enough facts and information about my birth choices and breech in particular and have taken a lot of action.

My third trimester mantras: Think positive. Be present. Safe to soften. Take the actions for body balancing for baby as I have been doing, but trust it is working. Talk to baby. Relax. Limit my Facebook group time. Protect my mental and spiritual space surrounding this with healthy boundaries and discretion. Have faith and surrender.