Tag: evidence

5 Induction Truths

An induction is discussed with every pregnant person at some point, & these are 5 truths you may not hear anywhere else.

1. Sometimes Induction is Necessary.

High blood pressure, blood sugar control issues, protein in your urine, health concerns for the baby, and more can make it healthier for your baby to be better on the outside than on the inside. These are very valid medical reasons to be induced. Some providers prefer inductions to take place because of suspected big babies, low fluid, getting close or passing your due date, and other reasons. As we know from the evidence, these are NOT medical indications for induction.

2. You CAN Say No.

If everything is fine with you and the baby, then it is perfectly ok to say no to an induction. Even if you are in the hospital for an induction, you are STILL allowed to say no to anything that they offer, and you should be having a true informed consent and refusal discussion for each and every procedure. This includes breaking your water, starting medications, cervical exams, internal monitoring, the type of cervical ripening medication, and ANY TIME someone wants to touch you! Signing up for an induction does not mean you leave your autonomy at the front door. You’re still the boss applesauce!

3. Induction Increases Your Risk of Needing Cesarean Surgery.

Yes, there was ONE study that found that inducing everyone at 39 weeks reduces the cesarean rate, which actually was really problematic. I have discussed this previously along with a BUNCH of other scholars, however there is far more research that says the opposite. I really appreciate Dr. Sara Wickham’s resources on induction for help making informed decisions. This is something that needs to be discussed before you agree to any induction, no matter why it is being advised.

4. Induction Affects More Than Just When the Baby is Born.

Induction is forcing your baby and body to do something before they are ready to do it on their own. Most due dates are an estimate, and none are expiration dates, as babies keep developing even after they are born. Induction interrupts the hormonal physiology of birth, as Dr. Sarah Buckley has published on extensively. Interventions also affect breastfeeding, which can make feeding your baby more challenging after an induction. This needs to be part of the discussion when you are weighing the risks and benefits of whether to choose an induction.

5. Induction Can Take a LONG Time.

Especially for first time parents, induction can take a really long time. Locally most inductions start overnight with a cervical ripening medication and then proceed the next day. Will you be allowed to eat and/or drink during that time? Will you be allowed to take a shower? Will you be on the monitors the entire time? When are you allowed to get an epidural if you want one? Will your provider be there the whole time? What kind of time limits will they put on your progress? Will there be breaks? Can you bring your Fire Stick to keep watching your current favorite binge-worthy show? Ask questions to help yourself make the most informed decisions regarding your care!

The bottom line is this: If your provider is recommending induction, have an open and honest conversation with them using the BRAIN acronym:

  • Benefits–what are the benefits to this?
  • Risks–are there any?
  • Alternatives–what else could we try?
  • Intuition–what does your gut say?
  • Nothing–what happens if we wait?

Only YOU get to decide what is the right choice, and we want to make sure everyone goes into birth and parenting with their eyes wide open from the beginning. Want to do some more digging before making a decision about an induction? Asking for TIME can be the most empowering way to step away from what can be a high pressure feeling power imbalanced situation when you are sitting there with your pants off talking to your provider. We talk to clients about this all the time, so feel free to give us a call for a consult if you want a little help!

Childbirth Education Improves Outcomes

A recent study found that taking a childbirth education class improves birth outcomes. People who took a childbirth education class in this study were three times more likely to have a vaginal birth. Taking a childbirth education class helps improve confidence and skills for coping with labor and delivery. Childbirth education is still important, no matter what kind of birth you are planning.

Group & Private Classes Available

Coping with Labor Naturally is a 3 hour group class that covers the basics you need. The next one will be Saturday February 8th, 9am-noon, and you can sign up here. I will also teach this class in April, July, & October in 2020, so stay tuned if you are interested but not quite ready to sign up yet. This is a great class to bring your partner so they can learn ways to help you in labor. You will also learn which tools to bring with you and which to request when you get to the hospital.

If group classes aren’t your thing, maybe a full private childbirth education class would be right for you. Full private childbirth education classes have 6 hours of private instruction in your home or at my office space. I am a Lamaze certified childbirth educator who only uses evidence-based information. Yes, we will talk about the hee-hee-hoo-hoo breathing, but I cover everything from pregnancy nutrition to birthing positions to postpartum healing. I’m also an experienced birth doula, so I know the ins and outs of the local birthing scene too. This 6 hour class comes with a 96 page spiral-bound book of handouts and articles packed full of information for parents too!

I also have the option of a private 3 hour birth planning only session. This class is easy to customize for your needs and specific situation. I’m happy to cover whichever topics you might be interested in learning about, and help you come up with a plan. This is a great option for people who might be shy or have a very specific situation that needs specific information. This is also a great option for those birthing at home, who might want all the comfort techniques and help writing a transfer birth plan. Contact us directly to schedule a class and get more information!

Online Options

Maybe you’re really busy and would prefer an online option? Lamaze has some great online courses that are inexpensive and evidence-based.

  • FREE Labor Confidence with Lamaze Course here
  • Safe & Healthy Birth: Six Simple Steps here
  • Labor Pain Management: Techniques for Comfort and Coping here
  • Breastfeeding Basics: From Birth to Back to Work here
  • Bringing Home Baby here
  • Vaginal Birth After Cesarean (VBAC): Informed and Ready here

There are other online courses as well that I like, but I will say that most people benefit from some in-person, hands-on learning too. No matter how you choose to learn, taking the time to prepare for childbirth is a GOOD thing to do. Refreshing your knowledge and skills, even if this isn’t your first birth, are also good uses of your time and energy. I’m always happy to recommend books to read too! Childbirth education is important. Childbirth education is helpful. Childbirth education is worth your time.

Midwives in Southwest Indiana?

Evansville needs midwives to support healthy birthing families!

Southwest Indiana needs midwives, and the lack of them here is surprising. It is frustrating for me as a doula for several reasons. Our area deserves to have midwifery options, especially as midwifery care has proven benefits for patient satisfaction, cost, and birth outcomes.

What does the landscape look like for people searching for midwifery care here? We currently have two Certified Professional Midwives that travel here for home births, one from Bedford and the other from Bloomington. However, home birth is not an option for everyone. In 2019, we only have one Certified Nurse Midwife catching babies at one Evansville area hospital.

So what is the big deal? Midwives are experts in normal pregnancy and birth. According to the Midwives Alliance of North America “all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns.” Midwives are not surgeons, and all obstetricians are, which fundamentally changes the way that they approach your care. The Midwifery Model of Care “whether practiced in clinics, private homes, hospitals or birth centers, has at its core the characteristics of being with women, listening to women, and sharing knowledge and decision-making with women” (MANA). Midwives expect pregnancy and birth to be normal and watch out for signs that pregnancy, labor, and delivery might need intervention. That is not the same approach as an Obstetrician, and if you want to read more about the comparison or some social science research about this I highly recommend this book and especially this article and this one too from Robbie Davis-Floyd. She is the most renowned anthropological expert when it comes to this stuff!

Midwives have also been proven time and time again to be linked to better outcomes for their patients. People who use midwives for their care are THREE TIMES more likely to be satisfied with their care when compared with obstetrician-led care. Midwifery care has also been shown to be the most cost effective care in the hospital setting.

Who cares? Well, I do, and I’m not alone. I chose midwifery care for myself when I delivered my babies in Cleveland. As a doula, I regularly get asked for recommendations about providers, and I can’t even count the number of disappointed people I have talked to when I tell them that there is only one midwife here in town available to catch babies in one hospital. There are plenty of factors that go into choosing a provider, including insurance, location, practice style, personality, and so much more. While one midwife is certainly better than none, people choosing to birth here surely deserve more options. We need more midwives in Southwest Indiana.

For a little comparison, just down the road in Owensboro, KY there are 4 Certified Nurse Midwives catching babies at the hospital. Owensboro has a population of around 60,000. Evansville has a population of >115,000! If we include the populations of the surrounding 5 counties (Gibson, Posey, Spencer, Vanderburgh, & Warrick) We have a local population of over 320,000 people, and we know that there are people traveling here from Northern Kentucky, Eastern Illinois, and even further counties in Indiana to give birth, and they aren’t even included in that population count! Not every pregnancy and birth here needs to be attended by a surgeon. Yes, family practice physicians are also an excellent option, and there are some great ones here, but midwifery care is more specialized and has a different approach than the medical model of birth.

Southwest Indiana needs midwives, and we have some currently working to complete their training. As I sit writing this I know three midwives who are currently in school and planning to practice here when they graduate. Two will be Certified Nurse Midwives who catch babies in the hospital and one will be a Certified Professional Midwife who attends home births. Growing families deserve options for their care, and these midwives will be an amazing addition to our community when they are finished with their training. I can’t wait for the day when birthing families in Southwest Indiana have more midwives to support them as they grow.

Have you ever considered hiring a midwife instead of a physician for your pregnancy, birth, and postpartum care?

4cms is NOT Active Labor

Active labor starts at 6 centimeters

Many moons ago, we thought that once you reached 4cms, you were in “active labor” and the pace of your labor should start to pick up and keep going no matter what. In 2010 Zhang and colleagues published a groundbreaking research study that re-examined labor patterns and redefined the beginning of active labor as starting at 6 centimeters! This was a HUGE academic smack-down of the 50+ year standard of Friedman’s curve that defined active labor as starting at 4cms.

Why does it matter? The BIGGEST reason physicians were recommending cesarean section in 2011 was “arrest of labor” or “failure to progress” and apparently they were making the call far too early! You can read more about that whole thing here. After this study was published, the American College of Obstetrics and Gynecology (ACOG) came out with this position paper saying, whoa, let’s slow down this trend in the rise of cesarean births, and even outlined why and how. That position has since be reaffirmed multiple times by ACOG, BUT, I am still not seeing all local providers using this evidence in their practice and I still hear some providers and staff telling people that they are in active labor when they are 4cms. Look, your Aunt Becky might not know the evidence, but you surely hope the people taking care of you are up to date on best practices from 5+ years ago right?

The evidence is clear: If you are 4cms dilated, you are NOT in fact, in active labor. Your labor still has a chance to stall out or even stop. While that is frustrating news if you are in that position, it is also good information to have in case someone might suggest that something is wrong because labor stalls and that you need to DO something about it. Labor takes time and patience. If you are not in active labor yet, leaving is actually an option. (And no, your insurance will not refuse to pay, that is a myth that has been debunked many times over including here.) As long as everyone is safe and healthy, asking for more time to allow your labor to progress without unnecessarily intervening with medicine you might not need is NOT an unreasonable request. Remember to use your B.R.A.I.N (Benefits, Risks, Alternatives, Intuition, & Nothing or Not Now), sometimes that N of NOTHING is important to remember to request!

As your doula, it is my job to know that 6 centimeters is when active labor begins and to help you remember to ask great questions about your care! Getting to 6 cms is typically what takes the longest time, and I help people cope with getting there physically too. I promise I do try not to geek out too much while hanging with clients in labor, but it does happen.

So remember 6 centimeters is when active labor begins!