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Non-Chemical Inductions at the Hospital

I attended two hospital inductions last week that did not involve pitocin or pain medication.  In fact, they did not involve any medications at all. 

First, a disclaimer:  this post is not meant to be a full exploration of risks/benefits of inducton methods.  Please seek full informed consent before choosing any induction method–whether at home or at your birthplace. 

Second, I do not fancy inductions at all.  I am, however, quite happy when my clients do not need pitocin or an epidural during the dreaded induction.

Induction #1:  This mom was 41 weeks and having her 2nd baby.  Dr. Polo Shirt inserted a foley catheter at 9pm.  Mom began feeling contractions almost immediately.  She used gravity for a few hours to help the cath work and then went to bed.  Around 4:30am, she had to concentrate on her contractions.  Nurse offered pitocin at 6am and client declined.  At 8am, Dr. Polo Shirt removed the cath.  Her membranes ruptured on their own at 10:10am.  Baby was born at 10:45am. 

What is the deal with the foley?  This is a urinary catheter.  But in this case, it is inserted vaginally.  The cervix needs to be dilated enough to admit the cath.  Once it is above the cervix, the bulb is inflated.  My understanding of the way this process works:  the bulb mimics the pressure of the baby’s head.  Typically, it falls out when the mom dilates to 4 or 5cm.  It is not painful but may feel distracting since there is tubing coming out of the vagina.  It is usually taped to the inside of the mom’s thigh.  There is a risk that the doctor/midwife will rupture the mom’s membranes.  However, for someone who wants to avoid medicine, this might be an alternative to explore.  Having seen this work beautifully and gently several times, I’ve become a fan of this method over other induction choices.

Induction #2:  This mom was 37 weeks and also having her 2nd baby.  She had a medical condition that required her baby come early.  Knowing this, she prepared her body through acupuncture, massage, hypnosis, and other easy induction tricks.  She was 3cm when admitted in the late afternoon.  Her doctor offered pitocin or artificial rupture of membranes.  My client chose rupture of membranes.  This procedure is painless though contractions may feel stronger without the “cushion” of an intact bag.  There are several risks.  The most significant is a chance of cord prolapse which would result in an immediate cesarean.  After her water was broken, it took some time for labor to kick in.  We climbed many, many flights of stairs and I used several doula tricks.  She dilated ever so slowly and she was offered pitocin 15 million times.  Just before midnight, things became intense.  Baby was born around sometime after 3am.

The typical induction is cervadil or cytotec followed by artificial rupture of membranes followed by pitocin (followed by epidural).  These non-chemical options don’t always work but can offer other options.

Bait and Switch

“Yes, we support natural birth.”  Knowing full well that most first-time mamas are induced so it is a moot point entirely.  The average gestation for a first time mama is 41 weeks 1 day.  When do most OBs start suggesting induction?

“Yes, we support VBAC.”  Until you fail to follow the standard protocol and suddenly you’re told (in LABOR!) that you can no longer have a VBAC.

“Yes we welcome birth plans.”  Until you submit yours at 38 weeks and the OB crosses a line through the things she won’t do.  And it is awful tricky to find a new OB willing to take you (the difficult patient) after 38 weeks.

Think I’m exaggerating?  Think I make this stuff up?  No.  The families I work with are handled this way all! the! time!  I have so many stories.   

Let’s take today, for example. 

My student switches to a practice recommended for their wonderful VBAC support.  She cancels her regular prenatal appointment because she believes she is in labor.  She is told to go straight to the hospital with her bags packed. 

Her contractions are just 1o minutes apart.  This may be a practice run.  This may take a couple of days.  She decides to stay home awhile.  And then a receptionist calls to tell her she will no longer be “allowed” to have a VBAC since she didn’t go in when they said. 

How do you disallow someone from having a VBAC?  The baby will come out.  There is no stopping it.  It is a normal, bodily process.  It would be like telling someone they were not allowed to digest their lunch. 

This manipulative and insulting treatment has got to stop.  It must.