Sunday, November 30, 2008

Let Labor Happen

The increase in cesareans today is linked to the increase in inductions. but there is certainly a seduction to induction today. The reason for inductions being so prevalent today is multifaceted. There are reasons to medically induce a labor. The signs of preeclampsia is one reason. There are some conditions that make the pregnancy threatening to the mom's health as well as the baby's. But many inductions are not medically indicated.

When a mom has had a fast birth the first time, sometimes there is concern about a precipitous labor with the second. I have accompanied moms in just such an induction. Many times the induction is easy, but it can also cause the labor to be more painful and longer than it would have normally been if not interfered with by the induction.


Sometimes childcare arrangements for the couple with one or more children, makes an induction seductive. Knowing the exact day the birth will occur helps some couples decide to have an induction. The element of the baby not being ready, or the body not responding to the induction in a favorable way is always a risk.


Sometimes an induction is decided upon due to fear that the baby is getting too big. I have witnessed births where the ultrasound confirmed a baby that was estimated to be over 8 pounds, actually to be born only weighing 7 pounds. The accuracy of a late ultrasound for judging size falls under scrutiny. There is as much as a 40% inaccuracy rate of these ultrasounds.


Medical induction methods can vary. Pitocin is often used- given either in large amounts quickly (active management) to being given slowly over a slower period of time. Cytotec, although under a lot of scrutiny for inductions, can be given to either orally or vaginally. Although this drug was not determined to be used for inductions, but is a gastro ulcer medication, it is a cheap alternative with good results if used properly and with discretion.


Prostaglandin gels can be used to help ripen a firm cervix. Sometimes the gel itself is enough to cause labor to begin. Artificially rupturing the membranes is also a method used to get labor started. Although there is no assurance that labor will occur in a timely fashion and usually means augmenting the labor with Pitocin after it has occurred.


Unfortunately women will often follow an induction suggestion made by the caregiver without regard to all the options available to them. And sometimes all the risks are not discussed. The increase of cesarean births is definitely one of the risks that needs to be discussed. Sometimes when drugs are augmenting a labor, it causes the baby to not choose it's own position and timing to enter the birth canal. Malpositioned bodies are certainly a cause in having to have surgery for arrest of labor. Increase of infection and bad reactions to the drugs used can also increase the risk of cesarean births.


Often times a mom comes to me and asks how she can get her labor going. God provides a great source of natural prostaglandin by way of semen. Certainly the same sensuality that got the mom pregnant can and will help the baby begin the labor process if the cervix and the baby is ready. Oxytocin, the natural form of Pitocin is also manufactured in the woman's body naturally by way of nipple stimulation and orgasm. So. intimacy and cuddling is certainly a natural way to let your body get ready for labor.


Many times when I am with a woman who is in early labor and she asks what she can do to get things going. This is my response, let labor happen. There is no need to make things happen. If you are in early labor, a warm bath will often slow things down and allow more rest if it is late. If early in the day, staying upright will facilitate both the decent of the baby as well as the movement helps the mom deal with the pain of labor. A warm tub will often accelerate labor in the active stages. But, taking a power walk before your labor kicks in could prove to be detrimental if your labor is a longer one.


New studies show that labors for first time mothers can average 19 hours. So, resting, keeping yourself distracted with labor activities, eating and drinking lots of fluids remains the advice I give moms in labor. Just let your labor unfold. Don't do too much, but don't do too little. Focusing on your labor and each contraction is not the way to help the time pass either. Do what you can do to stay as normal as possible in early labor.


Confidence in her body and the absence of fear will help her labor unfold more than anything else. So, learning to trust her body, learning techniques to help her relax and dealing with the fears she has ahead of time will help her to let go and open up her body to birth her baby.

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