Tips to Avoid Induction

Tips for Clients
(Ana Hill's CAPPA training topic)

No complaining about normal discomforts to your care provider- complain to your doula or your friends- but the care provider often feels the need to "fix" it for you with an induction.

Adjusting your expectations about your due date- first time moms are usually pregnant for 41 weeks and a few days, and moms who have given birth before usually go 40 weeks and five days... so remember your due date is a guess date based on a 28 day cycle. Only 4% of moms go into labor on their due date.

Correcting suspect due dates with caregiver- do this early if you do not have a 28 day cycle- advocate for yourself if you know how long your cycle is- share it early on so that is taken into consideration.

No horror stories told or listened to... they affect your mind body connection as well as how your care provider sees you. Don't listen to the stories and don't offer up any for him or her to project onto you.

Chiropractor care and prenatal massage is great for helping the baby to be lined up properly. Gail Tully's website www.spinningbabies.com also offers some great guidelines for aligning your baby for optimal fetal positioning. We also offer a great Line Up Your Baby for Labor class.

Sexual activity- those who stayed sexually active tended to not go postdates. The oxytocin and prostaglandins are wonderful ways to get things going.

Prodromal labor is a problem for many moms who have a malpositioned baby- so optimal fetal positioning is important. But often times it is also some issues that are causing fear that will delay labor beginning and sometimes cause labor to become dysfunctional once it does begin.

Some studies are showing perhaps these things can help:

Vitamin D supplementation- 4000 IU daily is recently been linked to more cesareans and malpositioned babies when the Vitamin D is too low... perhaps considered in the way the pelvis is lubed by doing so...

Fish oil- 400 mg DHA daily...matures baby's brain and helps the mom prevent PPD.

Protein 80 to 100 grams a day.

Rest and hydration go together... don't over do in the last week as to go into labor and be exhausted. Some say take your current body weight divided by 2 is the number of ounces you may want to drink of water daily.

Consider your expectations and determine if they are realistic with the birth care you have selected. Perhaps a change of venue and care provider will get you the birth you desire.

Keep in mind induction is not the same as labor. Our bodies being pushed into labor is not the same as our body going into labor on its own. Oxytocin and endorphins work very differently than the drugs used for induction- it does not pass the blood brain barrier. It can be more challenging since it brings on a different labor pattern- contractions much closer a lot sooner- transition lasting longer.

Remember what is controllable and what is not. The method of pain relief may not be as effective. The method of birth may be different. Failed inductions does not mean your body failed. The body's job is to protect the baby from being born too early. So if your body does not think this baby is really ready to be born, your body will try to work against the induction medicine. Some studies show it may increase your cesarean rate by 50% over the normal rate. So understand what happens if it does not work- you may have a cesarean birth.

Find out what your Bishop score is before you go in so you know what your chances are of an induction that may be smoother.

You can consider acupuncture, a competent herbalist, a chiropractor and a massage therapist. There may be some risks to consider when doing herbal or homeopathic or kitchen sink inductions. It is an oxymoron to say "natural induction." (these are my therapists- my acupuncturist, chiropractor and massage therapist.)

The bottom line is know what to expect and be a great advocate for yourself prior to going to the hospital for your induction.

Consider these sites if your induction does not go as you had hoped. Solace for Mothers and ICAN.

Infant Massage

Do you enjoy a good massage? I have a massage therapist who I find provides me with a little slice of heaven (www.kmiatlanta.com). And if you have experienced a great massage you must also understand how much a baby who has been so used to being constantly touched by his mother's body while in utero would love to be massaged once out.

2 Wonderful Breastfeeding Videos

The studies show hands down that the best way to avoid nipple trauma is a class BEFORE you have your baby. So, please consider a great class to help you avoid problems. But here are two videos that may assist you if you have any problems.

Maximizing Milk Production

Hand Expression of Breastmilk

And if in doubt of a medication passing into your breastmilk- try this link LactMed.

poems for labor

In the midst of the chaos
When the wind is howling I hear
the ancient song
Of the ones who went before
And know that peace will come
-Susan Stauter

May the sun bring you new energy by day,
May the moon softly restore you by night,
May the rain wash away your worries,
May the breeze blow new strength into your being,
May you walk gently through the world and know its beauty all the days of your life. –Apache blessing

For as long as it lasts let the singer be the song.
For as much as it’s worth let the truth outweigh the lies.
For this single moment in time let my own voice be heard.
–Susan Stauter

“Come to the edge,” he said.
They said, “We are afraid.”
“Come to the edge,” he said.
They came.
He pushed them and they flew.
-Apollinaire

What lies behind us and what lies
before us are tiny matters
compared to what lies within us.
-Ralph Waldo Emerson

I know nothing with any certainty, but the sight of the stars makes me dream. –Vincent Van Gogh

What Makes Women Warriors?

According to Wikipedia "A warrior is a person experienced in or capable of engaging in combat or warfare, especially within the context of a tribal or clan-based society that recognizes a separate warrior class. According to the Random House Dictionary, the term warrior has two meanings. The first literal use refers to "a man engaged or experienced in warfare." The second figurative use refers to "a person who shows or has shown great vigor, courage, or aggressiveness, as in politics or athletics."

So I want to consider when a woman is in labor- how does she become a warrior? I love the phrase "warrior woman." I feel the way we carry ourselves through our journeys of adversity we become warriors. But for the sake of this blog, I want to explore the aspect of labor and birth.

A woman who shows "great vigor, courage or aggressiveness" in labor and birth... hmmm. Does a woman have to birth naturally- without any pain medication to be a warrior? Nope, I don't think so. Is she more of a warrior if she goes natural while being induced with labor augmenting drugs? Perhaps she may think so, but nope I don't think it is a competition. But women make it a competitive arena. Just share with another woman that your intention is to try to go without pain medication and she will tell you how ridiculous that is- making you feel like it is an insurmountable feat to try to do so. But find a woman who did give birth without medication and she will tell you that you do get a prize for doing so... and she will explain how easy her recovery was, how well breastfeeding went, etc. But this is not always true.

We had a client who took our classes and hired a doula and planned an pain medication free birth. But due to some past issues, her labor as it unfolded brought up a lot of stuff she thought she had dealt with, but had not. Her labor was hard and unmanageable and she chose to get an epidural. Was she a warrior? By all means she was! With her second birth, she planned on getting an epidural in her labor and did so. She had a great second birth. Was she less of a warrior? Nope, I don't think so... She figured out what she needed and worked through that which she could, and chose the labor that was right for her.

My daughter chose a homebirth with her son. When people heard she was doing so, they commented on how brave she was. She then would ask where they were giving birth and when they named their hospital, she would tell them no they were brave! She did not feel comfortable giving birth in the medicalized birth arena. Was she more of a warrior? I feel her battle would have been more difficult if she had gone to a hospital. She was a warrior in her labor the same as the first mom.

I have written about doing the next best thing- when your options or choices change in your labor- it is about being flexible as things arise. But being a warrior to me is more about not allowing yourself to be bamboozled and manipulated. It is about asking questions and then finding the answers that are right for you.

I received a call recently from a woman who was seeking doula support for a hospital birth where her care providers were midwives. But in their prescribed birth plan- the only one you are allowed to have- where you check items... it stated that you should only choose natural birth if you could control yourself. Hmmm... what does that mean? I do not think a woman in labor needs to act in some prescribed way that is considered in control by those who are supporting her. She should feel free to move and make sounds that help her in her labor. This group also stated that they would be the ones who decided when you may need labor augmentation and they would decide how it is administered. Wow- so does the woman give up her autonomy in her decision making about her body and her birth? When did informed consent get thrown out of the door? This same practice does not "allow" a mom to go past her 41st week of pregnancy although the ACOG says that she is not past due until her 42nd week.

I do appreciate that this information is handed out early in your pregnancy so you can decide if this is the way you want your labor managed.

Warriors- what should our battles be? We do not need to fight with care providers when we are in labor. We need to battle our fears ahead of time- not in labor. We need to fight fatigue and do the work of labor , and those around us need to be on our team- our comrades in the battle!

I love the scripture in Exodus 17 "Moses' arms soon became so tired he could no longer hold them up. So Aaron and Hur found a stone for him to sit on. Then they stood on each side of Moses, holding up his hands. So his hands held steady until sunset." As a doula, as a friend, as the care provider, as the nurse...this is our role with a woman in labor.. to hold up her hands so she will be supported even when tired...

I love this quote by Laura Stavoe Harm,"There is a secret in our culture- it is not that birth is painful, it is that women are strong." We need to find that vigor and courage that we are made to have in labor. Being courageous is what makes us warriors. Having the courage to keep looking if the place and provider is not the right one for us; having the vigor to drive farther away to get those if they are not in our neighborhood. We need to have the courage to look within ourselves and determine the path we want to follow. But part of that determination must be with informed consent.

And we need to take ownership of our decisions.For instance you can not decide to get an epidural and then complain about the side effects you may have from them- as if someone made you get that epidural. You can not stay with your care provider and then in labor when they are not supportive complain that they are not on your team.

Warriors are made by battling through adversity- finding the truth for yourself- and having courage to move forward. It is not about a prescribed way to give birth- it is about making it your own!

It is in a relationship...

Relationships take time to develop. When you pick a doula it is best to hire her as soon as you can so you can develop a relationship with her. She needs to be someone you feel you can be honest with and share your inner most thoughts regarding your birth fears and ideals. It needs to be someone you can trust. This is a double road though- it is up to you to make this happen as well as the doula.

We had a client who hired a doula several months out. Although they discussed things and chatted along the way, some things were said or shared that made her question her decision in her selection of her doula. She did not address these concerns. She did not ask for clarification or share her thoughts about what was said or misunderstood. And just like when your partner does a bunch of little things that bother you and you do not address them, the group of them together makes for a sore spot between you. This did not make for a relationship that would foster a great doula-client relationship.

We see women select care providers and find out along their journey that this care provider was not going to be supportive of their ideal birth. But instead of addressing their concerns, they either dismiss them or they decide that perhaps it won't really make a difference. But this is a relationship that will not foster a great care provider-client relationship.

Do yourself and your doula a favor... in fact do everyone in your life a favor and share with them the thoughts that make you uncomfortable when they occur. Address them so they can either be resolved or so a decision can be made early on to switch doulas if the doula is not a good fit. Sharing early on may have been something that could have allowed the relationship to grow and flourish rather than falter. After all it is about the relationship. Every match is not one made in heaven. But being honest is the best way to maintain relationships that will bring the blessings to your life and your birth!

We had a client tell their doula they did not want a particular doula to be their back up. When questioned about it, they did not feel she would be a good fit since her personality when they met seemed different than what they felt they may need in their labor. We have enough back up options that we certainly are able to accommodate that request. But keep in mind, just as Paul states in the bible that he became all things to all people to win as many as possible, a doula can become what you need. For instance I have had clients want me to be gregarious and fun in their labors. I have had some ask for almost complete silence in their labors. I have had some who loved the casual conversations in the background that insured them all was normal. Doulas become what you need in your labor. But you need to let them know what you need. Since every woman has her own particular needs, your doula needs to know what you think you will need. But ironically that may change when you are actually in labor. She knows how to be flexible as your needs change.

A doula who is gregarious and funny at the Meet the Doula Tea may be the quiet, calm spirit who holds the sacred space of labor and birth for you. So, remember just as you may have a different personality at a party than at your labor, so she may as well. Ask questions that will enlighten you to her full personality before deciding she may not be who you are looking for to support you.

I often tell women not to lie to their care provider- don't expect them to be truthful if you are not willing to be truthful to them. I feel if you can't be vulnerable and honest with them, your relationship is not one of trust for your labor and birth. This is certainly true for your doula as well. Be honest, be vulnerable, be open- it will help your relationship become what will be most beneficial to you for your birth experience. Understand that misunderstandings occur, but share your feelings if they do so it can be cleared up. Communication is paramount for growth in this relationship.

I spoke to a friend who is a bit older than me. I said the bad thing and the good thing about getting older is you don't care what people think of you. But the truth is you should always care how others feel from your actions or words. But again, sharing how one makes you feel will help resolve any negative feelings you may have from someone else's actions. She said that sometimes when we get older we know things, we feel we need to speak the truth- even bluntly- and that those who are not in the same place are unwilling to hear the truth. I think about the phrase, "folks don't care how much you know, they need to know how much you care."

Sometimes I think in an effort to share what we know from our experience, we have our comments come across too emphatic and opinionated. I used to think that if you did not fully believe something, then you could not really have a strong opinion worth sharing. Now with age I realize everything is not so black and white. Fully supporting women sometimes means not sharing your opinion unless they really ask for it. As a doula that is often hard to not feel the need to share what you feel is truth that will protect them. But sometimes too much information can overwhelm a mom. It is a fine line in this relationship. We begin to feel responsible for them instead of to them.

Polly Perez a friend of mine- and an internationally known birth advocate shared this with me recently. "

I had to remind myself the difference between feeling responsible TO or FOR many times....
That is why I wrote the following handout and even put it in one of my books hoping it might be helpful to others.
Hope this will help your in some way in your current situation....

Here is the handout---
The Difference in Feeling Responsible TO and FOR

When you feel responsible TO others....
You show empathy, encourage, share, confront, level, are sensitive, listen.
You feel relaxed, free, aware, high self-esteem.
You are concerned with relating person to person, feelings, and the person.
You are helper/guide.
You expect the person to be responsible for themselves and their actions.
You trust and let go.

When you feel responsible FOR others....
You fix, rescue, control, carry their feelings, don’t listen.
You feel tired, anxious, fearful, liable.
You are concerned with the solution, answers, circumstances, being right, details.
You are a manipulator.You expect the person to live up to your expectations.

So, find a care provider and a doula who will feel responsible to you. And be responsible yourself and share your feelings- after all it is about developing a relationship. Be open and honest. Let her know what you think is important and will need. And then know you will be fully supported in your labor and birth!

Semantics....

Recently in a prenatal meeting I posed a number of phrases to get the couple's thoughts- it helps me to understand what is important to them. There was one "I gave birth, I was not delivered," that I posed to them. Usually it is met with how they feel giving birth is something they do- vs. being delivered is something that is done to them. But this mom did not share until much later what she felt about that phrase. She said, "I actually prefer the word "deliver" because it's more empowering to me; "birth" seems too passive, as if you're a bystander."

This response made me realize that different things provoke different feelings in folks. I have to say this was the very first time in years of using these phrases to promote understanding and dialogue, that a woman shared this thought. I realized that if she felt "deliver" had more power, than by all means I wanted to use the word "delivered" when talking to her about her experience.

But this made me realize that if words are powerful, who gives them the power? Individuals do! It is important to allow a woman to use the words that help her have more power. For instance the hypnobabies program have words they use... deliver is replaced with giving birth, the husband is the birth partner, contractions are pressure waves or sensations, labor is birthing time, pain is discomfort, labor room is birth room, transition is transformation, false labor is pre-birth waves, pushing is ahhhh pushing or breathing your baby out and due dates is guess dates. They want to replace all negative connotations to be positive words.

But wait- who makes words positive or negative? Shouldn't the mom be able to decide what works for her and what does not? I personally like the word birth more than deliver- but it is not my birth- or not my delivery- it is hers.

Hypnobirthing has their own words to use- some that are considered no nos that promote fear instead of correcting the years of negative subconscious belief. Well again- what if our subconscious belief has been full of positive birth beliefs? And what if we are not afraid of words like powerful contractions or labor is hard work- or labor hurts but I can do this? Shouldn't I be able to use those words or phrases?

I think women should use the words they want to use. I hate that my phrases that were to promote thought and discussion made this mom feel I was coercing her to believe my words... nope - I wanted it to help her discover what she felt. And it did. Words are only given power by the one using the words or finding the word has power for them. Please share the words you need with those who are there to meet your needs!

My youngest daughter uses words I am not comfortable with sometimes and when I say so to her- she reminds me that we give the power to the words- that words themselves have no power. So, if you want to have specific words used or not used in your labor- then tell those around you what words work and what words you want to have avoided. If you are surrounding yourself with folks to help you achieve the experience you want, help them to help you by sharing the words you desire to hear as well.

But, I think it is unrealistic to expect everyone in a hospital atmosphere to not use their "normal" phrases. At a home birth it may be easier to accomplish this. I think making some birth art or encouragement cards with the phrases would be a great reminder for those around you. I have tried in my years as a doula to help change some semantics by hospital staff thinking I was helping women. For instance I do not like referring to a mom as the cesarean section but instead she is the mom who had a cesarean birth... But much to my surprise, I was taught by some wonderful women in ICAN that they did not like the term cesarean birth- because they felt it softened the surgical experience that they so wanted to avoid in their future.

There are several other phrases- like the word circumcision vs genital mutilation- hmmm you know how one feels based on using that second phrase don't you? But some words hold less impact on their use- for instance I love the baby who is breastfeeding called a nursling- the mom nurses her baby- because I feel it is much more than just feeding a baby at the breasts. Lactivist call formula artificial breast milk. When a woman says the contraction she just had was a bad one, I do try to get her to use the word powerful instead because I think it helps her to re-identify it in a more positive way. I am not sure I will ever get women to embrace the word rush or surge for contractions... even though I do think labor can be a series of rushes and rhythmic surges... but some moms don't relate to those words. And who am I to try to make her use my words?

So, rather than forcing a woman to use words that she does not relate to or words that for her have no power- words that she has a hard time embracing- let's let women decide for themselves what they want to call their experiences... when we force them to embrace our words we dis-empower them by doing so. So, explore new phrases- ask yourself how the words make you feel- then share the ones that work for you with those who are there to help you!