posted April 07, 2004 08:04 AM           

I figured that you may have some knowledge re: the below:

For the past few weeks, my OB staff as been concerned that my kiddo's "small for date" (I'm currently at 37 weeks and some days - EDD 25 APR -, and my fundal height's been about 1.5-2 weeks behind for a bit). An ultrasound was ordered at 34 weeks, at which point she was pegged as being about 2 weeks behind in her size (roughly 4 pounds); though her heart rate, "practice breathing" movements, cord attachment/flow/etc., and amniotic fluid levels were all fine. Since that point, I've had weekly Non-Stress Tests, each of which (when they kept her monitored long enough for her to wake-up) she "passed" with flying colors with "textbook" readings.
My OB would now like another ultrasound this Friday, saying that if her growth has "slowed" (if she's below about 5 1/4 pounds by that point), he's going to order an induction for Tuesday or Wednesday of next week.

My concerns:
* Aren't ultrasounds notoriously sketchy re: weight?
Is there anything that the technician/OB can do to ensure the verity of the readings?
* I have been pushing for/working towards an unmedicated birth (against the apparent wishes of *everyone* in my support system, although my husband's going to support me in the hospital room...he was mostly frightened that I was going to start screaming at him in the midst of labor). Just how difficult is it to make it through induced contractions?
--- What are the risks (both to mother and baby) inherent in a pitocin induction? Is breastfeeding more difficult to establish, even after an "uncomplicated" induced birth?
--- Why is the rate of jaundice in the newborn higher with induction?
--- What is the average C-Section rate associated w/ such an induction? Why is it higher than with non-induced labor? What risks to the child (especially respiratory) are associated with C-Section?

A note: I can neither give birth in a birthing center nor afford a duoula.
My husband is currently in military training in southeastern Alabama, and we are pretty much bound by the constraints of TriCare Prime and our location.

Thank you very much for any help you can provide.

- Corri

posted April 07, 2004 12:28 PM         

as you are under the care of the medical establishment, i don't know how well you will receive this advice, but anyway.....

i believe babies will come when they are ready, and there are so very many who do not fulfill all the criteria of the 'statistics', who are perfectly healthy.

a good midwife will tell you this. she also would tell you that, as an outstandingly healthy young woman, you have everything to gain from a homebirth and nothing to lose.

i know that your insurance is covering your medical expense, but does it cover all of it, or do you have to pay a percentage?

either way, if you were to contract a midwife right now, she probably would not charge you a full fee, and she probably would allow you to pay in installments that you could afford. in my case, the cost of the midwife was drastically less than even the small percentage of the hospital fees i had to pay.

an induction is an extremely traumatic experience for a little babe....and an experienced midwife would know if there were any problems and would not hesitate to send you to a hospital if truly necessary.

pig semen (pitocin) is not the way nature meant babies to be forced into this world!

it must seem outlandish to you, but my heart hurts every time i see a babe subjected to the trauma of a hospital, so i added my 2 cents anyway.

i would like to add that, in the event of an emergency, a hospital and its staff are a gift from heaven. i'm not condemning hospitals here at all. just so you know.

love and light and happy birthing,
talaith

posted April 07, 2004 01:49 PM         

Sending you much light...for you and the wee one.

posted April 07, 2004 02:53 PM         

I can't claim to be any kind of expert regarding this stuff.. I'm even hesitant to give advice that goes against what your OB says because I care a great deal about you and I don't know how I would forgive myself if you took some of my advice it turned out to be harmful to you or your little one. Also I've recently read some freaky stuff regarding new laws that hold women legally accountable for the health of their unborn children. Like the woman who refused to get a c-section and one of her twins subsequently died.. She's being charged with murder. *shudder*

That said, I would foremost recommend that you listen closely to and follow your intuition. So far, it sounds like the only unusual thing going on is the baby's size, everything else shows she is fine. I'm not sure about the ultrasound's reliability regarding weight or any better way of measuring that. Either way, I don't understand why the doctors think she will be better off outside your womb for these last three weeks? It seems to me that the medical establishment doesn't have much faith in women's bodies. Doctors seem soo quick to perform C-sections or start the pitocin drip. I don't think they are necessary half the time they are administered. Most often I think that C-sections are performed to protect the doctor from potential lawsuit. I suspect that you doctor will want to induce labor because that is the only way he can see to 'control' your pregnancy which isn't fitting his expectations of how it should be progressing. If there were other indications indicating stress or trouble I would be more inclined to suggest induction but if the baby is just small... well.. lots of babies are born small and perfectly healthy. Weren't you a small baby?

I have heard that the pitocin drip and the epidural often go virtually hand in hand. Pitocin makes the contractions come harder and faster. However I do have a friend who had labor induced with pitocin and she didn't get the epidural. It was very difficult but she did it, so it is possible.

Here's some stuff that I found about the risks.

quote:

---

(From "Birthing from Within")

Maternal-
*Hyperstimulation of the uterus resulting in prolonged (tetanic) contractions, which can cause:
~Premature separation of the placenta (abruptio placenta)
~Uterine rupture resulting in emergency Cesarean birth or death
~Decreased oxygen to the baby (because of reduced uterine blood flow)
~Rapid labor and delivery resulting in cervical or perineal lacerations, pelvic hematoma, and trauma to the newborn

*Water intoxication (because pitocin is an anti-diuretic) leading to an irregular heart beat, hypotension, nausea and vomiting, excessive swelling, and difficulty nursing

Fetal or Newborn-
*Tetanic contractions cause decreased oxygen supply to the fetus, resulting in fetal heart rate decelerations.
*Newborn jaundice
*Decreased platelet aggregation (clotting capacity)

---

I don't know why the jaundice is more likely..

I haven't come across actual statistics yet as to whether or not c-section is more likely after induction but I would bet it is. I found a stat that says a white woman with insurance in certain hospitals in this country has a 50% chance of c-section! I believe this is from fear of lawsuits. Many doctors believe c-section to be a safer method of birth. I would ask your doctor what his rate of c-section is, aparently hospitals keep a record of this. Ask him also what his beliefs on the matter are. A 1996 study showed that 31% of female and 8% of male OBs said that they would want a c-section if they or their wives were pregnant.. Many said even if the pregnancy were uncomplicated or low risk.

I'm going to do some more looking around today for info and come back with what I find, prox. How would you feel about posting your question at this forum- MotheringDotCommune. It's affiliated with the magazine called Mothering which I think is a wonderful publication. There are lots of experienced mothers there that I think could have some useful advice..

posted April 07, 2004 03:02 PM         

FK, did you have to have constant electronic monitoring during labor? I've heard that because of the risk of oxygen deprivation due to the pitocin that this is necessary.

posted April 07, 2004 03:05 PM         

Oxytocic Drugs
Oxytocic Drugs [like Pitocin] are like "holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air but not to breathe".

"Few childbearing women realize the inherent risks of oxytocic drugs. In addition to the more benign effects of uterine stimulants, the American manufacturer of Pitocin points out in its package insert that oxytocin can cause:

maternal hypertensive episodes,
cardiac arrhythmias,
uterine spasm,
titanic contraction,
uterine rupture,
subarachnoid hemorrhage,
water intoxication,
convulsions,
coma,
pelvic hemotoma,
postpartum hemorrhage,
afibrinogenemia,
fetal death.
Uterine stimulants that foreshorten the oxygen-replenishing intervals between contractions by making the contractions too long, too strong, or too close together increase the likelihood that fetal brain cells will die. The situation is somewhat analogous to holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air but not to breathe.

All these effects increase the possibility of neurologic insult to the fetus. No one really knows how often these adverse effects occur because no law or regulation in any country requires the doctor to report an adverse drug reaction to the country's drug regulating agency, even if the patient dies."

-Doris Haire, R.N., CNM "Update on Obstetric Drugs and Procedures: Their Effects on Maternal and Infant Outcome," Birth Gazette 13:1, 1996.

Induction Warnings
-by Gail J. Dahl. author of Pregnancy and Childbirth Tips. This letter originally appeared in Midwifery Today's Birthkit, Spring 2001.

I read with shock that physicians are offering induction at 38 weeks in the United States. I am sure that this offering is made without informed consent being given. Perhaps we need new warnings like:

Warning: Induced labor may cause permanent brain damage to your baby.
Warning: Induced labor may cause you to undergo an emergency cesarean operation.
Warning: Your baby requires 38–42 weeks and longer for gestation. Forcing your baby out of the womb early may cause risks and side effects to occur to both you and your baby. Some of these side effects may cause permanent damage.
Caution: Taking your baby out early by induction drugs may permanently damage your baby’s immune system.
Warning: Ultrasound date estimates are often in error by more than two weeks. Inducing a premature baby will cause harm to both mother and baby.
Warning: A birth induction using the pig semen derivative PE2 may cause you to lose your sex drive for years.
Warning: A birth induction may cause you to hemorrhage during labor and for months after the birth.
Caution: Allowing your baby and your body to choose the birthdate will give you a faster, easier and safer childbirth.
Hearing the stories of women who have experienced a failed induction and women and babies who have experienced permanent side effects from the hormones used to force labor is one of the saddest parts of my day. I believe that injecting these men who are so willing to rape our babies from our bodies would give them a touch of how it feels to be torn apart from the inside. I liken birth induction to smashing a tube of toothpaste out with a hammer. Sure you got it out, but what is left of the baby and mother?

The artificial contractions actually slam your baby's head into your pelvis unlike a normal contraction that will squeeze your baby out. It is critically important that we begin to inform young women about the dangers and risks of this procedure before they become pregnant, when they are open to new information. I hope you continue to speak up about the dangers of elective labor induction.

-Gail J. Dahl

Also by Gail J. Dahl: Whose Schedule?- Induced Labor and Informed Consent in Canada This is the story of how one woman's hospital birth experience changed her from a real estate agent into a bestselling author and childbirth activist. A must-read!

these things are important.

posted April 07, 2004 03:07 PM         

OXYTOCIN (PITOCIN)
Description
Oxytocin means "rapid birth." It is a synthetic hormone named for the natural posterior pituitary hormone. It stimulates uterine smooth muscle contractions indirectly and helps expedite the normal contractions of spontaneous labor. As in all significant uterine contractions, there is a transient reduction in uterine blood flow. Oxytocin also stimulates the mammary glands to increase lactation without increasing the production of milk. The drug is administered in the prehospital setting to control postpartum bleeding.

Damn it, please post real information and not some wives tales about pig semen. Although semen does carry oxytocin, scientists do not gather up a bunch of pig ejaculate, glean the hormone from it and inject it into a pregnant woman.

Here is more information on the SYNTHETIC chemical:
http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/oxytocin.html

Here is the actual pharmaceutical insert:
http://www.kingpharm.com/uploads/pdf_inserts/Pitocin_PI.pdf

You are maybe thinking of Prostin E2:
http://www.pfizer.com/download/uspi_prostin.pdf

Although I am not a big proponent on inducing labor - it may have to be done in various circumstances. I was an induced baby as was my brother as well as several other peeps I know of. I was only 6lbs, and now I am 5 foot 9 and no one would ever confuse me with being a weakling. LOL

Also, it is very evident you are anti-doctor Taliah - which is your choice, but you are quoting from some of the few stories out of MILLIONS of births.

I know someone like you that hated doctors. She was a nurse and felt the medical community had much to be desired (and on some fronts that is true).

She decided to have her baby with a midwife...and went through hours upon hours of labor.

posted April 07, 2004 03:41 PM         

proxi-
K-NOW that your body was made to go through this perfectly natural physiological event and that your heart knows the right decision to make, be it to follow the doctors advice or go out on a limb.

posted April 07, 2004 03:45 PM         

i honestly don't hate doctors....they have helped me tremendously. i didn't mean to imply that.

some medical professionals have referred to pitocin as pig semen, in my experience. perhaps they were talking about PE2.

regardless of the method of induction, many experts agree that any type of induction is harmful, even natural ones, such as black cohosh, which many midwives use.

also, i do agree that there exist both good and bad practitioners in both fields, medical and midwifery. and the harm that each causes is very sad indeed. i'm very sorry about your ex-sister-in-law's child. i did mention that one would need to find a good midwife. i too have had experience with an incompetent one. for my next child, i definitely will find a good one!

and there are many studies showing that homebirth is a safer birthing method than hospital births.

posted April 09, 2004 04:59 PM         

My experience- I had a vaginal birth with my son- 2 weeks premature, 10lb 3oz moose, they gave me pitocin, very painful -but he was stuck. it worked, although at times I wondered if perhaps I should of had a c-sect. My point is, if doc is concerned with the growth for some reason, and wants to induce, I would feel because of perhaps the size of your little one, your delivery time may be lessened, you may not need "as much" of the pitocin to make things happen, with me, they just kept increasing and increasing and increasing.......anyways, was born healthy........both of us traumatized though, dang (lol)

Two years later I gave birth to my second daughter, 4 weeks early...7 lb, 5 oz (I make 'em big I guess) she was jaundice and and had some minor respiratory problems, couldn't come home for four days, had to remain in incubator........tough, mentally draining.

There appears to be concern on behalf of Dr. regarding the weight, ask a lot of questions, talk to the nurses or his assistants, express your concerns and ask their opinions. Having unnecessary c-sections seem to have slowed down. My main concern is why he is so concerned with the childs growth rate.......me, if there is that much concern.....I would simply say, lets "do it now", especially if this guy has been around for awhile and he knows what he is doing. I'd rather be safe than sorry......again, ask lots of quesitons, then go by what your gut says.
Also, make sure its just not a scheduling issue with him, I've heard where sometimes things are "sched" because of someones vacations, etc., which in my oppinion is kinda sick, however is reality.
Watch the "red flags".

Good Luck Schweeetie, you'll be in my thoughts.

posted April 09, 2004 11:50 PM         

I put my faith in my midwife, when every instinct I had told me that she didn’t have my best interest at heart. I told her hours before she broke my water that I needed to go to the hospital for this birth, but she said no. I shouldn’t have listened to her.

I wanted to find a new midwife in my 7th month, but my husband would have none of it. He trusted her, he said, and insisted we keep her. So I did so for him. The problem with my labor was that my babe was in the ‘military position’ meaning he was facing backwards (not breech, or upside down). The thing is, the midwife knew this, and told me so in about my 5th or 6th month. She said it was nothing to worry about, and that I would need to do some exercises.

She never told me what exercises, although I asked repeatedly, and she never mentioned it again. I assumed that she knew that everything was fine; she said it was numerous times after that.

Well, it wasn’t. after our c-section at the hospital, she came to my room and apologized; told me she should have known that his position was the reason I wasn’t dilating and that my labor was so painful and the birth so difficult. Sad – it didn’t have to be.

But – she did know! She lied. Why – I’m still trying to figure out. When I look back, I see all the little signs: she never remembered my name, lost my file constantly, lost the directions to my home, was always late for my home visits, etc….

I always gave her the benefit of the doubt though. She has one of the best reputations in my state. What I believe is that because she is a fundamentalist Christian, she judged me as not worthy to have the home/water birth I so desired. She knew I had good insurance and would be well taken care of at the hospital. I think she knew all along that I would require emergency transport to the hospital. Which I could have avoided if I had gone when I knew better.

Anyway, the most important thing is to trust totally your healthcare provider, but more importantly, your heart. and having all the facts helps tremendously.

The hospital people who performed my birth were the most kind, gentle, generous, loving people….and they will always be in my heart. they saved my son. And I am very grateful for all of them and their expertise.

posted April 10, 2004 12:54 AM         

prox~ you are in my thoughts

posted April 12, 2004 09:55 AM         

best wishes to you and your babe. i would love to be pregnant -- lucky you. i know it will be a wonderful experience for you.

the articles i posted above are available at one of my favorite webstites, called birthlove.com (some articles require membership; some very good ones don't). another great site for discussion is called the Earthy Birthy Thought Swap. lots of wisdom there (lots of thrifty tips too).

Birthlove
Earthy Birthy

posted April 13, 2004 05:15 AM         

EVERY DRUG HAS SIDE EFFECTS!!!!! But it does NOT mean that any side effect will occur. The manufacturer has to list ALL POSSIBLE side effects, according to Federal Law!! This does NOT mean that any or all will happen!!!

Tylenol can damage your kidneys, your liver, so does that mean that if your kid has a fever, the kid will not be allowed to take Tylenol? Come on!!! Quit scaring the crap out of Prox!!! The safest place to have a baby is in THE HOSPITAL!!! where there are trained medical professionals at your fingertips. Yes, Midwives are wonderful, but I too have seen births go bad cause Emergency Medical help couldn't get there fast enough!!!

All this misinformation can only serve to scare Prox....and this is a time that should be blessed and serene...not full of terror.

I had induced labor and my son grew up to be a wonderfully healthy person. Breast feeding was absolutely NO problem!! I also had NO drugs....all natural delivery....so induction does not mean ULTRA INTENSE pain.

Prox....many blessings to you and your baby. May your Guardian Angels and the Angels of birthing stand by your side and make it an easy, happy birth!!

posted April 13, 2004 10:42 AM         

proxieme asked the folowing question:

quote:

---

--- What are the risks (both to mother and baby) inherent in a pitocin induction?

---

therefore, i answered her question honestly and forthrightly. and my baby was induced, and it caused much unnecessary trauma. and to repeat the above:

quote:

---

No one really knows how often these adverse effects occur because no law or regulation in any country requires the doctor to report an adverse drug reaction to the country's drug regulating agency, even if the patient dies.

---

different people believe different things. many people believe passionately that home birth is safer than hospital birth, with studies to show it. and vice-versa.

the point is, we all cared enough to respond to proxieme, from our hearts and what is true for us.

i most definitely would want to know all the side effects inherent in any drug i would give my child, especially how it would effect his birth. and then make my own decision.

dear proxieme ~

i am sorry if what i wrote caused you any fear. i do wish you a serene and blessed birth.

posted April 13, 2004 11:52 AM           

LTD - Thank you for reassuring me re: induced birth. We went to the OB yesterday and discussed the results of the ultrasound; he said that while she's still small, she has been growing - she's probably just meant to be a lil' kid (which makes sense...most of the babies on my Mom's side are & my Grandmother's convinced that smaller babies - within reason - are more hardy). He said that his gut had been to go with an induction this week, but since I'm only 1 cm dilated and 50% effaced, he doesn't want to put me and the kiddo at risk for a C-Section - although we'll see how things go next week.

I'd heard some horror stories re: induction, but now I realize that I've also heard horror stories re: "normal" birth, home birth...every kind of birth.

Harpyr -
Yep She's small but respectably so

And I'd like to reiterate -

posted April 14, 2004 02:45 PM         

------------------
Sincerely,
divinia

posted April 15, 2004 09:07 AM         

Not disregarding what anyone has said, although I might would have to argue that some of the things posted in this thread were LESS than tactfull for a pregnant woman to read who is nervous enough already! But, that said...

I was given picotin with my first daughter, and it was the most pleasant of deliveries, but then again, is there a pleasant delivery? Not really coz it hurts, BUT, the benefits are wonderful and just keep that in your mind...you'll see your baby!!

As far as sonograms and their weight predictions, sometimes they are right on target..sometimes not...with my first daughter the sonogram pegged it perfect and she weighed 7lbs...the 2nd child though, they told me she'd be like 10lbs...and she weighed 6lbs 13oz...so....

But, keep taking care of yourself and listening to your physician...and ask him/her tons of questions...that is what they are there for!