Sunday, August 8, 2010

So much to do, so much to learn, so little time

I'm around 37 or 38 weeks along now, and it's mind-boggling to think how soon we are due to meet our newest arrival. On the one hand, I can't wait - on the other hand, sometimes I can't help but wish we had just a bit more time... a bit more time to learn, to prepare, to research. Either way, of course, the baby will be coming at the perfect timing.

Today, when we took Shira for a few check-ups, I picked up a magazine while waiting in line. It was an old one, back from 2001, but it featured some very interesting stories. A tragic one spoke of a woman who delivered a healthy baby but died soon after because of an uterine rupture caused by pitocin administration. The uterine rupture went undetected for a period of time which could have been crucial to intervening, because the effects of her epidural didn't wear off yet.

Pitocin and epidurals, probably the two most common birth interventions, which are supposed to be completely "safe" but obviously are not - and in the case mentioned above, their combination caused death. When a deadly complication does occur, the hospital speaks out saying that "complications are extremely rare and could not be predicted". Of course no one can predict who is going to be the victim of such a tragic outcome. But you know what? If something carries risk, however slight, you do not use it unless there is an obvious and unequivocal need. Isn't this plain common sense?

In most cases when pitocin is applied, it is not because there is an obvious and unequivocal need to use it. It's usually because a woman went past her due date (which, let's face it, can be a pretty random number) or because her labor slowed down once she arrived in the hospital (no wonder, with all the poking and prodding it can get extremely stressful - a hugely important factor in determining ease and efficiency of birth. Any veterinarian can tell you that, but when we're dealing with humans we forget it for some reason). And epidural? There is never a real "need" for one (in a normal, unmedicated, naturally progressing labor). It does nothing for the actual well-being of Mom and baby or for advancing the labor - on the contrary. But it's very convenient for the staff and we've been convinced into thinking we can't ever do without it.

Even if the risk is "minimal", why take it when it's possible to go risk-free?

Here's a link to a blog I discovered today, called Midwifery Ramblings. Read the lovely home birth post and the post on the dangers of pitocin.


Katie said...

My dear Mrs. T.,

I agree that natural childbirth is best. However, I strongly disagree that there is never a "need" for an epidural.

When my water broke, I wasn't dilated, effaced, or experiencing contractions. I wasn't "in labor" at all, but obviously needed to deliver the baby to prevent infection. The midwife tried several mild methods of induction before deciding to use pitocin.

The pitocin-induced contractions were so painful that my blood sugar skyrocketed to over 200. I was allowed to choose either an epidural to stop the pain, or an insulin drip to lower my blood sugar. Using insulin would have put the baby at risk for extremely low blood sugar. I chose the epidural, my midwife allowed me to rest for a few hours until the baby dropped, and then I experienced an easy delivery. The baby's blood sugar and mine were both fine, which would not have been the case if I had used insulin.

I truly feel the epidural was a necessity for my baby's health. Without it, my baby may have been born with low blood sugar, and needed medical intervention. Instead, he was perfectly healthy, and he and I were able to spend the moments after his birth cuddling together.

Mrs. Anna T said...

Katie, I should have clarified that I mean the general stance that women "need" epidurals to numb labor pains - otherwise, it's "impossible" to handle natural (not pitocin-augmented, which is far more painful) labor.

The Stay at Home Wifey said...

Having just given birth 2 months ago to our wonderful first born, a very contented boy called Aiden, I agree that oxytocin and epidurals are way overused. In our case my labor started with my waters breaking, then soon after contractions started. I labored very slowly with contractions only 5 min apart from the beginning. I was home birthing with a midwife, but due to the regulations here in Florida I timed out after 24 hours and only 8cm dilated 80% effaced. I then had to transfer to the hospital. I was given oxytocin to try to finish labor, but it had no effect on me at all. Then after another 6 hours I was given an epidural so they could give me the strongest dose of oxytocin and so I could get some rest before the pushing started. None of this worked and so after 13 hours in the hospital with absolutely no progress I ended up with a c-section.

Had I been allowed to continue past 24 hours at home with the midwife I truly believe I would have eventually birthed my son naturally. Now I will have to fight just to be allowed to try again with any future blessings as very few hospitals in Florida allow VBAC's.

Hope everything goes smoothly for the arrival of your new blessing.

Hope said...

Respectfully, everything in life has some risk associated with it. So it's impossible to ever go "risk free". It just depends what your personal factors are as to which course of action is the least risky. Crossing the road involves some risk, but if my garden didn't grow very well and I cannot get food otherwise, then the risk of crossing the road is simply less than the risk of possibly starving before the next harvest. But good points otherwise!

American Niqabi said...

THat's so exciting that you'll be having anothing little one in just a couple weeks! :) Congradulations and I"m so excited for you and your family. :)

Mrs. Anna T said...


I must say I don't exactly get your example of crossing the road.

What I meant is: the vast majority of birth can be intervention-free. When interventions aren't *needed*, of course it's *less* risky to go without them. So our health care providers are supposed to push for the sensible approach of as little intervention as safely possible.

Mrs. Anna T said...

The Stay at Home Wifey,

I'm so sorry for what you had to go through. My first labor was over 24 hours as well, with a "break" in between, and I find it horrifying a woman will be pressured into so many interventions just because she wasn't "on schedule".

Anonymous said...

I love your blog and wish you every blessing as you await your new little one.

I'd like to say that while I'm not a fan of over-intrusive medicine, that there are definitely very wide gradations of labor pains and I'm glad I had access to epidurals for my labors and deliveries. My babies were large, the largest over ten pounds, and the pain was beyond my ability to cope with it by the time I had dilated to four. On the other hand, my sister, who compared her labors to "mild cramps" and never had an epidural, stood by my labor bed with tears in her eyes, saying "it was never like this for me."

So for all the moms out there who needed - and received - epidurals, I feel; I felt your pain. :)

mom_of_4 said...

Mrs. T, I would also like to offer an opinion to whether there is a "need" for an epidural. My first labor was very long and didn't progress because I was inexperienced and fighting the contractions and the feeling of being out of control. When I finally got the epidural, I was able to relax and rest and my labor progressed much better than when I was on my own. My second labor was with twins and an epidural was needed for a manual intervention to turn the second twin internally. My last labor was so quick an epidural wasn't needed. No matter what, the baby comes out and no mother needs to feel shamed for how she managed the process. Yes, epidurals often lead to further intervention, and I agree that the majority of mothers could labor without epidural with the proper preparation and support, but if their birth experience is a positive one because of it, then who are we to judge?

Mrs. Anna T said...

Mom of 4,

I do not want to sound argumentative, but it seems to me that during your first labor, perhaps you wouldn't have needed an epidural if there was a supportive, experienced figure near you (a midwife, doula, simply a mother experienced with natural birth), who would encourage you and tell you that you should work *with* the contractions, not fight them.

I'm far, far, far from judging any woman and it's very difficult to look in retrospect and speculate how things COULD have been, but if the inhibition is fear of contractions, surely women should be encouraged to find alternative ways to go through them, instead of being encouraged to take an epidural as happens in all hospital settings today. The first doctor who heard I wasn't going to get an epidural actually snorted and said something along the lines of "you'll be begging for it."

This is not, and I repeat, NOT about making mothers feel guilty about "not doing it as naturally as possible." But the simple fact is that epidurals carry risks for mother and baby, and therefore should be avoided (not encouraged! not pushed!!) when at all possible.

mom_of_4 said...

Mrs. T, I think you're right in that a good support person who can coach someone through their labor would greatly reduce the "need" for an epidural. What I wanted to offer is that for those who do not have that support, or the ability to manage pain, the benefit of an epidural can sometimes outweigh the risks.

Karen said...

Pitocin can also cause fetal distress which in some cases can be fatal. However when your labor goes on for more than 18 or 20 hours after your water breaks, you start to be at higher risk for dangerous infection. If it comes to that point I do consent to pitocin as I would much rather have that than a c-section.

As for the epidural...knowing how bad my labors hurt I can never blame a woman for wanting one. I know I personally can't resist the offer once I'm advanced in labor. If I'm at home I still want one...I just can't have it LOL so it's better for me to be at home even if hurts so terribly bad. I had Bell's Palsy from my last epidural so I'm not going to push my luck again.

Mrs. Anna T said...

Karen, it's true you are in higher risk of infection when your water breaks - which is a VERY GOOD REASON to perform fewer cervical examinations. They expose you to a higher risk of infection! But of course doctors ignore this and just shove their hands to "check" how you are "progressing", all the time. And then they push pitocin to "protect" you from the danger of a prolonged labor - which is often caused precisely by them not leaving you alone.

And I won't even talk about the idiocy of *artificially* breaking the waters, and THEN beginning to worry about increased risk of infection when it fails to "augment" labor.

Being in the hospital with all the unfamiliar germs increases risk of infection too, versus being in your own home.