by Christine Ramos, RN, BSN, CCE, CD, CBC
When Angela was 5 months pregnant she was diagnosed as having a mild case of symphysis pubis dysfunction, (a condition during pregnancy where the gap between the two pubic bones widens, causing discomfort or pain). During a routine prenatal checkup in her 34th week, Angela complained to her obstetrician that her pelvic discomfort was keeping her from having a decent night's sleep.
Her obstetrician readily assured her that in four weeks she would not have to endure the discomfort any longer. He planned on inducing her labor on her 38th. week of gestation. Though initially uncertain whether she wanted a medically induced labor Angela complied with her doctor's plan simply because she trusted his judgment. She figured if it there were any risks he would sit her down and discuss them, not appear so confident and unconcerned as he did during that visit in his office. Angela was scheduled for induction on the Wednesday of her 38th week.
But on that day it seemed as though her body and baby were simply not ready for the birth that was commanded of them. Angela did not respond well to the induction methods, (first cervical ripening, then Pitocin intravenously).
Her contractions were incredibly painful but despite her suffering her cervix dilated to only 4 centimeters. Though she wanted to try giving birth without pain medications she couldn't imagine enduring those contractions any longer. Angela tearfully requested an epidural.
And to top it off she was now bed-bound, unable to bear weight on her legs and attached to a fetal monitoring device when she had wanted to be free to walk during her labor. Fear and uncertainty came over Angela and her husband.
After ten hours of ineffective contractions her doctor announced that she'd soon have a c-section due to her labor failing to progress. The couple's baby could not tolerate the powerful contractions without soon being born they were told. In what seemed like a dream Angela was prepped for surgery and shortly afterward her son was pulled out of her uterus.
Instead of the immediate cuddling Angela had envisioned throughout her pregnancy her baby was temporarily whisked away to neonatal intensive care because of minor difficulty breathing. And instead of rooming-in with her son during the postpartum hospital stay as she had wanted Angela requested that he be cared for in the nursery as she was in far too much pain from her c-section.
Months later Angela could not help but feel anger and resentment toward her obstetrician. She subsequently learned how labor inductions lead to twice the likelihood of having a c-section.
So why didn't her doctor discuss these risks in statistical facts to her? Why did he appear so nonchalant over the idea of induction knowing the type of birth experience Angela wished for.
Sure her pelvic discomfort was a nuisance, but was induction a justifiable option compared to the risks involved? Of course she was grateful for the health of her son, but she couldn't help but wonder if she had been misled...
Angela is one of many as more and more women these days are consenting to the scheduling of their baby's delivery, with no medical rationale for it. The U.S. induction rate has more than doubled since 1989. Nearly half of postpartum women in a 2002 survey reported that some effort had been made to begin their labor. Yet interestingly, the World Health Organization recommends that no more than ten percent of pregnant women be induced. It is apparent that despite today's modern techniques, induction of labor still holds considerable risk compared to natural onset of birth. And most inductions are done for reasons simply not supported by sound medical research.
So what is the driving force behind this culture of birth-on-demand? It seems this trend is multifaceted but also reflecting a very revealing occurrence in this society. From the prevailing thought between traditionally trained physicians who believe the human body is a predictable bio-machine to the way how many now view things in life as needing to be convenient, time efficient, and fast paced, birth seems to be just another function to streamline. When presented in a certain way there appear to be certain perks to having a controlled birth:
You can be sure to have your practitioner of choice at the delivery, (Dr. X will be not be on call the weekend of your due-date).
You can arrange for your husband to be available and child-care for your other children while you're expected to be at the hospital.
Want to make it to your sister's wedding with enough postpartum time to get back into shape? Easy! We'll schedule the birth the minute you're thirty-eight weeks.
Indeed, I can certainly understand the allure of a scheduled birth. Sometimes it is for the convenience of the doctor, other times for the patient. Some choose a controlled birth for reasons which seem to have a medical rationale. Many doctors will induce labor for a suspected big baby. This rationale has been shown to produce no benefits but instead increase the chances of having a c-section. Some physicians will induce a woman who's had gestational diabetes. To date there has been no credible evidence in support of this reason for induction. And of course there is the routine induction for the woman who is 41 weeks pregnant. What some may find startling is that there is no sound research which supports routine induction at any point in pregnancy.
Furthermore, experts believe that the median length of pregnancy in healthy first-time mothers is forty-one weeks, which means that a full half of these moms will go beyond their forty-first week of pregnancy.
Then there are the controlled births involving a scheduled c-section. There are women who opt for an elective c-section because of fears of becoming incontinent of urine if they deliver their baby vaginally. Though there is some validity to these fears symptoms are usually mild and infrequent. And there are identified happenings during the birthing process which increase these risks. They are:
- Cutting an episiotomy
- The use of vacuum extraction or forceps to help deliver baby
- Having women lie on their backs while giving birth
- Not having the birthing woman obey her own reflexes to guide pushing and instead allowing care-giver directed pushing which is often more forceful
- Pressing against the woman's belly to help move the baby out
- Pressing against the vaginal opening as the baby's head is born
Avoiding the above will reduce the risk of problems holding urine.
Also, a very effective exercise used for the prevention and management of urine incontinence are Kegel exercises. Kegel exercises work by strengthening a muscle in your pelvis called the pubococcygeus, (pronounced pew-bo-kak-se-gee-us; PC for short). This PC muscle encircles the urinary opening so by strengthening it you essentially gain greater bladder control. Wondering exactly where this muscle is? Try this. while sitting on the toilet spread your legs apart and see if you can stop and start the flow of urine without moving your legs. It is the PC muscle that stops the flow of urine. It is recommended at first you do ten, five times a day; then increase the number of exercises by 5 each week, still maintaining five sets each day.
There are also the women who, because they had a long and hard labor for their first child, are afraid of repeating a similar experience and therefore chose to have an elective c-section. What I teach my expecting mothers is that just as every pregnancy is unique so is every birth. A labor that lasted over twenty-four hours the first time may only be two hours for the next pregnancy.
In fact, I know of many women, both personally and professionally, who have had dramatic differences in their birth experience from one child to their next. The fundamental issue in healthy pregnancies seems to be the tools women have accessible to help them through the process of birth.
Fear of pain, anxiety over the unknown, and the worrying of everything from the health of our newborn to the loss of control all render the mind a very powerful influence over the body. The body then tenses and constricts inhibiting the smooth release of our precious baby.
Tools, whether they be enlisting the support of a doula, utilizing the cognitive techniques of good childbirth education, or relying on acupuncture for pain control all have a similar common goal, and that is modifying how a woman will perceive the experience of birth. In reducing the anxiety and fear we allow the body unobstructed permission to perform its awesome work. Women also have the option of seeking counseling to overcome their deep fears.
Cesarean sections save lives, no one of course will dispute that fact. Millions of women and babies survive what would otherwise be tragic birth experiences because of this marvelous medical advantage. However, c- sections are intended to be an emergency intervention for the safety of mother and child. This procedure is considered major abdominal surgery, one that carries with it considerable risks such as infection, longer hospital stays, post-operative pain, and a much lengthier recovery which often interferes with a woman's ability to bond, adequately feed, and nurture her baby during the postpartum period. All of which again, certainly worth it if it meant the safe outcome of mother and baby.
Three years after the birth of her first Angela is due soon to give birth to her second child. But this time things will be different. First off, she will have a midwife as the obstetric practitioner and a doula for support. Though she will have to give birth at a hospital because of the small risk of uterine rupture she doesn't mind as long as she gives her body the chance of delivering her baby as close to natural as possible.
Her midwife is opposed to labor induction and gave Angela some educational literature detailing why it indeed increases the risk of medical intervention. Angela's expectations for a natural birth are realistic and she thoroughly understands and is accepting of the possible outcomes which may necessitate medical intervention.
But the biggest and most significant difference with this birth is that she's going to allow her baby to do what is expected of him. initiate his own birth. Now adequately educated to the risks of scheduled births Angela will reserve intervention to when it's needed for either the safety of her baby or herself.
It is apparent that perhaps for reasons yet unknown to us the coming of new life is directed by a force with a schedule all of its own.
Christine Ramos is a Registered Nurse with experience in the specialties of Maternal/Child Health and Cardiology. She is certified in Childbirth Education, Breastfeeding Counseling, and Doula and has written articles for numerous parenting publications and websites. Her first book, entitled 'A Journey Into Being. Knowing and Nurturing Our Children As Spirit' was just released June 2006. She is married and the mother of 2 boys ages and a girl. Christine offers private maternity services and always welcomes new clients. Please visit her website at www.IntuitiveNurturing.com.
Copyright © Christine Ramos. Permission to republish granted to Pregnancy.org, LLC.