My sister aunted me this week for the third time in 7 years. A beautiful baby girl named Macie; my sister’s first daughter. But this birth was very emotionally trying for my sister; she had anticipated a quiet, unmedicated birth, arriving at the hospital once labor was well established, and leaving quickly. But unfortunately, her obstetrical care providers had a slightly different habitual pattern to follow: once she hit 35 weeks, talk of when her induction would be scheduled began, and despite the fact that my sister remained adament that she wanted a natural birth – and even asked for NO MEMBRANE STRIPPING to be written boldly across her chart – this of course is not how the story goes.
For her 38 week appointment, my sister had scheduled to see a Certified Nurse Midwife who was labeled “natural birth friendly” at the office. Upon arrival her blood pressure was taken and was slightly elevated, but not alarmingly. The midwife came in and began a series of questions which were obviously meant to help establish concerns for preclampsia. My sister did not have these symptoms, and said so. (She also did not have protein in her urine.) She did mention she had been under tremendous stress lately and began rattling off a list of the overwhelming things going on right now, to which the midwife condescendingly snorted, “Your stressed because of birthday parties and cleaning house??” She then said, “Well I’m about to make you a whole lot more stressed,” and with my sister on the examining table, naked and exposed, proceeded to STRIP HER MEMBRANES as my sister cried, “No please don’t strip my membranes, I don’t want it to be like this!”
My sister became hysterical, crying as the midwife then retook her blood pressure (which was now 175/98) and told her she had preclampsia and needed to be induced. When the midwife left the exam room, my sister phoned me, and I advised her to get the hell out of that office as quickly as she could!
A common mistake is to assume that just because someone is a CNM (certified nurse midwife) they will be on your side in your wishes for birth. More telling about where allegiances lie is WHERE and by WHOM a care provider is employed, and that employers induction and ceasarian statistics. Now don’t get me wrong, there are good and bad doctors, good and bad midwives, good and bad postal workers, electricians, and PEOPLE, but I think a LOT of women assume that if someone has the title of ‘midwife’ they are going to naturally respect you and be pro natural birth. Not so. When I was pregnant with Sophia, I also saw CNM’s in a large obstetrical practice, and guess what? Talk of an induction for me began at least a week before my due date! This, despite my adament statements of wanting a natural birth, and the fact that this was my first baby (first babies are notorious for being “late”).
Back to my sister. She went home an absolute wreck – crying, on edge, thoroughly devestated by the violation which had just transpired. But she began monitoring her blood pressure with the help of her general MD and a relative who is an EMT. While her blood pressure went down considerably, it remained above normal, but only just. The midwife proceeded to call her – and every relative whose number she could find – to try to get her back (malpractice fears and damage control??). By the next morning, my sister deicded to go get the baby checked out. She went into the hospital where she was immediately put on pitocin, despite the fact that the baby looked good and had good stats. My sister’s blood pressure? 127/79.
There was no preclampsia.
Why the push these days for induction? Some may say better safe then sorry, but in fact, studies have shown time and again that routine inductions are by far more risky then waiting and watching. So then why the hurry? Routine inductions are NOT recommended by ACOG (American Congress of Obstetricians and Gynecologists) or The World Health Organization. So why is it I can count only a few women in the past couple years who went into spontaneous labor, and literally dozen’s who were routinely (not medically necessary) induced?
Are doctors behind it? Does it stem from a doctors lack of verbal barrage about the inherent dangers? Are uncomfortable and tired mom’s-to-be behind it? It seems that Americans often have an over-assured faith in technology; if it’s a modern technology, it must be better then the old way, right? This probably explains why most Americans walk around believing we have the best infant and maternal outcomes in the world – when in fact, the USA ranks at the bottom of the industrial world in infant and maternal mortality.
Here’s what we know about elective inductions: they increase the ceasarian rate threefold. They put undo stress on the baby (induction contractions are stronger then natural ones). They increase the epidural rate. Here’s an interesting example: cord wrapped around the baby is EXTREMELY common (actually serves a practical purpose too of shortening the cord so it is even less likely to slip into the birth canal before the baby does). 1 in 4 babies is born with the cord wrapped around it. My kids were 2 for 2 – Sophia had it wrapped around her neck and Grace had it wrapped in some weird fashion under her arm/across her chest and neck (leave it to Grace to be playing that aggressively with her cord!) Having the cord wrapped around the baby is not inherently dangerous. But once you augment labor with drugs, the dangers of the cord being wrapped around the baby go up exponentially. Pitocin contractions are much stronger then natural contractions, and oxygen being compromised becomes an issue. Then of couse if your baby’s stats go down, you have a (human manufactured) emergency, and your first ceasarian section.
I also wonder WHY it is so hard for everyone to just wait for the baby to decide it’s good and ready to enter the world. There is some debate on this as to whether it’s mom’s or doctors who are doing most of the elective induction pushing – and I’ve seen it from both, but despite my own and my sister’s expereinces, I have to say, I’ve listened to an awful lot of stories from mom’s biting at the bit to get that induction date. Mom’s get tired of being pregnant at the end and start jumping to get this baby out! Get that body back! Does a difference of a couple days or weeks matter so much? It does for the baby, we know that for certain. Babies release a chemical into the womb when they are ready to be born, and this kick-starts labor. Labor is NOT random and arbitrary. There’s a rhyme and reason, believe me. Do we pull our 15 year old into the kitchen and demand, “Why can’t you hurry up and be 16 already?? I’m sick of driving you around and you need to get your license!!” Do we put them out into the world before they’re ready, tell them to grow up and get a job and stop mooching off us?? Sounds silly, but that is essentially what an elective induction is. Telling your baby, your infant, that it is taking too long to grow up enough to be born.
DON’T misunderstand; I’m behind medically necessary inductions one hundred percent! In an emergency situation, inductions can be life saving. Take preclampsia, the issue of the day around here: it’s marked by high blood pressure and lots of protein in the urine, and there is mounting opinion that it’s an autoimmnue reaction to pregnancy. That’s bad. Preclampsia can be fatal for mother and baby. It is frankly dangerous to have. Ultimately the only way to cure it is to end the pregnancy. Induction can be lifesaving in this situation, because the risk of staying pregnant is greater then the risk of the induction.
Someone once said to me, “I’m just a c-section person and you’re just a home birth person.” What this sort of statement really shows is the level of division which exists in relation to birth and birthing issues. We have all these labels that we apply: women are either natural-pain-loving freaks, or drugs-me-up-and-knock-me-out types. Or, there is the “too posh to push” crowed. These labels all distract from the main issue, which I think we all care about, even if not everyone is aware of in-depth. No longer is birth about what’s safest for babies; often with the mom’s, it’s about what kind of person you are, which category you choose to define yourself with birth and the different labels (because after all, we WILL define ourselves with birth – it’s just THAT important). With doctors and hospitals, it’s about another thing entirely. Money.
But hey, birth is important! For most of us, it’s the most defining act we’ll ever be involved in. But there is a huge lack of information and support surrounding LABOR and BIRTH. This is WRONG. Babies have a right to be born when they are ready. Mother’s have a right to be supported and safe in any and every birth environment they choose, including in a hospital and with a traditional OBGYN. This is another cavate I have: look, the options should NOT BE 1) birth in a hospital and be hounded for induction/epidural/augmentation or 2) birth at home (naturally, and in peace!).
I like birthing at home. But other women don’t and would never be comfortable with that. But it shouldn’t be an either/or situation – the standards and expectations of support and care must be the same in both places (so step it up hospitals and ACOG!).
Ultimately, my sister gave birth to a beautiful baby, much loved and adored by her big brother’s and Mom and Dad. And some people will say, “Isn’t that enough? The baby’s ok, mom’s ok – all’s well that end’s well.” But is it? Is the only thing that matters what we get at the finish line? Does the expereince truly matter so little that we can rip humans from our bodies, defile each other in our most vulnerable moments, and then walk away feeling like a champ, like God?
Of course not.
My sister was brave and I’m proud of her. She handled an absurd and abusive situation with much more strength and panache then my temper would have allowed. But I’m angry that she was virtually robbed of a precious experience and treated like a silly young thing. Things need to change in the birthing world, and they need to change now. We’re hurting each other too much with the way things are.