Sweet caroline…. good times never seemed so good…. I’ve been inclined to believe it never would… -Neil Diamond. Only a midwife could pull a birth analogy from a Neil Diamond song. “Peri-natal psychologists and midwives I’ve talked to have all … Continue reading
Of all my posts on this blog, the one that has stirred the most controversy is the one on Castor Oil for Induction. The article I posted wasn’t even a blog post, but a short synopsis of the research I did to support MY POSITION on the effectiveness of castor oil as an induction method.
Just today I received a rather snarky response to the article claiming that I “didn’t effectively research” and was “one-sided” putting women who might read it and “not do their own research” at risk. Oh, and that I cited an article/study that was irrelevant to the use of CO as it relates to induction. I cited many articles, many more than one, and AGAIN: I was writing this article as an assignment. I had to SUPPORT my position. And I did just that.
Geesh. I’ll approve the comment, of course, all in fairness, but I think the author went a BIT too far in her umm…. criticism? of my post.
Listen, it’s a free world out there. I post my thoughts and positions relating to birth on this blog ‘cuz it’s mine. You are free to comment, critique, whatever. Just be fair. And remember that is IS my blog, and as such I can post MY thoughts and positions on it.
SO I will say again: I do not believe castor oil is safe for use on a scarred uterus (ie: VBAC), and may cause some really funky labor patterns in any woman’s uterus. Bottom line: I believe that induction disrupts that wonderful chemical symphony that the body (and the baby) creates to begin labor WHEN IT IS TIME. So whether it’s castor oil, prostaglandins, Cytotec, WHATEVER, fundamentally I believe it changes the energy that surrounds a birth when compared to one that begins spontaneously. And ***I*** believe it changes it for the worst, not the better.
And again, I’m a US citizen and am entitled to post just that: my beliefs. And for the record, they are based on MOUNTAINS of research, not a “whim” and certainly not without a great deal of care and thought as to the possible implications my beliefs might have on others who read them.
I will be quite transparent: I do not believe induction is safe, healthy, natural or any of the other commonly used adjectives that commonly surround it. I believe induction is sometimes warranted, but within very limited parameters and with VERY careful consideration given to the implications of that decision. I do believe a woman has the right to choose it, but also believe she should be fully informed.
And since “anyone can google castor oil induction” and find out how to do it with little information provided on the risks, I thought a balanced response to that information was in order.
So… hit delete, or whatever you want to do – that’s cool (free country after all) but don’t accuse me of being cavalier with information that just might save someone’s life and the life of their baby. Because I certainly am not.
Granted, GD is sortof a smoke & mirrors type “disorder” of pregnancy lacking much real science behind current treatment protocols. But this newest information is really stunning.
The researchers found a profound link between serotonin and insulin production. And ” because serotonin is made from tryptophan — an amino acid that comes from high-protein foods such as milk, eggs, meat and fish — this result also provides a clear link between the amount and type of protein consumed by the mother early in pregnancy and the generation of islet cells needed to protect her against gestational diabetes late in pregnancy, when the fetal caloric needs are highest.”
Just as good are the long-term benefits of a high protein diet in early pregnancy. Not only are moms storing up (on a cell level, this has nothing much to do with weight gain) against the development of gestational diabetes in the 3rd trimester, but also against the risk of insulin resistant (Type 2 diabetes) in their long-term future! I mean, WOW!!!
“The research indicates that modulators of the serotonin pathway, including drugs, diet and genetic inheritance, may affect the risk of gestational diabetes and, possibly, the long-term risk of developing type 2 diabetes, according to the researchers.“
So the midwives ARE onto something with all that talk of protein!
Ok, so if you’re going into a hospital that has a 30% cesarean rate, and you go in for an induction, does that make your chances of a cesarean go up to 60%? Probably not, but it did make me ponder. SO many of the induction I hear about from friends, relatives, etc. end in a cesarean. To say that half of them do is not a stretch.
CONCLUSION: Labor induction is significantly associated with a cesarean delivery among nulliparous women at term for those with and without medical or obstetric complications. Reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population.
LEVEL OF EVIDENCE: II
(C) 2010 The American College of Obstetricians and Gynecologists
Here is the article just published with these stats:
Ehrenthal, Deborah B.; Jiang, Xiaozhang; Strobino, Donna M.
Obstetrics & Gynecology. 116(1):35-42, July 2010.
… when I think about becoming pregnant again. I’d really like to, don’t misunderstand. One more baby, the end of an era, all that. But. The thoughts of thwarting all of the well-meaning yet condescending voices that will surround my scarred uterus makes me nauseous. Truly. There are so many reasons why NOT to have a repeat cesarean, yet the voices we hear are why “TO” have one. The media, the mother-in-law, the mom, sisters, friends, colleagues…
Blogs like this remind me of the fight, the comments, the ugliness that follows pregnant women in our society who don’t play by “the rules”.
But I have fought this fight before. I can certainly fight it again. This next time around though I think I’ll choose my outings more carefully. I was so happy to be expecting last time after so long that I didn’t arm/guard myself against the inevitable comments regarding my VBAC attempt. Next time I will be more careful. Because The Voices are so powerful, even if we see the sheer lunacy behind them.
This ia really exciting. The study found HERE compares not only planned homebirth vs. planned hospital birth but also throws in planned hospital birth with both physician AND midwife. I often hear, “Well, I had a midwife in the hospital. That’s about the same as a homebirth.” No, it isn’t and here is the support for that position.
Not only are the planned homebirth outcomes better ACROSS THE BOARD, but they are bett with a homebirth midwife vs. a hospital midwife. Really cool info to have when asking or arguing for the safety of planned homebirth. (This booklet from Molly also has some great talking points in it!)
This just made my day. The canadian system has it’s caveats, no doubt, but the overall theme is that planned homebirth is SAFE with a trained midwife. I could do without the “registered” midwife thrown in there because I think it undervalues the work and safety of trained midwives who refuse to register (and there are many many GOOD reasons to not register). Of course they could not participate in the study and I doubt they were asked to. Afterall, who are they and WHERE are they? That, of course, is a question for another day.
I understand that the off-label use of pharmaceuticals is a normal occurrence in the medical world. I get that. What’s not cool is that this is done in maternity care as well with dire consequences.
I’m not talking about the random, “uh-oh”, I’m referring instead to the drug company themselves issuing statements saying “We do not endorse the use of this product for any use other than that described on the label.” Yeah, they’re probably just covering their b*tts but still. They said it. Yet it happens everyday in the labor and delivery department of nearly every hospital in the country. It has become so commonplace to induce labor that not only have we stopped wondering how/if this affects the baby or the mother we have now started grabbing whatever drugs we can find that give us “a better induction outcome”.
Bishop’s score be damned. God created women’s body to birth. With consideration made for the odd-one-out with pituitary damage or other disorders that truly make her body hold onto her baby long past safely, using drugs to begin labor before the body begins to open up on it’s own is risky risky risky.
Births are kindof like bowel movements. They happen on their own. Can’t plan ‘em, can’t stop ‘em, can’t hurry them along. Bowel movements happen (errr… I can’t help but think of a certain bumper sticker I’ve seen alot of right now).
Birth HAPPENS as well. Babies are born when it is TIME. If we have accepted that every other body system has knowledge to know when to open and release, then why can’t we accept the body’s wisdom in birthing when it is time?
You might have had a Cytotec induction. And so did your sister, your friend, aunt, daughter’s 2nd grade teacher… and all went well. On the surface perhaps. But what did it do to that baby’s emotional/psychological health to be so rudely pushed into the world before he/she was ready to come? And what about the women reading this who is a victim of a cytotec induction who is grieving the loss of her womb? Suddenly hurrying a baby out seems less important when faced with an emergency cesarean to save your baby’s life and a hysterectomy to save yours.
All from a couple of tidy white pills manufactured to treat ulcers. Who’da thunk?
Quite surprisingly, this piece about midwives and homebirth is quite balanced if not a bit to the left. Kudos. One of my favorite lines:
““All women have choices,” Rach Zeller of Buffalo Homebirth says. “They can refuse anything that they’re being asked to consent to. They need to take it upon themselves to really understand what the ramifications are of what procedures they allow.”
So we are back to the old question we birth advocates keep going round and round about. The age-old question of “Which came first, the chicken or the egg?” Is it the doctors who need to change or the women who need to stand up and demand birth be allowed to progress as GOD intended? Because let’s face it – women’s bodies were created and I believe INTRICATELY DESIGNED to give birth. And like any other God-thing that we humans get our hands into, we may never fully understand the ramifications of messing with that perfection.
A WOW news release on MedLine this morning regarding the safety of planned homebirths. Get this:
All of the outcomes studied occurred with comparable frequency in the planned home and hospital birth groups. These included intrapartum death (0.03% vs. 0.04%), intrapartum and neonatal death within 24 hours of birth (0.05% vs. 0.05%), intrapartum and neonatal death within 7 days (0.06% vs. 0.07%), and neonatal admission to an intensive care unit (0.17% vs. 0.20%).
[My note: actually, the numbers show slightly better outcomes at home. ]
“As far as we know, this is the largest study into the safety of home births,” the authors note. The findings, they conclude, indicate that with proper services in place, home births are just as safe as hospital births for low-risk women. ~ BJOG 2009;116:1177-1184
NOw of course this is a “foreign” publication (British Journal of Gynecology) so I don’t know how much credibility it will get here in the trenches, but WOW. Very cool that the news is getting out there to US med students and physicians!
Interesting. Hmmm… Note the recent practice bulletin by ACOG regarding induction of labor:
“A physician capable of performing a cesarean should be readily available any time induction is used in the event that the induction isn’t successful in producing a vaginal delivery,” Dr. Ramin concluded. “These guidelines will help physicians utilize the most appropriate method depending on the unique characteristics of the pregnant woman and her fetus.”
Obstet Gynecol. 2009;114:386-397.
Ok, so all we need is “a physician capable of performing a cesarean” to be “readily available” should an induction be “unsuccessful”. Interesting. But for a VBAC “trial of labor” hospitals should have “immediate access” to anesthesiologists? Hmmm….
And on the use of oxytocin: “The main adverse effects of oxytocin are dose-related uterine tachysystole and category II or category III FHR tracings.”
But for nipple stimulation, which is often a labor augmentor (if you want to medical-ize it) used by midwives at home births, the risks include “uterine tachysystole with FHR decelerations and increased trend in perinatal death.”
Interesting isn’t it? That oxytocin doesn’t carry a risk of perinatal death but NIPPLE STIMULATION does?