Cool prenatal videos

This was a really neat site, and I’d like to buy the whole video, because it looks so neat. There are many video clips available on the website, some very short — only 15-20 seconds long — while others are a tiny bit longer, with actual video (as well as some computer generation) of pregnancy from fertilization through birth. I’ve not watched all of the clips — only a handful of them, really — but they seem quite informational. One of the clips, just as an example of the information, is that an 8-week-old embryo (10 weeks of gestation) usually exhibits right- or left-handedness. At ten weeks!! The video of the beating heart is at 4 weeks 4 days post-conception.

One note, as you go through the videos, is that they date the pregnancy consistently from the time of conception, rather than from LMP (last menstrual period, about two weeks prior to fertilization) which is when most pregnancies are dated. So the “due date” is at 38 weeks, instead of 40 weeks. They have that information as standard on every page of the video, but it bears repeating lest it is overlooked.

Where to draw the line?

I’ll start off by saying, “I don’t know.” There are now and have been in the past different cases which are thorny issues — both related strictly to birth, and those that are not — which have to deal with parents’ rights to choose for their children (or themselves) vs. “the state’s” or “society’s” right to interfere in such matters. There are some clear-cut issues — when a parent is abusing a child… and yet even in that, some people may consider spanking an abuse while others consider it to be merely one form of correction and discipline which parents have a right to use. Some people are trying to get circumcision made to be illegal; and while I think circumcision is unnecessary and ought not be done, I don’t think that I have the right to forbid others to do it, and think it might be trampling on religious rights a bit much (although I think that Christians should not circumcise their children for religious reasons). Yet I don’t think that parents should be allowed to have their females circumcised no matter what their religion. Call me inconsistent.

But where will this end? That’s what concerns me. Do parents have the right to choose what is in the best interests of their entire family? Yes — within reason. They cannot decide that because their 13 year-old is “eating them out of house and home” that it is in the best interests of the family as a whole that that child no longer live with them, or that the child stop eating, or that the child should die. But certainly many other things are within the purview of the parents. Most if not all states have laws concerning buckling children into seat belts and approved car seats. A three month-old child cannot buckle himself into a car seat, after all. When I was working at the pharmacy, I’d see all sorts of things, including people driving up to the drive-through window with unbuckled children. The most memorable is a baby in a bouncy seat, in the front passenger’s lap — oh, yeah, that’s protection! If parents don’t buckle their kids, and they have a wreck, the children could be killed, and they were unable to protect themselves. Does the state or local government have a right to step into the family and dictate to the parents how to treat their children? Some might argue “no,” but most would say that most certainly the authorities have a right to protect the innocent child.

What about the right of parents to decline medical treatment for their children? What if the medical treatment is “iffy” — what if there is a strong chance that the treatment will not work, but will only make the child sicker? Some years ago, there was a case in which a woman had two children diagnosed with HIV or AIDS (her other two children were healthy). When the first child was diagnosed, she complied with all of the medication and treatments that the doctors ordered or suggested, and watched her child die a horrible and painful death, sickened and made weak and in pain by the medications which were supposed to be saving his life. When her second child was diagnosed, she refused all the treatments and medications, saying that she’d rather the child quickly die and in less pain than with the “life-saving” (but health-taking) drugs her first child took. The state took her to court, wanting to force her to give the child the medicine, or to terminate her parental rights and turn the child over to foster parents who would medicate the child. The judge ruled in her favor, though, saying that she had every reason to believe that the drugs would not actually help, and she was within her rights to refuse. Despite the dire predictions of the doctors, the second child was still living and seeming to be in perfect health, two years after the diagnosis, without taking any anti-AIDS/HIV medications. But what if the treatment options were more clear — if the child gets the treatment, there’s a 99% chance that he will live and be perfectly healthy; and if he doesn’t get the treatment, there’s a 99% chance that he will get terribly sick and/or die — and the parents still refuse?

What if it’s somewhat murky? Is any increased risk worth terminating parental rights, or overstepping the parental bounds of authority? We’d best be careful. There have been cases in which women have been forced to undergo C-sections for less-than-clear-cut “medical” reasons. It’s possible that these were ultimately overturned… after the woman was cut open — but perhaps some have been upheld. One such case I’ve heard about is a woman who wanted a VBAC. That’s all — no medical problems that I know of other than a previously cut-open-and-sewn-shut uterus. The risk of uterine rupture is about 1/200, with the risk of death or serious injury to the baby a much smaller percentage than that. Yet she was denied a chance of a vaginal birth because the judge found that her baby had sufficient rights of his own to force her to have surgery.

Don’t get me wrong — I’m strongly pro-life… but I’m also strongly pro-family and pro-liberty. I think the baby had the right to be born alive, and should not have been allowed to be killed at that or any other point in his life, before or after birth. But is the slightly increased risk of death from uterine rupture (which is not completely eliminated with a C-section) a strong enough argument to force an otherwise autonomous woman into having surgery? Is it strong enough to override her parental authority to choose what is best for her, her baby, and her family? We’re not talking about killing babies deliberately, here — we’re talking about a slight risk, but in the absence of uterine rupture, the outcomes will be better for both mother and baby with a vaginal birth.

What about drug use during pregnancy? — and “drugs” includes tobacco, alcohol, and illegal or illicit drug use. Smoking cigarettes most definitely increases the risks to the baby — of preterm birth and low birthweight (which by themselves carry with them a whole bunch of risks and longterm consequences) and also of stillbirth and neonatal and infant mortality. Illicit drug use ditto; and alcohol probably the same, but “fetal alcohol syndrome” is more particularly associated with it. As long as women have the right to ingest all of that stuff during pregnancy, exposing their “captive prisoner” (the baby) to the toxic chemicals, then surely loving and thoughtful parents can choose between two medical options that have both risks and benefits, picking the course of action they think is best altogether.

However, if the parents (or more particularly, the mother, since she is the one who really calls the shots, since it’s her body carrying the baby) are being grossly negligent, then it’s possible that as the state can step in and remove children who are being subjected to abusive parents, so the state can step in and force a woman to stop prenatally abusing her child. But we must be very, very careful when we do things like this. Horror stories abound in the foster-care system (and all that surrounds it), of children being repeatedly abused but nothing is done about it, while perfectly innocent parents are stringently investigated due to an angry neighbor’s spiteful and false report, and even of children removed from parents (abusive or not) and placed in abusive foster homes. Similar things might exist when tampering with the maternal-fetal relationship. I might liken forcing a woman to undergo a repeat C-section rather than an attempted VBAC as being in the second or third category — the “cure” is worse than the disease; whereas I would have little or no problem with forcing a woman who is pregnant and abusing drugs to enter some sort of treatment, so that her innocent child is not born addicted to crack. But so much of the problem exists not in a particular case, or a case-by-case basis, but rather the precedent that is set when the government starts interfering. What might be perfectly innocent or even laudable interference can become heinous and loathsome, depending on the circumstances. And as this post points out, it is hard to draw the dividing line. When you’re not talking about certainties — such as, “if you do X, then your child WILL die or be harmed,” but just, “if you do X, then your child MIGHT die or be harmed… or might not… and if we do Y instead, your child also might be harmed or killed.” For instance, I think the stillbirth rate is about 1/1000 around 41 weeks and perhaps 2/1000 around 42-43 weeks or above — still pretty darn good odds that any given baby will NOT be born dead if the mother declines an induction or C-section. There is a slightly increased risk of stillbirth, but very, very far from a certainty. And it’s also a possibility that the child will be harmed or killed as a result of an induction or C-section — something like not being able to tolerate an induced labor, or actually being premature so ends up in the NICU for weeks, or with serious asthma or other breathing problems, or something like that.

For me, it seems to come down to the parents’ intentions and desires — if they are good and loving parents, and want what is best for their child, then they have the right to give or withhold treatment as seems best; but if they are selfish or uncaring, then their motives may be suspect. But then the problem becomes, what if the “people in authority” believe that the parents do not have their child’s best interests at heart — such as the woman whose children had AIDS, mentioned above? Whoever took steps and set in motion the process to override her parental decision to withhold the drugs with the horrific side effects was either convinced that the child needed them (and thus that he was acting in the best interests of the child, while the mother was not) or he was some sort of sadist who liked to see children get sick and die horrible and painful deaths. Hindsight proved the mother to be correct; but we don’t always have the luxury of hindsight, nor the luxury of time.

As big as the implications I’ve highlighted are, they are even bigger — this topic is so broad and wide-ranging, covering everything from prenatal care, labor decisions, vaccinations, child care, home school, circumcision, ear-piercing, food choices, etc. If loving and concerned mothers (and fathers) cannot choose what they believe to be in the best interests of their child and/or the whole family, who gets to make that choice? What if society (or science or medicine) decides that eating meat is bad for people, so they take away your child so he can be fed a “proper” vegetarian diet? What if they decide that vegetarianism is bad, so they terminate parental rights so they can feed your child a “proper” omnivorous diet? What if you decide that vaccinations are not in the best interest of your child – that your child’s situation is such that you believe that the risk of vaccinating is higher than the risk of not vaccinating? Should the state overrule you, and decide your child must be vaccinated? What about home birth? or unassisted birth? What if the court system decides that ACOG and the AMA are right and homebirth is unsafe — should they have the right to forbid you to have a home birth, to incarcerate you in a hospital and force you to give birth there?

Does the state have the right to tell you what to do with your child? Why or why not? Tough questions to answer in general, although specific questions may be clearer. I can say, “Absolutely not, because I am a good and loving mother, and I’m doing what I believe to be is best for my child. I am not harming and certainly not killing him, so you have no right nor reason to step into my family and tell me what to do.” And I think that most if not all of you reading this would be able to say the same with a clear conscience. But who decides where the line is drawn between a good parent and a bad one? Ah, now that is a scary thought.

My Ultrasound

Today is the 5th anniversary of the one and only ultrasound I have ever had during both of my pregnancies (not counting the numerous Doppler u/s to check the baby’s heartbeat prenatally and during labor, which I didn’t realize at the time was ultrasound). One of the cool things about midwives (at least, the midwives I’ve chosen, although perhaps not most/all midwives are like this), is that they didn’t act as if my medical record were somehow a secret file that I shouldn’t know about. In fact, as I reached the end of my pregnancy, they gave me a copy of my whole record up to that point (and copied the most recent page at every visit, to make sure my record at home was as complete as theirs), just in case I needed to go to the hospital without them — that way the hospital personnel would have my complete prenatal file, if they had any questions or needed any clarifications. So, I have a copy of the ultrasound exam, both the hand-written scrawl of the doctor as well as the type-written one from that information. Just for kicks, I’ll put both of them up, so you can see the notoriously horrible “doctor’s scrawl”, as well as the one you can actually read. πŸ™‚

u/s scrawl

u/s typed

I’m not totally sure what the different abbreviations are, but will comment on most of them anyway. I think it’s funny that “Indication” says that the baby is LGA or Large for Gestational Dates; however, the estimated fetal weight was 7 lb 3 oz at 37w5d, and his birthweight (nearly two weeks later) was 7 lb 5 oz. So they were both wrong; and unless I’m greatly mistaken, 7.5lb is about normal for a full-term baby. There was “none” comparison because I hadn’t had any other ultrasound; he was correct that there was one fetus who was in cephalic position. “BPD” is biparietal diameter — the measurement of the top of the baby’s head from side to side. I wasn’t sure about FL, HC, and AC, so looked it up — femur length (which I guess correctly), head circumference and abdominal circumference. As you can see, he estimated “GA” (gestational age) from each of those different measurements (I presume there are some sort of averages the computer is programmed with), and came up with remarkably consistent dates to each other as well as my actual due date — in fact, they are identical. But notice that it says “+/- 22 days” — three weeks give or take, from the ultrasound’s best estimate. This is why you should be wary of late ultrasounds used to determine your actual due date, particularly if they overthrow previous due dates based on accurate ultrasounds, known date of conception, regular menstrual periods, etc.

Not sure what the CI is that is 85%, but the rest of the things are ratios of the previous measurements, and are all within NR (normal range). “WNL” means “within normal limits” (had to look that one up too!); and the rest looks pretty straightforward — checked to make sure that the baby had kidneys, bladder, stomach, etc.

Note that the AFI (amniotic fluid index) is 19.8cm, which the “impression” says “is high for this gestational age.” I’ve read that a normal AFI is anywhere between 5-25 cm, so not sure why 19.8 is high. I guess it’s still within normal parameters, even if most babies/mothers do not have this much at 37 w 5 d?

The reason for the u/s was that my midwife, at that day’s appointment, thought she heard two heartbeats. She spent probably 90 minutes with me that day, with a large portion of the time trying to ascertain for sure that she was hearing only one heartbeat — at one point, she called in her labor assistant (who ended up being the one who was on call when I went into labor), and they were both listening to my belly, with an EFM aimed at one quadrant and the Doptone or fetoscope or whatever aimed at the other quadrant where she was also hearing a heartbeat loud and strong, and both were tapping their fingers in time with the baby’s heartbeat, trying to see if it was indeed one baby (just echoing), or two babies with two heartbeats. Not being able to satisfy the question to her liking, and being unwilling (or perhaps legally unable) to attend a twin homebirth, my choices that day were to have an ultrasound or plan a hospital birth. Oh, yeah, big choice. I weighed my options for like half a second. πŸ˜‰ Anyway, after the u/s was complete, she said that it was probably the extra fluid that allowed the baby’s heartbeat to echo and sound like two different heartbeats.

Pollution and Prematurity

Since September is National Infant Mortality Awareness Month, and since 67% of infant deaths in the first year occur in babies born prematurely, if we can lower the premature birth rate, we can lower infant mortality.

In June of this year, a new study was released, which showed a higher rate of preeclampsia and preterm birth among women who lived within 2 miles of the busy Southern California interstate system. Here’s the full study.

Background: Preeclampsia is a major pregnancy complication leading to substantial maternal and perinatal morbidity, mortality, and preterm birth. Increasing evidence suggests air pollution adversely affects pregnancy outcomes. Yet, few studies have examined how local traffic generated emissions affect preeclampsia in addition to preterm birth.
Objectives: Examine effects of residential exposure to local traffic-generated air pollution on
preeclampsia and preterm delivery.
Methods: We identified 81,186 singleton birth records from four hospitals (1997-2006) in Los
Angeles and Orange Counties, California. We used a line-source dispersion model (CALINE4)
to estimate individual exposure to local traffic-generated NOx and PM2.5 across the entire
pregnancy. We used logistic regression to estimate effects of air pollution exposures on
preeclampsia, preterm delivery (PTD, gestational age <37 weeks), moderate preterm delivery
(MPTD, gestational age <35 weeks), and very preterm delivery (VPTD, gestational age <30
Results: We observed elevated risks for preeclampsia and preterm birth from maternal exposure to local traffic-generated NOx and PM2.5. The risk of preeclampsia increased 33% (odds ratio (OR) =1.33, 95% confidence interval (CI): 1.18–1.49) and 42% (OR=1.42, 95% CI: 1.26–1.59) for the highest NOx and PM2.5 exposure quartiles, respectively. The risk of VPTD increased 128% (OR=2.28, 95% CI: 2.15–2.42) and 81% (OR=1.81, 95% CI: 1.71–1.92) for women in the highest NOx and PM2.5 exposure quartiles, respectively.
Conclusion: Exposure to local traffic-generated air pollution during pregnancy increases the
risk of preeclampsia and preterm birth in Southern Californian women. These results provide
further evidence that air pollution is associated with adverse reproductive outcomes.

What can be done about this? Not really sure. Move? Try to avoid the freeways, and use the car’s air conditioning system so the air goes through the filter (the researchers’ suggestion). Have a lot of plants in your house, if you live close to a high-traffic or high-emissions area? Perhaps get a personal air purifier?

It’s interesting that only about 60 years ago, doctors “knew” that the placenta acted as a barrier to protect the fetus (which it does… partially), so they gave drugs to mothers under the assumption that the baby could not be hurt. The nausea drug Thalidomide vividly proved them wrong (images of babies born after their mothers took Thalidomide here). Now, doctors are rightly concerned about the air we breathe.

Born for Breastfeeding

The Lamaze website has this very nice article, which details how women are born for breastfeeding. It starts when we were just fetuses in our own mothers’ wombs, continues through puberty, escalates during pregnancy, and comes out in full force after birth.

Just as your body is designed for pregnancy and childbirth, so too you were made for breastfeeding your baby. (And you don’t have to do anything to prepare for it!)

But, just because it’s natural doesn’t mean that it will happen flawlessly. The article gives information on how to help ensure a smoother transition into nursing (immediate skin-to-skin contact); but one way to help get you prepared is to see other women breastfeeding. Your local La Leche League group will usually have numerous nursing moms that you can observe. But what if you’re too shy or self-conscious to do that? (You shouldn’t be, by the way — if they’re not too self-conscious to let you observe them, you shouldn’t be too self-conscious to watch; but it is understandable if you are.) What if you don’t have a local group? What if you’ve rarely or never seen another woman nurse, never seen a baby latch on right? What if you’ve heard horror stories about painful nursing, bleeding, cracking, and otherwise sore breasts? It doesn’t have to be that way. Breastfeeding with Comfort and Joy is a wonderful book to have, to help with any of these scenarios. With sensitive and beautiful photographs demonstrating a proper latch and helpful text, you can look at breastfeeding women for as long as you want or need to. A proper latch can go a long way to eliminating most if not all of the common breastfeeding problems.

Fetal Memory

This was quite intriguing — an article written about a study into fetal memory. Basically, they looked at babies under ultrasound and played some sound outside the womb (a buzzer, like they typically use during biophysical profiles to startle the baby to see how his or her heartrate changes), and kept on buzzing until the baby no longer reacted; then they buzzed the baby again several weeks later, and the baby again didn’t react — possibly indicating that the baby recognized and remembered that sound.

That’s not too surprising to me, nor to a lot of other parents, particularly mothers. But it is refreshing to see science catching up. It also has some possible practical implications — in the opening of the article, it talked about a young woman who as an infant was best soothed by her mom singing the Aerosmith song “Angel.” And it turns out, that the mom had frequently played that song (and others), when pregnant with her — when the song came out. [I’ve got to insert here, completely unrelated, that it is still a huge shock to me, to see that this young woman was 21 years old, and was born in 1988 when “Angel” came out. That is just so wrong! NO! Babies born in 1988 are only, like, 5 years old! Right?? No?! Ok, so I feel old. Sigh… End non sequitur.]

Anyway, it sounds like this young woman as a fetus developed a memory for “Angel,” and when her mom sang it to her after birth, she was calmed by the familiarity of the song. So, pregnant women today might be able to intentionally do something similar — get a CD of some sort and play it frequently, and then remember to play it (or sing or hum songs from it) when the baby is fussy. Of course, it’s not guaranteed to work — especially every time the baby is fussy — but if it works sometime, that would be very cool.

It is known that babies can distinguish their mother’s voice best, and they also know the voices of people who were around the most when they were in utero — typically the father, older siblings, perhaps close friends and family who were in frequent contact with the mother. And I remember one story years and years ago — I can’t even remember for sure where I read it, but I think it was in Reader’s Digest possibly 20 years ago or so (which means that this could have been researched years and years ago, if somebody wanted to badly enough), of a man who would sing a particular song to his pregnant wife’s belly, and then soon after his baby was born, he started singing it to her, and she turned her head towards him. She remembered the song, or at least recognized his voice.

Actually, in a way, it seems like a no-brainer that babies remember. Of course they do! They know their mother’s smell, voice, and heartbeat from having those things all the time during pregnancy. Even leaving aside the hidden or latent memories that some people have when hypnotized, of being in utero themselves or newly born (I’ve read a few things that gave me chills, of young children matter-of-factly stating what happened to them just after birth, although they had never been told), it is nonsensical to suggest that memories only start happening at three or four years of age, or whatever is the earliest that the average person remembers. Of course we remember. We just forget later, as more and more memories are laid down, and the past becomes shrouded in the mists of time. Just like I don’t particularly remember more than a handful of meals I’ve eaten in my life — yet it is obvious that the effects (for good or for bad) are still with me, even so I don’t necessarily remember very much of my life prior to the age of three, but the pathways of memory stretch much further back than that.

This research reminds me of the research done into “infant pain” back in the 1950s or so. The assumption was that newborns don’t feel pain. I don’t know which idiots came up with that insanity, but they obviously fooled their teachers enough to be awarded the title of “doctor” — but they’re still idiots in my book, because they had no common sense. So, they’d stick babies with pins and note their “primal responses.” Um, yeah. How ’bout I stick you with pins and note your “primal response”? Of course, later, more open-minded research was done to show that the “primal response” of babies crying and flinching away from the source of the pain was, believe it or not, actually a pain response. Even later research has demonstrated that early third-trimester fetuses feel pain, just like premature infants (nothing magic about coming out of the mother’s womb — what the baby is after birth, it was before birth — only the location is different). This shouldn’t surprise anyone, particularly those who work with premature infants, and note their fragility and the need to keep them calm because handling and touching them can cause much bigger stress reactions than happens in term infants.

Maybe next time researchers have some bright, new idea, they should run it past a few mothers first. Because we’ve been right for generations. We’ve just been waiting for the brilliant researchers to catch up with our innate knowledge. πŸ™‚

It’s Distressing

Part of my “summer busy-ness” included going to the backside of nowhere, with no internet for nearly two weeks. You probably didn’t notice it much if at all, because I was able to set up enough posts to keep active (and I could get online at the library… as long as I could get to the library), but I sure noticed! I am so addicted to the internet! πŸ™‚ In addition to a plethora of emails, I had a huge number of posts from blogs I subscribe to, to catch up on, since coming back. It’s really almost insane — I need to cut back… but I don’t want to miss out! πŸ™‚ So, I missed out on the whole “Pit to Distress” viral blog posts.

I did read N is for Nurse‘s original post which seemed to start it all — in fact, her refusal to “pit to distress” was one of the things I was thinking of when I wrote the post about laboring women having and needing a patient advocate. The remainder are in no particular order, except perhaps the order in which I read them. A few of the links will be to blog posts that have multiple links in them, so I may end up linking to a single post more than once, while inadvertently leaving out another post, thinking I’d already linked to it. So, I’m human. If there is a good post you know about that is not included in these links, feel free to post it/them in the comments!

The first one I read was from Jill at The Unnecessarean, followed by part two (which also includes multiple links). Then, Keyboard Revolutionary has another set of links; with Rixa at Stand and Deliver having two posts — the first has an interesting set of comments after it, because Rixa has a graph of fetal heart-rate with a graph of maternal contractions, and asks L&D nurses who read her blog “what should you do in this instance?” — and gets a multitude of answers, which leaves one commenter saying, “Funny thing about the EFM commentary here. It *perfectly* illustrates how constant EFM is total crap–because nobody can agree on what they are seeing!!” [That may be what Pinky was referring to in this post. And fwiw, here is one post and another post on ACOG’s refining fetal heartrate monitoring guidelines.] The second post has multiple links as well. Jenn from Knitted in the Womb weighs in with her tales of being a doula at some Pitocin-induced/augmented births, as does Sheridan at Enjoy Birth. One of the contributors to our Independent Childbirth educators blog posted this.

From the nurse/midwife side of things: Ciarin at a Midwife’s Tale; Reality Rounds (NICU nurse), on nurses declining to follow a doctor’s order that they disagree with; a triad of posts from L&D nurse Melissa at Nursing Birth — Pit to Distress part 1, part 2, and understanding the pitocin dosage; former L&D nurse now new CNM Rebirth Nurse; and finally, Nicole at It’s Your Birth Right weighs in. In addition to the posts, I’ve read most if not all of the comments on them, which are also very interesting.

Then there is this article — not exactly on “Pit to distress,” but it does tangentially discuss the topic.

This is frustrating, because aggressive dosing of Pitocin, even if not given the term “Pit to distress” (even in jest), can harm mothers and babies. Obviously, contractions that are too strong and/or too close together can distress babies, since it reduces their oxygen supply. But it can also cause a mom’s uterus to rupture, even if she has an unscarred uterus — i.e., no history of C-section or other uterine surgery. Of course, this is not typical — but it can sometimes happen. As one of the posts said (I think it was “Nursing Birth”) — Pitocin, like many other drugs, can have different effects on different people — for some, a tiny amount of a drug will be enough to knock ’em out or make him loopy, while another person can take a bottle of it and barely get drowsy. A tiny amount of Pit may put some babies in distress or hyper-stimulate a uterus, while other women and babies will hardly have any effect from a maximum dose.

Does “Pit to distress” happen? Yes. How often? No clue. Anybody’s guess. It probably varies like every other statistic or factor, like epidural rate, induction rate, C-section rate, etc. In other words, some docs are going to be horrible, and others are not. I remember reading something somebody wrote about birth plans — this nurse or midwife basically said that it was nearly embarrassing to read some birth plans that specified “no pubic shave” or “no enema” or such like because these practices were nonexistent any more. Then several readers chimed in with their own personal stories of them being on the receiving end of these practices which were supposedly “not happening any more.” In my area, I could see stuff like this happening because of what I know of the nearest hospitals’ typical practices in certain things. [My mom was given routine general anesthesia, a pubic shave, and episiotomy — without her consent, and even specifically against her will — for all 4 of her births in the 70s, even though the “natural birth” movement really caught on in the middle of the decade, and many hospitals had modernized their services and practices by the time I was born. A friend of mine only barely escaped being given a routine enema when she gave birth at a different area hospital in 1996. The only way she avoided it was that she had an attack of diarrhea [as part of the normal birth process, not from actual illness] when she was being admitted.) So, some things may not happen in most hospitals — but if it’s even 1% of hospitals, that’s probably 30-60 hospitals where X is still occurring on a routine basis, even if the other 3000+ hospitals aren’t doing it any more. If these hospitals have only 1 birth average per day that’s still 11,000-22,000 women annually who are routinely submitted to these antiquated and archaic procedures. Or to overdosing on Pitocin. I’ve never personally known a woman whose uterus ruptured under any circumstances — but that certainly doesn’t mean it can’t and doesn’t happen! So, even if the majority of “birth people” and nurses say that they’ve never seen it happen at their hospital, doesn’t mean it doesn’t happen anywhere.

Of course, Pitocin, like every other drug, should not be used unless necessary or medically beneficial. If a doctor — or midwife! — is using Pitocin to speed up your labor simply so they can get done and get gone, that is *ahem* not a medical reason. Some doctors tend to have the idea that labor should never plateau, go slow, sputter, or even stop. That tends to be not allowed. “The labor curve must be followed, at all costs!” [Only slightly tongue-in-cheek.] Some doctors use Pitocin on all women — a few of the stories in either the blog posts themselves or the ensuing comments mentioned this — one doula said that her client was told sometime towards the end of her pregnancy, before labor even began, that she would be started on Pit when she got to the hospital; another L&D nurse expressed frustration that Pit orders were written up for a woman before she was even admitted and assessed (the doctor did it when s/he called to tell them the patient was on her way).

What can you do about it? First — trust your doctor. Seriously — pick a doctor or midwife you can trust. This will entail more than just picking a name out of the yellow pages, or from your insurance company’s “preferred provider” list, or asking your friends who they went with. You wouldn’t have agreed to marry your husband based solely on someone else’s recommendation, nor picking a name at random from a list of “available men”; you probably wouldn’t buy a car just from a description, without even test-driving it, so why on earth would you choose the birth attendant based on such little information? Ask questions, and look for red-flag answers, including such nebulous answers as “only when necessary.” As some of the posts have showed, some doctors apparently consider a 100% Pitocin rate to be “necessary.” Unfortunately, some care providers merely provide a bait-and-switch — appearing to be one thing during prenatal visits, and morphing into somebody completely unrecognizable during labor and birth. Not much you can do about that, except being aware that it can happen, and trying to make sure it doesn’t happen to you. Of course, another possibility is that your favorite care provider will be unable to attend your birth, leaving you with someone else who may not share his/her philosophy.

Second, make nice with your nurse. She will be the one actually managing your labor (or being hands-off), so having her on your side can make the difference between having your wishes followed and having them brushed aside as unimportant. You don’t have to call it “bribery,” but you’ll catch more flies with honey than with vinegar. Something like candy bars (perhaps Snickers, “packed with peanuts” or some other thing that has protein in it) is quick and easy for you to have in your room, to give to your nurse when she first meets you in your room — greasing the wheels and all that. Of course, if she’s on a diet, that might not be the best; but you could think of something else that might go over well that’s not just a carby, starchy, sweet thing to eat (mixed nuts? shrimp tray? — a little difficult to get if rushing to the hospital, but if you’ve got the time, you’ve got more options). If she’s going to advocate for you, you don’t want her weakening due to an empty stomach! πŸ™‚ [Also, if you’ve got food in your room, it’s easier for you to eat it without appearing obvious, in case your hospital has rules against moms eating while in labor. Just note, that may be their rules, but not necessarily your rules.]

Third, educate yourself — know how Pitocin is administered and what you should be looking for when having it — not just the negative side effects like contractions too close together, but also the desired effect of contraction strength and/or pattern. Ideally, you shouldn’t have to do this, but it wouldn’t hurt to know. Know also that you can ask that Pitocin be stopped and/or turned down — it is not at all unusual for labor to continue on its own and in a good pattern after having been jump-started by Pitocin. If you are contracting at an adequate pace, and/or are dilating sufficiently (although I will stress that dilation is not the only way for labor to progress), but a nurse is continuing to up the Pit, you can ask why and/or request that she stop increasing the Pit and perhaps even reduce it or turn it off. Certainly you should know the symptoms of your uterus being overstimulated, so you can be more effective when requesting or demanding that the Pit be turned down. I’ve read several stories (including some comments on these posts I’ve linked to) of women who were hyperstimming, but didn’t know they could ask that the Pit be turned down — some even thought that their level of pain and/or contractions was normal, since “labor is supposed to hurt.” If your nurse won’t turn it down even though you are clinically contracting too frequently, request a new nurse or to speak to the nurse in charge. Of course, if you’re in labor and particularly if you’re having back-to-back contractions, this won’t be easy for you to do, so this is where a doula or other labor attendant (husband, etc.) comes in.

Hopefully, you will never need this information. But if you do, I want you to know it.