Unnecessary inductions lead to problems

Here is the link to an article about a recent study in Australia which concluded that when an induction is done without a medical reason, both mother and baby are at higher risk of problems than if labor begins spontaneously. These problems include a higher incidence of use of forceps or vacuum, Cesarean section, hemorrhage in the mother, admittance to the nursery for the baby, and resuscitation in the baby.

Thanks to Dr. Jen for the link.

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Misoprostol taken without doctors? NO!

This post is inspired by a search term somebody used to find my blog. I hope they found what they were looking for; but just in case, let me be crystal clear in this post:

Misoprostol can be a very dangerous drug to a pregnant woman and her baby.

Used early in pregnancy, it can induce a miscarriage or abortion; the further along in pregnancy a woman takes it, the greater the risk of negative sequelae, like uterine rupture, retained placenta, and postpartum hemorrhage. All of these things, if left untreated, can kill a woman. Even if they are treated, the woman can be left with long-term consequences. For instance, a uterine rupture may necessitate a hysterectomy; a retained placenta can cause heavy blood loss and/or infection; postpartum hemorrhage is by definition a heavy blood loss. Have you ever given a pint of blood as a blood donor? One time I did, I was dragging around all day, from the loss of one little pint of blood. Imagine losing a quart! (Or possibly more.)

The use of Cytotec (misoprostol, “miso”, the “little white pill”) may be beneficial in some select circumstances — in fact, may be preferable to a D&C for miscarriage, for instance. But in my opinion, it should never be used without medical attendance — the potential side effects, though rare, can be deadly. I know some home-birthing midwives will use Cytotec and don’t see a problem with it. I think that’s dangerous. If the uterus becomes hyper-stimulated at home, and the baby can’t handle the oxygen deprivation, or if the uterus splits in two due to the hard contractions, what can be done at home? Can they make it to the hospital in time? Will the hospital be prepared to react the second the woman enters, or will it be another 30 minutes until the O.R. can be prepped?

I rather suspect, however, that the person who was searching for that information was actually wondering about it for use in an abortion. If this applies to you, I will say this to you: Don’t do it! It doesn’t work all the time anyway, can damage the baby if it doesn’t work, and damage you even if it does successfully kill the baby. Go to RealChoice for some stories about women who have died following abortions even under medical care — women whose symptoms of infection, retained products of conception, postpartum (or rather, post-abortion) hemorrhage went undetected or ignored by doctors. If you are wanting to induce an abortion so that your family or friends don’t find out that you are pregnant, and you end up with one of these dangerous and potentially deadly events, they won’t know you’re even sick, or what to do. If you do have a problem, and they take you to the hospital unconscious from lack of blood, they may not know what the problem is, or be able to take the proper steps in time to save your uterus, or even your life.

I think that taking misoprostol is playing with fire anyway, but to do so without any medical supervision is just plain dumb!

I hope I wasn’t unclear.

How many times Cesarean

This search term somebody used to find my website is the inspiration for this post: How many times can a woman have a C-section?

This is something that really needs to be understood, and possibly there needs to be more research. Because of ACOG’s change of guidelines, many doctors and hospitals are now refusing to allow a woman to have a VBAC, insisting instead on an “elective” repeat Cesarean. (How elective can it be, when that’s the only choice given her??) But some women have medically-indicated repeat C-sections, and some women actually freely choose repeat surgery (sometimes thinking they must, because “their bones are too small” or some such thing).

Someone I met once said that her doctor said it was okay to have up to five C-sections. My question (which I suppose I’ll have to get answered sometime) is, what happens if she gets pregnant after that? [innocent smile] Well, she’d have to have yet another C-section, or have a VBAC. But the real question isn’t “how many CAN you have?” but is more “how many is it SAFE to have?”

I argue that if it’s not medically necessary, then it’s not safe to have one at all, because of the higher risk of complications to both baby and mother from this major abdominal surgery, as well as the risk of future problems related to a pregnancy in a scarred uterus — and the risks go up with every surgery. However, C-sections in America are fairly safe — they carry only 5-7 times the risk of death to the mother as vaginal birth. (That fact and others are listed here.) The risk to the mother and any future babies is also increased, usually exponentially, with every additional C-section. These risks generally are related to the placenta and include accreta (the placenta grows through the uterine lining), previa (the placenta grows over the opening of the uterus), and abruption (the placenta detaches from the uterine wall partially or completely, prior to the birth of the baby. Maternal hemorrhage and hysterectomy are also increased.

So, the best way to avoid a repeat C-section is to avoid a primary one! Not all doctors and not all hospitals are created equal — you need to make sure that your doctor and hospital both have low C-section rates — I cannot stress enough that your care provider and labor support team (including L&D nurses at the hospital) will greatly affect your labor and birth. Having a doula is also proven to reduce the incidence of C-sections, while improving your labor experience. Keeping yourself healthy and low-risk will also reduce the likelihood of having a C-section. Educating yourself is necessary.

But, if you’ve had one C-section, then here’s the abstract of a recent study about the likelihood of a successful VBAC. It shows that the rate of complications related to VBACs (including uterine rupture and dehiscence) went down after the first successful VBAC. So, if you’ve already had a successful VBAC, and now all of a sudden your doctor or hospital won’t allow another one, you may need to ask for the medical reasoning, especially in light of the latest evidence. Here is a link to a listing of research done on VBACs. It is a “sound bite” version, if you will, of the research — provided so that you can get the name of the study and the journal it appeared in, so that you can look up the full article with greater ease.

But what if you’ve already had more than one C-section? Can you still have a vaginal birth? Yes! Check out the following links (in no particular order):

  • a blog post written by a woman after her first vaginal birth… which was after four C-sections (it’s the last story on the page, written Feb. 2005
  • a website from the UK, with some stories of vaginal birth after two or more C-sections, plus links to other research on VBAMCs (vaginal birth after multiple Cesareans)
  • a birth story of a VBA3C (vaginal birth after three Cesareans)
  • an excellent website, with a very long page on C-sections, including VBACs, VBAMCs, etc.

Check out my other posts about C-sections, for more information, as well as links to some really cool videos!

Update: — this article features a mother who had seven Cesareans with no complications, and mentions a doctor who performed thirteen C-sections on one woman in the 1970s. Wow.