We know that inductions can lead to two problems- babies who were truly not ready and due date guesses that were wrong- leading to a baby who needs help and therefore earns a stay in the nursery or NICU. Or a mom whose body was not ready and her body did not comply with being forced into labor and therefore her failed induction led to a surgical birth by cesarean. I adore the Cochrane Datebase of evidence practiced medicine. And I adore Medscape which reports new guidelines by the medical societies set up by their specialties- the ACOG guidelines have now changed regarding inductions. I wonder if this was due to the ever increasing premature infants that are being born across the US and also the escalating cesarean birth rates.

So read ahead the newest guidelines regarding induction:

July 23, 2009 — On July 21, the American College of Obstetricians and Gynecologists (ACOG) issued revised guidelines on when and how to induce labor in pregnant women. The updated recommendations are published as a Practice Bulletin, “Induction of Labor,” in the August issue of Obstetrics & Gynecology. The bulletin aims to guide physicians regarding their choice of induction methods that may be most suitable in specific settings and to elucidate the safety requirements, risks, and benefits of various regimens to induce labor.

Benefits vs Risks of Labor Induction

For the last 2 decades, the rate of labor induction in the United States has more than doubled, with more than 22% of all pregnant women in 2006 having labor induced. This increase in use necessitates a careful review of indications, risks, and benefits.

The goal of labor induction is to stimulate uterine contractions before the spontaneous onset of labor, resulting in vaginal delivery. The benefits of labor induction must be weighed against the potential maternal and fetal risks associated with this procedure. When the benefits of expeditious delivery are greater than the risks of continuing the pregnancy, inducing labor can be justified as a therapeutic intervention.

“There are certain health conditions, in either the woman or the fetus, where the benefit of inducing labor is clear-cut,” coauthor Susan Ramin, MD, from the University of Texas Medical School in Houston, said in a news release. “And, there are some nonmedical situations in which induction also may be prudent, for instance, in rural areas where the distance to the hospital is just too great to risk waiting for spontaneous labor to happen at home.”

Recommendations Based on Sound Evidence

Based on evidence from methodologically sound outcomes-based research, the bulletin attempts to review current methods for cervical ripening and for inducing labor and to summarize the efficacy of these approaches. Also highlighted are indications for and contraindications to inducting labor, pharmacologic characteristics of various agents used for cervical ripening, regimens used for labor induction, and the requirements for safe clinical use of these techniques.

The bulletin authors searched the MEDLINE database, the Cochrane Library, and ACOG’s own internal resources and documents to identify pertinent English-language articles published between January 1985 and January 2009. Although articles reporting results of original research were given priority, review articles and commentaries were also consulted, as were guidelines published by organizations or institutions such as ACOG and the National Institutes of Health. However, abstracts of research presented at symposia and scientific conferences were excluded. Expert opinions from obstetrician- gynecologists were used when reliable research evidence was not available.

Indications for Labor Induction

Possible indications for labor induction may include gestational or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth restriction, and postterm pregnancy. However, physicians should decide whether labor induction is warranted on a case-by-case basis, after consideration of maternal and infant conditions, cervical status, gestational age, and other factors.

Contraindications to labor induction include transverse fetal position, umbilical cord prolapse, active genital herpes infection, placenta previa, and a history of previous myomectomy.

When labor induction is deemed necessary, the gestational age of the fetus should be determined to be at least 39 weeks, or there must be evidence of fetal lung maturity.

The first step in labor induction is cervical ripening using drugs or mechanical cervical dilators to dilate the cervix sufficiently before labor is induced. The next step is to induce labor using oxytocin, membrane stripping, rupture of the amniotic membrane, or nipple stimulation.

Misoprostol, which is approved for treatment of peptic ulcers, is often used off-label for cervical ripening as well as for labor induction. In women who have had any previous cesarean delivery, however, inducing labor with misoprostol may increase risk for uterine rupture and should therefore be avoided.

Clinical Recommendations

Specific clinical recommendations and conclusions, all based on good and consistent scientific evidence (level A), are as follows:

* For cervical ripening and labor induction, prostaglandin E (PGE) analogues are effective.
* When labor induction is indicated, low-dose or high-dose oxytocin regimens are appropriate.
* Regardless of Bishop score, the most efficient method of labor induction before 28 weeks of gestation appears to be vaginal misoprostol. However, infusion of high-dose oxytocin is also an acceptable option.
* For cervical ripening and induction of labor, an appropriate initial dose of misoprostol is approximately 25 µg, with frequency of administration not to exceed 1 dose every 3 to 6 hours.
* For induction of labor in women with premature rupture of membranes, intravaginal PGE2 appears to be safe and effective.
* In women with previous cesarean delivery or major uterine surgery, the use of misoprostol should be avoided in the third trimester because it has been linked to a greater risk for uterine rupture.
* The Foley catheter is a reasonable, effective option to promote cervical ripening and labor induction.

An additional clinical recommendation, based on limited or inconsistent evidence (level B), is that misoprostol, 50 µg every 6 hours, to induce labor may be appropriate in some situations. However, higher doses are linked to a greater risk for uterine tachysystole with fetal heart rate (FHR) decelerations and other complications.

As a proposed performance measure, the guidelines authors suggest that the percentage of patients in whom gestational age is established by clinical criteria when labor is induced for logistic or psychosocial indications.

“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.

Authors and Disclosures
Laurie Barclay, MD

Laurie Barclay, MD, is a freelance writer and reviewer for Medscape.

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Many women feel if they go past their due date- they are late. Many times providers will put pressure on a mom when she goes past her due date… please before you read this read my article on due dates- so you totally understand you are due within a four week period- week 38 to week 42… so going past the magical date is not being late at all.

Today I received a text from a mom who is 10 days past her magical date assigned to her by her doctor as her due date. She sees her doctor tomorrow and she wanted to review some induction methods prior to going to the doctor. So I thought I would share them in this blog and hope others will chime in with more.

I think there are several methods- so I will start with the least invasive first… Relaxation- just realizing that the pressure needs to be lifted will help some moms relax enough to begin labor on their own. I sell a cd from Earth Mama Angel Baby called “Getting Labor Started.” The relaxation methods on it along with the guided imagery will help many moms begin to let go and begin to release what it may be that is holding them back. The mind body connection is a strong one. It can cause labor dystocia if you are not able to allow your body to begin the work that it needs to do.

When one sees herself as normal- and relaxed… letting go of the preconceived notion that she is no longer beautiful or sexual- she may be able to also have some great sex. The prostaglandins in semen help to ripen the cervix and nipple stimulation in foreplay along with the orgasm that hopefully follows or accompanies the sex releases oxytocin. Pitocin is the synthetic form of oxytocin- but one that does not pass through the blood brain barrier. Trust me oxytocin is much nicer than Pitocin!

Making sure the baby is lined up properly will also help. This is especially important if you have been having lots of “false starts” to your labor. If the baby is not quite lined up right it could cause your labor to not only begin but could also cause a longer labor. We offer a class based on Gail Tully’s knowledge (www.spinningbabies.com). So make sure the baby is lined up great.

Evening Primrose Oil is taken by some women orally – first day with breakfast- then day two with breakfast and lunch- then day three with each meal and then on day four adding it vaginally from week 37 on. This is considered a natural prostaglandin and certainly could help to ripen your cervix. If you already have a diet rich in good oils- Vit E, Fish Oil. Omega 3 oils- this may make little difference. Some say it increases the chance of meconium with the baby- but that is still undetermined.

Getting your membranes “stripped” may be a good way once you go past your due date. Some care providers do this without really even talking to you about it first. You must be at least one centimeter dilated to help make this make a difference. But they insert their finger in your cervix- no this is not a comfortable event. It is also not without risks- infection, breaking your water by mistake, causing contractions that do not produce anything if your uterus is sensitive, etc.. but it can also help to release some prostaglandins to help get labor started. But keep in mind if you take your panties off and get up on the exam table this could happen if you don’t have a conversation prior to taking your panties off.

Getting the party started by having your colon begin the party is another way that some women resort to in order to avoid a medical induction. You may take castor oil- it is done in numerous ways- in root beer- in the blender with orange juice and ice- spread on toast with nutella, in the pan when you cook eggs, etc- or you may take borage oil instead. This is also why an enema may cause your labor to begin. What it does is start your colon contracting and thus the party begins and your uterus jumps in as well. Ask a mom who has been up all night with diarrhea if this is a good way to begin labor. If you are going to do this- I would suggest at least having a ripe cervix and beginning it early in the day so it kicks in before the middle of the night. (See my article on fatigue being an issue with the need for medication in labor to understand why a lack of sleep is never a good way to begin labor.)

Some natural prostaglandins can be found in foods as well. Fresh pineapple- rich in bromelain, eggplant, flaxseed, nuts and seeds…foods rich in Omega 3 Oils are great for this. We have always known that a great diet does effect pregnancy and certainly can effect labors.

Acupuncture and acupressure can be useful in helping to get labor started. As doulas we have some areas we may use to help get labor to kick in if your water is broken and you are on a time crunch. There are several places that can help to align your body rhythms to help your body ready for labor to begin. A good acupuncturist is imperative- www.grdhealth.com, dr khalsa is my personal acupuncturist. A good massage therapist can also massage certain areas that will help to get your labor going as well. If you insist on seeing a female massage therapist I can recommend Regina Elvis at themiracleofmassage.com and if you want an active KMI type massage I can recommend Harry Kramer at www.kmiatlanta.com.

There are several herbal things that can be taken. Since I am not an herbalist, I will encourage you to seek one out if you need guidance with the use of herbs.

Now if these things don’t work- and your care provider begins to look at the need for medical inductions there are several methods. One is to break your water to help begin labor. My suggestion is to ask the questions- What are the risks? What is the time frame they require before they begin the next intervention? Often labor when it starts by having your water break on it’s own- will begin within 8-12 hours- but when it is broken artificially that is not always the case.

You may ask about ripening a cervix by having a foley catheter inserted to help to stretch your cervix or having cervidil- tampon type method that is embedded with prostaglandins- inserted may be the next step prior to any other intervention. This increases your bishop score and therefore allows for a more favorable chance for an induction to end with a vaginal birth. If either of these cause a problem they can be immediately removed. Some believe that cervidil does cause your cervix to be irritated, causing vaginal exams afterwards to be possibly more painful.

There are some care providers who still use the very controversial Cytotec or misoptrostil. Although the manufacturers of the gastro medication warn severely of using it with pregnant women for induction- and 60 minutes and 20/20 have both done exposes against it’s use… it is still be done. The small pill is inserted vaginally or orally and once in your blood stream could possibly cause problems that could be very dangerous. Once it is in your blood stream the removal is virtually non existent. I will encourage you to do a google search and read about it for yourselves.

Pitocin is a most used method for induction. It requires constant monitoring. Whenever constant monitoring is involved- keep in mind it is because there are inherent dangers. This is given intravenously and can be closely monitored. But some care providers use it gently and increase it very slowly- therefore mimicking natural labor often. But often times it is given very actively since the care provider does not feel you need to be going without an epidural and senses that rapid infusion will help you get that epidural sooner than later. If Pitocin causes problems, it can be discontinued.

Remember that inductions are not without risks. Certainly there is a risk to going more than 42 weeks as well since it does increase the risk of stillborn births. One of the best ways to determine how your baby is doing is to do agree to a non stress test and biophysical. This test is one that is able to let you know how your baby is really doing- how the environment of the womb is doing. Often I have been at inductions for postdates to see a baby born with tons of vernix and showing signs of not being late at all. Due dates are subjective. Your normal gestation is also subjective.

I walked around 70% effaced and 3 centimeters dilated for over three weeks with my first two babies. You may wonder about my third pregnancy. I did not allow anyone to check my cervix since I did not value the findings as being information that was needed. I was ten days “late” with each of my babies. My first grandson was born to my youngest ten days past her magical date. My oldest daughter gave birth to her first two babies four days early and her last baby on her magical date. So… what does that all mean… that labors are all individual. That you are an individual and so is your baby.

Enjoy the last weeks or days of your pregnancy. Change your phone message to “No baby yet, we will update this message when He/She is born with the details. Don’t leave a message unless it is urgent as we are nesting.” And then don’t answer your phone. When sharing your due date- share a due month instead. Don’t let others determine how you feel about the last weeks of growing your baby.

Please feel free to comment to this entry. I would love to hear what worked or what did not work for you personally. Thanks!

Well I figured I write about this all of the time- maybe it would be good to share another professional’s view of induction. Here is a link to her blog as well http://gaildahl.wordpress.com/

10 Reasons to Avoid Induction

A common decision today’s parents will face during childbirth is birth induction. A birth induction happens when the labor of a pregnant woman is artificially started. Today’s parents need to know why it is important to avoid birth induction and why it is important to allow labor to begin normally and naturally without any interference. Here are the reasons you would want to avoid induction in childbirth:

1. If you induce the birth of your baby you will be at risk of delivering a premature baby. New studies are showing that babies who are even slightly premature have more problems at birth and beyond. There is no proven health benefit to forcing your baby from the womb before your baby has had enough time to properly develop. Even in the last few days before the birth of your baby, last minute finishing touches are ongoing. The final layers of fat are placed, the lungs are receiving the finishing touches even as you are going through labor. All of this will help your baby to be comfortable in a change of environment. Your baby will most likely be ready ten days after your estimated due date, especially if you are a first time mother. There are no studies showing any benefit whatsoever to artificially starting labor and there are many studies showing the risk of premature birth to every baby. Wait for your labor to begin normally and naturally.

2. If you induce your labor, your labor will become more painful and prolonged. Your contractions will be too long, too strong and too close together causing your baby to have difficulty breathing and your contractions to be less effective.

3. If you induce your labor you may not be ready physiologically or emotionally to give birth without your baby signaling to your body the exact time it is ready and able to labor. Inducing labor, by any means, will cause unnecessary stress on your body and your baby.

4. If you induce your labor, your baby may experience harm caused by the mechanical force of the artificial contractions that can damage your baby’s brain and affect your baby’s ability to breathe.

5. If you induce your labor you may be at risk of secondary infertility due to the increase of the risk of damage to your uterus caused by uterine rupture.

6. If you induce your labor you may be at risk of bleeding throughout your labor and after childbirth because of the damage caused to your uterus by the induction drugs creating a greater difficulty in caring for the new baby along with the increased possibility of prolonged postnatal depression caused by the induction drugs.

7. If you induce your labor you will not be able to experience a natural birth due to the increased pain during labor. The narcotics used in a epidural cross the placenta and cause increased stress on your baby as the narcotics hit your baby’s immature liver and brain causing a decrease in the cardiac and brain function. Your baby will find it hard to breathe because of this. Your baby will have great difficulty breastfeeding because of the afterlife of the narcotics. Very few women are able to have an induced birth without additional drugs to handle the increased pain from the artificial contractions.

8. If you induce your labor you will unknowingly trigger a cascade of medical interventions like, strong medications to force your cervix open, multiple narcotic drugs for increased pain, continuous fetal monitoring, forceps delivery or the use of a vacuum extractor; when the attempt at the induction fails.

9. If you induce your labor you will become a high risk for emergency cesarean delivery, (as high as 50%) as many induced labors fail and leave both mom and baby in medical distress. In the case of an extreme medical emergency, for either mom or baby, consider bypassing induction and going right to a cesarean section. Adding induction drugs to an already stressed mother and baby may cause additional damages to both. Allowing a woman to labor naturally before a cesarean section will help to further develop the baby’s lungs.

10. If you don’t induce your labor, and allow your labor to begin normally; your labor will be less painful, your labor will be shorter and more productive, (your body will be ready for it), your baby will be able to breathe, you will reduce your risk of cesarean section, you will reduce the health costs associated with your birth, you will have less need for pain medication, you will have a shorter delivery, you will have a faster recovery and you and your baby will be healthier as a result. Your baby will breastfeed more easily and you will find it easier to bond and attach to your new baby. If you are anxious about your baby’s arrival, make sure everything is ready for the baby’s arrival, the house is clean, groceries are purchased, banking done, extra food prepared, official registration papers for your baby and the myriad of other things you will need to take care of at this time. Avoiding a labor induction is one of the best secrets to having a safe and gentle labor and delivery for both mother and baby.

Secrets Newsletter 2008. Gail J. Dahl, “Pregnancy & Childbirth Secrets”.

There was a neonatal physician on the local 5 o’clock news this week who made this statement, “Having a baby as few as four days early increases the newborn complications risk by 20%!” and the statement was made that, “Northside Hospital the nations busiest labor and delivery center with over 18,000 births per year supposedly issued a new rule that women can not schedule an elective c-section or be induced before their 39th week of pregnancy.” But my experience working with moms who give birth in the Atlanta metro area- and yes even at Northside is that is not being done. Doctors seem to be able to find a medical reason for an induction even when the birth later shows the risks were not there.

Who is doing all of these inductions? What is causing this to happen? I believe it is not only the doctors who schedule inductions and cesareans for factors that include convenience as well as malpractice concerns, but it is women who are demanding it. The doctor in this interview eludes to moms getting tired during their pregnancy and wanting to have the baby born. So, do no harm should mean that the doctor advises a mom that this is risky. That not only will an induction lead to more of a chance of a surgical birth, but more risks that she will not be bringing her baby home when she is discharged.

I can tell you that I have conversations almost weekly from moms who were induced or told to have a surgical birth due to their baby being too big. Then the baby is born and is well within the normal range of size. She then goes on to have a vaginal birth with a subsequent child who is much larger than the first. What happened? Did her pelvis get larger the next pregnancy?

This is a link to the original newscast:

The news story went on to state, “The number of Cesarean sections has skyrocketed in recent years. One out of every three babies is now delivered surgically. New research shows women may want to think twice about scheduling an early delivery.”

The news reporter, Beth Glavin states that “a pregnancy is considered full term at 37 weeks.” But since often a woman does not know exactly when she conceived or when she actually ovulated it is difficult to know for sure if she is 37 weeks or 36 weeks and three days for example.

One OB online states “A normal pregnancy should last 38 weeks if you count from the day of conception. However, the day of conception is not always easy to determine, especially in the ancient past. Therefore, people then have used 40 weeks from the first day of the last menstrual period, on the assumption that women have 28 day cycles and they conceive 14 days after the start of their menses.This traditional way of counting has been in use till now.

Therefore, when we say you are 10 weeks pregnant, you have actually conceived 8 weeks ago. Based on this type of calculation, a pregnancy will have the expected date of delivery at 40 completed weeks but a pregnancy that has completed 37 weeks is considered full term already.

Beth states that “the recommendation is that a woman wait until she is 39 weeks to consider having a planned cesarean.” But since inductions can lead to a cesarean = then shouldn’t a woman wait until 39 weeks to consider even being induced? The doctor on the news report says every week of early birth due to inductions can cause the risks to the newborn escalate. It is due to lung and brain development. “Before 39 weeks the baby is just not ready.”

This is another story – more reseach showing the risks of early inductions and cesarean births:

The study showed, “More than a third of the C-sections were performed before 39 weeks, the researchers found. Those delivered at 37 weeks were twice as likely to have health problems, including breathing troubles, infections, low blood sugar or the need for intensive care. Fifteen percent of those born at 37 weeks and 11 percent born at 38 weeks had complications, compared to 8 percent of the babies delivered at 39 weeks.”

A dream of mine would be for women to trust their bodies. For babies to select their day to be born. If a mom is more high risks, sure do non stress tests and biophysicals to insure that the baby is doing great. But the stress of going “late” and having a baby “on time” needs to end. We need to embrace that nature did not make a mistake. That MD does not stand for minor deity. That we can decide if we are going to get on that induction train or not. That the induction police don’t come and pick us up to drag us to have our babies. We must begin to take responsibility for our health and the health of our babies.

It begins with trusting our bodies. And it also goes to trusting our care providers. So if a care provider says an induction or cesarean is needed- ask more questions. Know the risks. Weigh their guestimations with knowledge and with what the studies show- wait if you can.

Gentle Birth Baby by Sarah Buckley

as summarized by Teresa Howard

Gentle Birth babies are effected for a lifetime.

Mammalian births- we are all basically the same. (I thought it humorous that she said this in her speech. It immediately made me think about Ina May Gaskin saying if you wanted to watch real birth on t.v., you should watch the Animal Planet!)

Safety, ease and pleasure = species for survival basis. So birth should be relatively safe, easy and pleasurable in order for any species to make it!

Anxiety and fright = prolonged labor
A woman needs to feel Safe, Private and Unobserved = this is what she calls the Recipe for ease of Birth

If this is the situation, then we should release the Ecstatic Hormones. This cocktail = oxytocin + beta endorphin (natural pain killer) + epinephrine (adrenalin) + non epinephrine: these release catecholamines –these rise at transition and it stimulates labor and the fetal ejection reflex + prolactin (the love hormone for moms!)

What disturbs Mother Natures plan for birth? Pitocin, epidurals, opiates and cesareans.

In 2005
21-40 percent of women were induced
50 percent tried to get labor going or their caregiver did
99 percent had pitocin after birth

Receptors in a woman’s uterus will shut down if over stimulated by pitocin.

The altered state of a woman in labor is for it to be normal when “she goes out to the stars to collect the soul of the baby” (… this is what Pam England refers to as laborland.)

When an epidural is given, the pelvic floor muscles are relaxed and it numbs the lower vagina.

When mothers spent less time with their babies while in the hospital their moms felt their babies were less adaptable and more intense.

Bupivacaine, a drug used in most epidurals have a half Life 8 hours in the baby after the baby is born.

Dim lights, no numbers (dilation or time constraints), covering the clock, encourages instinctive behavior in the mom during labor.

The three things a woman in labor needs to focus on are: BREATH, making SOUND if she desires and MOVEMENT.

I heard Sarah speak at the Gentle Birth Congress in Portland a few years ago- these are my notes from that speech. She is coming to Atlanta to the ICAN conference this year. She is fabulous!

New Kerala.com- a Sydney newspaper reported this on December 10th…Italics in parenthesis are mine for my input.

Inducing labour in pregnant women is risky

Sydney, Dec 10 : Inducing labour in uncomplicated pregnancies can be risky, according to a study.

A quantitative study based on 50,000 first births between 2000 and 2005 showed that induced labours were more likely than spontaneous births to lead to forceps delivery, caesarean section and haemorrhage. (now keep in mind- 50,000 births is a lot of births! and the data was recorded over five years!)

Babies were also more likely to be admitted to nursery care and to require active resuscitation after induced labour.

Mary-Ann Davey of Mother and Child Health Research at La Trobe University, who conducted the study, stressed that the sample included only those women whose pregnancies were progressing in a healthy and normal manner. (so these were not moms or babies at risk of something happening to cause a more interventive birth!)

“I used data that are routinely collected on all births in Victoria by the midwife attending the birth,” Davey said. “I selected those first births that appeared to have no clinical indication for induction of labour. (so these were elective inductions- not medical inductions! keep in mind most inductions today are just such inductions- “I am tired of being pregnant.” “I am afraid your baby is getting too big.”)

These were all single pregnancies of normal presentation born between 37 and 40 weeks. (so again these are not “late” babies- these are women being induced actually early at times- 37 weeks is considered premature still- what if the due date was off by a week- yes remember full term is between 38 and 42 weeks and many times gestation is just a guess at best! all women do not ovulate at day 14 and some women do not menstruate at every 28 days!)

Mothers had no complications, such as pre-existing diabetes, hypertension, cardiac disease or mental illness and those younger than 20 years or older than 45 were excluded from the analysis.

Davey believes that many of the labours were induced for reasons of convenience rather than for any medical indications. Sometimes the pregnancies might be induced because they are past the due date but only by six days or less. (so convenience is worth what cost? having your baby end up in the NICU? having a surgical birth with the complications that can cause? six days late is not even considered really past due yet!)

The risk of haemorrhage following induced labour was increased by 17 percent, of an instrumental delivery by 20-70 percent, of nursery care for the infant by 24 percent and active resuscitation by 15-100 percent, depending on the method of induction, said a La Trobe release. (so instead of having a healthy mom bonding gently with her new baby- soon to be nursing at her breast, she is recovering from an instrumental or surgical birth and her baby is in the warmer being tubed or worse sent to the nursery…for what?)

The risk of a caesarean was between two and four times more likely after induction. (so in Atlanta where some hospitals are already nearly 40% think about what the rate would be if inductions were only allowed when medically neccessary? would the rete drop back down to below 20%?)

…So can we safely say that inductions are not safe? Can we conclude that when it is done it is not without risk to both the mom and the baby? Can we share this with a mom when she complains about being tired of being pregnant? Or when a doctor “thinks” a baby may be too big? Can we just allow babies to decide for themselves when to be born? Can we stop playing God?

The increase in cesareans today is linked to the increase in inductions. but there is certainly a seduction to induction today. The reason for inductions being so prevalent today is multifaceted. There are reasons to medically induce a labor. The signs of preeclampsia is one reason. There are some conditions that make the pregnancy threatening to the mom’s health as well as the baby’s. But many inductions are not medically indicated. 

When a mom has had a fast birth the first time, sometimes there is concern about a precipitous labor with the second. I have accompanied moms in just such an induction. Many times the induction is easy, but it can also cause the labor to be more painful and longer than it would have normally been if not interfered with by the induction.


Sometimes childcare arrangements for the couple with one or more children, makes an induction seductive. Knowing the exact day the birth will occur helps some couples decide to have an induction. The element of the baby not being ready, or the body not responding to the induction in a favorable way is always a risk. (more…)

The Bishop Score is a method to help determine how favorable your body is for an induction. The less favorable, the more likely your induction will fail and thus lead to a cesarean birth. The more favorable your score is the more likely your induction will lead to a vaginal outcome. There are several reasons to induce. This is a question for you and your care provider. But determining how favorable you are is something you should know so you can make an informed decision regarding the likely outcome.
Points you earn / 0 / 1 / 2 / 3 /
Dilation (cm) / 0 / 1-2 / 3-4 / 5-6 /
Effacement (%) / 0-30 / 40-50 / 60-70 / 80 /
Station / -3 / -2 / -1/0 / +1/+2 /
Cervix / firm / medium / soft / /
Cervix Position /posterior/ meidan / anterior/ /
Ask the care provider these questions: (more…)

I want to be well now! I want to be done hurting- done being sedentary… done… And then this made me think about women who are pregnant. Seems women anticipate- prepare- read- go to class- talk about- and wait for the contractions to begin. But then we they do they either focus too much attention to the early ones that are not really worth demanding their attention yet, or they get anxious about them not starting and agree to an induction. But it is all a process. And when you try to hurry it up, there are consequences. And we need to understand that being patient and waiting for things to happen as they are supposed to is a virtue.

When we try to rush things, force things, whine about the time it takes, we are fighting the process. I have seen the rushed processes in labor and birth- they are not pretty. They are full of interventions, surgical births and regrets on the part of the parents. So, I am going to try to remember the words I preach as a doula… trust the process. I will wait patiently- trusting that my body is healing just the way it should- at just the right speed.

This process of cancer and the aftermath has taught me so much as a doula and childbirth educator. I just hope I can impress upon my students the need to trust their bodies and the process along the way.