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Archive for the ‘induction’ Category

I read a great blog post today by a Certified Nurse Midwife about the usefulness (or actually, the possible emotional harm!) of vaginal exams prior to the beginning of labor. I think this is a great read and good information to take to heart, and have at times said exactly the same words to both clients and class participants. I already posted this over at the ICAN Seattle blog, ( I am the co-leader of the Seattle Chapter) but felt it was so good, I needed to get it up on my own blog too!

The question I always ask is this…. ‘Will the information gained from THIS vaginal exam change what we are going to do today?’ In your present situation, unless you are considering being induced a vaginal exam is irrelevant. What do I mean irrelevant…it does not change what we are going to do TODAY and things can literally change overnight. Because of this, I encourage you to avoid all vaginal exams until you think you are in labor and are having a labor check or you are preparing for an induction. I encourage you to let go of your current cervical change expectations and focus on getting your mind ready for labor and motherhood. You can go from closed to delivered overnight. It will happen. Don’t start to doubt and don’t start to worry. Your body and your baby know the perfect time to move to birth.

Recently I had a student in a class come to me during a break and ask me if spotting, crampiness and some contractions were normal at 33 weeks. I told her that those symptoms might be a reason to check in with her Health Care Provider, as they might want to rule out pre-term labor. She went on to tell me that she had had an appointment the day before, where a vaginal exam was done, that was fairly painful. 1013-gyno-exams_vg
Ever since then, she had been feeling some contractions and cramps. When asked why the exam was done, she could not tell me, other than her HCP suggested it. I honestly did not know what to say, and wondered to myself if this woman was going to be birthing a 33 weeker because some things got stirred up when they should have left things alone. I did encourage her to check in with the provider, and am pleased to report that after another day, things settled down and she has not yet gone into labor!

Skip over to read this entire blog post by It’s Your Birth Right; Skip This Routine and think about keeping YOUR pants on if you are not in labor!

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I received a call from my doula student last night, updating me on her clients! I am ever so pleased to report that this woman gave birth non-induced and non-medicated and non-intervened with to a happy, healthy baby on Saturday!

And now for for the rest of the story…the doula met up with them the evening before the scheduled induction, and was really present for their discussion and decision-making process. The doula shared The Problems and Hazards of Induction CIMS information sheet from her doula training manual. Using her wonderful, reflective listening skills, she heard the mom say that she wanted to go into labor on her own, that she did not want to be induced and felt like she might want to switch doctors, but who would “want” her, as she was past her due date. As the parents talked, they realized that they would not go in the next day for the induction and would wait for labor to start on it’s own.

The morning of the now-cancelled induction, the mom started having some contractions! It started to look more and more like active labor. Amazing how removing emotional issues can be freeing for some women and tip them into labor. Alas, the evening saw things slow down and peter out. The parents went to bed and woke up Friday morning with no sign of any labor at all. Discussions with the doula involved re-affirming that her body and her baby knew what to do and that her baby will pick it’s due date and be born when it is ready. Friday night, labor started again, and this time, kept on going, a late night trip to the hospital, several hours in the tub and a wonderful baby landed earthside! Mom gave birth in an upright position, unmedicated and oh so powerful! The doula reports that the parents are thrilled with the experience, so thankful for the support and listening ear of their doula, who helped them to clarify what was important to them.

I was proud of this new doula, and told her so! I am glad that she sought out my help when she felt she needed it, glad she was there for her client and supportive of the couple as they found their way. And oh so happy this mom got to have a wonderful, empowering birth on her own terms.

The most recent class of new birth doulas from Seattle Midwifery School

The most recent class of new birth doulas I have had the privilege of teaching from Seattle Midwifery School


I am so lucky to have the opportunity to teach birth doulas as part of the faculty of the Simkin School for Allied Birth Professions at Seattle Midwifery School. I know I can help one family at a time as a birth doula, but I get the shivers when I think of how many families the doulas I have trained can go on to empower! I always tell my doula students, that if they ever need to bounce ideas off someone, or find themselves “stuck” and need some help, they can call me 24/7. I am always happy to help! I remember what it was like when I was starting out and was grateful for my experienced doula sisters who made themselves available to me. And now in turn, I can do the same! The circle of life continues!

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I had a newer doula call me yesterday for some advice. She had been in a recent doula training class at Seattle Midwifery School and wanted to talk over a current client situation. Her client was less than a week overdue with her second child and her first baby was a vaginal birth with no complications. Her doctor told her that she needed to be induced, sooner rather than later! Like…tomorrow! And when this client inquired as to why, the reasons provided by this surgeon were: 1) most women are done being pregnant by now and just want their bodies back, 2) the baby is only getting bigger and bigger every day, and pretty soon your baby’s head will not be able to fit through your pelvis. Remember, this is a mama who has a “proven” pelvis, meaning that a baby has already found it’s way out through this very same pelvis, that now is getting more and more unable to birth her second baby by the minute! When the client asked about waiting a few more days, the doctor replied that the client could only be induced on days that the doctor was on call, even though this is one practitioner in a large, well established practice with doctors on call 24/7 for the unlikely event that a labor actually starts on it’s own.

Since this multip’s (woman who has already birthed at least one baby) cervix was already dilated and effaced, the method of induction would be pitocin or if the client preferred, they could rupture her membranes. No discussion of the benefits or risks or alternatives of any of these interventions, no discussion of the evidence based research that supports the appropriateness (or not) of these interventions, nor any reason that indicates this induction is based on a valid medical reason.

The parents were confused, scared and nervous. Maybe the obstetrician was right, maybe it was best to induce the next day! They asked for more time to discuss this privately and told the OB they would call with more questions. They called their doula, using her as a resource to help them make this decision. And the doula called me. The more I listened to the comments allegedly made by the doctor, (and I do realize I was receiving this information second-hand!) the more I could feel myself shake my head in disbelief. How is this behavior ethical? Even The American College of Obstetricians and Gynecologists, (a professional organization, mind you, not a research institution) in their own literature and patient pamphlets states what is a valid medical reason for induction! And “wanting your body back” is not on the list! No evidence of improved outcomes following induction of labour for non-diabetic women who are thought to be carrying large babies has been found that warrants an induction for macrosomia in this case.

What is up? Where is the information about informed choice, benefits and risks? Where is the truth? A great resource for anyone facing an induction for non-medically supported reasons (and even for the medically supported ones!) can use the Coalition for Improving Maternity Care Problems and Hazards of Induction as a great guide. CIMS Problems and Hazards of Induction Fact Sheet

An extremely valuable resource was published this fall by some powerhouse organizations, including Childbirth Connections that I think should be required reading for all women of childbearing age, particularly, the pregnant ones: Evidenced Based Maternity Care: What It Is and What It Can Achieve You can read a pdf on-line, or you can order copies for free! What a fantastic resource. If you are a doula, childbirth educator, or other birth professional, consider ordering some for your practice to share with clients!

As for the woman mentioned in the original paragraph, at last report, she has been in early labor since this morning, all on her own and with the support of her partner and doula, waiting for things to pick up! Maybe it was that beautiful full moon over Seattle that “induced” her baby to come! May this baby arrive safely earthside before the moon sets again! phinney_moon

Moonset over the Olympics, from Seattle.  Photo by Karen

Moonset over the Olympics, from Seattle. Photo by Karen

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