Thursday, July 1, 2010

Inducing Labor Medically and Naturally: What I'VE Learned

My Baby Makin' Machine is apparently SO GOOD that it just doesn't want to shut off! Next time around I'm going to have to work on the "eject" button as a friend of mine put it.

I'm still having lots of contractions but they aren't very strong, and they aren't doing much as far as getting me more dilated and effaced. I'm not giving up hope though, and thinking maybe things will kick it up a notch before the little one arrives. A spontaneous birth does seem more exciting, and is usually better than getting induced.

For the record, I'm not being pushed into being induced, it's my choice, I actually brought it up to my OB. She won't even do them until you are over 41 weeks so the soonest I could be medically induced is at about 41 1/2 weeks. Not too bad if you ask me, since I'll be only days away from 42 weeks in my pregnancy.

I'm no stranger to induction. My mom was induced with all four of the children she birthed because of going more than 42 weeks in her pregnancies. Even after her water broke when she was pregnant with me (early), contractions never picked up enough to get things going.

I don't know if a lack of natural oxitocin could be genetic or something, but I suppose it's a possibility.

Some people need or want fertility drugs, or progesterone to help get/ stay pregnant. Some people take medicine to cure a headache, I suppose we all pick our battles on when we are willing to let "nature take its course" and when we want a little bit of medical help.

At first, the realization of this possibility did make me feel a tiny bit bad. I mean, was there something WRONG with me if I couldn't produce enough Oxitocin? Maybe I can and I'm just too impatient to know. Or maybe not. But then I thought for a moment--Even IF I went over 42 weeks and she didn't come. Even if I end up medically NEEDING forceps, a vacuum, or csection to help get her out. Even IF naturally my body just doesn't cut it... I FREAKING MADE A BABY! How much more of a miracle do I need? I'd almost feel selfish for wanting more when so many people need help, or have challenges conceiving. In the end I'm blessed with a baby--My baby.

Since my maternity leave has already begun I'm already loosing time with my little girl. That's less time for learning to breastfeed, less time to bond, less time for lots of other important things in life besides just her birth. There are some business you can start from home like medical coding. Unfortunately my job isn't like that. Unless things kick into gear before then, I'm planning to get induced Saturday.

Now this is a BIG "no no" to the natural birthing community. Especially since I'm not dying, leaking fluid, or more than 42 weeks pregnant, some people would say I should wait it out. I've thought and prayed about this a lot, and I've decided an induction this weekend is fine with me.

I did, however look into other natural-induction techniques beforehand and have pretty much exhausted all of my resources. If you're pregnant and interested in getting things going maybe one of these will work for you. I recommend trying some of these before getting a medical induction but I also recommend talking to your doctor about some of these before you try it. Especially numbers 4, 6, and 7.

Besides lots of walking, here's what I've tried:

1. Sex... LOTS of sex... and I know sex alone doesn't do the trick, but trust me--The job gets done, and still, no baby.

2. Evening Primrose Oil
. I've been taking them orally and vaginally for weeks now. Sometimes I'm more consistent than others. I think it did help soften my cervix some, so I'll keep taking it, but it's not like it's started labor or anything.

3. Red Raspberry Leaf Tea. My husband moaned and groaned as he picked up the $7 box of organic potion. People swore by it so I tried it. The box is almost gone and while it may have prepared my uterus for labor, it hasn't started it.

4. Nipple Stimulation. I tried this because again SO MANY people swore by it. It's suppose to help release natural oxitocin in the body and get the uterus to contract. So much so that it's actually warned, and you're suppose to be careful with the usage. At first I tried it on my own after reading a few articles about how to do it. But since I've never breastfeed or anything I wasn't convinced I was doing it right, so I busted out the breast pump. Still nothing. ... And thank goodness nothing came out either cause it may have freaked me out.

I tried it when I was having a few contractions thinking it would make them stronger but it didn't do anything.

5. Castor oil (topically). I read somewhere that drinking castor oil could induce labor, but so could applying it topically as a castor oil pack. So I went out, got some castor oil, rubbed it on my belly, and put a warm rice-filled sock on top. As silly as I looked (and smelled) I had really hoped it would do something. Besides, so many people SWEAR by castor oil. Nothing.

6. Castor oil (digestively). I didn't think I would resort to giving this a try since I heard so many horror stories about diarrhea and discomfort, and even some possible side effects with it causing your baby to poop before she gets out of your uterus. But I got a great recipe from a doula friend who reads my blog who told me mixing an egg in with a certain shake would help it "stick" better.

2oz of castor oil, vanilla ice cream, an egg, and some milk... I gave it a shot. It didn't taste that bad, but I normally don't drink things that fast. As soon as I started to smell and taste the castor oil in the shake though it was hard to get it down without gagging. I finished it off but felt nauseous right after. I thought for sure I was going to throw it all back up, but I didn't want that because I wanted it to WORK!

The egg didn't do the trick with me as I had a MAJOR system clean out. Contractions did come, and they lasted almost and entire day but they never got very strong. I could have made a 2nd shake after 3 hours but I felt so horrible I didn't think it was worth it. My husband told me "I told you so" and tended to me while I overcame my self-obtained sickness.

I didn't learn my lesson though. One last resort, after my membranes were stripped I downed another oz of the crap before bed. I mixed it in with a cup of pudding... Ruining the pudding. I should have just taken a shot of the stuff then enjoyed my pudding afterwards. The side effects wasn't as bad that time, contractions came stronger the next morning, but pittered out again.

I've read that this stuff works for SO many people, so I was really thinking it would work for me. When this failed, my faith in these "natural" techniques began to diminish.

7. Membrane Sweeping/Stripping. While this isn't considered a "natural" induction technique, to me it's better than the castor oil, and at least it's releasing your natural prostaglandins (which everyone likes to point out is in sperm) and getting things going without increasing the risk of cesarean or causing infection.

I made the mistake of not asking about this sooner because some of my influences warned me it was an intervention--The same people who later suggested giving it a go once I started considering medical induction.

I had it done once and it didn't hurt as bad as I expected... I'd heard a lot of people complain saying it hurt SO BAD, but I guess either my pain tolerance is higher than I thought, or maybe when it comes to getting this baby out, pain means progress!

I had my membranes swept Tuesday, and I've been having contractions ever since. We'll see if they pick up. Normally you can get them swept around your 40 and 41 week appointment.

8. Positioning exercises. I know sometimes the baby just isn't in the right position to get things going, so I've been trying all sorts of ways of sitting, rolling, and bouncing on my birthing ball. Knee-chest position. Walking up the stairs sideways, sleeping differently. It hasn't started labor, but hopefully it's still helped get her ready for it.

9. Acupressure. I looked up some youtube videos of pressure points and tried these. The ones on my legs and feet are hard to do since they're so swollen full of water, but I've tried them on my hands and other places and it doesn't seem to have done anything.

Some other things I looked into but haven't tried are acupuncture, and blue and black Cohosh. I decided I was done with the herbs, and done spending money on trying to get this baby out. Maybe she's not "ready" maybe not... Or maybe she is, but she needs a little help getting out. This takes me to the medical induction research I've done.

First off I was want to say how COMPLETELY DISAPPOINTED I am in that there isn't much information out there on how to have a better medical induction. Everything I find either says pitocin is the devil, avoid it at all costs, or gives suggestions on how to avoid it. Nothing really breaks down ways to use it responsibly, or ways to make it more likely to succeed.

Well, great. Thing is, this is what I've decided to do, and it would be nice if there were more articles out there for people who either decide to have an elected induction, or who need to be induced. Otherwise I feel like they're saying: "sorry, you're screwed, it's a lost cause."

I know that's not true though because my mom has perfectly fine inductions, and I've known several people to have them before their due dates even, and be fine. That said, I also know of people (mostly online) who it didn't work out for an ended with sad stories of csections and personal promises to never get the drug again.

A lot of people also talk about the pain of contractions being stronger than regular contractions. To that, I see it the same way as I see birthing a "big baby." Since it's my first, I don't really have anything else to compare this experience to. I'm sure it will hurt, but it's not like I've labored naturally before and will notice the difference.

Here's a good breakdown I read about pitocin from
"When inducing labor with pitocin, it works best when the uterus is ready to receive it. Giving pitocin before the uterus is ready or ripe enough to receive it is likely to produce a long drawn out, unsuccessful labor. There are natural and medical ways of ripening a cervix, both having to do with prostaglandins. Ask your doctor what you Bishop's score is before you agree to a pitocin only induction. If it is under 5, labor is likely to be unsuccessful, and you may want to inquire about prostaglandin inductions as well.
This was pretty much as good as it got. Not many details, or much more than I already knew, but at least it was a little promising. I talked to my OB and I'm going to get Cervidil (one of those ripening agents) first. She says there's a chance labor could get going on its own and I won't need any pitocin. I'm thinking positive but not holding my breath, just knowing how many other things "got labor going" but not strong enough.

I've pieced together my own research to find things that help make medical inductions more likely to succeed.

The first resource I used--believe it or not--was something I learned in my Lamaze book. Yes, even though me not allowing labor to start on it's own is breaking their #1 rule of healthy birth practices, (hey, I plan to keep the other 5!), I found in their book they break down some things that help make inductions more likely to succeed.

That's where I read for the first time about a bishop score. Basically it rates you based on your effacement (how thinned out your cervix is), dilation (how far open your cervix is), how soft your cervix is, position of your cervix, and station (how far down your baby has come).

The score is added up and between 1-10. The higher your number, the more likely you are to have a successful medical induction. As of Tuesday my score was a 6. According to this site, a score of 7 or higher for first time mothers has about a 1.4% chance of ending in a c-section. Of course, it would be ideal if I could get to a 10 before starting any pitocin.

I'm a dork, but for $.99 I downloaded this ap to keep track of how my score is. It's easy to look at, plug in the numbers, and understand.There are also other options for medical induction. That's a GREAT article by one of my very smart friends who writes for, and she breaks down the positives and negatives of each very well--From breaking the bag of waters to things like Prostaglandin Gels.

I'm still weighing my options and thinking about the positives and negatives of breaking my bag of waters before trying pitocin and vice versa. If my water is broken then I basically start the clock for getting the baby out within 24 hours. But it also allows me to walk around without having an IV, and not need continual fetal monitoring. However an IV isn't the end of the world, and they do have wireless monitors which I could probably still use to move around.

Prolonged or premature rupture of the membranes (water breaking) does subtract a point from my bishop score, but I've also read on other sites that pitocin is more effective if your water has broken so I'm still trying to weigh these options. Breaking your water before the baby is engaged though is a BAD idea because you can risk the baby's head coming down on top of the umbilical cord and that basically cuts off her circulation and then you need an emergency csection. Based on where I saw her head in my ultrasound Tuesday it doesn't look like her head is super low, so I'll probably pass on water-breakage.

The nice thing is Pitocin can always be turned off if things get going, or even if happened to change my mind. Once my water has broken I pretty much should stay. I see myself talking extensively with my OB about the pros and cons of each. Speaking of which, I'm so glad she's working that day!

I'm hoping the Cervidil, and maybe trying a foley catheter (which basically is like a balloon that goes in your cervix, and falls out once it's dilated to a certain point) before pitocin.

So, there's a few of my thoughts on it all. Hopefully putting all of my thoughts down may help someone else out there who's looking for the same information I am. I wish there was more out there on good rates to increase the pitocin, and at what point I can turn it off without contractions stopping instead of the black and white "pitocin sucks vs pitocin helps."

The more I know the better I'll feel if I do end up being medically induced. I plan to re-work my birth-wishes to add more about different medical induction options. I also hope to make good friends with my nurse and just stay informed and have fun through the process.

Yes, have fun! I had a dream last night that I was jamming around the room and working through my contractions. My husband and I were having a blast. The dream got weird when they switched my baby with some 3-year-old white kid, but that's beside the point. I feel confidant and excited to have my little girl. I'm not worried about being taken advantage of, and I am not afraid to ask questions and made my own decisions.

Who knows, maybe Lil' J will surprise us and decide to show up before her appointment. Either way, I know the way she's born won't matter to me once she's here, I suppose I just like being in the know. Just wish us luck and please, keep us in your prayers!

PS: If you have POSITIVE lessons about induction please share! I'd love to hear how it went for you.

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