Exciting Changes Coming!

GT Pentwater 2017

Sand, waves, beautiful sunset, RegCake…ahhhh…doula retreat! We (Shannon, Rachael and Jill) have been enjoying a quiet weekend away to refresh, re-fuel, and plan for our upcoming year. We have some exciting changes coming down the pike that we can’t wait to tell you about!

Starting in January (for NEW clients–nothing will be changing for existing clients), doula clients who sign on with the Gentle Transitions team will be getting the awesome experience of working with not one, but three skilled doulas throughout your pregnancy! We have decided to combine our individual businesses to be the Gentle Transitions Doulas. So, what will that look like?

  • Throughout the year, we will have 6 group prenatal meetings where we will discuss an overview of things to consider and research throughout your pregnancy, basic childbirth education, and comfort measures during labor and delivery. After the class, you will have time to chat with other expectant parents, and ask us any questions that you may have at that time. Clients can attend as many of these meetings as they like!
  • On the “off” months, when we do not have prenatal meetings, we will be continuing to host our Pregnancy Resource Meetings, going more in-depth on certain topics, or bringing in guest speakers from the community to share with us. These will be open to both clients and the general public.
  • Between 7-9 months gestation, clients will have a personal, one-on-one prenatal meeting with one of us to talk about your birth plan and any other questions you might have.
  • Throughout your pregnancy, you’ll get to text/email/call us and have all three of us consulting with you, answering questions, and recommending resources as needed.
  • Two of us will be on call at all time for births. When you go into labor, the primary doula on call will most likely be the one to attend your birth. If she is with another client, the backup doula on call will be there for you!
  • If you want to request a specific doula be at your labor and delivery, you can do so for an additional fee.

We are so excited about these changes! Not only are clients going to benefit from more support and meetings during pregnancy, but we will have better continuity of care between us, and be able to prevent “doula burnout” by having a structured on-call schedule. If you have any questions, please don’t hesitate to let us know! We look forward to continuing to serve expecting families in the CU community 🙂

 

 

Advertisements

Family-Centered Cesareans

by Shannon Morber

*************************

Disclaimer: Before venturing into the arena of Family-Centered Cesareans, I feel the need to address something first…

It’s no secret that just about any subject related to mothering can be a “hot button” topic, which includes cesarean births. This is an unfortunate reality to the parenting realm in the 21st century. The upside of hot button topics is that it creates a forum and space to dialogue about different viewpoints and share information. It can provide opportunities for each of us to consider new perspectives, potentially triggering expanded ways of thinking and self-growth. The downside? These topics can be an avenue for division, judgment, the shame & blame game and hurt feelings.

We here at Gentle Transitions would like to be unequivocal in communicating our feelings about birth…there is NO one “right” way to birth. There is no greater or lesser way; there is no “failing”. There is only birth. According to Merriam-Webster, birth is “the act or process of bringing forth young from the womb”. So, no matter how your young emerged from your body, it is a birth. It is YOUR birth, for better or worse. Talk about your experience with pride or if needed, seek out the help & resources you need to heal from it. If you did have a cesarean and you have trauma concerning that birth, connect with other mothers who have been there too. And don’t hesitate to reach out to us for any support you might need! We are here to walk alongside you on your path, witness your journey and encourage you every step of the way.

*************************

Okay, off we go now! 🙂 When mothers have a cesarean birth, they have two options for future births: planning a Family-Centered Cesarean (or sometimes referred to as a “gentle cesarean”) or planning a Vaginal Birth After a Cesarean (VBAC). In this post, I will be focusing solely on the former option for the time being.

In 2004, I had a cesarean birth with my oldest son. It was a positive experience in that I got to meet the little man who first made me a mom. However, it was a negative experience in that I felt ignored, disrespected and bullied by my healthcare provider and hospital staff throughout my labor process, which ultimate led to an unnecessary cesarean (in my opinion). While I did go on to have a VBAC in 2006, should a repeat cesarean ever be in my future, I would absolutely utilize options to make it more family-centered than my first!

You may be asking: What the heck is a Family-Centered, or gentle, cesarean? To familiarize yourself, view this brief video about how one hospital defines it and is making changes for expectant families. NPR also did a great piece on the topic, highlighting the benefits of it and one mother’s personal experience. And lastly, another Huffington Post author shares the top 5 most positive aspects in her family-centered cesarean birth.

What choices does a mother have to help make a cesarean more family-centered?

Now that you know what a Family-Centered Cesarean is, or what it might look like, let’s discuss the related options. The graphic below covers the vast array of choices you have to tailor your cesarean birth, according to your desires. From surgery preparation all the way through postpartum, you have a voice and can use it to help achieve the birth you’d like to have.15994864_1176555299108395_4406328689558233219_o

What steps can a parent take to implement a Family-Centered Cesarean?

1) Know your options.
Familiarize yourself with how other families have opted to have a family-centered cesarean. Ask questions & read books. Talk to other women in your community or online who have had one. If this is your first cesarean, have an idea of what to expect before, during and after the surgery. Check out the fabulous resources at ICAN (International Cesarean Awareness Network) and learn tips on recovering from a cesarean birth.
2) Stay in positive & continuous dialogue with your healthcare provider.
Inquire about your healthcare provider’s personal experience with a Family-Centered Cesarean and get a feel for their comfort level. If your provider seems uncomfortable or indicates he/she would rather not deviate too far from the standard cesarean norm, find another one who will actively work with you to achieve your birth goals. Some items in a Family-Centered Cesarean may require extra time and planning ahead (e.g. obtaining a clear surgical drape, extra nurse staffing assigned to be with the baby in the OR, etc.), so be mindful of earlier preparation and
3) Outline your preferences & choices into a formal birth plan.
Once you have educated yourself on your options and made your choices, it is always a good idea to let your healthcare providers and birth team know your preferences. That way, there is no room for confusion or miscommunication. You will feel more comfortable and confident heading into your birth experience with the peace of knowing those around you are all on the same page. Not sure what to include or wording to use? Check out this sample from Birth Without Fear.

Finally, remember that this lovely day is when you get to meet your sweet babe face-to-face. Drink in your baby’s features, smell their little heads to your heart’s content, sit in awe at the wonder of human reproduction and its results. Keep yourself as comfortable as you can. (Pain medication is necessary when recovering from major surgery; your body will thank you.) Go slowly in the days and weeks ahead. Ask for and accept help whenever it comes. Despite having a surgical birth that probably involves a longer recovery, it is still possible to have a gentle transition into your family life. May your birthing day truly be a day you look on with joy and love.

15780790_1162813620482563_4286866801990201457_n

Surviving Summer with a Bun in the Oven

It’s summer. You are hot. And in the last few weeks of your pregnancy. We have compiled a list of a few things around town and at home to help you survive the last few weeks of pregnancy and prepare for your new bundle of joy!

  1. Go to Sholem on one of the hottest days of the summer… the kind where you don’t want to leave the house at all. But trust me- go to the pool. Float down the lazy river and it will be a super relaxing and cooling way to get comfortable on a hot day at the end of pregnancy! You won’t be the only pregnant person there- I guarantee it! Don’t forget to bring your water with you though!
  2. Get a massage! Schedule an appointment with Abby Meyers of Abby Meyers massage to do a prenatal massage. Work out those knots and relax as she works her magic.
  3. Get a pedicure! It’s an awesome way to relax and pamper yourself- plus you will have pretty toes when you are done!
  4. Go on a date. You may not be able to do that for a while after the newest addition arrives, and it is a great way to connect with your partner before baby comes.
  5. Take a nap. You probably won’t be able to get solid sleep after baby gets here.  So, sleep as much as you can now- if you are tired, listen to your body and take a nap!
  6. Go get coffee or ice cream with friends. Or do both. Both is better. Again, your life is about to change. And it is awesome to get out and do the things you really enjoy… it really helps pass the time until baby gets here.
  7. Go get adjusted. A chiropractic adjustment from Emily McCabe at McCabe Chiropractic is a great way to get comfortable and can help get your body ready for the marathon of labor!
  8. Go do a session of acupuncture! I’ve never been more relaxed than I have when I’ve gotten an acupuncture treatment with Bensky Family Acupuncture. Plus it’s getting your body ready for labor
  9. Pack your bag. Some great suggestions here and here.
  10. Make your Postpartum Plan. A lot of times we prepare so much for baby’s arrival and forget all about how much help we will need once we are home.
  • Has anyone offered to set up a meal train for your family? Meals can be so helpful in this transition so be sure to take people up on that offer.
  • Make your Postpartum Care basket. After baby comes- you won’t want to walk all over the house to find the things you need those first few weeks- having a basket on each floor in your common areas of your house can make sure you have everything you need in one place. These are a few ideas of what to have in your basket: Birth Without Fear: Postpartum Basket
  • Schedule Belly Binding with Shannon Morber. There are a great deal of benefits listed here.
  • Order the ultimate Postpartum Celebration snack… a cake from RegCakes!

Even if it doesn’t seem like it, you WILL survive these last few weeks! Put some of these ideas on your calendar, and the time will fly by while you stay cool and calm.

Do you have a late summer or fall baby? What ideas could you add to our list? We’d love to hear from you!

 

 

 

A Smashing Success!

We are long overdue for a post about our big event of the year–the inaugural Growing Families Expo! On June 3rd, B. Lime and Gentle Transitions worked together to put on the Growing Families Expo at Presence Covenant Medical Center. It was an awesome event targeting young and expectant families, and we hosted 30 awesome vendors in our community. Businesses and Non-Profit organizations came together to share their products and services with families in the area. We had tons of amazing raffle giveaways, mini photo shoots with Echolight Photography, storytimes from the public libraries and Usborne Books, coffee and treats provided by Espresso Royale, Uncrustables from Smuckers, gift bags full of coupons and freebies from Meatheads, LuLaRoe, Teeccino, Preggie Pops and many more (see complete listing below!). We are so thankful to all of our vendors for partnering with us and hanging in there as we worked out the kinks of our first year. We are looking forward to being in a larger space next year, and offering more tables and larger spaces to the waiting list of vendors who have contacted us already!

We want to thank all of our amazing participants and guests–we couldn’t have done it without you!

This slideshow requires JavaScript.

We had such an incredible group of vendors to work with this year. Businesses and not for profit groups from all over CU came to share their services and products. Here is the complete list of 2017 Vendors!

vendors

Our gift bags were stuffed!! Along with what is pictured below, we had information/coupons/freebies from Preggie Pops, Nurtured Beginnings, Dragonfly Meadows Therapy, Espresso Royale, Postpartum Support Group, and the Illinois Microbiome Study.

gift bags

We had *so many AMAZING* raffle prizes to give away! Thank you so much to all of the community partners and businesses who contributed so many products and services to our raffle giveaways!

raffle prizes

If you haven’t already, please “like” our Growing Families Facebook page in order to find out about next year’s expo! Preliminary planning is already in the works, and we can’t wait to bring you an even bigger and better expo in 2018. Thanks again to all of our participants this year!

Getting Breastfeeding Off to a Good Start

by Theresa Hardy

breastfeeding pic for blog

At my monthly breastfeeding class, I always open with a discussion of concerns that expectant moms might have about breastfeeding. The top two concerns are avoiding nipple pain and establishing a good milk supply. I always reassure the moms that they have made an excellent first step towards breastfeeding success, and that’s coming to a breastfeeding class. Knowledge is power! By the end of our two hour class, we have gone over what to expect in the early days and weeks, how to improve baby’s latch, how to tell baby is getting enough milk, using good physical supports to reduce your fatigue, waking a sleeping baby, managing return to work and breastfeeding, as well as pumping and milk storage.

Your journey to successful breastfeeding begins with lovely, uninterrupted skin to skin contact with your newborn, which is simultaneously soothing and stimulating to baby. Skin to skin contact reduces crying, regulates their temperature, and brings them “right up to the dinner table” for a nursing. Newborns are often wide-eyed and alert immediately following their birth. Cuddled against your breast, baby may just latch on her own, or she can be assisted to latch. Take advantage of this alert time, because after an hour or two, baby gets really tired, and often needs to be coaxed to feed for the next several feedings.

There will come a time when your little one will need almost no assistance or supports to latch effectively, but newborns can’t reach or hold. They (and you) definitely benefit from physical support such as nursing pillows, rolled blankets to lift baby’s head and shoulders, and a nursing stool. You will be spending many hours a day nursing your little one, and those physical supports will reduce your fatigue as well as promote the best latch possible.

Since breastfeeding is new to you and your baby, you will be wondering how to know if baby has a good latch, and if he is drinking enough. Though your nipples will be tender in the early weeks, if baby has a good latch, you should feel a gentle tugging, and not pain. When baby is latched well, your nipple floats freely in baby’s soft palate. A shallow latch feels “pinchy” or painful. Baby makes a characteristic “kuh” sound when he is drinking. We like to see 10-15 minutes of active drinking each breast each feeding. You will hear more drinking as the early days go by. When your full volume of milk is coming in, you will hear gulping! Baby should be very content after a nursing sessions. We also expect to see more wet diapers and stools each day until about day five, then at least 4-5 stools a day.

Babies learn to breastfeed by breastfeeding. When your friends tell you how much easier breastfeeding is than bottle feeding, they’re not talking about the first few weeks. Over time, baby gets more and more efficient, and feedings get spaced out a bit. Feedings are shorter and more effective, and you will get lots of milky smiles. Perhaps the most important thing you can do is to get good help if breastfeeding isn’t going well. Most hospitals have lactation consultants on staff. I am a lactation consultant/pediatric nurse practitioner in private practice, and can do both home and hospital visits. At a consult, latch will be fine-tuned and adjusted, drinking will be assessed, and you will be shown how to position the baby so both of you are comfortable. Together, we will come up with a plan for breastfeeding success!

 

A Day in the Life of a Doula

Some days as doulas are totally normal… Other days we are hyper vigilant because a client could go into labor at anytime. Or maybe you weren’t expecting a client to go into labor and you have to quickly figure out and change the days plans to accommodate your client’s needs.We aren’t ever far from our phones and the phrase “I’d love to come, as long as I am not at a birth!” comes out of our mouths often. This is from a day last year when I had plans but knew a client was in the early stages of labor.

My morning started by gathering all of our booth supplies. Gentle Transitions was a vendor at our local Cloth Diaper Expo. My daughter loves to come with me and help set up and meet people, so we ran through Starbucks and went to set up for our show. Thankfully I have wonderful team members and I was able to leave early for a family event while they finished the expo.

A client had texted me the night before that she was having some contractions so I wasn’t surprised to hear from her at my cousin’s bridal shower that day. We talked through what she was feeling and some other positions to try and get relief/comfort.

I checked in with her once I got home- she was still doing good at home! But she could tell things were progressing and getting harder to handle.

We had dinner and my husband prepared to go out for a night with friends. He had planned to carpool with someone but had to let them know they might have to come back early if I had to leave.

He left and called me about 2 hours afterwards from a number I didn’t recognize. He was worried wondering if I had tried to call. His phone didn’t have good service where he was and he was concerned that I called or would need to and he wouldn’t get it. So he called me from a friends phone so I had an alternative number. You never know when you will need to go- these babies run the show! 😉 I am also thankful for a husband who cares about my job and all the little things that go along with it.

Around 2am my client decided to head to the hospital and continued to check in with me throughout the night… Until about 4am when they decided they were ready for me to come. I gathered my things and left for the hospital. When I got there she was on her hands and knees over the bed. She let me know most of her pain was in her back and she wanted to rest but the back pain became much worse while laying down. We worked on a few other positions that were restful but more upright. She continued laboring while her husband and I took turns applying pressure or massaging her lower back and fanning her while changing out cool washcloths for her neck and forehead. She was doing great and the hospital staff was so helpful. Not long afterwards she felt the urge to push slightly with her contractions. We followed her lead as she pushed and breathed as her body led her through each contraction. Soon, we could see much more of the baby’s head and before we knew it our nurse was making phone calls and asking to get the delivery set up finished quickly. Just minutes passed until that sweet girl was born. The new parents were so thrilled!

We got mom and baby skin to skin and baby started nursing pretty easily with just a few tips.

I got home in time for lunch and to hang out with some friends before heading off to meet another couple for our prenatal meeting. It was a great weekend full of babies, clients, friends and family! And I slept really well that night!

Pit: Labor and Postpartum

This is the 4th and final blog post on our series about pitocin. Check out our introductory post about pitocin here, our post about the differences between pitocin and oxytocin here, and pitocin in inductions here

We’ve talked about the role of pitocin during inductions, how pitocin differs from oxytocin, and how pitocin works in the body  biologically. Pitocin is not only used during inductons, but also to augment, or speed up, the labor process.

The most common use for pitocin during labor is what many providers deem “failure to progress.” What FTP means depends on the care provider. Often times providers base labor progress on something called the Friedman’s Curve. The Friedman’s curve was created in 1955 (over 60 years ago!!) that plotted the average woman’s dilation time, which came out to approximately 1cm dilation per hour of labor. For a GREAT detailed evaluation about the Friedman’s curve, please check out this post over at Evidence Based Birth. The most important thing to realize about the Friedman’s curve is that it cannot apply to every woman (that’s the nature of a bell curve!), and that so much has changed in the labor and delivery process since it was created so long ago. Thankfully, here in Champaign-Urbana, there are very few, if any, providers who still expect all of their patients to progress at the rate of the Friedman’s Curve. However, that does not mean that FTP no longer exists. It is still often diagnosed when mom is not dilating as quickly as their care provider would like (for a myriad of reasons).

No two labors are the same, and labor can speed up or slow down based on so many factors. Some of these include:

  • Malposition of baby
  • Epidural use
  • Mom feeling stressed/scared/anxious about her labor/location/people around her

There are obviously many factors at play, but in my personal doula experience, these are the most common reasons that labor seems to slow down, or “fail to progress.”

Labor slowing down, or stalling, does NOT mean that a mom needs pitocin to help it progress. Let’s look at some ideas that mom can try in order to get things moving again.

Malposition of Baby

If baby is positioned “perfectly” in the pelvis, and mom’s pelvis is properly aligned, generally labor and delivery will go very quickly. If the baby’s head is not aligned in the pelvis properly, her head will not be engaged properly on the cervix to increase dilation. Then, if mom does get to 10 cm, the baby can get lodged into the birth canal at a less-than-ideal angle, causing problems during pushing and delivery. So what can we do to help make sure baby is aligned properly? The biggest one that we doulas recommend is chiropractic care during pregnancy, and even labor. Seeing a Webster-Certified chiropractor during pregnancy can help keep everything aligned (and also relieve a lot of typical pregnancy discomforts!). Even in labor, a chiropractor can gently manipulate the pelvis to help create the right space for baby’s head to be engaged in the pelvis. (Check out our Community Partners page for some great chiropractors in C-U).

Additionally, we also recommend all of our clients check out Spinning Babies. Spinning babies is a series of exercises and body positioning to help encourage the baby to be in the best position for labor and delivery. If a mom is in labor and her care provider or doula thinks the baby is not in a great position, there are different positions that a mom can try to encourage the baby to turn even in labor. Check out the spinning babies “In Labor” page for more details on those!

If a baby truly is malpositioned in the pelvis, pitocin is only going to make things worse by intensifying contractions on the baby and for the mom, and potentially wedging baby into the pelvis even more tightly, rather than letting labor slow down to give the baby an opportunity to turn and get into a better position for birth.

Epidural Use

Epidural use in labor can also slow down labor, because the laboring woman is confined to the bed and not up and moving. Think about gravity–if a mom is up and moving, gravity is going to help the baby engage the cervix and move down. The opposite is also true–laying in bed, not upright, does not work with gravity, and can make the labor longer and slower. Additionally, mom’s reduced movement doesn’t allow ample opportunity for the baby to turn into the best position for birth. If a mom does choose to have an epidural during labor, it does not mean that she is doomed to have pitocin, too! In fact, one of the more recent labor tools that we have been using has been shown to drastically help reduce the length of labor and the risk of c-section: a peanut ball! Peanut balls come in different sizes to fit different women, and are used especially if the mom has an epidural. The peanut ball allows care providers and doulas to help get mom into different positions that will open her hips and pelvis, and allow more room for baby to move through the pelvis and into the birth canal in a good position. I remember after one particularly challenging labor, we tried using the peanut ball as a last ditch attempt to get mom to rest and open her hips. Less than an hour later she pushed out her baby, and the nurse exclaimed to me (in the hallway), “the peanut ball saved that birth!!” She was shocked and surprised, and to be honest, so was I! We couldn’t believe how quickly things started moving after 30 minutes of hip opening positions while mom was resting with the epidural in place. If your hospital doesn’t have peanut balls, consider getting one to bring with you in labor–you won’t regret it!

 

Emotional Blocks

Emotional blocks in labor are one of the more difficult things to discuss, purely because we can’t know exactly how a mom is thinking and feeling. Only SHE can know that! She may try to explain it to us, but when a woman is in the throes of labor, explaining how she feels emotionally in a given moment is difficult, to say the least! However, as doulas, we can help watch and observe our clients, and if we notice that mom is starting to appear nervous, or suddenly stressed, or uncharacteristically anxious, we can broach the subject and try to help. Sometimes it can be because mom had to move from a location where she felt comfortable to a less comfortable place (like moving from home to the hospital). This can disrupt the labor flow, and make the mom feel unsafe. When a woman feels unsafe, and her cortisol (stress hormone) levels rise unrelated to labor, her labor will slow or stall–it’s biology’s way of trying to give us the greatest odds for our baby’s survival. Talking through (ahead of time) what it will be like to get out of the house, into the car, and into the hospital can help alleviate some of those concerns ahead of time. In the moment, it’s important to do sort of a reality check. Am I really unsafe? What is scaring me? What can make me feel safer right now? These are all questions to ask yourself (if you can), or that a doula will ask you to help facilitate a smooth emotional transfer, and get labor back up and running again.

I heard someplace, sometime (super specific, I know) that for every additional person in the labor room, the length of labor increases by an hour. I have no idea if this is statistically true, but on paper it makes sense! If a woman is being watched during one of the most vulnerable experiences in her life, she’s bound to feel a little bit uncomfortable, or even unsafe depending on who the person is. It is ALWAYS okay to ask people to leave your labor space, be it at home or the hospital. If you don’t feel comfortable with that, your doula can help you get people out! Decide ahead of time who you’d be most comfortable with in labor, and either stick to your guns or remove people from that list! Once you start to feel safe and less “watched,” chances are good that your contractions will kick back in and start making progress.

If labor is slowing or stalling, running through these three categories can absolutely help get things moving again. There are lots of things to try before pitocin becomes the only option.

 

Postpartum

Immediately after birth, it is very common and sometimes protocol for women to have an injection of pitocin. It’s given so that it can help the (presumably tired) uterus to start clamping back down and healing the wound that is in there from the placenta, which slows blood flow and helps to prevent hemorrhage. Many women are less opposed to pitocin postpartum because it is not going to affect their labor or delivery (and is safe for nursing). Speaking of nursing, that’s the best way that you can prevent needing pitocin postpartum. When a mom nurses, the bond she is creating is created because of the release of oxytocin. That oxytocin helps the uterus contract, to encourage it to heal it’s own wound. Yet another reason to start breastfeeding right away after birth!

 

Conclusion

While I hope that you have learned a little bit (a lot!) about pitocin through this series, I hope that you take away the most important message, which is to be educated and not be afraid to talk with your own doula and care provider about your feelings on pitocin.  If interventions/options exist  for labor, delivery, and postpatum, but are not discussed ahead of time, very people know they are options and can be implemented. Make sure to keep the lines of communication with your care provider open, and discuss your wishes for labor and delivery at one of  your prenatals. Don’t be afraid to speak up if pitocin is being offered to you and you don’t understand why. Most importantly, feel empowered to enjoy your birth!

 

Pit: Inductions

This is #3 in a series of posts about pitocin. Check out #1 here and #2 here.

Inductions are a hot topic in the “birth world.” Are the necessary? Sometimes, absolutely. Are their unnecessary ones? Sometimes, absolutely. This post isn’t going to be about whether or not your induction is/was necessary, instead, I would encourage you to check out ACOG’s stance on inductions, as well as head over to Evidence Based Birth and check out her posts about inductions (they are awesome, and so thorough). What this post IS going to be about is pitocin during inductions, and other induction options that you might have. I say “might” because every situation is different, every care provider is different, and every hospital is different. As always, we are not care providers, so please discuss anything that you read here with your provider regarding your specific situation.

Inductions happen for many, many reasons. All induction methods are not equal, but one thing that IS something every woman who is facing induction should consider is her Bishop Score. The Bishop Score is a scoring system that providers can use to determine how likely an induction is to succeed, and also the liklihood of spontaneous pre-term labor. The Bishop Score is determined by scoring from 0-3 each of the following: cervical dilation (0-10 cm), cervical effacement (0-100%), cervical consistency (firm to soft), cervical position (anterior to posterior), and fetal station (how high the baby is in the pelvis).¹ For a great chart with this scoring system on it, check out Wikipedia. The higher a woman’s score, the greater chance of a successful induction (successful meaning ending in a vaginal delivery). A score of 8 or higher is generally considered to be favorable for induction. If a woman’s score is not “favorable,” it does not mean that she will be unable to have a successful induction, it just means it’s less likely. If you have a lower Bishop score, and are facing an induction, have a chat with your care provider to see what options you might have to make your chances of an successful induction better (waiting, for example, or possibly going home if induction doesn’t start labor).

If you and your provider agree that an induction is the best course of action for you, make a plan for how you would like your induction to proceed. You have options about how to start the induction process. These include a cervix ripening suppository, if necessary, which often takes more than one day to make an effect on the cervix. Cervidil and Cytotec are both used to help soften the cervix, but we strongly encourage you to look into the medical indications for using cytotec. If you choose a cervical ripening suppository, you will be checked into the hospital and stay (usually overnight) while the suppository is in place. Sometimes these cervical ripeners also start contractions, in which case you may need nothing else to get labor going! After doing the cervical suppository, often pitocin is the next option. Pitocin is usually started off slowly, and increased as labor goes on. Sometimes if a woman’s body appears to take over all by herself, pitocin is turned off. If your cervix appears favorable for induction, but you want to avoid pitocin, another option  is AROM (artificial rupture of membranes). This is sometimes done in addition to pitocin is the pitocin doesn’t seem to be doing the job on its own, but could also be done without pitocin. This basically means that your care provider will break your water, which hopefully signals to your body to start contractions. Another option for starting an induction is a Foley bulb catheter. This is a catheter that is inserted into the opening of the cervix. The catheter is slowly filled with water to dilate the cervix. Once the cervix is dilated to 3 centimeters, the catheter falls out or is taken out, and hopefully will have encouraged a woman’s body to start contractions and continue the dilation process.

Inductions do not always have to be an all-or-nothing process. We have all had clients and know others personally who have gone in to attempt an induction, have it not work, and leave to come back and try another day. Pitocin can be turned off and the induction can be halted, as long as a woman’s water is not broken. Once a woman’s water is broken however, the induction needs to proceed forward due to the risk of infection for the longer the induction process goes on. Have the discussion about what you would like to do if the induction does not work ahead of the induction, so that you and your care provider are on the same page.

There are also more “natural” methods for potentially inducing labor. We are not endorsing any of these, and none have been scientifically proven to work, however they are options that you can talk to your care provider about, should you be interested in them. The first, and most often recommended method of starting labor is by having sex. The prostaglandins from semen can help ripen the cervix, and an orgasm causes contractions of the uterus, which can also start labor. This will only work if a woman’s body is ready to go into labor, however. Having sex at the end of pregnancy is not going to put you into labor if your body is not ready for it! Other options are nipple stimulation (manual or breast pump) and taking castor oil. There are also plenty of opinions about which foods can also induce labor– we have never seen any of these necessarily work, but many of them are worth a shot (spicy foods, pineapple…you name it 🙂 ) Natural methods of labor induction can be used in addition to medical options for induction, as long as you have the discussion with your care provider ahead of time.

Next up in our blog series about pitocin, we’ll be discussing pitocin during labor for augmentation, as well as pitocin used postpartum. Stay tuned!

 

¹https://en.wikipedia.org/wiki/Bishop_score

Pit: Oxytocin vs. Pitocin

This is #2 in a series of posts about pitocin. Check out the first one here!

pitocin

Oxytocin, AKA the “love hormone,” is a hormone released in a woman’s body during sex, childbirth, breastfeeding, and plays a HUGE role in our bodies. It promotes bonding between partners and children, gets labor started, signals to the baby’s brain in utero that it’s about to be born, helps regulate fear and anxiety, produces an anti-depressant like effect, can inhibit drug addition and help with withdrawal symptoms, and in one study, the missing oxytocin recepter gene was linked to autism (source). WOW. Talk about a powerful hormone! Since this is a blog hosted by doulas, we’re going to focus here on the effects of oxytocin and pitocin during labor, delivery, and postpartum.

We still aren’t sure what exactly kicks labor into gear, but there are many postulations. Regardless of what starts labor, oxytocin is the critical hormone during labor and delivery. Oxytocin signals to the uterus to start contracting by increasing oxytocin receptors in the uterus, and keeps contractions going strong during labor. (Without sufficient oxytocin receptors, the uterus does not contract efficiently). It also helps reduce fear and anxiety, which is crucial during labor and delivery. Oxytocin is present in small amounts at the beginning of labor, and peaks at delivery, giving mom a sense of euphoria when baby is born, which immediately helps mom bond with her baby. It also contributes to the ejection of the placenta, and helps the uterus clamp down after birth, preventing postpartum hemorrhage.

Pitocin is a drug that is given intravenously during an induction of labor, during labor to augment (“help”) labor, and immediately postpartum. It is given continuously, and is increased manually throughout labor if deemed necessary. Oxytocin naturally comes in waves throughout labor, giving mom a break in between contractions. Pitocin, on the other hand, often causes contractions to be longer and stronger with smaller breaks in between due to the continuous nature of the IV drip. When a woman is in labor, oxytocin also works in harmony with other hormones in the body, including endorphins. With the increasing waves of oxytocin, mom’s brain is signaled to increase the level of endorphins released, helping cope with the pain and intensity of labor. Pitocin does not have this effect on endorphins (due to it not crossing the blood-brain barrier easily) which means pitocin augmented labors are often described as more painful and more intense than when labor is naturally progressing. At the end of labor, oxytocin peaks, causing the fetal ejection reflex, or Ferguson reflex–that “freight train” feeling that mom can’t fight–baby is GOING to come out. Pitocin is regulated by a pump, which means that peak is not going to happen. Once baby is born, a rush of oxytocin floods the brain, causing the new mother to immediately start bonding with her baby. The constant pump of pitocin interferes with the body’s signal to release that flood of oxytocin, so she doesn’t necessarily get that rush of “love” hormone right as she begins holding, cuddling, and nursing her baby. Oxytocin also signals the uterus to contract more, preventing excessive blood loss. One study showed that if a mother is exposed to pitocin during birth and immediately postpartum, the levels of oxytocin in her body 2 days later were actually LOWER than if she had not used pitocin. This can effect her postpartum recovery as well as her breastfeeding relationship with her new baby–both emotionally and physically, as oxytocin surge is needed to trigger milk let down.

Long-term, the same study is actually asserting that the more pitocin is used, it could actually have an effect genetically on the baby–essentially “turning off” the oxytocin recepter genes, meaning that when that baby goes to give birth as an adult, their body may not respond well to their natural oxytocin surges due to a lack of functioning oxytocin recepters.  Naturally occurring oxytocin in the mother would not have the same effect on the baby.

Pitocin, while able to physically give a desired result (assisting in functional uterine contractions), is not the same as oxytocin. It effects the mother, the baby, the labor, delivery, and postpartum time differently than it’s natural counterpart. These differences should not be taken lightly, and should be considered when discussing whether the addition of pitocin during a labor and delivery are necessary.

 

Stay tuned for part 3: Pitocin and Alternatives During Labor.

Standard Disclaimer: Doulas are NOT medical professionals, and anything that is suggested or mentioned as an option on this blog should always be discussed with your care provider.

Pit.

This is the first of 4 posts about pitocin use, and alternative options that a mom might have during induction, labor, and postpartum. 

“She’s on pit.”

“Are we doing pit?”

“Did you get the pit started?”

“Is she doing a pit induction?”

“The pit is running.”

 

Pit, or pitocin, is one of the most commonly used medical interventions in childbirth. I have seen estimated statistics as high as 60% of births using pitocin to induce or augment labor. Pitocin is used to induce labor, “speed up” labor, and routinely after birth to help prevent hemorrhage. Pitocin can cause labor patterns to be unnaturally difficult for mom and baby, often leading to other medical interventions and eventually even c-sections sometimes, that could have been avoided had pitocin not been administered in the first place. Is this always the case? Absolutely NOT. We completely recognize the need for labor induction and augmentation sometimes, and have personally seen pitocin-augmented deliveries go smoothly. But it’s not often the case, and many care providers don’t mention the difference between synthetic oxytocin (aka Pitocin) and natural oxytocin produced by mom’s body when she’s in labor. There are differences, and they effect mom and baby and labor differently. In fact, in 2013, ACOG released a statement about a study regarding Pitocin and the negative effects on newborns:

“As a community of practitioners, we know the adverse effects of Pitocin from the maternal side,” Dr. Tsimis said, “but much less so from the neonatal side. These results suggest that Pitocin use is associated with adverse effects on neonatal outcomes. It underscores the importance of using valid medical indications when Pitocin is used.” (source).

Just a few weeks ago, another study was released indicating a significant relationship between the use of pitocin and postpartum depression in mothers. The study results showed that, for women with a history of anxiety or depression, exposure to synthetic oxytocin during birth increased their chances of having postpartum depression/anxiety by 36%. In women with no previous history of anxiety or depression, their risk was increased 32%. These are not small numbers, folks. And keep in mind, this is only the percentage of women who were diagnosed and treated with medication. How many thousands of women struggle through their postpartum time with undiagnosed PPD or anxiety because they are afraid to tell anyone, or don’t even recognize it? I know I am one of them.

So, what’s a woman to do? When her care provider is suggesting induction, or her natural labor pattern is not “fast enough” or “progressing well,” or her care provider uses pitocin as standard protocol post-delivery, is she supposed to just say no and hope for the best? No! While we absolutely recognize the need for pitocin sometimes, I think we can ALL agree that it is significantly overused, and often leads to a string of events commonly called the “cascade of interventions.”

Over the next few weeks, I hope you’ll join me as I discuss some alternatives to pitocin for induction, labor augmentation, and post-birth, as well as share some resources for moms who are struggling with PPD. Stay tuned!

Standard Disclaimer: Doulas are NOT medical professionals, and anything that is suggested or mentioned as an option on this blog should always be discussed with your care provider.