pitocin

Maybe it has something to do with the fact that my mother had three natural, unmedicated births but I have always known that natural birth was something I wanted to do. Fast forward to Graduate school, where I learnt all the startling statistics about the gross over use of birth interventions in this country, which factor into the alarmingly high cesarean section rate and I became an ardent natural birth advocate.

I can’t tell you how many times I’ve heard things like: “I will for sure be getting an epidural” or “I want a c-section because I don’t want to be all stretched out down there” or “I want to get induced so I can plan when the baby will arrive.” And the list goes on and on. The truth is, there is a lack of proper education about childbirth. Many young women have no real idea about what to expect and most of their knowledge comes from the media, which portrays birth as a harrowing experience. Couple this naivete with the current treatment of pregnancy and birth by much of the medical field as an illness or disability and we have ourselves an intervention epidemic.

I found it so aggravating when people would ask me if I was planning on having an epidural and they responded with shock when I told them that I was planning on a natural birth. I mean, really people?! Childbirth is a totally natural process and the female body was designed to carry out this function perfectly. Granted there are times when interventions are 100% necessary and life saving but for the vast majority of births this is simply not the case. In fact for the majority of births added interventions can actually be a hindrance and can have a snow ball effect.

The World Health Organization recommended that the upper limit for the cesarean section rate was 15%, while the optimal rate should be 5%. In the United States the most recent data show that the c-section rate is a staggering 32.8%, meaning that 1 in 3 women deliver by cesarean section. The Healthy People 2020 goal is to reduce the number of cesareans among low risk women with no prior cesarean births by 10% and yet in some hospitals throughout the country the c-section rate is as high as 50%. Furthermore there is no evidence to show that having a c-section rate that is higher than 15% does anything to reduce maternal and/or infant mortality or morbidity, in fact just the opposite may be true. An increased rate of interventions often leads to highers levels of death and disease among mothers and babies.

So what’s going on here? Well there isn’t a simple answer since there are a lot of factors at play. Birth weight plays a large roll, the fact is that we are having bigger babies than ever and it’s becoming increasingly more difficult for our bodies to deliver them naturally. This is why it’s so important to eat right and exercise during pregnancy. In fact eating right and exercising are vitally important before and after pregnancy as well, but that’s a topic for another day. Another large factor is the elective and rampant use of interventions during childbirth and I believe this stems in large part from a lack of adequate education about the topic.

The most common major interventions used other than a cesarean section itself are pitocin (used to induce or augment labor) and epidurals. The use of epidurals have become the norm and natural birth is something that is viewed as extreme. When I told people I wanted to have a natural birth, I was told ‘you don’t have to be a hero’ and asked ‘why would you do that to yourself’. Child birth is a natural process not an illness or disease and treating it as such can impair the body’s ability to do what it does best.

I said before that interventions can be a slippery slope and here is what I meant. Epidurals can weaken the contractions that your body has naturally, which then requires you to go on pitocin to strengthen the contractions, but now your contractions are stronger and longer than they should be so you get a stronger epidural to manage the pain, which in turn requires more pitocin, which finally sends the baby into distress (due to the stronger and longer contractions) and you are wheeled off the the OR for a cesarean section. The same cycle can also be true when labor is induced. While all this is true it must still be noted that many women do receive epidurals and/or pitocin without needing further intervention.

You have to remember that pitocin and epidurals are serious drugs and whatever you’re receiving your baby is receiving. Of course these interventions are wonderful and life saving when they’re necessary but they are performed far more than what is medically necessary. Too many people opt to schedule a c-section or elect to have interventions without really educating themselves about the process. A cesarean section is MAJOR abdominal surgery, which involves slicing through 6 layers of skin, tissue and muscle and then sewing the individual layers back up again. Recovery is no picnic especially considering you can’t just relax but instead you have to care for a newborn and be up all hours of the night. The International Cesarean Awareness Network is a great place to go to learn more.

The last contributing factor I’ll discuss here and perhaps the biggest are policy instruments acting at the health system level. OB-GYNs are faced with more lawsuits than nearly every other medical specialty. This is because sadly and unfairly if something goes tragically wrong during labor blame is often placed on the medical staff present. So in order to reduce liability systems are in place to push for more interventions because it is wrongly believed that more interventions means better care. In order to change this we must change policy, which starts with education.

My intention here is not to demonize birth interventions and I don’t presume to tell women how they should have their babies or ostracize women who opt for birth interventions but I do think it is important to educate yourselves about child birth. I highly recommend taking a birth class as well as watching The Business of Being Born. You can also go to The Beauty of Being Born to read real women’s birth stories and share in their experiences. Also you may want to consider opting to deliver with a midwife that practices out of a hospital or birth center.

If you read Asher’s birth story then you know that I did in fact require the use of interventions. They were all medically necessary with the exception of one: breaking my water. This was the first intervention that I received and I believe that making this choice is what lead to the complications that required me to need further interventions, but that’s just a theory, since there is no way to know for sure.

At the end of the day when it comes to labor and delivery the most important thing is to have a healthy mother and baby, no matter how you get there, I just believe that in the vast majority of cases the best way to ensure that is to have a natural childbirth.

This is Asher’s birth story and some of the content may fall into the realm of TMI (too much information). So if you’re squeamish about labor and birth and the nether region body parts, then perhaps you should skip this post. Otherwise I hope you enjoy!

I had a lot of ideas about how I wanted the birth of my first-born to go. I wanted a completely natural un-medicated labor, that would be attended by a midwife in a hospital. I wanted my water to break on its own and to use perineal massage to avoid tearing, however tearing was preferable to an episiotomy. Raf and I had attended 12 weeks of The Bradely Method birthing classes and had learned all kinds of techniques and positions to use during labor. Well, things didn’t exactly go as planned. One of the first things you learn when you’re in labor is detachment and the next is that it’s an incredibly humbling experience.

On Friday December 7th, while I was in the shower I lost my mucus plug. I didn’t think too much of it since you can lose your mucus plug, days or even weeks before labor begins. Saturday night around 11:45pm I went to bed and shortly afterwards I started having contractions that felt like menstrual cramps along with a back ache. I began timing them and discovered they were irregular but I felt I should still call my midwives to let them know. As I suspected they told me to call back when they were 3-5 minutes apart and lasting for about 1 minute for 1 hour. After hanging up the phone I tried to get some sleep, but the contractions wouldn’t allow it, being anywhere from 4 minutes apart to 3o minutes apart. Nonetheless I tried to relax and conserve my energy. On Sunday the contractions went away and I was able to take a 4 hour nap, but just as I was going to bed Sunday night they returned and once again I had a sleepless night. All Monday the contractions persisted and were still quite irregular, but I felt that they were becoming stronger. Monday night I knew sleep was out of the question, but I tried to go to bed anyway to at least rest because I was exhausted due to the lack of sleep for 2 nights in a row. Well, just after we went to bed around midnight, the contractions started becoming regular and I began to seriously resent Rafaan for sleeping so soundly beside me. I knew I could no longer manage getting through them without him, so it was time to wake him up. For several hours he would massage my lower back during the contractions due to the serious back pain I was having. Around 3am, the contractions finally became close enough together to warrant calling the midwives again. After listening to me moan and groan through several contractions Kimla (the midwife on call) told me that I should call our doula, Sade and head over to the hospital once she arrived.

So we called Sade and in the meantime I went to the bathroom and felt my cervix, and was surprised to feel that it was slightly dilated but it only felt about 1-2 centimeters dilated…not that I knew how to check cervical dilation, but I was curious nonetheless. While I was busy feeling around my lady bits, Raf was packing our hospital bags, which despite being 6 days past my due date we had still not packed. As soon as Sade arrived we hopped in the car and made our way to the hospital. The whole ride over I was certain we would be sent home due to me not being dilated enough. We arrived at the hospital around 5:30am on Tuesday, December 11th at which point Kimla checked my cervix and told me I was 5 centimeters dilated and 90% effaced and that I would be staying at the hospital.

For the next several hours I labored in my birth room with Raf and Sade alternating between rubbing my back and providing me with support. I was laboring in the shower when I began to become very aware of a pain in my rear at which point I started to suspect that a hemorrhoid had reared its ugly head. The pain grew worse and worse so I started to bear down with each contraction and realized that it lessened the pain at which point I asked to have my dilation checked because I felt like I wanted to start pushing. You see, during our birth class our instructor told us that some women never get the urge to push but rather they know that it’s time to start pushing, when pushing feels better than not pushing. Little did I know that this little tid bit of information would be my undoing. A midwifery student (Alex) came in and checked me around 11:30am and told me I was 7 centimeters dilated at which point I nearly started crying. I asked her if she could break my water to speed things along (right then Raf and I should have known that I was not in my right mind), she said that it was too soon and that I should try laboring in the bed for a few hours. For the next two hours I laid in bed and tried to relax into each contraction and doze in between and at 1:30pm when Alex came back in I had dilated to 9.5 centimeters. Again I begged her to break my water to speed things along and this time she hesitantly agreed. She broke my water and found meconium in the water but since Asher’s heart rate was still strong she told me that there was nothing to worry about and that all it meant at this point was the pediatric team would need to be in the room when he was delivered just to be safe. I told her that I wanted to start pushing and she advised me that it was best to wait until I was 10 centimeters dilated but that if my body was telling me to push that I should listen to my body.

Now let’s be clear, my body was NOT telling me to push. I did not have the urge to push. I WANTED to push and it felt better to push. So with each contraction I started bearing down a bit, not pushing but adding pressure. A few hours went by and I was laboring in the birth tub when I realized that the pressure I had been adding to each contraction turned into full on INVOLUNTARY PUSHING! So I asked the midwife to come in and check me. By now Kimla’s shift had ended and Whitney’s had started so she came in and checked me with Hannah (another midwifery student). I thought I had misheard at first when she said I was 4 centimeters dilated…FOUR?! Well, apparently when you begin pushing before you’re fully dilated it can cause your cervix to SWELL SHUT. Whitney was able to push my cervix open to 7 centimeters again and told me that I would need to stop pushing and that I should use breathing techniques to get through each contraction. She also gave me sterile water injections in my lower back to help with my back labor.

So began what I lovingly refer to as transition ground hogs day. I would labor and labor and get to 9 centimeters only to be told the next time I was checked that I had gone down to 7 centimeters. This happened over and over. I began to think that this baby would never come out and that there was no way I would be able to have more children. I started to fear that a c-section was in my future because I literally could not stop my body from pushing of its own will. Some contractions I would be able to get through but then one would come along that would slam into me like a freight train and my whole body would become possessed and it would push for all it was worth and all I could go was scream in frustration. I started to ask for an epidural. I knew that I couldn’t stop my body from pushing and that if it kept happening my cervix would remain swollen and a c-section would be the only solution. There was a lot of sobbing on my part and begging everyone to JUST GET THE BABY OUT. I have never seen Rafaan so raw. He looked like he was ready to pull his hair out and was on the verge of tears the entire time. Later he would tell me that seeing me like that was the hardest thing he has ever experienced. Finally Whitney told me it would be a good idea to just talk to the anesthesiologist to hear about my options. The anesthesiologist showed up and explained that they would give me an epidural and a spinal block and all about the risks involved, then she had me sign a consent form just in case we decided to actually do it so that all the paper work would be out of the way. I decided that I wanted to be checked one last time before making the decision, because I didn’t want to have to get the epidural if I was almost there. Whitney agreed that this was a good idea but before she would check me she wanted me to march back and forth across the room while doing high knees and she wanted me alternate between sitting forward and sitting backwards on the toilet during contractions. So march I did. I marched with every ounce of energy I had left and for most of the contractions I was able to keep my body from pushing, but every once in a while one would come along that would get away from me.

Finally when I felt that I could go on no longer I asked to be checked again. By now Whitney’s shift had ended and Laura’s had begun, so they asked me a wait just a little longer while Whitney got Laura up to speed. When they finally came back in, Laura checked me and found that I was 7 centimeters AGAIN!! At this point Laura and Whitney both agreed that I should get an epidural. They both felt that we had exhausted all the options in door number 1 and that it was time to open door number 2. They also informed me that I needed to have some pitocin augmentation because my contractions were not consistently strong enough to push the baby out due to my uterus being overly tired. At 8pm I got the spinal block and the epidural both of which I didn’t even feel at all and shortly after that all the pain from my contractions was gone. It was wonderful to be free from the fear that I wouldn’t be able to stop my body from pushing. For the next 2 hours I laid in bed and rested and tried to recharge. At 10pm Laura came back in and told me that due to the pitocin making my contractions very strong Asher was beginning to experience some stress. She checked me and found my cervix to be much less swollen and 9.5 centimeters dilated. She told me that she wanted to try to get his head past my cervix and that during the next contraction she wanted me to push while she also pushed my cervix. When the next contraction came along I gave a great big push and Laura told me that it was working. Raf and Sade each held a leg while I pushed and Laura pushed my cervix back and finally Asher’s head made its way past the cervix and into the birth canal!! At this point despite the epidural, I began to feel immense rectal pressure and pain. Laura and Hannah were both administering perineal massage and using warm compresses to ease the pain, but the hemorrhoid would not be quelled. Laura told me that the only way to end the pain at this point was to push him out so I pushed with all the force I could muster. I remember thinking “if I keep pushing this hard, I’m going to tear” and I didn’t care one bit. I just. wanted. him. out. So I pushed and I pushed and I saw myself tear and I felt the ring of fire. Finally after an hour and a half of pushing Laura told Raf and I to reach down and we both caught our baby and pulled him onto my belly, at which point he pooped all over me and proceeded to slosh around in it and all I could think about was how perfect he was and that I could definitely do this again.

Just like that we were parents. Asher Nathan Anvari, weighing in at 7 pounds 11.5 ounces was born on December 11th at 11:36pm after 23.5 hours of active labor and several days of pre and early labor. He was one of the cutest newborns I had ever seen and I know I’m biased but everyone else said so too.

p.s. I’m not an advocate epidurals or pitocin, but I’m a perfect example about how sometimes they’re medically necessary. Sometimes things just don’t go your way, however I feel that my road to needing interventions would have been entirely avoidable had I allowed my water to break on its own and not pushed before I was fully dilated. Ah well, you live and learn. In the interest of full disclosure, I’ll tell you when I got the epidural the relief was wonderful but I had bad back pain at the site of my epidural for several months. I’m seriously hoping that my future labors can be all natural and I feel confident that I can achieve that.

Natural Birth & The Great Intervention Epidemic

Birthing Asher