Pamela Sauls, CMT, CCE, YBHDSimply put, Induction changes everything
The word induction makes most women cringe. They immediately see their birth wishes going out the window. Some, have no idea what they are asking for or will be up against. Some even go asking for induction, even when it is not medically indicated. Women should know what would've been a "strong enough" contraction (when the uterus naturally creates it), now with drugs like Cervadil, Cytotec and Pitocin, for most will accelerate contractions to above average levels of pain, for often, a much longer length of time. Do some women still accomplish their birthing goals, despite the induction process, yes. However, many would share the domino effect of “one intervention leading to another” is quite exhausting and not an experience you just want to go asking for without medical reasons.
Many Mom's have the challenge of weighing the risks and the benefits of induction, based on the medical experts advice, former medical history or possibly even pregnancy complications. The mom featured in this birth story, Megan, found herself in a quandary near term based of her preferences for her birth. Her desire was to transfer care, but unfortunately she found herself a little late in the ball game for that to happen. Therefore, she also had to be strategic to avoid medical practitioners in her practice, that were not supportive of the low intervention birth experience that she desired. This meant on top of having to weigh the medical reasons for induction, she also had to plan her induction four days in advance of when the least supportive doctor would go on call. As advocates for expectant moms, we want couples to remember, you are paying for a service. The best plan is doing everything in your control to stay healthy and low risk during pregnancy. If you and baby are ok, you will indeed have more options extended to you.
Megan and Paul knew their induction was medically indicated, due to her medical history of former blood clots. Also, protocol with the use of Lovenox. It wasn’t, of course, their first choice to be induced. They would have preferred labor to begin on its own. Megan agreed to report to her birth place, CaroMont Health Gastonia at 4:30 p.m. on January 5th, 2020 to begin cervical ripening. Those who have endured an early induction, as in two to four days worth, would all share the challenges associated with doing business this way requires much patience, much strength and often the ability to go long hours without sleep or real food which creates a plethora of obstacles to overcome. Megan, Paul and Megan’s mom know this firsthand. Megan’s mother learned what I call “hospital sinus head” the hard way. After about 12 hours of breathing recycled hospital air, the poor sinus are stopping up, but her mom toughed it out for almost four days. Supporting both mom and dad. Going out to retrieve coffee, food, etc.. Some forget, the hospital does not feed Dad, only mom, well, if you consider broth & jello food.
Other annoyances include, constant fetal monitoring with any use of drug/ chemical stimulant. Pain levels often increase from mere lack of mobility (even with a wireless monitor, if available). Any time induction includes a drug, (either to prep cervix, create contractions, epidural or other pain management/ narcotic use applies, you will be subject to continuous external fetal monitoring. This intervention alone causes many women a great deal of added discomfort, because the monitor must be positioning properly to get an accurate read of baby. The position can be good and the angle still challenge the reading. Baby's often hate the monitor and move in attempt to get away from it. A flat monitor head on a round belly, certainly doesn't help either and the velcro belts often cut into moms skin. Even the sticky pads from the wireless monitor, aka the Monica, still often irritate the skin, as well. Poor nurses, clearly chasing down baby for a good read is one of the most annoying parts of their job.
Keeping medical interventions down, both for her safety and for the safest route of passage into the world for her baby was Megan's top priority going into this induction. For Megan, the worse case scenario was a failed induction leading to cesarean surgery. Anxiety stemming from the thought of potential childbirth complications, certainly increases fear. Fear leads to panic breathing which also increases tension. Both of which, add to mom’s pain level. It’s a vicious cycle. Megan’s increased risk of a clot forming, which could ultimately take her life, certainly contributed to adrenaline being produced and released in her body. The unknowns or "what if's" as I like to call them, are quite challenging to get out of the pregnant mother's mind and thoughts. There is much psychology to giving birth and adrenaline production only serves to slow labor and/or completely stop contractions. The vast challenges for hormonal pregnant women to stay out of their heads, just breathe through a contraction and release fear and tension is REAL. Megan and Paul, didn't want to be fearful and anxious, but with each failed attempt to get her body in a regular contraction pattern, they couldn't help but be discouraged to some degree. I always remind couples to free your mind, focus on what you CAN CONTROL - LET GO of what you can't control.
Pitocin administration began Monday, January 6th around 5 a.m. and continued the entire day until discontinuing use shortly before 8 p.m. with her body only producing active labor length and strength contractions the last hour and a half. The medical staff had considered her pitocin saturated at this point and consultation of a new plan with the doctor was being discussed.
Megan and Paul had consulted and previously hired my Your Birth Helper Charlotte Doula team for both training, empowerment, advocacy and helping navigate through obstacles, in an effort to meet as many of their birthing goals as possible. Also, assisting her with any needs throughout her pregnancy, labor and beyond. We don’t go away when the baby comes out. We are available to support our clients should any needs arise postpartum. On Day 2 of Induction, several members of the Charlotte Doula Dream Team stopped by to encourage the couple to Stay Staunch!
Her OB on call Monday, Dr. Peach, was extremely patient and kind and agreed to temporarily stop the induction protocol so Megan could eat a real meal and the couple could get some well needed rest Monday evening. Her dinner from Logan’s really helped Megan with her "hangry feeling." Haha and Dad got brownie points too! We have to also give a shout out to Megan's nurse, Landon and Rachel Best were both so respectful in supporting their wishes and just a delight bedside, as well.
The medical team created a new induction plan which was to administer Cervadil, a cervical ripening drug, vaginally (3 to 4 doses as tolerated) through the night with the use of Cook's device, which was placed again on Tuesday, 10:30 a.m. Mom was very uncomfortable and had a lot more pressure this time around, unlike first use on Sunday. But, by Tuesday around 4:25 p.m., they checked the Cook's and it was not ready to release on its own. Mom was getting very discouraged, patience was running thin and physically her cervix was aching and her lower abdomen was sore to touch. The external fetal monitor certainly wasn't helping either.
Mom was not overly thrilled about the new plan to use Cook's device for the second time. However, the doctor explained it was possible, since the first usage did not produce typical results, that it was never placed or inserted correctly. First failed attempt to create cervical change with Cook’s was from Sunday evening from 7 p.m. until 9 a.m. Monday when removed.
Megan was quite the warrior woman along this 4 day Induction Journey and Paul was her ever present source of strength assisting her with very few breaks except to eat and use the restroom. Megan's mom was quite the trooper, as well.
Around 11 p.m. Tuesday evening, Megan and Paul tried an amniotomy to see if breaking the bag of water would enhance the strength of her contractions more naturally. The contraction monitor (the second belt/ TOCO monitor) clearly was not accurately picking up her contractions. At this point they placed an internal catheter to more accurately depict the strength of contractions. By 11:35 p.m. Paul called and asked for Doula support to assist them as active labor contractions were finally evident.
Husband Coach Paul shared, ”I knew my wife Megan was strong, but to witness her maintain that strength through the majority of her almost 60 long hours from start to finish, the word PROUD alone, can not adequately describe my love for her and what she endured for our baby.”
When induction is medically warranted, there are still various ways in which the induction can take place. And, most couples are not against medical protocol when it is truly medically necessary. They just don't want to be subjected to unnecessary routine interventions. I like to call this concept, "Symbiotic Birth." If medical staff could embrace this concept, women would be singing their praises all over town. Dr. Robert Bradley shared, we can not prevent the necessity for all drugs or cesarean surgery, but we can help ensure with proper labor techniques, that the medical interventions are saved for those who truly need them. The majority of trained mother's can relax and breathe through contractions, without pain management. It’s doing things wrong on top of the contraction that can create above average levels of pain. The key is don't just say you want a natural birth, (if that is your goal), actually train for it! Labor is challenging enough when you know how to properly get through a contraction. Let alone, when facing scenarios like back labor, induction or extremely long labor. Without such skills, the odds are certainly stacked completely against you. The key lies in knowing what to do and not to do, to work with your body, not against it. The goal: Accomplish as much as possible through each contraction!
It matters the level of support couples receive during the Labor and Birth process. It matters what and how the words come out and caution should be used of what is spoken in front of, or to the laboring Mom. For each child, Labor/ Birth is a ONE TIME- typically ONE DAY event never to be repeated. We get one chance to bring forth life, there are no re-do’s. We get one chance to capture precious moments in time. Therefore, every decision matters. Especially, when navigating pre-existing conditions during childbirth. After all, it is their body and their baby. Staff, family members or others surrounding Mom during labor should be aware, Encouraging is way different than just supporting. Megan’s husband and mom did just that!
Readers should note, we did learn CaroMont Gastonia has some unique rules, such as only 3 in room at time of pushing (no re-entrance, nor late arrivals would be allowed in). Basically, if you are not in room already (despite such a large birthing suite) you will be denied access to the room and if you desire birth photography and capturing precious moments after, this hospital is not for you. Remember, couples you foot the bill for the room and the medical services. Make sure your wishes for your target birth will be respected and honored, if not, there are other practices and locations who gladly will.
Couple's should be able to experience the best of normality in the labor/birth process (as their health dictates) complimented by medically necessary interventions. Both sides working together in harmony, because after all we are on the same team.
Team: Healthy Mom & Healthy Baby!
Megan and Paul had chosen to become skilled in The Bradley Method ® to better prepare her body and mind for birth, to best manage her contractions and to help train her husband to best support her along the way. Sarah Neri, YBHCE, YBHD had taught their childbirth education classes and attended to help encourage and support her on day 3 and 4 of her long labor marathon.
To end, I asked Megan, if she wanted to share any personal thoughts regarding her experience. She had this to say...
If there’s anything I could change or consider for next time, it would be to see only one midwife to be with us throughout the entire pregnancy so that you can build a relationship with them especially in the case of an induction for medical reasons. Induction can be daunting and especially a long one when your body isn’t ready which can make you over think and get scared that you won’t progress enough for the doctors. I kept thinking I’ve been on the highest dosage of pitocin for a while. They are going to want to cut me off and start over or give me a cesarean. I should have stayed focused. I had a great support system. My husband deserves a 100 out of 10. He was there for my every need and even though I was the one giving birth and using my energy and thinking I’m so tired. I know he was even more exhausted than I was. He kept going. He took care of me and that is the greatest feeling ever to feel supported in that way.
The scariest part of my Labor followed the administering of an epidural. My blood pressure dropped significantly after and my husband and I, had no clue what was happening. ( My blood pressure had lowered after a previous dose of fentanyl, but I wasn't sure when it actually started. My mom and Doula team were in the waiting room due to administration of the epidural). All of a sudden, everyone rushed the room and they put me immediately on all fours. I look up and see Paul’s face and he’s scared. I tell Myself omg something’s wrong he’s scared and know I just have to be strong and concentrate and do what I need to do to get baby out. Then they check me and baby was right there. (Paul ran down the hall to notify the others). I wish I would have had my doula team in there while pushing, because of how emotional it was for us, my mom and Paul. I really needed good coaching and to take my time, but with the situation, I had no idea what was really going on and just wanted my baby out. I know I definitely could have avoided the use of fentanyl, but Paul said he would contact doula in an hour, I was like no I wanted y’all (birth team) then. And, I think he feels the same way. He wishes he would have contacted sooner because, during that time my back pain was the greatest and mom and Paul were doing awesome with counter pressure and helping me out. It was exhausting to coach them, to help coach me, if that makes sense and I needed that guidance and more positions, but couldn’t really ask for it. I knew Pam would be able to help and I needed a reset. I definitely should have been more educated on pain management side effects at my hospital before hand.
With an induction, you don’t know how it would go. I wanted to labor at home and be comfortable and Paul and I get into a rhythm. Then we would have the doula team when we needed at hospital, but things didn’t work that way. If Tuesday night, would have went like Monday, it would have been a dream. That’s for sure.
Happy ”BIRTH” day Estelle!! You did not take kindly to your evacuation notice, you challenged your mom with back labor and a slow to dilate cervix for over 60 hours before your grand entrance!
Megan and Paul’s goal was to depict a very transparent journey of how induction may alter your birth story. In closing, Couple's should consider wisely the pro's/con's, with the #1 question always being, "Is Mom and Baby ok?" If that answer is yes, why the eagerness to induce? What constitutes the induction as best for mom and baby? Sometimes, it may simply be a calendar issue and couple's should remember, it is called an estimated due date- not an exact one. Simply put, Induction changes everything, but in the end Paul and Megan would tell you, that little baby is so worth all the tiring challenges and effort! Welcome to your #CharlotteBirthFamily Baby Estelle! You are so loved!
Your Birth Helper & Teams are happy to give you both the title of "Power Couple" for technically enduring 4 calendar days of induction, with every single contraction monitored in a hospital setting, which also means 3 days without adequate sleep and food in 60 long hours to give birth and avoid surgery. We salute you both! Congratulations Sideikas Family!