Wednesday
September 21, 2011

Induction… to Motherhood?

Before my last doctor’s appointment, I talked to my aunt who lives in Arizona about where I would be giving birth (in a hospital) and why (it is 100% free with my insurance – yes, that’s one reason to become a teacher). She shared her daughter in law’s birth experiences with me (two natural births in a birthing center with a midwife) and when I told her I had some pretty strong preferences for how I wanted to give birth, she advised me to talk about it with my doctor sooner rather than later.

So what are these preferences? Well, I hesitate to share because I know how passionate people can be about birthing choices and I don’t want anybody to think that I’m trying to say that my choices are the best or better than anyone else’s. I’ve come to conclusions based on things I’ve read and people I’ve talked to and I think these preferences are best for me. Not best for everyone, just for me. So please be gentle in the comments, ok?

Photograph by Emily Weaver Brown Photography

If I had a bunch of extra  money and didn’t have amazing healthcare benefits, my ideal birth would be at home with a midwife. I would go through as much preparation as possible to avoid interventions and after the baby was born, I would eat birthday cake and drink champagne in my own bed with my husband and our new addition. I do know all the risks involved with home births, but I believe the benefits outweigh the risks, for me.

Since our funds are limited and a hospital birth wouldn’t cost us a dime, no matter what interventions were necessary (no extra for a c-section), a home birth that could cost over $2,000 if my insurance decided not to cover it was out of the question. Instead, I’ll give birth in a hospital which makes me a little sad, but makes my husband and our families much more comfortable.

Knowing that interventions are more readily available in a hospital, I’m realizing that it is going to be much more difficult to avoid them than if I was at home or in a birth center. The first of these interventions I wanted to discuss with my doctor was induction. I let him know that I’d rather not be induced unless it was medically necessary. I know that when I’m nine months pregnant, I’m going to want that baby out. I’m going to be uncomfortable and anxious to meet the little one, but, if I can, I’d like to go into labor on my own without pitocin.

Photograph by Shot in Vancouver

My doctor’s first answer was that I’m the boss and ultimately I would make the decision, which was a decent answer. Then, he asked why I felt that way and when I expressed my concerns about the counteractivity of pitocin and an epidural (which I would undoubtedly have due to the intense contractions that pitocin creates) and how it can often lead to a c-section (something I’d really like to avoid), he told me that the whole process was an art and seemed to allude that he had mastered this art. While I trust that he’s a very competent OB, I know that he can’t guarantee that an induction won’t lead to a c-section – to be fair, there’s no guarantee that a natural labor won’t lead to a c-section, either, but I feel that inductions increase the chances.

I also told my doctor that I anticipated being late with this pregnancy because my mom was two weeks late with both me and my brother. Then he got into size and I started getting nervous. See, doctors can supposedly tell how big the baby is going to be from ultra sounds and fundal measurements late in pregnancy. However, I’ve known several women who were induced because their doctors thought their babies were too big and they ended up having small to average sized babies. Well, I was 9 pounds 12 ounces when I was born. Yep, I was the biggest baby in the hospital and when my family would look for me in the nursery window, I was easy to find because I was so much bigger than all the other babies. When I told my doctor this, he said I’d probably have a 10 pound baby. While I don’t doubt that my genes will play a part in the size of our baby, I am a little concerned with how he jumped to that conclusion so quickly. Isn’t that a bit presumptuous? Since my husband’s family has small-ish babies, couldn’t that even things out for us?

Photograph by T. Lawrence

While this whole conversation has raised a red flag for me, I’m trying not to worry too much about it yet. I plan on taking things one day at a time and if induction comes up, I’ll deal with it then. For now, I’m starting prenatal yoga next week and hope to sign up for birthing classes soon. I’m still deciding between The Bradley Method and Hypnobirthing (anyone have experience with either? or something better?), but I do know I want to start early as I tend to have a problem with anxiety and relaxation techniques can only help!

Did you have an idea of your preferences early in pregnancy or did you start thinking about it much later?

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Comments (16)

  1. My hopes for labor are very similar to yours! I want a 100% natural childbirth, but am doing it in a hospital- which makes me nervous, yet is comforting at the same time. Nervous because I am afraid there may be an attempt to convince me that I need medical intervention. Comforting because I know if something were to go wrong, I’d be in the best place to fix it. I’m due at the beginning of December.

    I am doing Bradley classes and so far I really love them! Read “Husband Coached Birth” by Dr. Bradley- this book gives you a fantastic look at what the Bradley Method preaches. My husband and I both read the book before starting our classes. The classes are wonderful because they prepare you for many other things besides pain management and the birth process…in fact there is one whole class dedicated to breastfeeding!

    Good luck!

  2. Amy, I’m 17wks along and am in the care of a group of midwives at a stand-alone birth center. Their suggestions for avoiding an overly large baby are to stay away from easy sugars and starches, particularly after 20wks. So picking more whole fruit than fruit juice, more whole grains than refined, more brown rice and yams than white rice and potatoes… that sort of thing. Protein and complex carbohydrates should keep the mother’s body feeling full longer, and help the baby grow at an appropriate rate. (Which is a concern for the midwives, since a baby sized well for the mother’s body will require fewer interventions and transfers to hospital care.)

  3. Amy, I’m 17wks along and am in the care of a group of midwives at a stand-alone birth center. Their suggestions for avoiding an overly large baby are to stay away from easy sugars and starches, particularly after 20wks. So picking more whole fruit than fruit juice, more whole grains than refined, more brown rice and yams than white rice and potatoes… that sort of thing. Protein and complex carbohydrates should keep the mother’s body feeling full longer, and help the baby grow at an appropriate rate. (Which is a concern for the midwives, since a baby sized well for the mother’s body will require fewer interventions and transfers to hospital care.)

  4. I was lucky and had a lot of time to conduct research during my entire pregnancy. Watched “Business of Being Born: and “Made in America” after I read The Bradley method. I did not take any birthing classes. I read the book and decided to apply it to my labor. I opted for a hospital birth instead of the birthing center to ease my mother’s worries. I was fortunate to have a hospital that allowed me to adhere to my birthing plan. No offers of epidurals..they allowed me to labor alone for the most part with occasional monitoring , in my own nighty, ate and drank as I pleased, walked around, changed positions as needed. From what I’ve learned…most women are not aware that they have the right to choose. They go with the flow and follow orders without this knowledge. I personally wanted to do it naturally without any interventions. I was 5 days past my due date. My ob had me scheduled for an induction and I just didn’t show. I returned her call and informed her that he was just not ready to come yet and I could safely carry him to 42 weeks if necessary. That didnt satisfy her so she had me come in to see one of her colleagues. The other ob determined that all was well and I could wait another week but she didn’t think it would be long. He was born 41 weeks and 3 days. No drugs, no interventions, no complications.

  5. I was lucky and had a lot of time to conduct research during my entire pregnancy. Watched “Business of Being Born: and “Made in America” after I read The Bradley method. I did not take any birthing classes. I read the book and decided to apply it to my labor. I opted for a hospital birth instead of the birthing center to ease my mother’s worries. I was fortunate to have a hospital that allowed me to adhere to my birthing plan. No offers of epidurals..they allowed me to labor alone for the most part with occasional monitoring , in my own nighty, ate and drank as I pleased, walked around, changed positions as needed. From what I’ve learned…most women are not aware that they have the right to choose. They go with the flow and follow orders without this knowledge. I personally wanted to do it naturally without any interventions. I was 5 days past my due date. My ob had me scheduled for an induction and I just didn’t show. I returned her call and informed her that he was just not ready to come yet and I could safely carry him to 42 weeks if necessary. That didnt satisfy her so she had me come in to see one of her colleagues. The other ob determined that all was well and I could wait another week but she didn’t think it would be long. He was born 41 weeks and 3 days. No drugs, no interventions, no complications.

  6. Hi Amy,

    I also wanted an intervention free birth and chose to birth at the hospital with the urging of my mother. My birth experience could not have been better, I labored at home for as long as I could and once I got to the hospital the nurses and doctors respected my birth plan- it helped that my baby came very quickly so they didn’t have time to bug me too much.

    The best advice I can give you is to hire a doula. Our doula was AMAZING she was an incredible support person and helped my labor progress in ways that the doctors wouldn’t have (my doctor even said so herself!). Many doulas are even reimbursable by your insurance so check it out.

    Also, I used a Hypnobabies home study course which I would highly recommend, I have never been more relaxed than I was during my labor. You can get a home study course on Ebay if you’d like to save some money on the curriculum.

    I love sharing my positive birth experience with others so please contact me if you have questions or want to know more! Best wishes, you’ll do GREAT!

  7. 2 things that came to mind:
    My ultrasounds were saying that my baby would be 10lbs at birth… he was 8.3! (they are NEVER 100%)
    and
    I’ve had friends push out 10,11,12 & 13 pounders!! It’s do-able so don’t let that get you down! :)

  8. We used the Bradley Method (we took a class) and I wouldn’t have been able to manage my contractions without the techniques that we learned. It gave me the confidence to labor at home and taught my husband pressure points to lessen the contractions. I second Rachel’s comment recommending a doula. If they’re not covered by insurance, they can be expensive, but it will be someone who gets to know you, knows your wishes, and can intercede on your behalf with your doctor if need be – and that is more than worth their fee.

  9. For the exact reasons you stated and more is why hubby and I chose to have a natural homebirth (which turned into a waterbirth in the end) with only my two midwives and him (also against the wishes of all except my father). Yes this option is very expensive, but as our government (Australia) gives a decent sized financial baby bonus we decided to use that bonus for the birth. And as it turned out I went into labour with a breech baby that the miwives did eventually turn, and then also had to move half of my cervix out of the way, but I still had a natural birth and my baby never once went into distress and scored a 9/10 on her AGPAR. Had I gone to hospital they woul have given me a c-section. Saying that though, if financially a homebirth really isn’t viable then I would suggest undertaking a private midwife who can be there with you at the hospital and make sure your wishes are being adhered to as nuch as possible. They make sure the doctors don’t pressure you to do things that aren’t necessary but should something come up and your midwife feel that what the doctor is recommending is actually best then at least you know it had to happen that way. Also with her expertise write up a solid birth plan in case of both natural and c-section deliveries, you’d be surprised at many choices you actually have that they won’t tell you about when there

    Oh and the baby size thing is rubbish – both my husband and I were born 2 weeks late at 9lb and our daughter came 1 week late at 7lb…

  10. Yikes. If I was in you shoes- hearing that from the doctor, I’d be worrying too.

    My husband and I are opting to pay a large chunk out-of-pocket to use a midwifery practice, rather than the much cheaper OB option- specifically because I don’t want to to be fighting with a doctor that’s pushing me to induce because the baby will be too big, etc.

    I used midwives for my first pregnancy and despite their patience, still wound up with an induction and C-section. However, because they let me go the full 2 weeks after my due date, and let me labor for 36 hours before suggesting the C-section, I agreed it was medically necessary and I have no regrets.

    If I had not trusted my care-providers 100%, I’m not sure I would feel as at peace with my delivery.

    If you don’t feel that you trust your OB 100%, listen to your gut. Consider other options.

    If you really don’t want to consider a midwife (FYI- lots of insurance plans DO over midwives! Check their listing of providers they may even have a Nurse Midwife section, as mine does)- would you consider a doula? She might help advocate for you and your wishes during the birth process.

    Also, what about reaching out to your local ICAN (International Cesarean Awareness Network) Chapter to see if they know of OBs in your area (and on your insurance plan!) that won’t pressure you for induction?

    Overall, I say trust your gut feelings. If you think that OB is the right match for you and you trust him- good. If not, explore other options.

  11. I feel the same way you do. If I was in your position, I would do the same thing. Up until 2 years ago, a midwife assisted birth was not covered by my province’s (Canadian!) heath care so if I wanted a home birth I would have to pay out of pocket like you. They are now covered, but the demand is so high that is it almost impossible to get a spot with a MW. Thankfully, I was able to get a spot and will hopefully get the natural home birth that I want.

    Many women have had very positive, natural births in a hospital. Good for you for having the conversation with your doctor sooner rather than later.

  12. I would say, if you’re not comfortable with your doctor, and he is already giving you red flags that he has a different birth plan than you do, I would look around. Maybe interview a few other OBs in the area, and check out forums on mothering.com ect to see if others in your area have recommendations for natural birth friendly OBs. Also, is there an option for a midwife to attend to your birth in the hospital? I will probably decide between a birth center and a midwife attended hospital birth. I’m 5 weeks pregnant now, and just waiting to hear that heart beat! good luck with your plan!

  13. I am 31 weeks along and totally hear and understand your concerns. I had the same which is why we chose a midwife and are planning a home birth. But I totally understand not being able or feeling comfortable with that choice. And the kind of birth you want can be done in the hospital…you just need to know your rights, stand up for what you want, and do everything you can to be well prepared and healthy for delivery. I am an RN and though I have never officially worked in L&D …I know you can do it! I can’t stress being educated quite enough.
    My mom was overdue with my brother and just didn’t show up for her scheduled induction. The hospital called her that Friday morning and asked her where she was and she kindly said she wasn’t coming in. My brother was born on Sunday, naturally in the hospital with no complications.
    Laboring at home for as long as you can also helps.
    I am taking a Bradley class with my husband and we LOVE it. There is also another type of class called Birthing From Within…I don’t know much about it but it was the other option our midwife recommended.
    Also, stay hydrated, get 60-100 grams of protein a day, do LOTS of keegels!! If you have any more questions about the Bradley class just shoot me an e-mail!

  14. Those are big red flags. If I were you, I’d start looking at other options.

    I paid out of pocket for a home birth and it was the best decision I ever made. It wasn’t supposed to be covered by insurance, but I guess the clerk that stamped my claim didn’t read it carefully. ;)

    It took some scrimping and saving, no doubt. But it was worth it. I had two midwives and an apprentice in my home for half of the 65 hours of my labor, and then for about four hours afterward.

    They made me smoothies and English muffins, they left me alone when I wanted to be alone. They were awesome.

    And it didn’t all go well. It was not an easy birth at all. I have a narrow pelvic arch and my cervix was hanging out in front of Tessa’s head. In the end we were on oxygen, she was deceling, and was vacuumed out. Midwives can do what needs to be done when it is needed.

    If I had been in a hospital there is no way I would have been allowed to labor for 65 hours. They would have sectioned me due to my pelvic arch way earlier than that.

    You’re using the whole “This is what works for my family” line to keep people from being mean to you in the comments. That is fine, but please let me gently say that it is NOT working for you. You are concerned about your care provider and that can lead to difficulty in labor and delivery.

    Whether you give birth in a hospital or at home, trust is essential. Look for someone new.

    • Thanks for the concern!

      I actually love my doctor and I think he is the perfect fit for me. He has made it clear that I’m the boss, but he’s not going to sit there silently and not offer his opinion. I can listen to his opinion and either take it or ignore it, that’s up to me.

      Reasons we’re having a hospital birth:

      1. Funds are limited and we can’t front the money and hope we get reimbursed.
      2. My husband and our families are not comfortable with anything other than a hospital birth and I’m not willing to fight them for it.
      3. I am not completely against having an epidural. I’d like to labor at home as long as I can and experience contractions, but if I want the epidural once we get to the hospital, I’ll get one.

      I’m not saying that this is right for my family just so I won’t get mean comments. It is right for my family. It may not be right for you, but we’re lucky that we get to make our own decisions!

  15. Well, okay–not sure why you felt the need to justify it to me and not anyone else who said something similar. It’s YOUR birth and you seem to be in control!

    Have a wonderful time meeting your little one!

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