And, I'm not defensive because I had numerous unnecessary ultrasounds, because I had an elective induction, or because I had epidurals. I'm defensive because I'm not the fucking idiot she thinks I am.
I want to like both your posts many times. I guess I will just have to be satisfied with one each.
And, I'm not defensive because I had numerous unnecessary ultrasounds, because I had an elective induction, or because I had epidurals. I'm defensive because I'm not the fucking idiot she thinks I am.
I can understand this, but I think that's The issue. You were informed and made a decison with an OB who discussed risks and benefits etc. I think many, many more people in this country do not have the information And are making decisions based on the idea that technology and interventions are absolutely best at all times and that's just not the case.
Eta: I think the problem is that her article is not the best way at helping to address the underlying issue. It comes across patronizing.
I am now coming to a place where I am taking everything natural birth advocates say with a very large grain of salt. I read and thought a lot about natural births during my first pregnancy. I have now had two pregnancies and births under the care of OBs. Those experiences were so drastically different than what the natural birth movement told me to expect, that it is hard for me to take them seriously.
On that note, are there any studies that support that pitocin contractions are so much worse than natural ones? I have had one pitocin induced labor and one un-induced labor and the contractions felt exactly the same. I realize that I may be the outlier, but I did google it and only found message boards talking about how pitocin induced labor is so much worse, no actual sources.
Also, I am very tried of the whole "labor pain is special, productive pain not like all that other regular pain". You know what? THAT DOESN'T MAKE IT ANY LESS PAINFUL. Labor was excruciatingly painful. No amount of positive thought changes that.
I've been wondering the same thing. I had a pitocin induction, and it wasn't bad. At all. I only knew I was contracting because I could see my stomach tightening. A couple left me a little breathless, but it was just the squeezing sensation, not pain. Once my water broke I did feel pain, and I got an epi about 30 minutes later because it was then or never due to how far dilated I was. But I only have been through labor once so I have nothing to compare it to. I just don't understand the fear over pit contractions.
there is a way to convey this "message" without coming across as smug and self righteous. Also it was really long and I got bored quickly because of my almost instant dislike for the writer.
alexis Anecdote, but I know a lady who had her second baby in the hospital entrance because #1 was a pit induction and the ctx never got that bad with #2 so she didn't know when to go to the hospital.
I've only had a pit induction, but I went from zero contractions to almost non-stop contractions when my water was broken. Was each contraction worse than a single non-pit contraction? Probably not. Would a non-augmented labour have a period of super close super painful contractions? Probably, I guess. But for me (who was planning an epi anyhow), going from zero to 60 was my cue to ask for the epi OMG NOW.
I never had pitocin but having my water broken took my contractions from manageable to absolutely horrible. I felt like Injust could not get contrl of the pain at that point because it wsd constant And so severe. And I had been contracting at least 4x an hour consistently for 4 weeks at that point Including back labor for the first 2.5 weeks when E was positioned half transverse and crooked.
I've been wondering the same thing. I had a pitocin induction, and it wasn't bad. At all. I only knew I was contracting because I could see my stomach tightening. A couple left me a little breathless, but it was just the squeezing sensation, not pain. Once my water broke I did feel pain, and I got an epi about 30 minutes later because it was then or never due to how far dilated I was. But I only have been through labor once so I have nothing to compare it to. I just don't understand the fear over pit contractions.
My pitocin contractions were awful, and I'm not sure if the epidural even touched them. The way I described it immediately after giving birth was like my abdomen was being run over by a car. I remember how relieved I was when it was time to push because the only thing that seemed to relieve the contractions was pushing through them.
My pitocin induced contractions were awful too. My natural contractions were just equally awful.
And I understand that many women would not want a pitocin induced labor. If I have another baby, I will probably not go that route again. I was just wondering if there is actual data to support that generally women have a harder labor with pitocin. It seems to be commonly accepted as true, but all I've seen to support it are anecdotes. All anecdotes tell us is that different people have different experiences.
Also, is it not worth considering that some of the early testing/interventions decrease costs later if issues are picked up earlier as opposed to later?
Post by longtimenopost on Apr 23, 2015 10:07:42 GMT -5
I get ultrasounds every two weeks to check my cervix, because during my last pregnancy I had a baby at 26 weeks because no one checked my cervix. I'm glad for her that she had a healthy, low risk birth but this article wouldn't have been written if she had a routine ultrasound that caught a problem and prevented a tragedy.
I didn't read the entire article, but wanted to chime in that I'm a scientist (chemical engineer) and I didn't want any interventions. Two of my children were born at a free standing birth center with a midwife in attendance. One was born underwater. My first was only born in a hospital because there wasn't a birth center then and I thought that hospitals could surely handle a low intervention birth (they couldn't, not well at least, but I didn't know that at the time).
Eta: my second was born squatting in a birth tub and my third was born squatting on a birth stool. My third was having serious decels and they expected him to come out blue and he needed to come out fast. Squatting is the most effective way to accomplish that. He was born nice and pink to everyone's surprise. My first born in a hospital bed didn't have as good of an outcome for me.
I don't love the article, but do think there are valid points, especially with regard to the process of pregnancy in the U.S. I had DD in Norway - and wil be having DS within the next 2 weeks in the U.S. and the processes are just so different. My experience so far:
Norway: - all prenatal care done by midwife, will refer to OB or specialist if any issues - only 18 week u/s - will refer to follow up u/s if necessary. - encouraged to stay home as long as possible when in labour - "standard birth procedure" is usually only nurse midwife and nurse - OB is called if risky situation occurs - midwives are generally quite anti epidural/intervention - imo possibly to a fault. There is a widespread belief that epidurals slow down the process. - impossible to get a scheduled c if you want one - need to have very compelling reasons if it is your first birth.
U.S.: - prenatal care done by OB - if you want to have a c, no prob, we'll set that right up for you - more testing (group b strep ie is not even tested for in Norway) - Inductions seem to be much more common - "come in to the hospital as soon as your water breaks, regardless of contractions - we'll induce you immediately" - was assumed that I would have epidural if vaginal birth - lots of raised eyebrows when I indicated that I'd prefer to see how it goes and assess along the way.
To be honest, I would prefer a middle ground. Ie - support and encouragement of low intervention birth, but obviously with adequate monitoring and appropriate intervention and pain management options. I experienced the midwives in Norway to be too stingy with the pain management (though, looking back, it was completely fine that I didn't get the epidural I requested bc at that point I was too far along - I just felt a bit "tricked" bc they kept saying, just wait a bit longer and see how you do). However, I am feeling a fair amount of pressure to just get the pitocin going asap, then we'll set the epidural, or just schedule a c/s already here, and I can't help but feel like there is a degree of financial motivation in both countries.
In Norway, fully covered healthcare, and cheaper for hospitals to have vaginal births, fewer epidurals and lower c-section rates. In the U.S., healthcare providers are for-profit and thus incentivized to have a higher level of tests, procedures and interventions, even in cases where they may be overkill.
Obviously I have not given birth here yet, though - am v curious to see how the experiences compare.
I get ultrasounds every two weeks to check my cervix, because during my last pregnancy I had a baby at 26 weeks because no one checked my cervix. I'm glad for her that she had a healthy, low risk birth but this article wouldn't have been written if she had a routine ultrasound that caught a problem and prevented a tragedy.
I get ultrasounds every two weeks to check my cervix, because during my last pregnancy I had a baby at 26 weeks because no one checked my cervix. I'm glad for her that she had a healthy, low risk birth but this article wouldn't have been written if she had a routine ultrasound that caught a problem and prevented a tragedy.
I'm confused, did you not have a 20 ish week us that would have checked this? Or are you saying that all women should be having regular us to check cervix length throughout pregnancy?
Or are you just saying that you are thankful you are having them now. Because if that's the case I think even she wpuld understand your having them regularly now because you no longer fall into the category of a low risk pregnancy.
in the US "if you want to have a C no problem we'll set that up for you" <-- pretty sure this doesn't really happen, at least not in most places. Not a lot of OBs just want to give people random caesareans for no reason.
The US is not a monolith. This is the hospital and OB you chose.
I had a midwife. No cervical checks, no OBs, was not told to come to the hospital right away, did not have any IV's or even a heplock, was allowed to labor in a tub or a birthing ball, no constant fetal monitoring, the midwife read my birth plan and talked me out of an epi because it wasn't in my birthplan.
They also let my husband catch DS (reminded him, in fact), delayed cord cutting, no immediate bath, etc.
And I'm pretty sure we're in the same city.
You're totally right (and we are in the same city) - i didn't mean to generalize so I totally apologize if that's how I come off. I'm probably a bit colored by the fact that my experience seems somewhat similar to what I have read in posts here and about US births online - but yeah. It is 100% just my experience based on the practice I am at here. (and so is my experience in Norway, even though I get the impression that the processes are more homogenous there, as it's a smaller country, with a nationalized healthcare system).
Since I arrived to the US at 35 weeks pregnant there were hardly any practices willing to take me on as a patient, so my experience would likely have been a lot different if I'd had a longer stretch of prenatal care here, too.
in the US "if you want to have a C no problem we'll set that up for you" <-- pretty sure this doesn't really happen, at least not in most places. Not a lot of OBs just want to give people random caesareans for no reason.
At my practice the OB straight up asked me if I would prefer to have one at my very first appointment. But again, that was when I was 35 weeks and maybe it would have been different if I had become a patient earlier. They also asked me over the phone when I was contacting practices to see if they would accept me as a patient.
But again - obvi just based on my very limited experience.
I was able to have the "norway" type birth spoken of here in 'murica without any trouble whatsoever. I just chose a midwife practice that, when I met them, told me this was what they aimed for when it came to uncomplicated pregnancies.
I get ultrasounds every two weeks to check my cervix, because during my last pregnancy I had a baby at 26 weeks because no one checked my cervix. I'm glad for her that she had a healthy, low risk birth but this article wouldn't have been written if she had a routine ultrasound that caught a problem and prevented a tragedy.
I'm confused, did you not have a 20 ish week us that would have checked this? Or are you saying that all women should be having regular us to check cervix length throughout pregnancy?
Or are you just saying that you are thankful you are having them now. Because if that's the case I think even she wpuld understand your having them regularly now because you no longer fall into the category of a low risk pregnancy.
I think all women should have their cervix checked at some point between 16-20 weeks. I had an u/s at 20 weeks but they did not check my cervical length. My data is skewed because I am a member of babyloss/micro preemie communities, but I know so many women who had preventable 2nd and 3rd tri losses or micro preemies because this wasn't checked.
ETA I know cervical length can change FAST so it's not always possible to detect shortening in time for an intervention, but it seems worth it to try!
I'm confused, did you not have a 20 ish week us that would have checked this? Or are you saying that all women should be having regular us to check cervix length throughout pregnancy?
Or are you just saying that you are thankful you are having them now. Because if that's the case I think even she wpuld understand your having them regularly now because you no longer fall into the category of a low risk pregnancy.
I think all women should have their cervix checked at some point between 16-20 weeks. I had an u/s at 20 weeks but they did not check my cervical length. My data is skewed because I am a member of babyloss/micro preemie communities, but I know so many women who had preventable 2nd and 3rd tri losses or micro preemies because this wasn't checked.Â
ETA I know cervical length can change FAST so it's not always possible to detect shortening in time for an intervention, but it seems worth it to try!
I thought cervical length was somethig that was routinely checked as part of the A/S. But, Like you said, in many cases I don't think this would prevent ptl.
With the twins I had cervical checks routinely nevause I was high risk.And in fact, my cervix was checked just one week before I went into ptl. At that point it was measured at a 5. Just days before I went into ptl it was 2. The only reason we knew it was a 2 at that point was because I mentioned I had been having a lot of bh So I was checked again. But in that case, it was an abnormal ie not low risk behavior, a lot of bh, that found the issue not us. I would have had to have an us every few days to catch it like that.
I'm not saying us isn't effective in a high risk case such as yours or even mine with the twins. It most certsinly is. But I'm saying even us won't prevent this every time, so for women with no history of incompetent cervix I don't think the answer is us checks Given how quickly things can change.
Don't have time to read whole thing, but ugh this lady sounds annoying. I'll read this weekend.
Obviously everyone has anecdotes. The general consensus I've gotten so far in my training in obgyn is that most physicians would love "normal" low intervention, uneventful births. It makes everyone's life a lot better, including the physicians. In an ideal world no women would have pre-e, diabetes, previa, abruption, etc, but that's not the case and I'm glad in this day and age we are able to deal with these medical conditions. You can't compare things to 1850.
The first person to be questioned and blamed in a bad outcome for the mother or baby is the obgyn.
Also I dont know where this notion that students and physicians think more technology always equals better. Definitely not the case, including in fields outside of obgyn, especially in geriatrics and end of life care.
Hahaha, I feel the need to specify that a "Norway birth" is not all sunshine and lollipops - while I had a good experience, the hospital where I delivered had not been updated since the late 70s, plenty of blown-out lightbulbs and sketchy facilities.
Also, I was encouraged on the phone to not come in until the nurse shift change at 7 am when I called at 1 am about coming in because my contractions were getting really close together. DD was born at 5 - had I waited, she could have easily been a kitchen floor "Canada baby".
Meanwhile, the hospital I'm set to deliver at here in the US offers in-room manicures and a snack fridge. So there's that.
in the US "if you want to have a C no problem we'll set that up for you" <-- pretty sure this doesn't really happen, at least not in most places. Not a lot of OBs just want to give people random caesareans for no reason.
At my practice the OB straight up asked me if I would prefer to have one at my very first appointment. But again, that was when I was 35 weeks and maybe it would have been different if I had become a patient earlier. They also asked me over the phone when I was contacting practices to see if they would accept me as a patient.
But again - obvi just based on my very limited experience.
Sooooo......you had to find an OB in the US at 35 weeks, and got stuck with one practice that it sounds like you wouldn't have chosen otherwise and you are attributing their thoughts on C sections to the entire country. Okayyyyyy.
Also, is it not worth considering that some of the early testing/interventions decrease costs later if issues are picked up earlier as opposed to later?
In what ways? I'm not trying to be argumentative, I'm legitimately asking how this reduces costs. Do you mean people choosing abortion for instances where major complications or birth defects are detected thereby eliminating the need for expensive medical treatments later? Or something else?
I think all women should have their cervix checked at some point between 16-20 weeks. I had an u/s at 20 weeks but they did not check my cervical length. My data is skewed because I am a member of babyloss/micro preemie communities, but I know so many women who had preventable 2nd and 3rd tri losses or micro preemies because this wasn't checked.
ETA I know cervical length can change FAST so it's not always possible to detect shortening in time for an intervention, but it seems worth it to try!
I thought cervical length was somethig that was routinely checked as part of the A/S. But, Like you said, in many cases I don't think this would prevent ptl.
With the twins I had cervical checks routinely nevause I was high risk.And in fact, my cervix was checked just one week before I went into ptl. At that point it was measured at a 5. Just days before I went into ptl it was 2. The only reason we knew it was a 2 at that point was because I mentioned I had been having a lot of bh So I was checked again. But in that case, it was an abnormal ie not low risk behavior, a lot of bh, that found the issue not us. I would have had to have an us every few days to catch it like that.
I'm not saying us isn't effective in a high risk case such as yours or even mine with the twins. It most certsinly is. But I'm saying even us won't prevent this every time, so for women with no history of incompetent cervix I don't think the answer is us checks Given how quickly things can change.
I don't think cervical length is typically checked. I get mine checked due to a prior LEEP procedure. The Dr. advised that they would have to check my cervix each time because of that. I took it to mean otherwise they woudn't have? But who knows.
At my practice the OB straight up asked me if I would prefer to have one at my very first appointment. But again, that was when I was 35 weeks and maybe it would have been different if I had become a patient earlier. They also asked me over the phone when I was contacting practices to see if they would accept me as a patient.
But again - obvi just based on my very limited experience.
Sooooo......you had to find an OB in the US at 35 weeks, and got stuck with one practice that it sounds like you wouldn't have chosen otherwise and you are attributing their thoughts on C sections to the entire country. Okayyyyyy.
I reiterate - I'm really sorry for generalizing - my comments are obviously based on my one experience in Norway vs my experience so far at a single practice in the US. I didn't mean to sound crappy about it and do not mean to attributing their thoughts on C-sections to the entire country.
Hmm, I guess I'll be the dissenter. I didn't see it as she was saying no one should ever have a c section Or interventions. I did see she was anti drugs. But overall I saw it more as her saying we should be better informed about those decisions, how they improve outcomes or not, the risks and benefits etc.
I don't have the specific statistics but the U.S. has more birth interventions than most developed countries and yet we have one of the highest infant and maternal mortality rates. I think there is something to that.
I also understand how this can be hard to read if you have had a c section. I get that because I have had one. But, while I still have negative feelings surrounding my c section I am also confident that it was the best choice for me and my baby because it was an informed choice. Just as my choice to have a VBAC was informed. I had a team of midwives, OB'S and MFM for my twin pregnancy so I felt like I received positive advice from a variety of points of view. That combined with my own research made me comfortable in my choices of intervention etc.
Throughout the article she says low risk or uncomplicated pregnancy. So she isn't talking about the woman with Blood pressure issues, GD, breech presentaton, or even someone like Brie who noticed decreased fetal movement and spoke up which lead to the us which discovered the low fluid and then the induction and so on. (Just to name a few of the many complications possible). Or maybe not even someone of ama as that can be a complicating factor at times.
I'm not sure I completely agree with not having any sonograms during the pregnancy. I do see value in being informed (obviously since that is my whole point). But, we likely do not need as many as we believe. I opted our of the NT Scan with J. It was not presented as something I needed to do and knowing that we would not choose to do an amnio, and CVS was still newer, we decided that it only had the potential to make us worry. Obviously this isn't a choice everyone would make, but it was what we were comfortable with and again making an informed decision. We opted to have the NT scan with the twins because we knew from the beginning it was a riskier pregnancy and by that point MT21 was available rather than an amino etc.
I guess the point of my post is that I do see value in making informed decisions in childbirth and I think too often in this country the decisions made arE done so without all of the information regarding risks and benefits etc.
I actually agree with her points, and I've had births every which way. I've been induced (augmented after SROM with my last) with all of them. Two were medical, one was an induced med-free hospital birth and the other an induced homebirth. There were things I knew I wouldn't opt for, assuming I remained low risk, after having my second daughter. I went ahead with AROM with her, but it was not necessary at all, but it was standard, routine practice. But it doesn't come without risks, and quite a few of them. I didn't want the "big" things, but at the time I had a "what the hell, let's just do this" since I was 6 cm and not in labor yet.
I support choice. I wish there were more viable options. Not just access to midwives, but health insurance covering midwifery care, and not having to deal with insurance bullshit to get covered.
"Dr. Ewigman and I talked about how some people derive false certainty from prenatal sonograms, thinking that if the clinicians see nothing unusual, the baby will be born perfectly healthy. I explained to him that that was one reason I didn't bother; I knew from my own research on birth anomalies how often sonograms mislead. He observed that our culture has "a real fascination with technology, and we also have a strong desire to deny death. And the technological aspects of medicine really market well to that kind of culture." Whereas a low-interventionist approach to medical care -- no matter how scientific -- does not."
This part is true in many cases. The false sense of security with various routine tests and procedures. Ultrasound is not an exact science. This really hit home after losing my first son when it was revealed after autopsy and pathology testing that he had undiagnosed heart defects, major ones. I had the diagnostic ultrasound, and was told all was good, but all was not good, and I felt it. I knew it deep down, but tried to reassure myself because the ultrasound said he was fine. He went into congestive heart failure at the end of my pegnancy. So, no, ultrasounds don't detect everything.
I had an ultrasound with my first daughter at 30 weeks because my fundus was measuring 5 cm ahead (mild idiopathic polyhydramnios). It detected she had increased lateral brain ventricles, suspected ventriculomegaly. I was referred to a MFM specialist and had NSTs and BPPs during the last 8 weeks of my pregnancy. She was being monitored, and the last three ultrasounds showed her ventricles increasing in size. That coupled with her being tachycardic during an NST made them want to schedule an induction to monitor her better. She had testing and more scans done after birth... all was fine. No ventriculomegaly or concerns of hydrocephalus.
But even with those experiences, I had the first trimester screening with my fourth baby, and though I was planning a homebirth again, had dual care and saw a MFM specialist for very detailed level III ultrasounds to monitor his heart. I saw the specialist on three occasions. I do think the genetic screenings can provide useful information, because it gives the provider information and this can affect one's care. Having a higher risk assessment profile allows them to screen for anomalies associated with the condition one received a screen positive for. I think knowing one has options that do not involve invasive testing is very important. The "false positive" myth is what really irks me.
I had fetal DNA testing and had a couple visits with the MFM specialist with my newest LO, but didn't have further diagnostic testing after 22 weeks. I don't understand not wanting to have at least the diagnostic u/s. It may not yield 100% accurate results all of the time, but it can still provide valuable information, so I have a heard time with forgoing it or understanding the position behind it.
alexis Anecdote, but I know a lady who had her second baby in the hospital entrance because #1 was a pit induction and the ctx never got that bad with #2 so she didn't know when to go to the hospital.
I've only had a pit induction, but I went from zero contractions to almost non-stop contractions when my water was broken. Was each contraction worse than a single non-pit contraction? Probably not. Would a non-augmented labour have a period of super close super painful contractions? Probably, I guess. But for me (who was planning an epi anyhow), going from zero to 60 was my cue to ask for the epi OMG NOW.
I never had pitocin but having my water broken took my contractions from manageable to absolutely horrible. I felt like Injust could not get contrl of the pain at that point because it wsd constant And so severe. And I had been contracting at least 4x an hour consistently for 4 weeks at that point Including back labor for the first 2.5 weeks when E was positioned half transverse and crooked.
This is not uncommon. The membranes cushion the cervix, so once it's gone it can make contractions much more painful. I wonder how often that gets explained before doing it. It is best for membranes to stay intact. Since they only rupture spontaneously before labor in 10% of cases. According to recent, available date, membranes typically rupture spontaneously in transition or during the second stage. This is the ideal.
Even if I needed a medical induction, I wouldn't allow AROM. It can not be undone once it's done. Pitocin can be lowered or turned off, but AROM sets the ball in motion for hospital births, and it increases the risk of fetal malpositioning and makes it harder for baby to get into the optimal position should it be OP or in an awkward position. And it increases the risks of infect and cord compression.
I've read stories of contractions being management at 6+ cm, and then once membranes are ruptured the contractions become unbelievably painful.