In my second pregnancy, I was again diagnosed with gestational diabetes. I thought I had done a great job of controlling my blood sugar and my diet. So, at 38 weeks, after keeping all my visits, and trying hard to be a good patient, it was explained to me, that my labor had to be induced the following day. I was to going to be scheduled for an ultrasound, an amniocentesis to check lung maturity, and if all of that was fine, labor induction would begin. You can imagine my reaction. What made matters worse, is that my own doctor was not even there that day, and my husband and I got this news in the hallway! After that experience, I went home mostly tearful and upset, but also pretty angry. I would do whatever was needed for my baby. But my doctor had been called out for an emergency, and this other doctor saw me that day in a busy, crowded, Atlanta clinic.
This story has a happy ending. I went home that night just praying for God to help me, and he did. That night, I woke up at around 1 am, and discovered that my water had broken. We got in the car, and hurriedly drove downtown to the hospital. I got there in time, and this was real labor. Soon after they put me in the labor and delivery room, I was getting the urge to push! The doctor on call who I had never met before was very nice, and my daughter was born at around 4 am that morning with no problems. I was so thankful that everything was ok, and most of all that I did not have to go through any of those other procedures.
The same doctors that took care of me that day in my pregnancy, were eventually the ones who trained me in high risk OB clinic as a resident. So, looking back, I still wonder what in my chart, alerted them to make the decision to induce labor as they had done. Could it be they had the impression that my glucose control was not that good, or that the baby was too big, or that my blood pressure was up?
That brings me to my second article in a series. One thing you will learn as an OB patient, is that in a medical setting involving you, and your pregnancy, is that you have to speak up for yourself, and be your own patient advocate. I learned that, on that day. No one was going to stand up for me, except me.
That brings up so many topics that we could talk about. Induction, that feeling of losing control in the doctor-patient relationship or in the hospital, how to address problems with your healthcare provider, among many more. We could start by talking about labor induction, which is a common practice in modern obstetrics. There are probably many reasons for this.
For some, the end of pregnancy is just so uncomfortable, and so some women just push for it to be over. Wanting the discomforts of pregnancy to end makes induction attractive for a patient. For the OB doctors, they are pushing to bring the pregnancy to a safe close, and deliver a healthy baby, so they are all over the details of looking for any potential medical indications that need to be addressed. And the ability to schedule a delivery is attractive, which means more babies are not being delivered at 2, 3, or 4 o’clock in the morning, which is also nice for the doctor and the medical staff. Some patients are very interested in the logistics of the birth. They may have family members who are trying to make travel and work arrangements to be present for the big event. So, being able to plan the birth day is attractive.
An important thing to remember is that doing an induction for convenience has to wait for 39 completed weeks. And, it has to be scheduled. Usually this is not going to happen on a holiday or a weekend, just FYI. Of course there are plenty of reasons why labor sometimes has to be induced, regardless of whether a cesarean might be the result, when immediate delivery is medically needed.
Just as there may be some advantages, let’s consider some of the disadvantages.
In a labor induction, your body is being pushed to do something it may not be quite ready to do. When the cervix is unfavorable (determined by the Bishop’s score –measuring five parameters of favorability) even at full term, the ripening that needs to occur to make the cervix responsive to labor contractions may not be fully developed. This means, there is a possibility of increasing the need to progress to a cesarean section. This is important to know, if you are hoping to avoid a cesarean section. If you really don’t care whether you have a C-section of not, and just want to be delivered at any cost, the price you may have to pay is to have a cesarean section with each delivery after that (the risk of C-section starts to go up after the first two). There are situations where vaginal birth can be attempted in the next delivery (VBAC, or vaginal birth after cesarean, or TOLAC for trial of labor after cesarean), but for the most part, it can also be regarded as being slightly higher in risk, and depending on the reasons for the first cesarean, you may end up being offered a repeat cesarean again and again.
The process of induction may prolong the hospital stay, and the labor itself may take longer. Of course, everyone can think of an example when labor progress may go much quicker with a little Pitocin, but in the case that your body is not really ready, it could take longer. Some patients remark that the contractions experienced with the IV medicine Pitocin feel harder and more painful than the contractions of natural labor. This may not make much difference if you are planning an epidural anyway, but it is worth mentioning.
Every pregnancy is different. What worked out for someone you know, may not work out for you. It’s important when timing an induction to make sure that the cervix is favorable. I like to use an analogy of picking fruit. It’s a good idea to wait until the fruit is perfectly ripe and just about ready to fall off the tree, to pick the fruit. So, if you can follow this analogy, we are waiting for the cervix to be just about ready to do its thing on its own. Actually waiting for spontaneous labor has its own good points. Labor seems to go more quickly, often an epidural is not needed. But then again, sometimes it goes so quickly, that there is not even time for an epidural, and that can be a little scary, but it is usually over before you know it.
When, as a patient, you feel like you are going to have a meltdown about some issue, it’s a good idea to make an appointment and also let your healthcare provider know ahead of time about the issues that are on your mind. If you spring this on them when they are in the middle of a busy schedule, you are apt to be met with a less than favorable response, simply because there is just no time allowed for it in the schedule, and everybody hates not being on time. Think about that. Patients hate waiting, and doctors hate that feeling of always feeling an hour behind schedule. If you have ever worked in a restaurant, one thing you learn is that people are the most cranky when they are hungry. Add to that the stress of waiting for an office appointment, and thinking about all the things you could be somewhere else doing, you begin to realize the problems we as healthcare providers are faced with on a daily basis. So, if you have been keeping a notebook full of questions, or have decided that this will be the day that you are going to bring up the discussion about the birth plan, bear in mind that many larger clinics are expecting the doctor to see upwards of 20 patients per half day. That means that return OB patients are about five or ten minute appointments, and that’s barely enough time to scratch the surface, review the pertinent labs, etc. Most clinics keep schedules that make it very demanding for the doctor, so realize that special scheduling may have to be made consultations about “other than” routine issues.
However, as a patient, you should feel like you are getting explanations that you need to make you feel comfortable with the process. When there are alternatives, you can ask about these, and educating yourself about pregnancy issues is always an advantage, because the more you know, the more you will understand about what your healthcare provider is thinking, and some of the decisions that are being made regarding your pregnancy. Keep in mind that your healthcare provider’s goal is essentially the same as what you want. They want you to have a happy, healthy pregnancy, without a lot of hassles. They also want what you want. Usually, a birth plan is not really needed.
Depending on the situation, usually things are allowed to proceed as naturally as possible, with minimal interventions. Where interventions are needed there are usually good reasons, and there are usually options. You should feel like you are being informed and being brought into the decision making process. On the subject of the birth plan, you can always find a basic birth plan by Googling it, and this can be the basis of research that you do for yourself on all the options you will need to know about for your delivery. Or, you can just leave that to the professionals. This is not our first rodeo.
Another point to make is that you really want to be on the same wavelength with your healthcare provider long before it is time to make major decisions about your pregnancy. If you have the feeling that they are listening and receptive to your needs, and responsive, it is much more likely that they will take your personal needs into consideration when it comes to making decisions concerning you and your pregnancy outcome. Write down your concerns so that you can ask questions like bullet points. Just get straight to the point and keep it simple, so that you will get a straight answer.
Disclaimer: The above information is given for educational purposes only, and cannot substitute for the advice of your own health professional who is familiar with your unique medical condition. Please seek the care of a qualified health professional as soon as you suspect you may be pregnant, and in the event of a suspected medical emergency, go to your nearest hospital emergency department for further evaluation when it is urgently needed. Consult with your health professional regarding your pregnancy.
For more information on my practice at the Wellness Boutique, or to subscribe to my email list, please use the email contact box.
Wellness Boutique is my OB/GYN practice and has been in downtown Hartsville since 2012. We are located around the corner from the Center Theater on North Fifth Street and West College Avenue. If you know where the Black Creek Arts Council is, and SPC Credit Union, we are across the street. I have been a practicing OB/GYN in Hartsville, on staff at Carolina Pines Regional Medical Center since 2001. I have been in private practice since 1999. In 2000, I was featured on The Discovery Channel, A Birthday Story, in the episode called “Sickle Cell”, which was filmed at Crawford Long Hospital of Emory University, in Atlanta, Georgia where my four children were born.
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