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Archive for the ‘Labor/Birth’ Category

Is home birth safe?

Most doctors in the US will say no, absolutely not. But is that really true? Here are a couple studies so that you may decide for yourself.

1. 2009 study published in the Canadian Medical Association Journal (CMAJ)
Conclusion: “Planned homebirth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric intervention and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.”
 Details: This is a very good study because it looked at only women who were low-risk; even the women who gave birth in the hospital would have qualified for a home birth if they had desired. Therefore, the study is not biased in favor of homebirth, but is as fair as humanly possible. For a planned home birth, rates of perinatal (baby) death per 1000 births was 0.35. For the planned hospital births with a midwife, rates of perinatal death per 1000 births was 0.57. For planned hospital births with a physician, rates of perinatal death were 0.64. Notably, the study finds that women who had planned home births were significantly less likely to have bad maternal (mother) outcomes, such as severe tearing or hemorrhage.

2. 2005 study published in the British Medical Journal
Conclusion: “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”
Details: This study looked at all of the planned home births in 2000, attended by Certified Professional Midwives in the US and Canada, in locations where home birth is not integrated into the healthcare system or well-accepted by most medical providers in the area.

3. The Maternal Mortality Rate in the U.S. is atrocious, for how medically advanced we think we are. 
Instead of having fewer mothers die in childbirth now as opposed to 20 years ago, the US has actually seen an increase in maternal deaths since 1990. This means that a woman in her twenties is more likely to die in childbirth than her mother was. As an industrialized country, we fall dismally behind countries such as Canada, Japan, and the Netherlands, all of which have midwives attending the majority of births. We rank 39, which means that 38 countries have better maternity survival rates than we do…and most of them are substantially better.

So what have we done wrong? Why are women more likely to die in childbirth than they were only 20 years ago? Could it be  due to the skyrocketing unnecessary medical interventions such as induction and cesareans? Could it be that maybe, with all our medical advances in case of emergency, we’re so on edge that doctors actually create the very circumstances they were trying to avoid? Could it be that most births are not medical emergencies, and that most women will give birth safely to healthy babies if left to their own timing, with a midwife who will offer support and appropriate medical care throughout this phenomenal life change?

Maybe. Maybe we’ve had it all wrong.

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Birthing Positions

Traditional medical practice dictates having a laboring woman laying on a table during delivery. In fact, most people tend to think of birth as happening in this position. However, this is not for the mother’s benefit in the least. Instead, it is for the benefit of the doctor, so he or she can easily see without having to crouch or get on hands and knees. Can you imagine a typical doctor in the “good ol boy’s” club at your local hospital kneeling beneath a a woman to catch the baby while the mother sits on a birth stool, squats, or stands?

No, I can’t envision that either.

Despite ease for the doctor, this position is less than beneficial for the mother or baby. In fact, it is quite easily the worst position she could be in. Lying back closes the pelvic opening, making it more difficult for the baby’s head to get through. It also ensures that the mother has to work against gravity, trying to get the baby up and out. This is not a recipe for success, and along with the labor pain medication many women are given, it frequently creates serious trouble for the baby. You may have heard of terms such as “fetal distress” and “failure to progress” to describe the reason for an emergency c-section. These are listed side effects of labor drugs, but they are also caused in part by the difficulty of getting a baby through that closed space.

Convenience for the person who is not in labor doesn’t seem like a very good reason, does it?

So, if back-lying is not ideal for birth, what are the best positions? Really, a mother given freedom of movement throughout labor will generally be able to intuitively find the best position for her, and for that particular labor. However, here are what are generally the best positions for birth:

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Squatting

Squatting is virtually unpracticed in most Westernized countries. However, it is by far the best way to give birth. In a squat the pelvis opens up fully, and gravity helps draw the baby down. For women who live in countries where squatting is culturally normal, this is also an easy position to hold for the length of time necessary for birth. For someone unused to squatting, an assisted squat while holding onto a bar, partner, or rope is possible.

A squat is a great exercise to practice during pregnancy in preparation for birth. To do so easily, especially with a large baby belly, open a bedroom door. Place a foot close to the edge on each side and hold onto the doorknobs while you lower yourself into a squat. You can sit there a while before standing. Repeat as many times as desired. Even if you decide not to use the position during labor, it is a great prenatal exercise.

Sitting

For women who prefer not to squat, sitting with knees spread wide apart is very similar in benefit. Using a birth stool or toilet (the latter is usually not recommended because you don’t want the baby to drop into cold germ-water!), just sit upright or slightly lean back or forward as desired. This is easier because we’re used to sitting like this on the toilet, and it also opens up the pelvis and uses gravity to our benefit.

Sitting up is my personal birth position of choice. The first two births I was not allowed to sit up, even though I had an overwhelming urge to. I still get frustrated just thinking about the individuals who hindered me. My third birth I was able to sit on a birth stool, and it was the best labor I’ve had. No screaming, no yelling, no frustration. Very little pain. My body was exactly where it needed to be.

Standing

Standing also uses gravity to help bring the baby down. To do this the mother stands, leaning and holding onto her partner or a chair for support. She can either face her partner, or be supported under her arms while she faces away. This also works while kneeling on a bed, facing her support. These first three positions are very beneficial because they are types of vertical birth.

Kneeling

Finally, kneeling is chosen by some women during labor. A woman can kneel on the floor and hold onto the bed or chair while pushing.

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Really, there is no “wrong” position for birth, as long as a woman is able to choose her own position. If she is listening to her body and given the freedom to do so, then she will naturally shift and adjust to what is best for her unique birth. For labor-support, follow her lead. If she seems unsure, ask if a certain position listed above sounds good. If she tries it and hates it, no harm done, but she just may discover the perfect place for birth.

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I sat on the toilet in our bathroom, holding onto my husband and drowning in sheer misery. This labor was too hard. I felt like I was about to die from pressure and pain. Or scream in frustration.

It wasn’t this difficult last time, was it? I’m sure it wasn’t. Nothing could be as horrible as what I was going through at that moment. Nothing.

I looked up countless times to tell my husband that we were having no more kids. No more! I’d say. I am finished doing this! But the words never made it past my lips. Instead I thought it to myself, drowning in pain and an overwhelming feeling of helplessness. This was one experience I couldn’t escape. The baby was coming, whether I wanted her to or not.

Sometimes, staying pregnant seems like the easy way out.

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Transition. As any mother who’s given birth sans intervention knows, this is arguably the most difficult part of labor. After hours of work – of contractions and no sleep – it strikes. Suddenly, you feel helpless. Contractions double up and barely pause between surges. Each can last two minutes, with barely 30 seconds of rest between. It’s impossible to get comfortable and becomes difficult to handle the intense pressure of the baby descending. Women get nauseous and have hot or cold flashes. They may start spitting, burping, or vomiting.

The worst part is the hormonal upheaval. A capable woman who was handling labor well will suddenly feel like she can’t do it. She may want the baby out right now, just to no longer experience labor. These feelings are due to a surge of adrenalin released into the brain that triggers our “fight or flight” response. Temporary fear, panic, nausea, and shaking are normal during transition.

But transition is actually a very good sign. This is what our bodies do immediately before pushing the baby out. The emotions and sensations tell us that our bodies are nearly ready for birth. It is during this short period of time that the cervix finishes dilating and the baby’s head begins pushing down into the vagina.

Although transition is difficult, it is also only lasts a relatively short period of time. Usually between 5 and 20 contractions occur. A woman’s partner or birth assistant can help her get through this difficult time by encouraging her, and reminding her to breathe deeply through each contraction. Some women find physical touch extremely comforting, some prefer not to be touched at all. No matter which type, no woman should be left alone during transition.

For anyone supporting a laboring woman, it is very good to know the signs of transition. Due to the “fight or flight” response, women may ask to go home if they are laboring in the hospital. This is also the time when many women will ask for an epidural or other labor drugs. We want something – anything – to stop labor pangs. Even if a woman has decided that she really wants to give birth naturally, she may ask for drugs or an epidural. I have to be careful here, but asking for a painkiller does not necessarily mean that she actually desires one. Some women ask in response to their sudden intense desire to escape labor, but would not want the drugs any other time. Now, if she keeps asking, then of course give her the painkillers, but also know that all the signs of fear and panic and a feeling of helplessness and an “I can’t do this anymore” mindset means that the baby is coming soon. A drug or sedative is not going to help for long, and will be a hindrance during pushing. Encouragement and support are extremely helpful at this time, and gentle reminders that she gets to meet her baby soon.

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I wanted a c-section. Or to just go to the hospital for some serious drugs. Time lost meaning as I sank deeper into labor-land. Then the contractions paused briefly. I sat, relishing the break. Suddenly my body instinctively bore down in a push. I reached my hand down and felt hair on top of a tiny baby head! 

A surge of renewed energy snapped through me as I made myself ready to meet my baby.

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Several weeks ago I wrote on medical methods of induction, many of which are no-nos if you’re wanting a natural birth. So now it’s time to write about natural induction (which, by the way, I now have plenty of experience with after my third daughter was two weeks later than planned. We were expecting a late-June baby, and ended up with a mid-July baby).

First, let me say this: it is best to let a healthy baby come when she or he is ready. If you are pushing your “due date” or it has already passed, then the best thing to do is just relax and allow the baby to begin labor when ready.  There are things you can do to speed up the process by a couple days, but if your baby is not ready to come, then baby won’t come unless you force the issue.

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Sex

Male sperm works to soften the cervix and causes contractions. Obviously this will not work if you are using condoms, but women more sexually active during late pregnancy tend to have babies come earlier than those who don’t, according to Ina May Gaskin, who is considered the nation’s leading midwife.

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Walking

The swaying motion of walking helps move the baby down and into the correct position for birth. If the baby is already low, the movement will start to press her head against the cervix, helping it to open and efface. It also keeps mama healthy, which is essential for a natural birth. Don’t walk until you’re exhausted because you’ll need energy for labor, but a good 30-minute walk every day will help the birth process.

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Sleep

Okay, this may sound counter-intuitive, but getting adequate sleep is important for a mother about to go into labor. If your body is worn out from miles of walking and too much sex (like there ever is such a thing!), then it will delay labor in an attempt to rest. If this is the case, then sleeping is the best thing you can do because you do not want to begin labor exhausted. Especially if you are a first-time mother. Get enough rest! It will make labor easier.

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Nipple Stimulation

Stimulating a pregnant woman’s nipples will contract the uterus. After giving birth, a nursing baby’s suckling helps the uterus contract back down quickly, thus reducing a woman’s risk of hemorrhage. Before the moment of birth, nipple stimulation helps start contractions or keep them going. For some women this is a sure-fire way to start labor. Oral stimulation is best, either from a nursing toddler or a spouse, but manual stimulation or using a breast pump work as well. Used in conjunction with intercourse, it is extremely effective. This also happens to be a great way to try to jumpstart a slowed labor in the hospital rather than using Pitocin or Cytotec.

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Massage

There are pressure points on a woman’s body that help initiate labor contractions. A massage therapist trained in what is safe for pregnancy and labor is a great person to see. Someone trained in acupuncture and acupressure would also know what to do. However, you don’t necessarily need a trained professional to do the massage. Although a professional will be more experienced, a friend or partner can firmly massage the following areas:

~Hand: massage the webbing between thumb and index finger.
~Ankles: massage the ankles all the way up to mid-calf, focusing on the inside of her leg, a couple inches above the ankle bone.
~Sacrum:  massage the lower back right between her hip bones, focusing on the two dimples just above the top of her buttocks crease.

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Homeopathics

There are a couple of homeopathic remedies that can encourage labor to begin. Most midwives will not distribute them prior to your “due date,” but check with your midwife or a naturopath to get some. The great thing about homeopathics is that they will not force a baby to come who is not ready. Using them will just give a baby who’s ready a little nudge to start labor. If they don’t work and just cause annoying contractions that do nothing productive, drinking a small cup of coffee will stop them. Caffeine counteracts homeopathics. Also, be warned that taking too much of a homeopathic will cause the reverse of the desired effect. I learned this the hard way with my third child when I accidentally stopped a batch of promising contractions by taking too many pills.

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Castor Oil

Okay, castor oil is disgusting. But it is a fairly fool-proof way of starting labor. It is a little more aggressive than any of the previous natural inductions listed. A tablespoon with breakfast should start some strong contractions that turn into labor. If you decide to try castor oil, make sure your care provider knows what you are doing so she can be ready for you. Be warned, castor oil is a laxative, so it will clean you out as well as get your baby out.

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Herbs

A good midwife or naturopath will be able to prescribe herbs to induce labor. These are similar to castor oil in that they are more aggressive than the first few methods listed. As with the homeopathics, I do not want to list particular herbs because it is something your care provider (who knows your medical history and situation) should recommend. If you are seeing a regular doctor who doesn’t know about herbs, try going to a naturopath or acupuncturist who works with pregnant women.

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Acupuncture

If you don’t mind needles, then seeing an acupuncturist may be a good way to start labor. When choosing a provider, however, make sure you go to someone with excellent references and experience in working on pregnant women. If you’re nervous about needles, as I am, many can also do acupressure and heat over various points to initiate labor.

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Sweeping the Membranes

This is apparently a fairly effective method of beginning labor within 24 hours. During a vaginal exam, the doctor or midwife can gently insert a finger into the cervix and swipe in a circular motion to stimulate contractions. This method does, however, carry a slight risk for breaking the bag of waters with a sweep that is not quite gentle enough. This wouldn’t necessarily be a bad thing, except that having a broken bag of waters but no labor carries a risk of infection for your baby, and will necessitate medical induction within a day or so if labor does not begin.

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I recently read Born in the USA by Marsden Wagner, who is the former director of women and children’s health for the World Health Organization. He made a great observation on the essential difference between midwives and the majority of doctors when it comes to childbirth.

Doctors view birth as something that happens to a woman.

Midwives see birth as something a woman does.

Seemingly a minor difference, but it means everything for how women in labor are treated.

Midwives assist a laboring woman give birth. Everything they do is to provide support for the woman while she works to birth her baby, and they are there in case something should go wrong. Women are considered “clients,” not “patients” because they are not sick. They are simply pregnant.

On the other hand, doctors deliver a baby. They see women as patients with a condition that must be fixed. Namely, she is pregnant and she should not be pregnant anymore. The goal is to get the baby out as quickly as possible, generally through medical methods and by their own expertise. It is rare to see a doctor who is willing to allow a healthy labor to happen naturally without attempting to meddle. Doctors are expert meddlers. It’s really all about control. But labor cannot be controlled, and when doctors (or nurse-midwives) attempt to control the uncontrollable, they tend to end up doing things that are not necessary or beneficial for the mother or her baby.

Doctors should be backup for when a woman actually does need assistance, not the default option for every woman in every birth. We need support during pregnancy and birth. Not always a medical degree.

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Less than three weeks ago I gave birth to my third daughter. Exciting, right?! Well, I’m excited. She’s adorable and it was literally the perfect birth. Absolutely perfect. Once I finish writing my birth story I’ll post it for anyone who wants to read about a home birth. Anyway, since I’ve now had three natural births, one in a hospital and two at home, I think it’s time to write about pain management during labor.

Although the majority of women in the U.S. choose to get an epidural to block feeling, there are definite risks to the procedure, both for the mother and her baby. I don’t think anyone would disagree that a drug-free vaginal birth is by far the safest. Unfortunately, not many women believe that they are capable of a drug-free birth. Most, if not all of this is due to our cultural opinion of birth. Nearly everyone, from doctors to the media, treats labor and birth as a medical condition that requires medical intervention and a highly-specialized doctor present to “get the baby out.” However, a healthy woman, left to herself or with a trusted labor assistant, will also give birth, and generally much more quickly and peacefully.

With all that being said, let’s talk about labor pains.

Now, labor is a lot of work. It is hard work. And for good reason. During labor our bodies go through incredible physical and hormonal changes as the baby moves down the birth canal to be born. How many are in awe that a baby is able to fit through an opening that is so small? I know I am! With all the changes occurring within a laboring woman’s body, there is also a level of discomfort. Each woman experiences it differently; some refer to the sensation as an intense ache on her pubic bone, some women describe extreme pain.

Whatever experience you’ve had or heard stories about, there are ways to alleviate painful sensations during each contraction (also called a surge or rush by many natural childbirth books – I like those terms much better, don’t you? They describe labor much more accurately than contraction does. What a distant, medical word) – without drugs. Here are some ways to handle the surges:

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1. Relax

Seems counterintuitive, right? When we experience pain or discomfort our natural reaction is to tense up in a “fight or flight” mentality. Our adrenaline kicks in and we’re ready to react. Normally, this is a good thing. However, labor is not something we can escape from, and it is not something to fear. We are bringing new life into the world, and that is a wonderful thing! Tensing muscles during a surge will only make the pain worse. Our tendency is to tense up, then when that makes it more painful we tense up more, which creates even more pain. It turns into a vicious cycle in which a woman even begins to tense up in anticipation of the next contraction.

In order to break free of that cycle, it helps to relax our muscles, especially in the abdomen, butt/vaginal area, and jaw. If you’re having trouble relaxing those muscles, allowing your mouth to fall open in a “duh” expression helps open up the birth canal as it lessens tension in your vaginal muscles. I know, it sounds weird, but those two sets of muscles are connected. It is possible to relax all these muscles even while you’re using others, such as while standing or kneeling.

2. Breathe, Breathe

“Breathing” does not mean the short, “hee hee hoo hoo” breaths that classes like Lamaze teach (well, they used to, at least; maybe they’ve changed). Patterned breathing techniques like that are only used to try to distract a woman from her contractions. When I say “breathe,” I mean deep, full, belly breathing. The kind we all used to do as children, before our culture taught us to never let our bellies stick out. Breathe like an opera singer or a baby. With each breath use as much lung space as possible. If you do it correctly, your belly should rise with each breath, but your chest barely moves. Try to visualize sending air down into your vagina instead of your chest. Deep breathing takes more oxygen into your body, which alleviates pain. Focusing on the breathing is also calming and brings your focus inward as you “give in” to what your body is doing.

3. Set the Mood

Just as there is a certain ambience that creates a romantic mood, there is an ambience that is good for labor. There are exceptions, of course, but most women need dim lighting, a peaceful atmosphere, and a very few trusted people in the room with her. If laboring at home, you can set up candles, play music, and hand-pick who is allowed to be there. If at a hospital, it will probably take a little more effort, but it is possible. Some hospitals provide cd players and bedside lamps, but others don’t. Find out beforehand and, if they don’t, you can bring your own stereo or light if you desire. Having only a few trusted people is also nearly impossible at a hospital, but you can limit who enters the room and when. In this case, a spouse or friend may have to keep unwanted people out. Also, if a nurse is rude or makes you uncomfortable, you can tell them to leave. Remember: you are paying them to help you during labor. Don’t be afraid to request a different nurse.

4. Move Around

I’ve written before that lying flat on your back is the worst position to labor and birth in. It not only closes the pelvic opening so that the baby has a hard time getting out, but it also makes contractions much worse for the vast majority of women. Early in labor, walking is great because it helps the baby move down and into a good position for birth. Later in labor, moving around to find the most comfortable position will help alleviate pain. Also, your body will tell you if you’re in a bad position for the baby as she moves down toward birth. Listen to your body, and if you don’t feel like being in a certain position, move (between contractions!) to a different one. Here are a few positions women find comfortable during late labor:

-standing, leaning forward against someone
-kneeling on all fours
-kneeling and resting upper body on a couch or bed
-sitting on the toilet, an exercise ball, or a birth stool
-resting in a tub of warm water
-lying in a side-relaxation position (on your side, slightly leaned forward, with top leg propped on a pillow and another pillow under chest and head)

5. Visualization and Listening

Many women find exercises such as visualization or self-hypnosis to be very helpful for labor. Hypnobirthing is an entire childbirth class that helps a woman learn self-hypnosis. There is also a good book on Hypnobirthing if you are unable to find or afford a class. Other classes, such as for the Bradley Method, teach visualization exercises. One popular one is called The Rainbow Visualization. Have your birth support read it to you in a calm, low voice in the months leading up to the birth, and then during labor they can read the whole thing or just the parts you find most soothing. A familiar voice is a very calming thing to listen to during labor. Have someone tell you a story, or read poetry or passages in Scripture to you. You can even recite favorites to yourself.

6. Massage

Nearly every woman loves some type of massage. During labor there are certain places that, if massaged, make labor easier. A skilled doula or labor assistant will be able to try various things to discover if one feels particularly nice. But, you don’t have to have a trained professional do it. Whoever you choose to be with you during labor can do it. One of the universal labor massage areas is the sacrum. This is the part of the lower back that lies roughly between the hipbones, just above the tailbone. Many women find that pressure on this area during contractions and even during pushing feels good. If your birth partner is unsure, have them start out firm but not too hard, then if you want more pressure, ask for it. Other good places to massage are the hands (especially between the thumb and index finger), feet, and ankles.

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So, there you have it! During labor remember: relax and give in to labor – you can’t escape it so work with it!; breathe into your pelvis; set the mood; don’t be afraid to move around; listen to a soothing, calm voice; and utilize the hands of whoever is in the room with you!

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Not too long ago at a birthday party I talked to a mom of a brand-new little baby boy. Her fourth baby. She was telling me about her birth; that she was five days past her due date and the doctor decided she “had to” induce. So, this sweet lady went in and was given a magical little “miso pill,” as she called it. “It’s a tiny little white pill they stick next to your cervix to start labor. My baby was born at noon. They had to do that to get my third baby out too.”

I stood there talking to her, trying to act normal and fervently hoping my look of horror didn’t show. That little “miso” pill, as she called it, is none other than Misoprostol, the generic name for Cytotec, a drug used off-label that has caused the damage and death of myriads of laboring women and their babies. Of course, I wasn’t horrified at the mom. There is no way she could know that the doctor she trusted was essentially performing an experiment on her to start labor. I was shocked that the doctor (who also happened to be my childhood doctor, which made it even more disturbing) would knowingly put this mother at risk without giving her any information on the drug she administered.

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Miso was first used as an induction drug in the mid-1990s. FDA approved as an ulcer drug, this pill has never been tested or approved for use on pregnant women. In fact, in 2000, the manufacturing company sent out a letter to all obgyns and midwives, warning against the use of miso because it causes uterine rupture (the uterus detaches and breaks open) and can harm or kill both mother and baby. And yet, eleven years and many deaths and lawsuits later, doctors still use it.

Essentially, the pill is dangerous because it’s unstoppable. With other induction drugs, like Pitocin, Prepidil, or Cervidil, the source of the drugs can be removed or slowed if a woman’s uterus shows signs of hyperstimulation or the baby goes into distress. Those drugs aren’t foolproof, but they don’t have as many cases of infant or maternal mortality due to uterine rupture as does misoprostol. A “miso” tablet, once absorbed into the body, cannot be stopped. It is an all or nothing deal. Therefore, even if the contractions strain the uterus to the point of rupture, there is no way to reverse or slow down those contractions.

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Talking to that mother got me thinking… if you know something about a drug a woman is given for childbirth, what do you say? Should you just stay silent, even though you know it causes death, disability, or infertility? Is it even ethical to stay silent? Do you tell her that the drug is that dangerous? Do you tell her to research it, knowing that she probably won’t? What on earth do you do in a situation like that?

In my mind, it would be different if the information was well known and in the news, such as the dangers of smoking cigarettes or binge drinking or a mainly fast food diet. Then I wouldn’t say anything because I know she made a conscious, informed choice. But medical interventions or prescriptions are an entirely different ballgame. We tend to trust our doctors and what they give us, believing that they have done the research and will give us the most beneficial treatment. This is not always the case. Most women don’t even know the potential side effects of labor drugs until it is too late and they’ve experienced the damage.

Women like the one from the party are the reason I started this site. Every woman deserves the right to make an informed choice about what is done to her body, especially during one of the most normal and natural processes she experiences: bringing forth life.

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