Fantastic Birth in Bangalore!

I want to share a little about a birth I attended a week ago. I'd been traveling up north and returned to have a prenatal visit with my clients . My client, who I will refer to as C, looked beautiful, felt good and was excited about the upcoming birth. As her due date was only three days away, she and her doctor had discussed her doc's induction protocol, which was that she would need to go in for induction six days after her due date. C had a feeling her baby would come late, as both she and her brother had been more than a week late. (The American College of Obstetricians and Gynecologists has a guideline of 42 weeks, or two weeks after the estimated due date; given that due dates are often so uncertain and most first-time babies come late, allowing only six days before inducing isn't giving the baby much of a chance!) She very much wanted to avoid being induced, so during our prenatal visit we talked about natural induction methods: sexual intercourse (prostaglandins in semen help ripen the cervix), nipple stimulation, acupressure and herbs.

Her husband, D, called me at 12:30 that night and said she was having contractions that were four minutes apart! I said I'd meet them at the hospital, got dressed and was on my way. Luckily, we arrived at the same time, and by the intensity and frequency of C's contractions, I could tell that she was in transition. We went straight to the delivery room, where we met the on-call doctor and a few nurses. The doctor checked C: fully dilated and ready to push! Of course there was no time for pain medication, and my clients had come prepared with a birth plan, which stated clearly that the doctor and medical staff should avoid common and often unnecessary interventions such as shaving, enema, IV, episiotomy, oxytocin, immediate cord clamping, separation of mother and baby, etc. C was amazing, listening to her body and following its natural urges to push, while D supported her in the most gentle and loving way until their baby boy was born at 2:19 am. He was placed on C's chest immediately and kept there, skin to skin, for 40 minutes. (It's extremely unusual for doctors/hospitals to allow this much time to pass before they take the baby away, but as long as a newborn is pink and breathing, all newborn procedures can and should be delayed for at least an hour so that mom and baby can be skin to skin and establish breastfeeding.)

Unlike in most hospital birth settings I've been a part of in Bangalore, the doctors and medical staff were kind, quiet (for the most part), calm, and respectful of C's wishes as stated in her birth plan. (That said, it was a very short labor, so it's impossible to know how much pressure for interventions there would have been if labor had slowed or did not progress as quickly.) She was not given an IV (just a hep lock) nor did the doctor cut an episiotomy. She tore naturally, and was extremely pleased to have a natural tear instead of an episiotomy. Both parents are very satisfied with the whole experience, and I'm so honored to have been a part of it!

Wagner Article: Being Seduced to Induce

Being Seduced to Induce: What Women Should Know About Their OBs

By Marsden Wagner M.D.

Women will only agree to caesarean section if they are convinced it is safe for them and their baby. One of the first efforts of obstetricians promoting caesarean section has been to take the scientific evidence on risks of caesarean section and torture the data until it confesses to what they want it to say.

One example: Obstetric hype in popular and professional magazines says research shows 60% of women who have vaginal birth have urinary and faecal incontinence. But a careful reading of the research papers they refer to reveals something very different. The hype lumps all women with vaginal birth together instead of doing what the researchers did – dividing them into risk groups. When analysis of risk was done, they found that women at high risk for urinary and faecal incontinence have had large numbers of births; have had babies weighing over ten pounds at birth; and most importantly, have been the victims of unnecessary, aggressive obstetric interventions during their labour and birth.

What are these aggressive, invasive obstetric interventions that have been proven scientifically to cause permanent damage to the pelvic floor and urinary tract and also lead to more otherwise unnecessary caesarean section? One example is the use of powerful and dangerous drugs to start or accelerate labour, a practice that has doubled during the past 10 years. These drugs make labour abnormal with violent contractions that can damage the uterus and pelvic floor. The only reason women agree to such induction is because they are not told the truth about the drugs, for example that Pitocin (oxytocin), a drug used for decades to induce labour, doubles the chance the woman will have urinary incontinence in the future. By withholding such facts doctors seduce to induce.

Induction with drugs is not the only aggressive, invasive intervention that is frequently used in vaginal birth and is associated with damage to the urinary system, pelvic floor and rectal areas. Episiotomy has been scientifically shown to result in more pelvic floor damage than a natural tear. When an effort was made in the 1980s to reduce caesarean section in the United States, the rate of using forceps or vacuum extractor to pull the baby out went up—some doctors just can’t stop doing invasive interventions. And there is good data that using forceps or vacuum to pull the baby out has more risk of pelvic floor damage than any other form of birth.

Obstetricians have turned birth into a surgical procedure and done damage to women’s bodies and now suggest the solution is to promote yet even more radical and aggressive surgery; caesarean section. The solution is less unnecessary invasive surgical procedures during birth, not more.

[Re: the Midwifery Today E-News article, Issue 3:23]: The two obstetricians tried to say that vaginal birth can damage a woman, but they never pointed out the ways in which caesarean section can do harm not only to the woman but to the baby as well. The following excerpt from my article “Choosing Caesarean Section” in The Lancet of November 11, 2000, reviews some of the dangers associated with caesarean section, the alternative to vaginal birth that some doctors are trying to promote:

‘In addition to the increased risk the woman will die with an elective caesarean section, there are other risks for the woman including the usual morbidity associated with any major abdominal surgical procedure—anaesthesia accidents, damage to blood vessels, accidental extension of the uterine incision, damage to the urinary bladder and other abdominal organs.1 Some of these risks are common: 20% of women develop fever after caesarean section, most due to iatrogenic infections requiring diagnostic fever evaluation for both woman and baby.1

There are also risks women carry to subsequent pregnancies due to scarring of the uterus including decreased fertility, increased miscarriage, increased ectopic pregnancy, increased placenta abruptio, increased placenta previa.1,2, 3 Recently in the United States the widespread use of the unapproved drug misoprostol (Cytotec) for labour induction has created a new risk of caesarean section in subsequent pregnancies. Women attempting VBAC (Vaginal Birth After Ceasarean) who are given misoprostol have a rate of uterine rupture of 5.6% compared with a rupture rate of 0.2% for women attempting VBAC not given misoprostol, a 28-fold increase in risk of uterine rupture.4 For women choosing caesarean section, all of these risks exist in all of their subsequent pregnancies even if the original caesarean section was not an emergency. The increased risks of ectopic pregnancy, abruptio placenta, placenta previa and ruptured uterus are all life threatening to both woman and baby.

For whatever reasons women choose caesarean section, very few are clearly informed about foetal risks. In an emergency caesarean section where the baby has developed a problem during the labour, the risks to the baby of doing the caesarean section will likely be outweighed by the risks to the baby of not doing it. In an elective caesarean section where the baby is not in trouble, the risks to the baby from doing a caesarean section still exist, meaning the woman who chooses caesarean section puts her baby in unnecessary danger. That some women are choosing caesarean section strongly suggests women are not told these scientific facts.

The first danger to the baby during caesarean section is the 1.9% chance the surgeon’s knife will accidentally lacerate the foetus (6.0% when there is a non-vertex foetal position). (5) Obstetricians may be less aware of this risk — in one study only one of the 17 documented foetal lacerations was recorded by the obstetrician doing the surgery.5 A much more serious risk to babies born by caesarean section is respiratory distress. Many reports in the scientific literature document the caesarean section procedure per se is a potent risk factor for respiratory distress syndrome (RDS) in preterm infants and for other forms of respiratory distress in mature infants.1 RDS is a major cause of neonatal mortality. The risk of newborn RDS is greatly reduced if the woman is allowed to go into labour prior to the caesarean section. Another serious risk to the baby born by caesarean section is iatrogenic prematurity (the baby is premature because the caesarean section was performed too early). Even with repeated ultrasound scans, the standard deviation for estimating gestational age is large, creating errors in judging when to do an elective caesarean section. Doing the elective caesarean section after the woman goes into spontaneous labour would markedly reduce this risk as well. A vast literature documents the increased mortality and morbidity, including neurological disability, associated with premature birth.’

So beware. Surgeons try to sell surgery. Never forget that obstetricians are, after all, surgeons. Women must be extremely cautious in the face of this hard sell and get the facts from those who do not have a vested interest in surgery.


Thanks to Leila McCracken and www.birthlove.com

For more about Dr. Wagner.

1. Wagner M, 1994. Pursuing the Birth Machine: The Search for Appropriate Birth Technology, Sydney, Australia: ACE Graphics.
2. Enkin M, Keirse M, Renfrew M, Neilson J, 1995. A Guide to Effective Care in Pregnancy and Childbirth, 2nd ed, Oxford University Press.
3. Goer, H, 1999. The Thinking Woman’s Guide to a Better Birth. Putnam, New York: Penguin.
4. Plaut M, Schwartz M, Lubarsky S, 1999. “Uterine rupture associated with the use of misoprostol in the gravid patient with a previous caesarean section,” Am J Obstet Gyn 180:1535-42.
5. Smith J, Hernandez C, Wax J, 1997. “Fetal laceration injury at cesarean delivery,” Obstet & Gynecol 90:344-6.


First published in byronchild/Kindred, issue 1, March 02

Labor Induction and Prematurity

Induction rates in the US and elsewhere, including india, are steadily rising, causing concern to ACOG (the American College of Obstetricians and Gynecologists), among others. labor induction refers to the artificial initiation of labor, often by cervidil application to the cervix, administration of Pitocin (synthetic oxytocin) through an IV, and/or artificial rupture of membranes (AROM).

One of the many risks/disadvantages of labor induction is potential prematurity. Because due dates are not exact, a doctor who may think s/he is inducing at 36 or 37 weeks, might actually be inducing at 34 or 35 weeks.

This month’s Journal of Pediatrics published a study that found that babies born even slightly premature, at 34-36 weeks, are six times more likely to die in the first week of life than those born after 37 weeks (full term).

Every day in the last weeks of pregnancy is crucial for the development of the baby. During these days, the mother passes antibodies to the baby to fight infection, the baby gains weight and strength, his/her lungs mature, and his/her suck-and-swallow coordination continues to develop.

For more about why it is so important to let labor begin on its own, click here.