Healthy Birth Blog Carnival: Let Labor Begin On Its Own

Last month, I announced the first in a series of Healthy Birth Blog Carnivals and asked for submissions from bloggers about “letting labor begin on its own”.

How labor begins sets the stage for everything that follows, and with only a few exceptions, letting labor start on its own is the safest and healthiest choice for both mothers and babies.

Unfortunately, according to the Listening to Mothers II Survey, about 1 in 3 women who gave birth in 2005 were induced and 16% had planned cesareans before labor began, for a total of half of babies being born before they were ready (not including those pathologically born early as a result of preterm labor). More troubling still, although the vast majority of respondents said that women should be told every possible complication before giving consent for an induction or cesarean surgery, most women couldn’t answer basic questions about complications related to these procedures, whether they had experienced them or not. In fact, women who were induced were actually more likely to answer questions about induction complications incorrectly.

Today, women have access to more information than ever before, thanks in large part to the bloggers who so willingly share their personal stories, expertise, and wisdom. I want to thank all of those who submitted to this Blog Carnival. I couldn’t have asked for a better collection of posts about how labor begins.

Our next Healthy Birth Blog Carnival will be on Healthy Birth Practice #2, Walk, Move Around, and Change Positions in Labor. Instructions for submissions coming soon!

Without further ado, here’s what our fantastic community of bloggers has to say about Letting Labor Begin On Its Own…

Debby Amis at The Family Way gives us a sneak preview of new research showing that Lamaze classes that covered the risks of labor induction resulted in significantly fewer women choosing to be electively induced.   Debby also reminds us that the Lamaze Healthy Birth Practice Papers can help hospitals comply with the new Joint Commission core quality measures, including the standard of avoiding all elective deliveries before 39 weeks.

Amie Newman over at RH Reality Check demonstrates the complexities of figuring out when induction is beneficial and how it can be done safely, using the medical evidence and women’s own stories.

A trio of posts critique the recent ACOG Practice Bulletin on Induction of Labor. Nicole at It’s Your Birth Right points out the bulletin’s doublespeak about elective induction – acknowledging the serious risks of elective induction but failing to advise against the practice.  Henci Goer here at Science & Sensibility separates fact from fiction when it comes to ACOG’s recommendations on the use of Cytotec (misoprostol) for cervical ripening and induction of labor. And I point out that the Practice Bulletin fails to provide any guidance for assessing and promoting labor progress in induced labors, leaving providers and women with no information to know when cesarean surgery is indicated or how to prevent it.

Molly Remer of Talk Birth answers the question, “How do I know I’m really in Labor?” and points out that one of the best indicators that “this is really it” is when the woman stops asking herself “is this really it?”  The Labor and Birth nurse at At Your Cervix shares some tips for coping with prodromal labor (contractions at the end of pregnancy that do not lead to progressive cervical dilation).

Desirre Andrews at Preparing for Birth catalogues a dizzying array of reasons for induction providers tell women and women tell themselves, none of which are supported by research. The only thing missing from this list was offered up on the the blog, My OB Said What?!? : If we don’t induce, you’ll “stay pregnant forever!” (Cue scary music.)

All kidding aside (but still managing to serve up a healthy dose of laughs), Jill at The Unnecesarean answers interview questions from Karen Angstadt at Intentional Birth in a magnificent piece about informed consent and refusal on Expectations Radio

Mom’s Tinfoil Hat investigates the evidence that rather than decreasing the risk of shoulder dystocia, induction of labor may actually increase the risk when a baby is large. She debunks the commonly held belief that mechanics alone are responsible for shoulder dystocia and suggests that labor interventions can also contribute.

Student midwife, Sarah Jean, explores the “knowing-doing gap” as it relates to elective induction, pointing out that even midwives find it difficult to support women in the final, uncomfortable, emotional days of pregnancy and can themselves feel the allure of induction despite their better judgment.

Speaking of those last days of pregnancy, Carol Van Der Woude shares a story of her daughter’s birth, in which the “family holding pattern” at the end of pregnancy, though a time of emotional vulnerability, offers a necessary time for reflection, rest, and support.  Meanwhile, Jen at Untrained Housewife shares how she felt when her fourth baby decided to stay in a full two weeks longer than any of her previous babies, and some of the natural techniques she used to egg on labor.

Angela England at Untrained Housewife has three kids (and a fourth on the way!) and three completely different, but completely normal stories about how labor startedJen at A Mother’s Voice reminds us that when the first contraction comes, we can never know for sure what kind of adventures and lessons the labor will hold.

In her VBAC Scare Tactics series, Birthing Beautiful Ideas shows why requiring a VBAC mom to give birth before her due date (or any cut off date) or else consent to a repeat cesarean is a red flag for a provider who does not support VBAC, and an invitation to keep looking.  In a similar vein, Lori Swain at Choices in Childbirth describes the determination and preparation women need to have a VBAC in a system that does not support it, again reinforcing the importance of finding the right provider.

Sometimes labor begins on its own too soon. Anne at The March of Dimes blog, News Moms Need, shares her story in three parts (1, 2, 3) of giving birth at 36 weeks, a reminder that intermittent back pain in late pregnancy can be a sign of preterm labor.

To date, the most effective strategy for preventing preterm birth is to reorganize prenatal care into a group model known as CenteringPregnancy. Community Health Center Radio interviewed the founder and Executive Director of The Centering Healthcare Institute, Sharon Schindler Rising about the remarkable outcomes of this innovative model (The CenteringPregnancy segment begins at 5:40.)

On the other side of the coin, women of size are more likely to carry their babies beyond 42 weeks, one among many contributors to the epidemic of induction in this population. The Well Rounded Mama shares some straight talk on the risks of induction, and provides a very thorough take on how these issues impact women of size.

Another population experiencing high rates of induction and cesarean are older mothers. Desirre Andrews asks, “Does the uterus suddenly become a hostile environment once a woman turns 35?” She shows that studies point to small increased risks in older women, but they don’t support electively delivering all of these babies early.

And last but not least, Ashley Motzenbecker at Days of a Doula looks at the evidence to sort out when induction for low amniotic fluid levels (oligohydramnios) is a good idea, and when it isn’t.

That’s all, folks! If you have a post you think belongs in this list, please feel free to link to it in the comments.

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  1. | #1

    What a great round-up of posts!

  2. | #2

    Thanks Amy for the link! Sad to say, but you could probably sort most of the comments on the My OB said WHAT?!? site into the Six Healthy Care Practices and see how the medical model often runs against what we know is best for mother, baby and birth. Enjoy your evidenced based articles and sources! a great resource for expectant families and birth professionals alike.

  3. | #3

    Thank you for the link, Amy!

    I didn’t submit it because it’s a guest post but the post linked below and the comments on it are really interesting, like this one from a 3rd shift L&D nurse…

    As a night shift RN, I have to say one of the upsides to 3rd shift is that induction and augmentation of labors in the middle of the night when the physican would rather be sleeping is much less prevalent. We are lucky and privileged to attend many more spontaneous and unmedicated labors because we do not have doctors pressuring us to “actively manage” labors in the dead of night. When I start to get weary of graveyards, I think of how much less enjoyable my job would be if I worked days and had countless inductions to manage in an arbitrary timeframe so that someone who gets paid a lot more than me can get home in time for supper.


  4. | #4

    Here is a post on inductions I wrote a couple weeks ago :)


  5. | #5

    Agreed with the others. There is great emotional cost in performing unnecessary medical


  6. | #6

    Great discussion! It is important to remember that beyond the financial costs and increased iatrogenic risk, there is an emotional cost in carrying out unnecessary tests.

    The medicine of the future must learn to combine “high tech – high touch.” Armando Ribeiro das Neves Neto. Sao Paulo / SP, Brazil.

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