Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Don’t Let This Happen To You #24 PART 1 of 2: Jessica & Jason’s Back Door Induction April 13, 2009

Continuation of the “Injustice in Maternity Care” Series

 

Throughout my time as a labor and delivery nurse at a large urban hospital in the Northeast, I have mentally tallied up a list of patients and circumstances that make me go “WHAT!?!  Are you SERIOUS!?  Oh come ON!”  Because of this I was inspired to start the “Injustice in Maternity Care” blog series, or more appropriately the “Don’t Let This Happen to You” series.  If you are pregnant or planning on becoming pregnant, this series is dedicated to you!  If haven’t already read it, I invite you to check out the first addition to the countdown: DLTHTY #25: Sarah & John’s Unnecessary Induction

 

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There are so many things about the current state of maternity care in the United States that frustrate, infuriate, sadden, and annoy me but one particular thing that really gets my goat is the back door induction.  As you might have already read, I am a labor & delivery nurse in a large urban hospital and we are BUSY!  Although I know there are hospitals that way more deliveries a year than we do, for the capacity of our hospital, 4500 deliveries a year is almost more than we can handle with our current facility and staffing.  (By the way, 4500 deliveries a year breaks down to about 375 deliveries a month and about 12 deliveries a DAY!  (Jeeze, I am exhausted just looking at the statistics!) 

 

One way to help organize all the chaos is to have an induction book in which doctors have to schedule all of their inductions at least 24 hours in advance.  This way we have somewhat of an idea about appropriate staffing and room assignment for our patients for each day (in theory).  (The exception to this rule is the induction in which there is a documented medical reason related to either mom or baby’s health that requires an urgent delivery of the baby.  For example, severe intrauterine growth restriction (IUGR) with a non-reassuring nonstress test (NST) and biophysical profile (BPP) or worsening preeclampsia.  We obviously don’t make these mom’s sign up for a spot.  They are usually a direct admit from the office to the hospital.) 

 

However, when a doctor is either lazy, anxious, rushed, or overall feels he is above the rules, he (or she) will send a patient in from the office as a direct admit to the hospital for labor when she actually is NOT in labor and will the proceed to INDUCE her under the guise of augmentation.  When providers do this, it increases the amount and acuity of our patient census and puts an unnecessary strain on our staffing which compromises the amount of individualized care we can give to our patients.  What these doctors don’t tell you is that inductions can take up to three days to complete!  If you are truly in spontaneous natural labor, even a slow labor, you won’t be in the hospital for 3 days.  Inductions take MORE time, MORE money, MORE staff, MORE resources and hence are MORE risky.  Let’s digress for a moment so that I may clarify the difference between induction and augmentation:

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Labor: Regular, noticeable, and painful contractions of the uterus that result in dilation (opening) and effacement (thinning) of the cervix.  Therefore if you are having regular uterine contractions that are noticeable or even painful but are not making any change to your cervix, it is NOT labor.  Likewise if your cervix is dilated and effaced but you are NOT having uterine contractions that are noticeable and painful then you are NOT in labor.  (Note: I have had low intervention doctors and midwives send multips (a woman who has given birth at least once) home at 4 or 5 cm if they are not having any contractions or not changing their cervix.  One particular patient I can remember was a G5P4 and was 5cm dilated when she came to the hospital.  We kept her for 4 hours but she never changed her cervix…she couldn’t even feel her irregular contractions and she was comfortable.  So she was sent home.  Two weeks later she came back 8cm dilated in hard labor and I assisted with her very quick birth.  She did amazing and the baby was happy and healthy!  Clearly, even at 5cm, she wasn’t in labor.)

 

Induction: the use of medications or other methods to start (induce) labor before the woman’s body has spontaneously begun true labor on its own.

 

Augmentation: stimulating the uterus with medications or other methods during labor that has already begun naturally to increase the frequency, duration and strength of contractions, the goal of which is to establish a pattern where there are three to five contractions in 10 minutes, each lasting more than 40 seconds. 

 

So just to be clear (and to adequately set up my story) if a woman is 4cm dilated but is not having regular, noticeable, and painful contractions that are causing cervical change she is NOT in labor.  If said woman is sent into the hospital and any interventions to stimulate contractions are started, then it is by definition considered an induction NOT an augmentation.  And if said patient was not scheduled to be admitted on such day, then it is considered a backdoor induction.   

 

Let’s continue with the story…

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It was a Friday morning before my weekend off and I came in to work at 11am as usual.  I was looking forward to the weekend since it had been a really busy week and I was exhausted.  For the first four hours of my shift, I triaged a few patients but ended up sending them all home for one reason or another.  As I was finishing up some paperwork at the desk around 1:00pm, Dr. T came off the elevator and over to the nurses station.  I overheard him telling the charge nurse that he was just at his office and was sending over a primip (a woman who has never given birth) for us to admit for labor who was 4cm dilated/50% effaced/-3 station by his exam in the office.  He then slinked towards one of our second year residents who, in my opinion, will definitely be joining the ranks of the aggressive labor management elite, and uttered, “I’m sending over a patient from the office, 4cm.  Could you break her water when she gets here and start her on pit.  I know you’re the only one who will do it.  The baby is still high.”

 

Situations like this one are exactly the reason why I shouldn’t eavesdrop!  The reason why Dr. T was concerned that “no one else” would break her water was that when a baby is at a minus 3 station and is “too high,” if the membranes are ruptured artificially the umbilical cord could slip down before the baby’s head, getting pinched between the baby’s head and the cervix, cutting off all blood flow from the placenta to the baby.  This is called a cord prolapse and it is a surgical emergency requiring an emergency cesarean section.  This emergency is very unlikely if your water breaks naturally at term during labor because typically when it happens naturally the baby’s head is well applied to the cervix which puts pressure on the bag causing it to break.  I wanted to turn around and shout at Dr. T, “If you are so concerned “no one else” will take the chance, why won’t you do it yourself?!  Is it really so wise if it is so unsafe?”  Furthermore, the thought of sending over a patient for “labor” and then immediately starting her on pitocin and breaking her water makes my head feel like its going to explode!  If she is really in labor then she does NOT NEED pitocin!  And if she “needs” pitocin, then she is NOT in labor!  This is a BACK DOOR INDUCTION and ladies, it happens all the time.  Think about it, it was a Friday and Dr. T happened to be on call that weekend.  Looks like he didn’t want to get a page over Sunday brunch that one of his patients was in labor!  AHHHHHHHHHHHHHHHHH! 

 

Sorry, I lost it there for a minute J.  But it is just these kinds of injustices that make my blood boil!  Let’s continue…

 

Come change of shift at 3pm I was patient-less since I had sent all my triages home and hence was assigned to the patient in room 9.  And guess whose patient it was!  None other than Dr. T’s “labor” patient!  Oh brother!  This was going to be an interesting night! 

 

From report I got most of the details:  Jessica was a 25 year old first time mom (G2P0) just a few days past her “due” date (40 weeks and 3 days).  Here health history was unexceptional: exercise induced asthma as a child that did not require any medications, tonsillectomy at age 7, and one miscarriage at 5 weeks two years ago.  Her pregnancy was normal, healthy, and uncomplicated.  The patient had arrived to the hospital at 1:30pm with her longtime boyfriend Jason.  Jessica’s day shift nurse had completely admitted her and started her on pitocin but because the floor was crazy busy all day, she had only gotten the pitocin up to 4mu/min and the residents had only gotten the chance to write orders and not to rupture her membranes.  (My thought = Yes!!)  [Note: For a description of how pitocin is administered check out: Don’t Let This Happen To You #25 PART 2: Sarah & John’s Unnecessary Induction].

 

Next I went into the room to meet Jessica and Jason.  Jessica was a bubbly young woman with big rosy cheeks.  Her boyfriend Jason was living proof that you can’t judge a book by its cover.  He was super funny and down to earth and very supportive of Jessica in every way, yet a bit intimidating at first because he was almost completely covered in tattoos and had multiple facial piercings J.  They looked like total opposites and yet were so perfect for each other.  We chit-chatted for awhile and really seemed to hit it off since we all had the same sense of humor.  I took the opportunity to satisfy my curiosity about how Jessica had ended up in the hospital since she seemed very comfortable the whole time we were talking.  The monitor strip revealed that she was having contractions about every 6-8 minutes but she was not even flinching as I saw them come and go on the monitor.  To gain a bit more information I started to ask some questions.  I kept the conversation light in tone, like “So tell me about your day today?” instead of “Why the heck are you here!  Run!  Run away!!”  J  Here’s our conversation:

 

Me: “So how did you end up at the office today?  Did you have a scheduled appointment or were you having contractions?

 

Jessica: “No I was feeling great!  I had a scheduled appointment and when they put me on the monitor for a non-stress test, the nurses told me that I was having contractions!  It was so crazy because I didn’t even know I was having them!  So then Dr. T decided to check me since I was contracting and I was 4 centimeters!”

 

Me: “Can you feel any of your contractions now?”

 

Jessica:  “I think so, well, am I having one now?  Wait, no, maybe now?  (Looks towards monitor) Yeah, I am having one now.

 

At this point I’m thinking: If you have to look at the monitor then the answer is no, no you are not feeling contractions!  Sometimes I turn the monitor screen off so the patients or family members can’t “contraction watch.”  J

 

Me: “So what happened next?  Did Dr. T tell you to come right over or did he say you could go home first?”

 

Jessica:  “He said we could go home first and get our stuff together but not to “dilly dally” because they were waiting for us here.  So we rushed home and grabbed our bags.  Good thing we packed last week!”

 

Me:  “Yeah, it’s great you were prepared.  What did Dr. T tell you the plan was for when you got here?”

 

Jessica: “He said that once we got here that he would break my water but they haven’t done that yet.  I guess it’s really busy today, huh?”

 

Me:  “Yeah, It’s a busy day.  Did he say anything about starting you on pitocin?”

 

Jessica:  “He mentioned that I might ‘need a little pitocin’ because my contractions weren’t in a regular pattern and were pretty far apart.”

 

Me:  “I bet it was a big surprise to you to be induced today, huh!”  (I couldn’t help myself!)

 

Jessica:  (confused)  “Well I didn’t expect to find out I was in labor today  that’s for sure!”

 

Me: “Do you guys have a written birth plan or any thing I should know about regarding your labor and birth preferences?”

 

Jessica:  “No nothing written.  Well, I wanted to try to go as natural as possible.  I don’t want any narcotics and I don’t think I want an epidural.  I mean, I’m not ruling it out, but I really want to go as naturally as possible……………I mean, I guess that’s not totally going to happen now because I am on pitocin but, well, you know…”

 

(Yes!  The “in” I’ve been waiting for! Sometimes I wish I could tape patients and then play back what they say to me to see if once they hear it back, they then realize how illogical their doctor is.  I mean sometimes I feel like a mom who has to sneak spinach into her kids’ favorite foods to trick them into eating vegetables.  I can never just come out and say my intentions, I have to play this “game” and hope they figure it out themselves.  This is something of a daily internal struggle for me.)

 

Me:  “Well that is not necessarily true because although we are limited by the fact that with the pitocin running I have to have you on the monitors, as long as I can trace the baby’s heartbeat I can help you into any position that makes you most comfortable.  Unfortunately pitocin is not a good as the “real” thing you know? What I mean is it makes contractions artificially stronger and longer than natural contractions.  But I will do my best to titrate the pitocin so that we get an effective labor pattern that both you and the baby can tolerate well.  We can all work as a team, sound good? J

 

Jessica & Jason: “Yeah sounds good!”

 

I’m sure, my savvy reader, you have already recognized why I started this post with the difference between induction and augmentation!!  The TRUTH is: If you are at term and someone has to “tell” you that you are “in labor” then you are NOT in labor!  I just feel so badly for these women!  I truly don’t think it is their fault!  I think that they put all their trust in their birth attendant and most of the time are just naïve and don’t know any better.  And I don’t say that to be patronizing, I say it out of love and concern.  And as I mentioned in the first post of this series, I don’t want to start off my first interaction with these patients by going off on a tangent about unnecessary induction because I don’t want to make them defensive, doubtful, untrusting, or upset because these emotions do not facilitate labor!

 

*Sigh* 

 

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Up For Next Time: Don’t Let This Happen To You #24: PART 2 of 2 

 

Read about Jessica’s labor, the birth of her baby, and Dr. T’s upsetting prediction about her birth too early in the game.

 

 

(Research for this post was aided by my trusty OB textbook from nursing school:  Maternal-Child Nursing (Second Edition) by Emily McKinney, Susan James, & Sharon Murray Ó2005)

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30 Responses to “Don’t Let This Happen To You #24 PART 1 of 2: Jessica & Jason’s Back Door Induction”

  1. Jen Says:

    I just found your blog a few days ago. I’m so glad I did! It’s so interesting seeing things from your point of view. I’m trying for a VABC this August. I’ve been trying to educate myself as much as possible, but I’m getting discouraged in the system at the same time. I read Ina May’s Guide to Childbirth. I loved it as it really opened my eyes. But now I get so infuriated at how hard women have to fight to give birth the way their bodies were designed to.

    I just wanted to let you know how much I enjoy your blog! You rock!

  2. atyourcervix Says:

    You’ve got to be freaking kidding me. You sound like you work in the same hospital as I do – with the same BS the docs try and pull. I also work in a large teaching hospital that does 4500 births per year. Our inductions and “augmentations” are out of this world astronomical! Epidural rates – through the roof! VBAC? Forget it. C/S after C/S after C/S for “failed inductions”.

    • nursingbirth Says:

      atyourcervix, seems like doctors are pulling bullshit all over the country! Hahaha! I wish the pregnant community knew what we know! But hey, I guess that is why we blog!! 🙂

  3. Joy Says:

    At Your Cervix mentioned your blog on hers and HAD to come over! I cannot wait to read more. I’m not a nurse. Actually I’m pregnant with our third baby. This is so helpful to read all of this! When I was in labor with my other two girls I was doing just fine on my own but they put Pitocin on anyway.

    First daughter, I only had a few drops before I was complete and pushing so they stopped the drip. Second daughter they MAD ME empty the bag even though it was only on for about 5-10 minutes. Doctors are just IMPATIENT in my opinion. I’d only been at the hospital for a few hours and was dilating beautifully on my own.

  4. Lioness Says:

    Blimey, I just found your blog, thought I’d just take a look and have bee reading for ages, I think I love you! I haven’t any children but I have a miscarriage story from the depths of hell, and how I wish I’d had someone like you advocating for me, it would have spared me a lot of unnecessary suffering in hospital. So – THANK YOU.

    • nursingbirth Says:

      Lioness, I think you’re right…it’s love!! 🙂 I am sorry to hear that you had such a terrible experience and I too wish I could have been your nurse!! Thank you for reading!

  5. […] is going to be doing a series of “Don’t Let This Happen to You”, and here is the first part of the next in the […]

  6. Ugh. I’d have wanted to SMACK that doc. I think you must have the patience of a saint.

  7. Christie Says:

    I am an RN in mother/baby and we can see on our monitor the women they bring in as inductions and almost all of the ones under 38 weeks end up as a c/s. I would love to know the statistics on “failed inductions” that lead to a c/s and sometimes a stressed baby. I myself am one that falls into that category and I was not a nurse then. I was induced at 37 weeks and my mebranes artificially ruptured at 0700 and ended up with an emergency c/s at 2323 that night b/c of fetal destress. I like you think there is a big problem with convience inductions. If women knew the truth about it, they would probably wait it out if possible.

    • nursingbirth Says:

      Christie, I feel your pain!! I am so sorry you ended up with an emergency c/s. My heart goes out to you because I can imagine how scary it must have been for you and must be for families in that situation. Thanks for the support!! There is a BIG problem with “convience” inductions and if RNs like you and me band together maybe we can make a difference! (or at least I hope 🙂

  8. Tina Says:

    “I just feel so badly for these women! I truly don’t think it is their fault! I think that they put all their trust in their birth attendant and most of the time are just naïve and don’t know any better. ”

    First let me start by saying I’m not a birth professional, or even in the medical field. I am, however, 38 weeks 4 days pregnant with #3(and been having contractions for the past month. Getting stronger and more frequent but nothing to write home about).

    I can understand what you’re saying about feeling bad for some of the women that come in but, the part about it not being their fault? I don’t know. They have 9 months to prepare. They couldn’t have picked up a book that was slightly more informative that “What to Expect…”? This is possibly the biggest thing that will be happening in their lives, up to that point, and they can’t educate themselves even a little? I have a hard time feeling bad for a women, or any patient, who is willing to blindly follow anything that so affects their body. Now I’ve certainly talked to women who had educated themselves and were still more than happy to go in for the scheduled induction or c-section but they at least made an educated decision. It’s the women who blindly follow doctors orders, with the “little ol’ me” attitude that really get to me. At least be an active partner in your medical care. Sitting by fanning yourself while the doctor calls all the shots, sometimes resulting in the exact opposite of what you want…well..I just don’t get it. Be an active participant in your health care, not a spectator. If someone’s not willing to do that much, I’m not willing to give them very much sympathy.

    • nursingbirth Says:

      Tina, First off congrats on your pregnancy and THREE CHEERS to you for being an informed “consumer”! I wish you a very empowering birth! I have to say that I agree with you. I often dream of a world where all pregnant women read all the right books (anything by Ina May Gaskin, Pam England, Penny Simkin, Marsden Wagner, Michel Odent, Henci Goer to name a few!), went to child birth preparation classes (not just a “tour” of the hospital), felt as passionately about natural birth as I do, had the confidence and amunition to stick up to their health care providers for what they want, and didn’t blindly follow anyone with an “MD” after their name. I DREAM about this world!! But unfortunately we live in a society that teaches women to fear birth and the women that are having babies today are the children and grandchildren of a generation that were passive consumers of health care and doctor’s advice. We live in a society that doesn’t know how to support women before, during, and after childbirth. That says “All that matters is a healthy baby” to women who have undergone a tramatic birth experience or “Don’t worry, you can have another baby” to women who have lost a child. Half of me feels the way you do but the other half still feels bad for women who are dupped, lied to, mislead, and let down by the broken system. Thanks for your comment! I hope you keep reading and I am so happy you are empowered to take charge of your own care and experience!!!

  9. originsdoula Says:

    Now I am very curious how many parents bring doulas into the hospital with them where you are. How do the OBs view them?

  10. Kateisfun Says:

    I love your blog, thank you so much for writing! I am studying to become a doula, and hope to also become a childbirth educator one of these days. I am realizing more and more that if women had some information BEFORE their births, they would be so much more empowered to stand up for themselves and their babies. It is also encouraging to have a medical professional such as yourself working in such a way that bridges the gap between “us” (homebirthing-hippie-midwife types) and “them” (the-“evil”-professionals-at-large), as that is really what it will take to change maternity care as it is known. Keep writing, and DEFINITELY keep using your position to influence all the births you can!

    • nursingbirth Says:

      Kateisfun, I am so pumped you are studying to become a doula!! We need more doulas! I like to think of myself as a “bridge” to haha!!

  11. Tina Says:

    “That says “All that matters is a healthy baby” to women who have undergone a tramatic birth experience”

    OMG, I wish I could count the number of times I’ve heard that about my first birth (twins born at 28 weeks). I had wanted natural, unmedicated birth but, because of positioning, that wasn’t possible (frank breech and a footling breech, trying to make the big escape at the same time). But, the birth itself couldn’t have been any “worse”. It was as medical as possible, including general anesthesia because of an OB who would only give the anesthesiologist 2 chances to get the epi in before getting impatient. As a result, hubby couldn’t be in the room, I didn’t get to see my babies until 12 hours alter and I don’t remember when I did get in to see them (don’t rememebr the first 2 or 3 days). A healthy baby, and mom, may certainly be the ultimate goal but it’s not “all” that matters, as I know you know.

    “Half of me feels the way you do but the other half still feels bad for women who are dupped, lied to, mislead, and let down by the broken system.”

    Ok, yeah, part of me does feel sympathy for these women. As I said, if someone chooses a scheduled induction or c-section, whie I don’t understand it, I support that right as long as they made an educated decision. But, like you, part of me gets frustrated when I hear (or read online) a woman say “I wanted ABC but the doctor made me do XYZ”. I dont’ think women “get’ that they ahve the right to say “NO”. It’s like, once they enter the hospital they HAVE to do what the doctor says “or else”. Or else what? The doctor isn’t going to hold you down and make you do something. I can see how an outspoken, bold woman would speak up but I can also see how it would be easy for a less forceful women to be railroaded into something she doesn’t want because they doctor says she “has to” or keeps putting pressure on the women even after she says “No”. So, I can totally understand your view, and agree, that it’s frustrating and I do’nt haveany sympathy while, at the same time, I can feel bad for women who just don’t know anything different.

    “But unfortunately we live in a society that teaches women to fear birth”

    That is SO true. Anytime a women mentions she’s pregnant it’s like every women within earshot feels the need to tell every birth horror story they’ve ever heard. You never hear a women tell another woman an empowering story, or even a not terrifying story. Now, whenever a friend tells me she is pregnant, I have been recommending “Ina May’s Guide to Childbirth”. It’s such a positive book and I feel it lets women understand that borth is something we’re made to do and, in most cases, we can do it. I also recently finished “Thinking Womans Guide…” and loved it as well. Made me wonder how many enemies Henci has among the OB world.

    Anyway, i’m rambling. As you can tell it’s a subject I do feel passionate about, even when I’m not pregnant. If I ever manage to get all my kids raised, in school and I go back to work, I really hope to be a Doula one day. In fact, most of the reading was done in preparation for the Doula program before we knew we’d be having #3 and I’d need the info for myself. I’ve loved what I’ve read of your blog so far and I’m sure I”ll be around for a while (and I rarely post marathon comments LOL)

    • nursingbirth Says:

      Tina, thank you so much for your comment! I am so sorry to hear about your traumatic birth experience and I hope you one day do become a doula so that you may help other women!

    • Tina, you said:
      “The doctor isn’t going to hold you down and make you do something. ”

      I just wanted to let you know that during my second birth (VBAC), the nurses DID physically hold me down to force me to push in the position THEY wanted. I wanted so badly to change positions, and every time I pushed I could feel my son start to come out — then slide right back in. After a while of that I was told I “needed” a repeat c-section. Thankfully those two horrible nurses left to get something to eat (for themselves, God forbid *I* should get to eat) and prepare my surgery, and I gave birth while they were gone.

      At other times (I have given birth five times, plus I was hospitalized early in my third pregnancy for DVT), I have been threatened, berated, condescended to, told my baby would die, I would die, I would leave my other children motherless. I’ve had hospital administrators come to my room to try to threaten me to make me comply — one threatened that if I didn’t follow doctor’s orders then my insurance would not pay for my hospital visit and the whole cost would fall on me, another threatened to call hospital security and forcibly take my child from me if I didn’t allow them to take him to the nursery. I had one OB (my first OB during my first pregnancy) abruptly drop me as a patient at SEVEN MONTHS because I wouldn’t bow to his sudden requests to change hospitals so he wouldn’t have to drive in traffic. At seven months I was forced to desperately scramble for a new doctor — and many I spoke to refused to take me simply BECAUSE I was so far along!

      I have tried to stand up for myself. I have Social Anxiety Disorder, which makes it very hard, but sometimes I have succeeded anyway. Most of the doctors I have encountered make it an absolute FIGHT. Being educated about birth is not always enough when doctors, nurses, and hospitals are willing to make your life miserable as a punishment for not being a “good patient.” And, if like me, a woman doesn’t realize that she can’t trust the doctors until she’s already been screwed with an unnecessary c-section (foolish! I thought my first OB was a fluke and surely the new one could be trusted!), that makes the fight all the harder.

      And frankly, while women DO need to educate themselves about birth, most THINK they are. It’s not fair to blame women for not knowing that they aren’t reading the *right* pregnancy and childbirth books. It’s not fair to blame women for believing that the doctors who went to medical school and have a state license are not telling them bald-faced lies. It’s not fair to blame first-time mothers, who are already probably terrified about this enormous new responsibility to care for an entire brand-new life, for not having the confidence to go against friends, family, doctors, and everyone who tells them that their baby could die. Instead the onus needs to be on the writers, doctors, and advice-givers who keep feeding women all this crap.

  12. […] make a birth more of a challenge.  Ask LOTS of questions.  Or, the variation on this, the “back door induction“…allow yourself to be convinced that you are in labor and in need of […]

  13. enjoybirth Says:

    I just attended a birth like this as a doula. I am writing it up to put on my blog. I didn’t know what to call it. But Back Door Induction is perfect. I told mom what was up before she went in. She called the OB to say no… but OB insisted she was in active birthing time and didn’t know it. Ugghh. I will post the link to my story when it is done.

    I will be teaching my Hypnobabies Students about Back Door Inductions when I cover Inductions in class from now on!

  14. Christine Says:

    I just found your blog today and I love it! I am really fascinated by childbirth, and am thinking about going to nursing school. I have two teenagers, and my pregnancies and birth experiences were both good. The reason for my comment is that I recently attended my friend’s birth. She had an uneventful pregnancy, and her midwife was talking induction at her 39 week appointment. My friend wanted to do this naturally, so she put off the induction discussion for one week. If she did not go into labor on her own by 40 weeks, 5 days, she was scheduled to be induced. She had the Cervidil all night, then pit the next day. He membranes ruptured on their own about 4 hours after the pit was started. She was laboring very well on her own with her husband and I supporting her, but of course she was tied to the bed from the pit and IV fluids she was receiving, not to mention the continuous monitoring, so all of her ideas about moving around were out the window. About 4 hours following the rupture of her membranes, she was feeling alot of pressure, and was found to be 7 cm. At this point she agreed to IV narcotics, and proceeded to sleep for the next four hours. I mean, she was totally out of it. She ended up with a c-section for failure to progress (she stayed stuck at 7 cm for hours). The baby was perfectly positioned, had a great heartrate throughout the whole labor…I just think she was not ready to go into labor yet, and would have had a beautiful birth had she been allowed to go on her own. I am still coming to terms with how her labor and birth was handled…it was very disappointing and amazing to me that MIDWIVES would push for induction with a healthy baby and mama…there was no reason. Anyway, I love your blog, and I agree with all of your points of view! Keep writing!!! Christine in Atlanta

  15. Just wanted to write to say how much I like your blog! I just discovered it while reading the Unnecesarean blog. I have linked to it several times from my blog because I want people to read it! Keep up the amazing work!!!!!

  16. sarah Says:

    The one thing I would add is that if you do Hypnobabies the contractions may not hurt (I had a 42 hour labor and I didn’t have contractions that hurt) BUT, you cannot, cannot, talk through them and you certainly don’t need someone to tell you that they are happening. That was how I knew real contractions I would have to squat down and couldn’t talk when I got them. Towards the end I did moan through them, but no competent talking.

  17. […] pitocin if things didn’t progress.  (From a L&D nurses blog, this is what she calls a Back Door Induction.  I am going to add this to my information when I teach about Inductions in my Hypnobabies […]

  18. Andrea Says:

    I haven’t read all the replies but just saw your blog today and am thoroughly enjoying it, but hating what doctors do. When I read your comment about young mothers simply being naive and not knowing I don’t think it is an insult at all. My SIL and I have said many times that you make your decisions with the information you have and I think many first timers (and second and third timers) don’t have nearly enough information because doctors simply don’t tell you. I was 19 when I had my first and was very unknowing and consented to an unnecessary section. With my Second birth (14 months after the first) I still didn’t have much information but a little more. And still with my 3rd I had a lot more information but when you’re in that vulnerable state, going on little-no sleep and they pull the ‘dead baby card’ or some other card on you, it’s hard to let your voice be heard. I wish I would have had someone there indirectly pointing me at what I had originally wanted. If I have another I will be seeing another doctor as I realize now that my OB never once cared about me or my babies- just his own schedule and what was convenient for him. And I will be taking someone with me to my appointments in those last weeks to help me make my voice heard. Thanks for sharing your thoughts/experiences.

    • nursingbirth Says:

      Andrea, Thank you for sharing her own experience and insight into how it is to be a young mom without a lot of knowledge of the “system”. I am so happy to hear that you have learned from your experiences! You deserve a birth attendant who cares about you and your baby!

  19. […] some great advice in her “Don’t Let This Happen to You” series when describing how one couple dealt with an induction.   Nursing Birth accurately describes the birthing climate in many of today’s hospitals and […]

  20. I got a little sidetracked with my other comment (response to Tina), but I think this is part of what happened with my first baby. I was young (20), and very inexperienced. I’d read a lot of books (and I kicked myself later, because the first book I read AFTER the birth, which I’d either just started before the birth, or it was on my to-read list, actually talked about the dangers of Pitocin and warned against it), but I had never actually known anyone who had a baby. (Well, obviously I mean that no one I knew had had a baby while I knew them.) I was already raising my two then-toddler-aged step-children, and my more-experienced husband wanted me to go to a birthing center and have a midwife, but I was terrified and just wanted that whole “safe, professional” hospital birth with my first baby. I figured I could do a midwife birth after I had some experience and knew what was going on. (Sigh.)

    Anyway, I was 41 weeks along, and that night was the third or fourth time I went to the hospital thinking I might be in labor. I was thrilled when they told me this was it — but then they told me I wasn’t progressing fast enough and needed to be “augmented” with Pitocin. This was while I was still checking in! I just didn’t know any better (wish I’d been farther into that book!!), so I said ok. Looking back, I think they figured that I was 41 weeks and they might as well induce me while I was there.

    I wasn’t planning to have pain medication, but those unnaturally strong contractions did me in. All I knew about pain meds was that I should avoid an epidural, so when they offered Demoral instead, I said ok. Demoral made me hallucinate, and while I was hallucinating they “convinced” me to have an epidural. Then they gave me so much that I could not feel anything below the waist at all, and could not push. My OB yelled at me, telling me to push. I kept saying I was trying, and he kept saying, “No, you’re not! Push!” Ultimately he sectioned me for “CPD.” Utter BS.


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