(The names of people and places have been changed for confidentiality purposes.)

Bella attended my childbirth class where I once volunteered at a center for unwed mothers. Her physician’s policy was to induce labor if the length of the pregnancy was one or more weeks past the due date. Bella’s attempt to persuade her OB to wait longer went unheeded and he stated that the pregnancy could end up as a stillbirth if she waited for a spontaneous labor to begin. She was at 41 weeks gestation. This statement alarmed her, and out of fear,  she consented to an induced labor.

Her doctor scheduled the inducement the following week. I told her that I could stay overnight if she wanted my support, but she said, her mother would be there and she would call me when she was in labor.

Cervidil (ripening agent) was administered into her cervix soon after she was admitted to the hospital. She was restless during the night and did not get much sleep. At 5:00 am the nurse started Pitocin.  Bella called me at 6:45 a.m. to let me know that she was in hard labor and to come. When I arrived at the hospital, Bella was lying on her side attached to the EFM and the IV for Pitocin.  I could tell that she was already feeling overwhelmed by the contractions and reminded her about relaxing and her pace breathing. She appeared completely exhausted and it was difficult to get her attention. I discovered that she had received  received the analgesic Nubain for pain,  and Phenergan for nausea. I played her favorite music and spoke to her parents. I invited them to be a part of comforting Bella during her labor. I reminded her to pace her breathing and relax with progressive massage. I told her how strong she was and how well she was doing. However, she was so drowsy, that it was a difficult challenge to keep her focused during contractions. Her contractions were now becoming more irregular with less intensity. I encouraged her to sit-up and to get into a better position for dilation and dissension. Upon examination she was at only 4 cm. but 100% effaced. She began to experience some back labor so I immediately began back massage and counter pressure techniques.
The nurse increased her Pitocin dosage to strengthen her contractions. Bella sat upright and was doing very well with the coaching. She at times mentioned again the back pain. She insisted on more analgesic for the labor. I wanted to get her into the position on her hands and knees, but her exhaustion and connection to the EFM and IV made this change too cumbersome.
She asked for an epidural. I reminded her of the risks, but she insisted. I asked if she would like to check the progress of her labor before the epidural. She agreed. She was at 6-7 centimeters. I let her know that she had made a lot of progress. She still wanted the epidural. After she received the epidural she seemed very happy and relaxed. She was sitting up and talking with us. Within 30 minutes of the epidural procedure the baby was in fetal distress. She immediately received oxygen until the baby was out of danger. Bella slept for an hour and the EFM indicated that labor had slowed down considerably. I encouraged her at that time again to sit up to help with the descent and dilation. She began having more intense contractions. Soon she had the urge to push.
When her OB came to check to see if she was ready to push she was completely dilated and at a +1 station. Bella was instructed to push with her legs supported. The baby continued to remain in the same station. We tried various pushing positions but there was no progress. When another nurse came to take over the shift, she examined Bella and discovered that the slow progress was due to dystocia with the baby’s head in the posterior position . This can happen with an Epidural affecting the baby’s ability to turn in the anterior position for delivery. The OB made the decision to deliver with the Vacuum Extractor. I encouraged Bella’s mother and step-dad to support her during the pushing, and I immediately got out of the way . Bella’s OB performed an episiotomy and after two attempts  pushing, her baby was born. Her mother cut the cord with the baby lying on Bella’s chest. Bella displayed confidence in the maternal role by giving directions concerning newborn procedures. I stayed long enough after the birth to assist with breastfeeding and then departed, allowing the family their privacy and time with the baby.

I learned from this birth that even with a number of medical interventions women can emerge  emotionally confident when they participate in the decision-making process during labor and birth. I also learned that supporting the family by encouraging them to participate in the birth can create a powerful emotional bond with each other and the newborn.

Unfortunately, it took a long while for Bella and her baby to recover from the second stage procedures of an episiotomy and vacuum extraction.   Her baby suffered lacerations to the head while she suffered lacerations to the perineum.  Bella also complained of a backache possibly due to the epidural.

Bella wanted a natural birth, but because of fear brought about from her doctor’s policy on inducement, she was subjected to almost every medical intervention in childbirth, less a C-Section.

Note: A woman’s due date is determined by different factors: duration of menstrual cycle, time of OB examination, etc.    At best, the due date is only an “estimate or guesstimate”.  Post- term pregnancies are considered after 42 weeks. There is a risk of premature birth when inducement occurs before 40 weeks. Spontaneous labor is safer than inducement in a healthy, normal pregnancy.  Induced labor has increased substantially along with an increase in premature births.  Too many inducements occur because of scheduling convenience and or women not willing to wait for spontaneous labor to begin. There are studies linking the use of Pitocin  in some cases, as a possible cause of Autism because it replaces the natural “love” hormone, oxytocin in spontaneous labor.

 Reference:
Is Pitocin Associated with Childhood Autism?

Medical Interventions in Childbirth