Saturday, February 25, 2012

Induction Without Pain Medications- Can It Be Done?

(Picture via http://www.globalrph.com/oxytocin_dilution.htm)
Inducing labor- in the natural birth community it has a well earned bad name.  I admit to feeling the same distaste for the common place attitude toward induction.  A study recently even found that induction more than doubled the chance of c-section, so one could say that the "bad reputation" that induction has is well earned.  Many women, like this one, came away from their induction with a very upsetting birth story and plans to NEVER be induced again. 

So why the post on epidural free inductions, especially from a sworn advocate for totally natural birth? 

Well, occasionally I run into women who have a very valid medical reason for induction and often they are shut down in their attempts for at a birth without any pain medication.  My first reaction is also "DON'T GET INDUCED!!!!" but frankly, that isn't always helpful, especially when the induction is needed for the safety of the baby.

Yes, I do personally believe that women are induced too often for non-medical purposes and that the procedure is far overdone.  But, when it is needed, a woman CAN still get induced and avoid an epidural.

Here are some thoughts (not medical advice- because of course, I am NOT a medical person!) and tips from other moms on how they approached induction and still had triumphant, often pain-med free, birth.  This is NOT a hopeless attempt and you are still capable of having a good birth.

~Begin with a positive attitude~

If you really do need an induction, don't throw in the towel on your epidural free birth before it even begins.  Women DO this.  You can too.  But you have no chance of accomplishing it without an epidural if you never try.   Plan for the best and do everything you can to get what you want. 

~Select your birth team carefully~

One big thing that separates a great birth from a negative experience is simply how a woman is treated in labor and postpartum.  Birth is a deeply emotional and impressionable time that mom will remember forever.  A birth staff (doctor, midwife, nurses) that are simply NICE can make a huge difference.  If they are also understanding of your desire for a natural birth and willing to help you, then you can have a very different experience than if the staff just thinks you are some stupid yahoo.  

~Think about a doula~

If an induction is needed a doula can be an invaluable tool.  They often are familiar with the hospital system and come equipped with comfort techniques and natural ways that may help speed your labor.  It can be really helpful to have someone on your side who can help you, guide you, and buoy you up, especially during a long induction.  This can be a great tool for dad too, as dads need breaks!

~Try to naturally prepare your body for labor~

There are things that women find helpful in getting labor started outside of the hospital.  (Note, I am not recommending any of these, just throwing ideas out there for consideration.)

-Sex with orgasm- This will help get your own natural oxytocin pumping and and the semen can serve as a natural cervical ripener.  You might even enjoy it.  And it is FREE!

-Staying active- Keep up with your upright and active lifestyle might help with positioning and uses gravity to get that baby down.

-Practice relaxation- relaxing in any labor takes practice for most women.  Practice daily, with your partner and by yourself.  Try relaxing in different situations (stressful, painful, before bed, at work, sitting, laying, walking, etc).  Learn to recognize your breath, control it, and release all non working muscles. 

-Various other things like Chiropractic, massage, and acupuncture are tried to start labor.  Many women swear by these methods.  

~Be aware of "natural induction" techniques~

There are tons of things out there that women try to induce their own labor.  Though not personally a fan just because you are "tired of being pregnant" for some they may be better than the alternative medical induction.

Some things that people try and recommend-
  
           - Black and blue cohosh- herbs that some feel help kick start labor.

-Evening Primrose oil- sometimes people insert it vaginally to soften the cervix, others take it orally or both.


-Red Raspberry leaf tea- said to be a uterine tonic that helps tone and strength then uterus. 

-Castor oil- though it sometimes causes vomiting and diarrhea, some claim it is very effective in starting labor outside of the hospital.


~Research various induction methods and decide which ones you think might be best for you~

There is more than one way to get induced medically.  Obviously you need to listen to your care provider, but here are some medical methods of induction so that you are aware of the many options out there.  This is not a comprehensive list.


-Sweeping the membranes- pros- does not involve medications- cons- can be uncomfortable.

-Cervadil- a cervical ripening agent, sometimes you can even go home and rest and see what happens.

-Foley bulb or catheter- inserted inside your body, it is filled with water and can apply pressure to help open the cervix without drugs.  Pros- no medication Cons-can be very uncomfortable.  The bulb will fall out around 4 centimeters dilation.  

-Cytotec- also considered a cervical ripener.  It is (last I knew) not approved for use in labor induction.  But it can start contractions.  One pro that I have heard from a few mothers is that they liked not being attached to an IV and the freedom of movement that that gave them.  Con's- some deaths reported and very intense contractions.

-Pitocin- probably your most widely know induction drug.  Usually given via an IV.  Pro- it can be adjusted and even turned off and sometimes a woman's body will begin to labor on it's own after just a little nudge from Pitocin.  Cons- some report difficult contractions, IV hook up can be uncomfortable and limit mobility, and is different than your bodies own naturally produced oxytocin.  You can read the full package insert here


~Avoid breaking water~

(Again, not telling you what to do!)  Breaking water is often a routine part of induction.  It does not involve medication, but you do need to know that once your water is broken, you are usually expected to deliver a baby within 24 hours.  If you don't want that restriction, you may want to avoid having your water broken, or wait until dilation is pretty far along.  (It is often done as early as four centimeters). 

 ~

I hope that all women can have a birth experience that is wonderful and healthy for all involved.  To end I wanted to share a few different induction birth stories that women have sent to me.  Their tips will be much more helpful than mine! 








19 comments:

Our Life With Two Boys said...

with my second kiddo, he "pulled the emergency cord" (aka: his short umbilical cord) too soon and we had a Grade II placental abruption... i thought it would mean an automatic cesarean birth, but was surprised that the OB allowed my midwives to continue care for a vaginal birth... i did have to be induced though (pitocin, artificial rupture of membranes)... i was on a relatively low dose of pitocin because i responded well (i like to think it was because my body and my baby knew we didn't have time to mess around), but that labour and those contractions were way more painful than my other two unmedicated births... i was confined to my bed for most of the labour... i distinctly remember one contraction that felt like my entire body was contracting and it didn't seem to stop, even after the contraction subsided... that was the only time my midwife suggested i take something for pain relief... i said i'd wait another few contractions and if they were the same, i would try something... within 2 contractions, i was pushing...

long story short: inductions can be done without anesthesia... but i totally understand how it becomes too painful to cope without pain relief...

Becky said...

I was basically induced with my second child. (My OB would argue that my labor was *augmented* though I hadn't actually begun labor yet. I had a slight trickle of amniotic fluid, and barely any contractions. It was not in my birth plan, but I was GBS positive and needed antibiotics, etc- I know now that there are alternatives, but the dr was pretty adamant it was necessary) anyway Pitocin was used. The thing that helped most was relaxation techniques that I learned from Natural Childbirth the Bradley Way. I would imagine actually taking a Bradley course might be even more helpful. I think I spent transition in the shower...most of that time was spent yelling (*ahem* I mean vocalizing, lol!) It was not pretty, but I did it without pain meds, and the induction went well, all things considered. I was past 39 weeks, with my 2nd child, and I really do think knowing how to relax (through most of labor, anyway) helped.

Becky said...

PS- Even though we had a positive outcome, in hindsight, I would've explored induction methods other than Pitocin. It really does make contractions basically unbearable, especially closer to transition.

Jen said...

I've had three medically necessary inductions for pre-eclampsia. With my first, I had an epidural that I believe was justified because I was so sick, the induction lasted 26 hours, and I really didn't have any other coping mechanisms open to me. My second induction involved an incompetent nurse who gave me narcotics without my knowledge or consent and then bullied me into a spinal after I was already pushing. My third induction (with twins!) was pain med free and awesome.

Amie said...

I've been induced (once a planned induction and once a strongly "augmented" induction) twice and didn't get an epidural, with the first one I had a shot of something to relax me though, both them I had my water broken as well - it wasn't fun but it is possible.

One should not discredit or ignore natural induction methods, EPO and ,with this last one especially, massage really got things going.

dissonance_n_desire said...

My second birth was an induction due to pre-eclampsia. It was very frustrating since we had planned on a low intervention birth center birth and had to change that to an induction in a hospital. Anyway, my midwife started the induction gently and used only Cytotec to get things going. Had that not worked, she would have then broken my water, and then, finally resorted to pitocin, starting at the lowest dose, and turning it off once labor was established. I didn't have any pain medications with this birth and I think a lot of that was because I didn't require pitocin.

I guess what I'm trying to say is that if you have to be induced, there are options other than pitocin to try, which may increase your ability to get through labor without a lot of other interventions.

Enjoy Birth said...

I have seen moms have natural birth while being induced. It is possible! However moms and birth partners need to be very informed and keep an eye on how often the nurses are turning up the pitocin! Slowly and then stop turning it up when a good pressure wave pattern is achieved. I actually have created a video about inductions. http://www.enjoybirth.com/kno-induction.html With other tips and general pros and cons.

Mama Knows Best said...

i was induced at 43 weeks epidural free. it was hell. but im proud to say 2 labors 2 babies 0 epidurals.

Meagzilla said...

I just had my first and only child this fall via unmedicated, natural induction. I guess I had no idea that it was such an anomaly?

I decided to get us a doula when I was about 32 weeks along. We found one we really clicked with, and she supplemented our care alongside my OB. Fast-forward and I was 13 days past my EDD and my baby's umbilical cord was calcifying (the placenta was still good though) and her heart rate kept dropping from 160 bpm to less than 80 bpm for more than 3 minutes at a time. At first, we thought it might just be because she was rolling over on her cord, but when it kept happening, we agreed that it was time to get her out. I had been having very light contractions for 4 days at that point, and using evening primrose oil, black and blue cohosh in a tincture, as well as cottonbark extract under my tongue. NONE of it worked. My cervix was ripe after perenial massage, but I was only at 2cm when we checked into the hospital.

I talked the nurse into a heplock instead of an IV so I could keep walking around. The birthing room came with a ball and shower stall that I used quite often. We started with a foley and saline. That got me to about 6cm, where I stalled for almost 7 hours, at which point my baby's heartrate was dropping regularly. I let them rupture my sac, and the "fun" really began! I walked as often as the pain would let me, and rolled on the ball, got on all fours, and after 13 hours and screaming loud enough they could hear me in Cleveland, my daughter was born with a mighty shove that nearly had her slide out of the catching doctor's hands! (I do remember telling them that if they started pitocin, I was going to need that epidural. I couldn't imagine any pain worse than what I was already enduring!)

Krista said...

Castor oil worked for me at the end of our options, but it was hard, fast, and hell on wheels (well, actually on the toilet and $@%#! birth stool) - probably because my body was super-prepared and despite days of on-and-off early labor, just hadn't tipped to full-blown labor before that. It sucked, and it really ruined the whole experience for me. If necessary, it can work, but WOW. I really don't recommend it.

Like the first commenter said, after that, I totally understand why some women choose meds.

Krista said...

Oh - that said, relaxation techniques I'd practiced did help, insofar as it was possible...

Keri said...

My second child was an induction. I was GBS positive, my water broke and 12 hours later my labor still had not begun. I found what got me through without any pain meds was exactly what the article states- a great labor team, my midwife, a great doula and my amazing husband who knew how important it was for me to have as much of a natural birth with the exception of the induction itself. Also the use of laboring positions and techniques. I found this birth to be extremely painful even though it was only 9 hours (my 3rd baby was a 27 hour home birth and he was posterior). Stay strong, remember it will end and your body was made to deliver your baby.

Meg said...

I just did this 2 weeks ago! I was scared, because I had only heard negative things about being induced, but I was able to go 100% pain med free (even afterward I didn't even take any pain meds). I thought it was totally do-able (they used pitocin). I had a doula and used hypnobabies and never even once considered needing an epidural. I asked to keep the pitocin low and see how I reacted, and they were very accomodating to that request. I only ended up with 8 units, which I believe is pretty low, and let my body take over the rest. I think that was the key for me. Keep it low, don't jump right into a big dose.

I had already tried sex, orgasm, epo orally and vaginally since 37wks, walking (I'd been walking 4 miles per day for my entire pregnancy), pineapple, nipple stimulation, raspberry leaf tea in mega doses. No dice. The Dr. scared me enough about my low fluid levels (5) to agree to the induction at 41 wks.

Alex said...

I really liked this post. I have been induced for IUGR 3 times (including my last birth which was a planned homebirth) and have been very proud of not using pain relieving drugs for any of my births (also had 1 birth non-induced yay!). I think it is all about your attitude and whether you really want to go for it without pain relief. The main thing is not to be using the induction as an excuse because if you do, in the midst of labour, it will be difficult to soldier on. Good luck to anyone being induced!

Bose said...

Very informative! have shared with FB! Induction Plan Template

Jenny said...

I was induced with my second using cervadil to ripen my cervix and then pitocin the next morning. I remember thinking to myself "contractions did not feel like this with my first". SO painful. Argh. (And that was compared to a posterior baby with back labor). I didn't have an epidural, but did end up with a narc. Could. not. deal. Once it wore off, I was at 9 cm and I just cried in pain. Totally understand why women get pain meds with pitocin!

Becky Galvez said...

Wad induced with my first but not my second and I think that the sexond birth was a lot worse for me. I did have to push at 8 cm with my second though because she decided to crown when I was only at 8cm! My water never broke with either and was done at the hospital. I didn't have drufs with either even being induced and I didn't take any iv drugs to calm me that they offered. It was rough when the contractions started but I was only in labor for 6 hrs start to finish so I think that is what made it possible with out the drugs. I don't think I would have been able to go mch longer.

timon hardy said...

Great article ...Thanks for your great information, the contents are quiet interesting. I will be waiting for your next post.

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billy said...

Being pregnant has been one of the most memorable experiences of your life. You were so happy to hear the news that you had a baby on the way and you have felt connected to the child growing inside of you for the past 9 months. However, you are nearing the end of your pregnancy and now you wish you weren’t pregnant anymore. You are feeling so much pain and discomfort that you just want the baby to get out of there. If you are a woman who is going through this, then you need some help.

ways to naturally induce labor

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