A gentle start to a hospital labor induction 2019, Boston

Below is the story and details of a successful labor induction using the medication Misoprostol (cytotech). First time Mom, 35.This story illustrates how it is possible to be induced slowly and allow labor to evolve over days with many breaks/rests for mom. Also. How a doula, nurse,  midwife, partner and OB each play a role.

Day One

Mom goes to hospital in the morning and receives a very small dose of cytotech inserted vaginally. First time mom, 42 weeks pregnant.  Midwife care

External fetal monitor is used for 1 hour to determine if baby is tolerating the medication well. After it is found that baby is fine, Mom goes for a walk with her support person for about 1-2 hours outside hospital.

Mom returns to hospital and has a vaginal exam. Cervix has softened and thinned a bit and is beginning a little opening. As this is a first birth Midwife suggests Mom goes home to resume normal activities and sleep at hoe.

Day Two

Mom returns to hospital in early for a second dose of cytotech as described above Exact same process of monitoring, walk and vaginal exam followed. Some slight change in cervix. Mom again goes home for the afternoon/night

Day Three

Mom returns to hospital for a third dose of cytotech. Baby tolerates this well and mom goes for another walk . Mom goes home to eat, rest and sleep. 

Day Four

Mom requests day off from the process. Midwife agrees as both Mom and baby are doing great. Midwife suggests a hike of a few miles nearby. Mom hikes and really feels this does help. She is getting some mild contractions.

Day Five

Mom returns to hospital for another dose of cytotech. Mom’s cervix is now beginning to change and shorten/open. Mom takes a long walk in the hospital and returns to Labor and Delivery in late afternoon. As Mom walks in the door of her L&D room her water breaks.

Mom labors normally (no pitocin given/needed). Nurse and support person help mom who is fairly comfortable walking, ball sitting, breathing.

Doula arrives around midnight. Mom is now in Active Labor. Mom goes in shower, then bath which helps a lot. Mom sits on ball for an hour or so, partner sleeps.

Mom decides on epidural after contractions intensify.  Mom sleeps and nurses turn her (she wakes for this) every 20-30 minutes and use Peanut Ball to keep pelvis open. Baby’s heart rate is on low side but not below normal. Consult with OB says ok to continue. 

Midwife checks Mom’s cervix in early AM. Mom is 9 cm dilated. Mom rests chats for another 1.5 hours in bed.

9:45 AM mom begins pushing stage. Mom at first is told by nurse to push on back with legs pulled up, holding her breath as she pushes . She finds this very uncomfortable.

Midwife suggests side pushing and Gentle Birth. No breath holding/counting is followed(gentle birth procedures). Mom pushes very well and baby is born at 10:45 AM. One tiny bit of pitocin is given to Mom at end of labor.  Baby is healthy. Doula reminds staff to follow Baby Friendly process of skin on skin for first hour (baby was taken away for weighing but brought back for this right away)

Top Tips for a Better Birth

Chances are you are hoping for the ‘best’ birth experience possible! While what defines ‘best’ varies these are 10 tips to greatly improve almost any birth experience.

1. Stay home in early labor. Remember first time births tend to be longer, so it could be a while. Also a majority of babies are born after their ‘due date’ the first time.

2. Rest or sleep as much as possible in the early hours. Don’t worry if it is not “perfect” or uninterrupted sleep. Rest between contractions when they start waking you up.

3. Keep the environment calm, quiet and peaceful. Close the door in hospital. Bring LED candles. Use the bath or shower a lot.

4. Eat whatever appeals to you in early labor. Have protein snacks ready. Try to minimize acidic foods. Chancs are you won’t feel like eating in active labor. Free access to food and drink in labor is Evidence based.

5. Drink frequently. No need to “over-hydrate”. Drink throughout labor. Support person prioritzes offering drink and refilling as needed. In addition to plain water try some energy mix ins like electrolytes, raspberry leaf tea, ginger tea etc.

6. Partner and support person/doula stay tuned in to what mom needs. Reassurance, massage, physical support and position ideas, run a bath, bring snacks and fluids, encouragement, advocacy, accept mom’s natural need for reassurance and confidence reminders.

7. Discuss and write down your Birth Preferences for your team. Have partner and doula remind you and advocate for you. Provide a copy to hospital, birth center or homebirth staff. Support person be sure each new nurse, MD or Midwife reads and understands Mom’s preferences. Discuss any questions or differences in proposed care.

8. Once contractions are harder continue to get upright and move hips around, lean forward, lean onto pillows/birth ball, kneel, squat or anything to help move the body and allow baby to navigate the pelvis.

9. Push in upright positions: kneeling, dangle, squatting with squat bar, lean over back of bed. Allow baby’s head to “ease” out in order to reduce tearing. Be sure team allows a “2 step birth process” where after head there is a brief few moments until body turns and follows head out.(reduces harm to mother and baby)

10. Ensure you are receiving Evidence based care. Ask you Key Questions about any tests or procedures suggested to minimize risks to mother and baby(handout in my birth class) Support person will have to do this when mom is in labor.

Oxytocin: The hormone of love, birth, breastfeeding, bonding and being human

Oxytocin is often known as the "hormone of love" because it is involved with lovemaking, fertility, contractions during labor and birth and the release of milk in breastfeeding. It helps us feel good, and it triggers nurturing feelings and behaviors.  It encourages bonding and connecting among parents and children and others as well.  Receptor cells, lining the uterus and elsewhere in your body, that allow your body to respond to oxytocin, increase gradually in pregnancy and then increase dramatically during labor. Oxytocin stimulates powerful contractions or muscle movements that help thin and open (dilate) the cervix, move the baby down and out of the birth canal, push out the placenta, and limit bleeding at the site of the placenta. During labor and birth, the pressure of the baby against your cervix, and then against tissues in the pelvic floor, stimulates oxytocin release and contractions. So does a breastfeeding newborn. Oxytocin flows through the new mom’s system and helps her to “fall in love” and feel bonded to her newborn. Each release of oxytocin has an accompanying release of endorphins in the brain which allow us to feel super relaxed, calm and dreamy or “far away” in labor. Endorphins are chemicals released by the brain that allow us to cope with stress and pain naturally. They allow us to tolerate the many powerful muscle contractions needed to open the cervix and birth your baby. This is one reason why many women experiencing labor have a huge “high” right after birth. 

Low levels of oxytocin during labor and birth can cause problems by:

• Causing contractions to stop or slow, and making labor take longer.

• Resulting in excessive bleeding at the placenta site after birth.

• Leading health care providers to respond to these problems with interventions.

You can promote your body's production of oxytocin during labor and birth by:

• Staying calm, comfortable and confident.

• Staying home and relaxed as long as possible (barring any Warning Signs or practitioner instructions for you)

• Avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures, bright lights, harsh words to birthing person, threats or other coercion.

• Staying upright and using gravity so your baby is pressed against your cervix and then, as the baby is born, against the tissues of your pelvic floor.

• Gentle touch, hugs, massage and positive interactions with a trusted support person

• Stimulating your nipples before birth, and giving your baby a chance to suckle (breastfeed) shortly after birth.

• Avoiding epidural analgesia or delaying it until labor is active (6 centimeters of dilation in the first time mother)