prostaglandin vs pitocin

[abigailvr]

Hi All,

I'm just curious what some of you mamas would do in my situation. I'm at 41 weeks today. I've been planning a birthing center birth, completely freestanding from a hospital, staffed by an OB and two midwives. I've been seeing the OB the last couple of weeks (I have varied throughout my pregnancy who I see for my prenatals.)

Today, since I am 1 week postdue, he had me go to a hospital for a nonstress test. Everything was fine with the baby, and everything has been fine with me for the whole pregnancy. He isn't going to considering inducing me with pitocin until 42 weeks, but he said that I could go back to the hospital today and get prostaglandin gel, or I can get it on Monday when I go for my next nonstress test.

Here's the meat of my question ("Finally!" I hear you cry): given the fact that once I hit 42 weeks the OB will want to induce with pitocin, and I won't be able to deliver in the birthing center, if you were me, would you take the prostaglandin gel on Monday? Would you have taken it today?

I've been trying other methods to get things moving: evening primrose oil (orally and vaginally), sex, nipple stimulation, spicy meals, and I'm planning to call an acupunturist that works on pregnant women tomorrow. So far I'm about 40% effaced, and have been for several weeks, and not dilated at all. Some of my friends with kids say that doesn't mean much, and once labor starts things will move along, but I'm feeling quite anxious. I don't want to be induced with pitocin, and I really don't want to have to go to the hospital. I'm just wondering if the risks of the prostaglandin gel are worth the extra chance of getting to be in the birthing center.

I'm really hoping that this is a moot question and that I will start labor spontaneously within the next few days.

[organic-cupcake]

I hope you are in labor now, and so have no time to read this.

If not, I'll share that I had my water break without contractions and used blue cohosh ( which I think led to a lot of barfing, but who knows) and then, accupunture to get the chi moving down, which was the thing that really created strong, regular contractions in a good pattern.

As a nurse, I've seen pitocin, and I personally, not scientifically,think it makes painful contractions. I don't have a lot of experience with the gel, but at least it is a localized medication. I say go for more of the natural semen prostaglandins... and then try whatever you can to get your midwife birth, because you have a better chance of fewer interventions, even if it is jumpstarted a little.

Good Luck!

[kama'aina mama]

The pivitol question for me is this: If you let them start with the prostaglandin gel, how EXACTLY will that impact your labor options (movement, monitoring, etc) and if it doesn't work will they cheerfully send you home or pressure you to stick around and start in on the pitocin at that point? It sounds like either induction is at the hospital. Am I misunderstanding? It sounds like if you say yes to any induction you say yes to hospital, but that if you say no (at least for now) you still have a shot at the birth center if you go during the next week. (Again, please correct me if I am misunderstanding you.)

Also, it seems to me that you always have a final say in what happens to you. If you hit 42 weeks and their 'threat' is hospital and pitocin (your two least favorite things) you don't have to comply. They can refuse to treat you at the birth center but they can't force you to come in for induction if you don't want to.

So, my long winded answer comes to this:
41 weeks, prostaglandin, birth center and I can leave if it's not working... I'll give that some good consideration. Might do it.
42 weeks, I've already kissed off the birth center and I'm not keeping a date for pitocin that I don't want.

[abigailvr]

organic-cupcake, I'm trying to find an acupunturist without a waiting list that can squeeze me in today. Hopefully that will work for me too! I'd like to avoid drugs at all, that's for sure.

kama'aina mama, the implication from my OB was that I could have the prostaglandin and go home, because he said I could have had it when I was there on Thursday, "and then again on Monday." For a medical doctor, my OB is fairly noninterventionist, but I know that isn't always saying much. I would definitely say no to the gel on Monday if it means that I have to stay in the hospital and move up to the stronger interventions.

Thanks for your input, both of you!

[gauge14iv]

The gel is a much gentler way to go - going straight to pitocin is pretty rough!

[mammamouse]

I'd find out EXACTLY what kind of gel they are using. I remember reading in The Thinking Woman's Guide to a Better Birth by Henci Goer that some gels are "safer" than others. Sperm has prostaglandens in it, too. Sex sex sex!

[abigailvr]

gauge14iv, that's what I was thinking!

mammamouse, someone on another message board sent me this link: http://www.naturalchildbirth.org/nat...entions06.htm, which says that the gel my OB was talking about is not FDA approved for induction. I think if I go ahead with the gel, I'm going to ask him to use cervidil, since Thinking Woman's Guide.. says that one is removable, if it causes hyperstimulation, which is the danger.

I just keep hoping the baby will decide that it wanted to come this weekend. *knocks on wood*

[mammamouse]

Yeah those pesky off lable drugs! They sneak 'em in everywhere! Good luck with yuor birth. baby has to come out SOMETIME! Right?

[abigailvr]

This is my new mantra: I can't be pregnant forever. (repeat as needed)

[organic-cupcake]

I'll have to check out this fabulous "Thinking Woman's Guide" sounds like it has practical advice. I've gotten to see two 41+ week babies this week and they were both incredibly aware and ready for interaction. So maybe the baby is just making last minute preparations!

While you're consulting with the accupuncturist, maybe you can get them to show you some analgesic pressure points, I remember at one point demanding someone make an emergency call to them, probably during transition. The baby arrived before they did!

Today is a good day to have a baby, hoping that's where you are.

[Britishmum]

I've bumped a very similar thread with lots of good advice on it for you - title is Fearing induction - 1 week late

Hope it helps!

[abigailvr]

The full title is The Thinking Woman's Guide to a Better Birth by Henci Goer. It's a great book! I think it should be required reading for any woman who is pregnant, so they can know what the risks really are of all the procedures the OB will suggest.

My husband's parents arrived for a 2 week visit from overseas last night. Someone suggested to me today that maybe the baby waiting for them, because maybe he needs them to be here when the baby is born. I hadn't thought of that.

We'll see!

[abigailvr]

Thanks Britishmum, I've read that one, and am doing a bunch of the home remedies suggested there as well!

[mamabutterfly]

sending you warm thoughts

abigailvr, I have no advice but want to give my encouragement and say I'm thinking of you and your body prepares to give birth and your arms prepare to hold your little one!

After my water broke the midwives were willing to wait three days and then talk about induction (checking me & the babe each day). At day 2 they gave me the castor oil option and I was very pleased that the spicy food started to work just before it would've been time for my dose! Anyway, I know it was a little sad to me to face the thought of moving from birth center to hospital, but I was glad I was able to really wrap my mind around accepting and being at peace with whatever happened.

It sounds like you are in a very good space about all of this, and I know you will do what you need to do! (I agree with others from my reading and experience of friends that the gel sounds preferable to the pitocin, doesn't rush things as much). We'll be thinking of you this weekend -- let us know what happens!

mamabutterfly

[gauge14iv]

Cervidil is the stuff - it gives your body time to get the cervix ready BEFORE launching you into labor - pitocin does not - and stay away from Cytotec!!!!

[abigailvr]

mamabutterfly, thanks for your encouragement and good thoughts. I hope that this weekend will be it too. It would definitely be nicer if the baby decides to come on its own.

Michelle, I definitely plan to stay away from Cytotec. I've read too much scary information about it to be willing to risk it! I am glad to hear a vote of confidence for cervidil.

[Lmommy]

So disappointed to hear another woman struggling under pressure to perform when her body knows better. The reason you haven't given birth yet (if you still haven't) is that your baby and your body are not ready. Who knows better? The force that grew your child miraculously and invisibly within your womb from a sperm and egg cell? Or a doctor who can only see from external measurements that your body is not within the average of patients he sees (and tampers with)?

You don't have to choose between these two evils presented to you, you can allow your body to birth as it knows best, WHEN it knows best!!! Some may balk and think "it's too late to take back such control of my birth options at 42 weeks" but I did it once and others can too. You can stop seeing an obstetrician who obviously doesn't have your best interests at heart, and you can give birth safely at home, away from the birth manipulators and monitors. I know few would probably make that choice so late, but it *is* a valid option.

Sometimes all it takes is for someone to give the option a voice, and suddenly your spirit knows that it is the right thing to do. Whatever happens, I wish you the best! Laurie

[cottonwood]

I've always wondered about this sort of situation where the midwife/doctor says that birth center is not an option after 42 weeks. What would happen if you just showed up on their doorstep with contractions a few minutes apart -- would they actually take the risk of transferring you to the hospital at that point just to cover their asses? Nuts.

Anyway... like Laurie says, the reason your baby hasn't come is because s/he isn't ready. Obviously your nonstress test concurs with that. You've read Henci Goer -- you know what she says about due dates and about the risks of inductions -- for your doctor to force induction at 42 weeks just because it's 42 weeks is really (IMO) poor management of birth. I know that's not the sort of input you were asking for, but say it *only* in the event that you are actually already thinking along those lines and need some support.

[abigailvr]

Sweetwater and Laurie, I agree with you. This is going to sound like even worse reasoning, but there are other pressures on me to have this baby soon. My in-laws arrived on the 27th and leave on the 11th from Holland (we live in California). I would love to just wait another week (at least), but then they might not get to see the baby, and I'd feel incredibly guilty.

It's a dumb reason to agree to induction, I know, that's why I'm really hoping that all my other attempts at more natural encouragements (nipple stimulation, sex, hot packs on my chest, evening primrose oil, and I'm going for acupunture on tuesday) do the trick and I don't have to make the tough decision.

I am leaning farther and farther away from agreeing to the Prostin. I've heard some not so fun things about it recently. I will see what my nonstress test on Monday shows, but the baby shows no sign of slowing down its movements, so I think it's just not ready to come yet.

[Lmommy]

Glad to hear you're still going strong! I just want to interject that I understand how there can be seemingly unsurmountable pressures to fit birth into the world's time table, but it would be a much greater shame if your in laws were unable to see the baby at all because it was injured by being forced to be born early and ended up requiring a stay in intensive care for a while.

There will be stories, probably photographs and maybe even video of your baby's first hours but certainly other times for them to see and give a truly loving welcome this glorious little one you carry safely inside you now. If your relatives' feelings are worth caring about, they will want the best for your baby and not a too hasty meeting that causes you both stress and harm.

The time table of birth is not arbitrary. Babies need their own exact time in the womb to grow and be ready for life outside. Induction is never without consequence (though sometimes the consequences may be subtle) and neither is the stress of trying to conform a birth to fit a rigid mold. Wishing you many blessings, safety and strength. Laurie