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Hi everyone,<br><br>
I am a first time mom due in early August. I am having a hospital birth in NY state - a home birth was not an option for us (we rent a tiny apartment) so with no other choices but a hospital birth, we ended up choosing a a midwife-based practice that is known to be the most "non-interventionist" in town. The overseeing doctor has a great reputation and we've been very happy with the practice so far - they have been very in line with all of the pro-natural approaches that we've become familiar with and apparently have made huge inroads at the hospital they deliver at. We will also be birthing with the support of a doula; this practice came highly recommended by her organization.<br><br>
That said, I had my 34 week appointment this morning and the subject of birth plans came up with the midwife I saw. I would like to avoid any medication if at all possible and she was very supportive of that. In addition, she made it clear that they don't do routine episiotomies, encourage us to labor in water, eat and drink, walk around, deliver in any position, not get hooked up to an IV, etc. All good. BUT, here are the things that worry me:<br><br>
1. She did say that she often encourages the use of stadol in the active phase of labor.<br>
2. She believes in the active management of labor in the third stage, and will insert a small dose of something (it was either cytotec or cyrotec, I think) in the rectum to help the uterus contract and prevent bleeding.<br>
3. They will "won't let me 10 days past my due date."<br><br>
As for #1, I have been able to find plenty of info on stadol and will discuss its possible use with my doula when writing up my birth plan in the next few weeks. But any opinions on that would be welcome - she said that it does not come with risks of respiratory problems. I could not find anything that said that about stadol specifically.<br><br>
As for #2, I am quite concerned. I have not been able to find much information in the natural birthing literature about active management in the third phase. If anyone out there has experience with this, links, and/or an opinion to share, I'd be grateful.<br><br>
As for inducing after 10 days - I am very aware of the cons of induction under any circumstances and am frankly shocked that this type of practice would have that policy. I plan on asking them more about it and pushing for a rationale, but has anyone out there come across this with midwife practices? Is this normal?<br><br>
Sorry for the long post, but I could not piece together adequate answers to these questions by searching past threads. Thanks!!! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/redface.gif" style="border:0px solid;" title="Embarrassment">
 

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Just the mention of Cytotec makes me want to urge you to run far, far away from this midwife and the entire practice. That drug should never, EVER be used on pregnant women! Please Google it and see for yourself.<br><br>
The fact that they even consider using that, and call it "routine," really makes me question everything else you said they claim to be okay with. A lot of times, CPs will say "oh sure, we'll let you do X and Y and Z, no problem" just to blow smoke up a pregnant woman's ass, and then when she shows up in labor, it's a whole 'nother story. It happened to me, I'd hate to see it happen to you.<br><br>
It's not too late to switch care providers and even have a homebirth if you want. I live in a small apartment too and am having one in August. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink"><br><br>
EDIT: I'm assuming you are seeing CNMs, who usually operate hand in hand with OBs and hospitals. I am not trying to slam CNMs in any way, but yes, to answer your last question, these types of things do sound normal for that kind of midwife. I am birthing with a CPM but am seeing CNMs for prenatals, and really, it's like night and day as far as what they believe and/or are required to do.
 

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I'm in Syracuse too. Is it Elaine?<br><br>
You should join the Syracuse Birth Circle group on groups.yahoo.com and ask specifically about this provider. That group of ladies pretty much has a dossier on every provider in a 2 hour range of here.
 

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I am seeing a CNM and feel that there are alot of medical things that I have to refuse with her. Also, there is alot of hosp "policy" that i have to refuse. And that's exactly what I do, refuse, no matter if it's routine or not. I make it known, several times, that I am refusing and in no way is it to be used. Then i quiz DH about what they have said, when they want to do something and what he is suppose to say.
 

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I know nothing about the rest of it, but was given stadol with my first birth (twenty week gestation baby) and it was horrible. Essentially it did nothing to relive the terrible (tailbone) contraction pain I was feeling and it essentially knocked me unconscious...so I would wake up what felt like every minute (my husband says it was actually about 10 minutes between contractions but that time did not exist for me) and scream and writhe in pain, and then pass out again as the contraction passed. I couldn't even stay conscious long enough to speak to my husband and doctor but I remember every moment of the pain. The doctor was profusely aplogetic, she was a young resident, and while she had heard this could happen with stadol she had never seen it before and said that she'd never encourage a mom to take it again. For most people it just "takes the edge off" or can make you not mind so much that you are hurting, but it can dull or in some cases wipe out consciousness. It was my own taste of what "twilight sleep" births might have been like. Sorry, I don't mean to scare you, but I would feel remiss if I didn't mention that this can happen.
 

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<div>Originally Posted by <strong>angelinuta</strong> <a href="/community/forum/post/11536322"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">1. She did say that she often encourages the use of stadol in the active phase of labor.</div>
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I would encourage you to speak further with your CNM about this. Tell her you want a <span style="text-decoration:underline;">totally</span> natural birth and ask her to please support that by not offering you any stadol or other medical pain relief. Just put it that simply.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>angelinuta</strong> <a href="/community/forum/post/11536322"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">2. She believes in the active management of labor in the third stage, and will insert a small dose of something (it was either cytotec or cyrotec, I think) in the rectum to help the uterus contract and prevent bleeding.</div>
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This is, unfortunately, fairly common. A lot of docs and midwives feel that a dose of cytotec or a shot of pitocin will help the uterus clamp down and prevent hemorrhage. While this is true, in almost all cases it is utterly unnecessary. As long as the placenta detaches on its own and is not pulled out, there is very little chance of postpartum hemorrhage. This is particularly true if you nurse your baby soon after birth, as the oxytocin released during nursing helps the uterus clamp down naturally. You can refuse the cytotec, and I think you should: there have been many reports of adverse reactions to this drug. Tell your midwife that you respect her opinion but you would like to allow the third stage to proceed naturally, with a shot of pitocin on standby just in case you start to hemorrhage.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>angelinuta</strong> <a href="/community/forum/post/11536322"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">3. They will "won't let me 10 days past my due date."</div>
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This is also VERY common, again for no good reason. Talk to your midwife about this in further detail. What happens if you refuse an induction? Will they drop you from care? Will you be transferred to the OB? If you go to 42 weeks and decide you need to be induced, how will they go about it? Cytotec? Pitocin?<br><br>
There's usually wiggle room with these sorts of policies. Talking it through in detail will enable you to make the best choice- whether that means switching practices or sticking with the one you have now. HTH!
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">I know nothing about the rest of it, but was given stadol with my first birth (twenty week gestation baby) and it was horrible. Essentially it did nothing to relive the terrible (tailbone) contraction pain I was feeling and it essentially knocked me unconscious...so I would wake up what felt like every minute (my husband says it was actually about 10 minutes between contractions but that time did not exist for me) and scream and writhe in pain, and then pass out again as the contraction passed. I couldn't even stay conscious long enough to speak to my husband and doctor but I remember every moment of the pain. The doctor was profusely aplogetic, she was a young resident, and while she had heard this could happen with stadol she had never seen it before and said that she'd never encourage a mom to take it again. For most people it just "takes the edge off" or can make you not mind so much that you are hurting, but it can dull or in some cases wipe out consciousness. It was my own taste of what "twilight sleep" births might have been like. Sorry, I don't mean to scare you, but I would feel remiss if I didn't mention that this can happen.</td>
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She must have been a pretty new resident. I can think of at least two moms in my new mom's group, when I had DS1, that this happened to. The stadol did nothing for their pain, just made them unable to complain about it. One said she felt like she was having an endless anxiety attack/nightmare.
 

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Even tho it is a common practice to use drugs with an off label use, cytotec is very dangerous and even says on its label that it should not be used on pregnant women or women in labor, yet this ulcer medication is getting lots of use on women in this country. It can cause you to lose your uterus. If that is a risk you want to take, go ahead. I do not advise it.
 

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The fact that those things are being touted as "routine" are pretty scary to me. Stadol? Cytotec? 10 day limit? Those are pretty interventionist policies. And not things that I'd want to be having to fight off while in labor. (Though many places do have a 14 day limit protocol for induction, which is kinda sucky but midwives can lose their medical backup.)<br><br>
Are there a lot of midwives in this practice? Did you get one really intervening one, or one really honest one? Can you discuss these things with some other practitioners in the group? (Provided you don't just up and switch, of course.)<br><br><br>
No need to hate on CNMs though -- the crunchiest, hands-off-iest, mellowest midwives I know are CNMs. I'd rather make the distinction of midwife versus "medwife" -- because the letters after the name don't necessarily tell you anything about the standards of practice.
 

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I know you mentioned that homebirth wasn't an option (but you seem like you want that) and I was curious if it's because you rent or because the apartment is tiny?
 

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I'm not a fan of Cytotec for induction at all, however, this woman's midwife uses it POSTPARTUM (caps for emphasis, not yelling). Meaning she uses it a part of Active Management of the Third Stage, post delivery.<br><br>
Cytotec doesn't carry the risks that it does during pregnancy, when used postpartum. The most frequent problem seen with it when used postpartum is a not so plesant case of the runs. It's VERY effective at stopping postpartum hemorrhage and I know of homebirth midwives who carry and use it for only that purpose.<br><br>
To the OP, research here's a start: <a href="http://www.cochrane.org/reviews/en/ab000007.html" target="_blank">http://www.cochrane.org/reviews/en/ab000007.html</a><br>
Google. Active Management of Third Stage for more resources.
 

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her suggested use of cytotec is for prevention of postpartum hemorrhage and delivery of the placenta- this use of cytotec does not carry the same risks as using it on a pregnant uterus<br>
ask for her references on the use of cytotec -- from what I can find the studies are all over the place- most common is that the results are the same between using pit/methergen combo compared to cytotec (orally or rectally) some show the benefit of one over the other- probably the answer is that there is no way to perfectly prevent or treat every hemorrhage<br>
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I can't comment too much on stadol as we don't use pain meds at home- I have had a mom or 2 that has transferred for sleep/pain relief and agumentation and have received 1 shot- the comment at the time was usually 1 shot will work but a second shot doesn't offer much---- another choice for theraputic sleep in labor is ambien it has a short half life and is not narcotic , drugs are not our first choice but are on a continium of what might be used in labor given a certain set of curcumstances- knowing what you might want to do in a particular curcumstance may help<br>
--------------------------<br><br>
not going past 10 days over your due date probably has more to do with hospital/medical policies and may not be a prefered protocol-- you can either find out ahead of time they will still take care of you if you refuse or if they automatically transfer you to their back up doc--- another thing is you can wait and fight that battle when and if it arrives
 

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I'm not sure if you know much about cytotec, but i'd definitely let her know in advance that you do NOT want that. I recomend reading either Ina May's Guide to Childbirth, or Pushed. Both have some good info on cytotec. It's not a good thing. You haven't been able to find much about it in your natural childbirth readings, probably because active management is NOT natural childbirth. Would you be opposed to finding a different midwife? It would suck to have to argue with someone about things like that while your in labor.
 

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We had our homebirth in a rent house. We had plenty of room, only used the bedroom and bathroom.<br>
Are there other reasons it's not an option? I would be worried about a practice who didn't mention these sorts of policies until the "eleventh hour". Makes me wonder what else they're not telling you.
 

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<div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>barefootpoetry</strong> <a href="/community/forum/post/11536351"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Just the mention of Cytotec makes me want to urge you to run far, far away from this midwife and the entire practice. That drug should never, EVER be used on pregnant women! Please Google it and see for yourself.<br></div>
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I think it's great to question everything. But, when they are talking about the active management of third stage with Cytotec, it's not technically on a pregnant woman. It's using Cytotec in the immediate postpartum woman.<br><br>
There have been some studies that show that active management of the third stage helps prevent postpartum hemorrhage, and that it is beneficial to the mom. Now, a certain person might not agree. And, of course, it's your body, and that is what should be respected. But, it's not as if these midwives are just making stuff up. There is some evidence out there that says active management of the third stage is better.<br><br>
Here's just one of those articles. <a href="http://www.emedicine.com/med/TOPIC3569.HTM" target="_blank">http://www.emedicine.com/med/TOPIC3569.HTM</a>
 

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I would call this practice highly interventionist. I agree with all the PP about running ANY TIME someone uses the words "we routinely....". You are an individual- not a routine.<br><br>
Any kind of opiate drug is going to effect both you and baby-- whatever relaxes you also relaxes your uterus which makes it less efficient and prolonging labor. Stadol will also make it harder for you to work with your body. Stadol will also effect your baby-- going into their blood stream (crossing into the brain due to no blood brain barrier on babies)- and take a LOT longer to metabolize out due to immature liver. It may cause "non reassuring fetal heart tones" which will lead to other interventions including possible c-section. It may cause baby to have a harder time nursing initially. We spend our whole pregnancies being told to avoid drug use (there have been moves to jail mothers who use opiate drugs like heroin or caine drugs like cocaine in pregnancy) but once we're in labor-- they want us to disregard this and use them like mad. It makes NO sense!<br><br>
Cytotec postpartum does not carry the same risks as when use for induction BUT use of something routinely to prevent the possibility of something that may not happen (PPH) and is unlikely to happen with a normal- non-interventive birth with mama bringing baby to breast after the birth- is ridiculous and akin to chopping off your breasts NOW to prevent any possibility of breast cancer.<br><br>
Treat a condition not a possibility.<br><br>
If you are forced to stay with this practice-- I really recommend hiring a doula who can help to protect your rights. I would also get the practice to agree to not actively managing 3rd stage labor (any pulling or tugging will increase your risks of PPH). You do have the right to say NO to any procedure you do not want BUT keep in mind that you will not be an exception to their rule. They will most likely find a way to force this upon you in some way.<br>
______________<br><span>Labor and Delivery<br>
There have been rare reports of infant respiratory distress/apnea following the administration of STADOL Injection during labor. The reports of respiratory distress/apnea have been associated with administration of a dose within 2 hours of delivery, use of multiple doses, use with additional analgesic or sedative drugs, or use in preterm pregnancies (see OVERDOSAGE: Treatment).<br><br>
In a study of 119 patients, the administration of 1 mg of IV STADOL Injection during labor was associated with transient (10–90 minutes) sinusoidal fetal heart rate patterns, but was not associated with adverse neonatal outcomes. In the presence of an abnormal fetal heart rate pattern, STADOL Injection should be used with caution.<br><br>
STADOL NS is not recommended during labor or delivery because there is no clinical experience with its use in this setting.<br>
(-<a href="http://www.rxlist.com/cgi/generic/butor_wcp.htm" target="_blank">http://www.rxlist.com/cgi/generic/butor_wcp.htm</a>)</span><br>
______________
 

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Encourages Stadol? That just seems...weird.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Cytotec doesn't carry the risks that it does during pregnancy, when used postpartum. The most frequent problem seen with it when used postpartum is a not so plesant case of the runs. It's VERY effective at stopping postpartum hemorrhage and I know of homebirth midwives who carry and use it for only that purpose.</td>
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I agree with this and have seen it used for postpartum hemmorage (but not routinely).
 
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