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IS THE PIT BULL Powered By Docstoc
					                                         IS THE PIT BULL?
                                  By: Jeanne Ohm, D.C., F.I.C.P.A.
                             Originally Printed in: I.C.P.A. Newsletter January/February 2000

In one day's time I received two calls asking about the relationship between the administration of
pitocin and neurologically compromised infants at birth and my intuitive antennas went off. Pitocin
is a synthetic version of oxytocin the naturally produced hormone in the laboring woman. It is
preferably administered through IV. As with all drugs, it does not come without its side effects, the
most common being increased blood pressure in both the mother and child. Even the American
Academy of Pediatrics agrees that no drug has been tested as safe for the baby in utero.

Pitocin is used for either labor induction or labor enhancement (what an inappropriate use of that
term!) The use of pitocin does not, however, duplicate the natural progression of labor. Pit
induced labors have longer, harder and more painful uterine contractions. Additional reported risks
of induction are:

For the mother: higher rate of complicated labors and deliveries, greater need for analgesics and
anesthetics, postpartum hemorrhage and a higher rate of placental rupture and separation life-
threatening to both the mother and baby.

For the baby: induction causes fetal distress, a higher rate of jaundice, a greater chance of a
prematurity, low apgar scores at 5 minutes, permanent central nervous system or brain damage
and fetal death. 1

In either induced or enhanced use of pitocin, the blood supply (and therefore the oxygen source) to
the uterus is greatly reduced. With naturally paced contractions, there is a time interval between
contractions allowing for the baby to be fully oxygenated before the next contraction. In induced
or stimulated labor, the contractions are closer together and last for a longer time thus shortening
the interval where the baby receives its oxygen supply. Reduced oxygen could have life-long
consequences on the baby's brain.

It is the belief (not necessarily the practice) in the medical profession that induction should occur
when the risk of continuing pregnancy presents a threat to the life of the mother or baby. These
situations include: some severe diabetics, kidney disease, severe preclampsia, severe high blood
pressure, kidney disease, and an overdue pregnancy where a danger to the fetus has been proven.
If induction were carried out only when these conditions were present, at most, an estimate of 3%
of births would be induced. 2

In reality though, due date paranoia remains the most common reason for induction and the
consequent use of pitocin. Surprisingly, studies on the due date calculations revealed frightening
evidence. Firstly, the due date varies significantly between first time pregnancies and subsequent
pregnancies. 3 Also, maternal race has been shown to be a determining factor in gestation time. 4
Another variable to the accuracy of the due date is the recent dependence of ultrasound as a
reliable criteria for infant size and gestational age. First trimester measurements have an error bar
of ± 5 days, increasing to ± 8 days in the second trimester and are as high as ± 25 days in the third
trimester! 5 Bigger fetuses are assumed to be older and in studies where the ovulation date was
known 70% of women who were classified as postdates were incorrectly dated. 6
Furthermore, studies on induction have shown that 30% of fetuses testing normal developed fetal
distress when labor was electively induced and the cesarean rate was 15% verses 2% for
spontaneous labor. 7

Using pitocin to enhance labor leads to an increase in epidurals, and therefore obstetric
intervention during birth adding additional risks to both the mother and baby. (See ICPA Newsletter
Jan/Feb, 1999). And finally, a controlled randomized study showed that the use of pitocin to
stimulate labor was not as productive for the progression of labor as allowing mothers to change
positions during labor by walking, sitting or standing. 8 Giving the mother back control of her body-
-what a novel idea and topic for a future newsletter.

As more and more interventions are added to the birth process, the cause of birth trauma is
proportionately rising. It is our job as chiropractors to continue to educate mothers about the
choices they have in birth and help reduce the devastating effects birth trauma is having on their
babies’ delicate nervous systems. It is a huge job ahead of us, yet I know chiropractors have the
passion and the means to make it happen!

    1.   "A Good Birth, A Safe Birth" Diana Korte and Roberta Scaer
    2.   Caldeyro-Barcia R. "Some consequences of obstetrical interference. Birth Spring 1975; 2(2)
    3.   Mittendorf R, Williams MA, Berkey CS, Cotter PF. The Length of uncomplicated human gestation. Obstet Gynecol 1990; 75(6): 929-932
    4.   ibid
    5.   Otto C, Platt LD. Fetal growth and development. Obstet Gynecol Clin North Am 1991; 18(4) 907-931
    6.   Nichols CW. Postdate pregnancy. Part I. A literature review. J Nurse Midwifery. 1985; 30(4):222-39
    7.   Devoe LD, Sholl JS. Postdates pregnancy. Assessment of fetal risk and obstetric management. J Reprod Med 1983; 28(9); 576-580
    8.   Read JA, Miller FC, Paul RH. Randomized trial of ambulation versus oxytocin for labor enhancement: a preliminary report. Am J Obstet Gynecol.

                          Why Women Do Not Like The "Induction of Labor" Procedure:

   Induced labor causes contractions to become far more painful than nature ever intended.
   Induced labor causes women who would not have chosen drugs for childbirth to ask for them.
   Induced labor puts the baby at risk of possible brain damage through oxygen deprivation.
   Induced labor puts the mother at risk of uterine rupture if she previously had a cesarean birth.
   Induced labor dramatically increases the risk of emergency cesarean birth.
   Induced labor causes a woman to lose control and confidence in the natural birth process.
   Induced labor causes a woman to be monitored excessively during childbirth.
   Induced labor increases a woman's chance of hemorrhage, during the birth and afterwards.
   Induced labor causes a woman to be unable to complete hormonal staging.
   Induced labor forces a baby who is not ready and a body that is not ready to try to give birth.
   Induced labor by rupturing the membranes may cause a woman's umbilical cord to collapse
    thereby increasing the likelihood of death to the baby.
   Induced labor by rupturing the membranes may encourage the baby to assume a position that
    may cause the mother more pain and a longer labor that would have been experienced
   Induced labor causes lasting side effects in the mother of complete loss of sexual desire,
    prolonged severe postnatal depression, and reduced immune function. The use of Prostin, which
    is pig semen, is most certainly a reason for the woman's loss of sexual desire reported regularly
    after childbirth.
   Drugs such as misoprostal, used for induction have not been proven safe.
   Induced labor may cause the baby to have lowered immune function, leading to allergies,
    asthma and brain seizures due to the effects of the animal hormone used to induce or force the
    labor, caused by the long after-life of this drug and due to the fact that many babies have been
    induced prematurely and their immune system is not fully developed yet.
   Induced birth may permanently damage the woman's uterus causing her to be unable or
    unwilling to bear more children

                                         Words with a Midwife

Q: How and why do you induce labor?
If and when the intrauterine environment becomes more hazardous for the baby than the outside,
or to relieve maternal suffering--which on occasion the mother can only subjectively describe. -Phil
Watters, OBGYN, Hobart, Tasmania Australia

I feel odd responding to this question because I don't induce labor. I am a direct-entry midwife in
Kentucky. I have only been practicing independently for a year; however, I was trained by Mary Ann
Watson, CPM, QE, a direct-entry midwife with over 18 years experience in homebirth. Her
philosophy/protocols regarding induction questions are:

1. What if I never go into labor?
Women were designed to give birth. Gestation for each mother with each baby will occur at its own
pace, just as labor progresses at its own pace. Just because the baby inside feels large enough to
survive, it may need more time inside to develop a crucial system. No woman has ever been
pregnant forever. Mary Ann continues weekly prenatal visits until the birth. As long as no
complications arise, she does not risk out or induce women just
because they are overdue.

2. What if my baby is too big?
Normal, healthy women do not grow babies they cannot birth. The species would have destroyed
itself if this were true. Induction may also contribute to malpresentation. If the baby is allowed
time to find a good birthing position, it will adapt to the pelvic inlet. Arbitrary induction may cause
labor to begin before the baby is in a good position.

3. Should VBACs be induced?
Mary Ann's practice prior to coming to Kentucky was primarily VBAC births. She has an excellent
record of successful VBAC births. Her VBAC moms are not induced and do not have a greater
complication or transport rate than her other clients.

4. What if the placenta stops functioning?
Normal, healthy placentas do not just stop functioning 14 days past the due date. I myself have had
one client go either 3 or 5 weeks overdue (she was unsure of her dates). Mary Ann has had clients
confirmed at 30 days or more overdue. Those babies were fine, and those placentas were healthy.

Some women do try to induce themselves with herbal preparations, castor oil, or some other home
preparation. She firmly discourages this, for all the reasons above. Many of these induction
attempts are not successful. One mother who was successful in inducing labor later regretted it.
She had three productive, relatively short labors. This fourth, induced labor was long, slowly
productive, and exhausting. She now discourages other women from trying to induce labor.

Our philosophy that birth is a natural process and our desire to allow it to progress with no
intervention that is not absolutely necessary begins with good prenatal care and with accepting
that labor will begin when it is time.
-Candy Hall, midwife