This week, Connie Livingston, a childbirth educator for more than three decades, discusses the ironic and challenging blend of technology and birth. Advancements in technology have increased tools for childbirth education — but also the opportunities for birth interventions.
When I began my journey to become a childbirth educator more than 30 years ago, little did I know that education would not indefinitely be limited to the classroom.
Beginning my career with a few home-drawn charts and a uterus knitted by a friend, my path of teaching expectant parents started in a small town in California. Drawn to serve in additional ways, I held volunteer positions for Lamaze International (then ASPO/Lamaze), ICEA, CAPPA and DONA International. The journey has been a long (and of course rewarding!) one, but as technology advances to an educational advantage, so does the technology that leads to increased birth interventions.
One challenging subject that has always been present, and more so today than in the 80s, is the topic of induction. Getting the vital information to both expectant parents and health care professionals proves to be complicated, but absolutely necessary.
Caregivers use a gestational wheel to determine the EDC or “due date” of the baby. This method assumes that all women cycle the same, and also that a woman’s body’s definition of term is the same. The reality, however, is that cycles vary as much as a few weeks from woman to woman. Usually, a more accurate measurement of a woman’s due “date” is more like plus or minus two weeks from the day. Therefore, a woman who carries to 42 weeks may not actually be “overdue.”
Unfortunately, many caregivers and pregnant women simply look at 38 weeks gestation (to the day) as when they feel a baby can safely be born. If the dates are not correct and they choose to induce, the baby may actually be born premature. This, in part, may be a culprit in fueling the high premature birth rate in the U.S., the rise in near-term infants in NICUs, and the skyrocketing cesarean section rate.
A woman’s body goes through a series of preparatory steps prior to beginning labor. Both the fetus and the mother seem to work together in determining when labor will begin. In order for an induction to be successful, oxytocin receptors must be in abundance on the uterus for oxytocin to bind and produce contractions. This may explain why a woman who is brought into the hospital for induction may not respond to the pitocin given to her. Unless her uterus is ready to accept the pitocin (oxytocin), the induction may not work. There is a scoring system that physicians use, which identifies women who most likely will respond to an induction. This is known as the Bishop score. Women who score relatively high (8-9) will have a greater chance of the induction being successful. However, a woman with a cervix that is not dilated, effaced, softened or anterior (and has a low Bishop score) may likely have a long, difficult labor when induced, often ending in a cesarean delivery.
The March of Dimes recently posted an amazing diagram showing the difference in the size of a baby’s brain at both 35 and 39 weeks. This graphic, in addition to the need for lung development, vision/hearing development, and the ability to suck and swallow can be moving details both expectant parents and professionals should be aware of. They may prevent some (or many) unnecessary inductions.
Technology has come far since showing reel-to-reel movies in childbirth classes more than 30 years ago. We, as childbirth educators, can use the vast majority of the technology available to the benefit of all. From informative “Did you know … ” posts on Facebook to tweets about the latest studies, perhaps the additional technological push of education on induction (and other birth interventions, too) can truly create a decline in the unnecessary use of technology during labor and delivery.
Connie Livingston RN, BS, FACCE, LCCE, CD (DONA), ICCE, IAT is President of Perinatal Education Associates, Inc. She coordinates two Web sites, Birth Source and The Birth Facts, and a blog, as well as a Facebook page (Birthsource) and Twitter account. Her two grown daughters and husband of 32 years are vital parts of her company. Also check out her books, “Innovative Teaching Strategies Handbook for Birth Professionals” and “Creating and Marketing Your Birth Related Business.”
Mother’s Advocate wants to know what your opinions are about unnecessary use of technology during childbirth – leave a comment below telling us what you think!