I’ve been to eighteen births and have noticed a trend among some of my clients. I’ve been to five births that were inductions and went the exact same way: cervical softener (Cervidil) followed by a foley bulb followed by Pitocin followed by an epidural. Once my clients got the epidural, their contractions really spaced out and the Pitocin seemed to stop working, even when it was turned all the way up. Two of the five clients had vaginal births (barely) but the other three were called failure to progress and went to a c-section. Is there anything I can do or recommend in these situations? I feel so helpless and bad for my clients. Or is this just the way inductions are?
Frustrated With Inductions
Dear Frustrated With Inductions,
I’ve been to many, many inductions and I really feel your frustration. It’s so hard when our clients don’t have the birth they want and have procedures that increase their risk of complications. I do have a few suggestions for you. When I implemented the following things into my practice, my clients had better outcomes. My first 100 births I had 40 inductions and my second hundred births I had 18.
1. I learned which doctors/hospitals had high induction rates. Once I figured out who was most likely to induce parents for false reasons (doctors who induce everyone at 40 weeks, slightly elevated blood pressure, slightly low fluids, Fetal Macrosomia - which is suspected big baby, etc) I was able to coach clients to switch to care providers who practiced evidence based care, true informed consent and supported client wishes - the induction rates of my clients decreased drastically. Encouraging clients to switch providers is an art because often their doctors will promise a certain type of birth and deliver another, like promising they support a mom going to 42 weeks and then at 41 weeks scaring them into an induction for no medical reason. It’s such a bait-and-switch and is so awful. When a client loves their doctor and believes them, convincing them that doctor or hospital will sing a very different tune when it comes time for labor is challenging.
You have to be direct, honest and patient with your clients without seeming judgmental. I even refused to attend birth with certain doctors or hospitals and usually that was enough to get people to switch because they thought “wow, if my doula is willing to let go of my business to not attend births at a particular place, it must be really bad.” I’ve only had two clients in my whole practice find another doula to stay at the same place. I also have had the privilege of working in cities with multiple birth options and I know this isn’t the case everywhere. Sometimes a parent only has one hospital as an option.
2. I learned how to help get babies out with various techniques. I took optimal fetal positioning (OFP) workshops and was able to help get clients into better positions while they were hooked up to monitors, IVs and had epidurals. I highly recommend Spinning Babies or Cornerstone Doula Trainings for training in OFP.
3. I asked for medications to be switched out. Little known fact - not all Pitocin bags are made the same. If the pit seems to not be working, ask the nurse to try a different bag. I’ve seen this work a few times where there was a bum bag of pit and switching it made contractions stronger (this actually happened at my own birth and switching the bag made a huge difference for the strength of my surges - read my birth story here).
4. I asked for last minute cervical checks. I’ve had four births in my practice where clients were literally being wheeled to surgery and I beg for another check even if one had been done recently. In all cases, my clients went from stalled at a certain dilation to full dilation once the decision for a belly birth had been made. I don’t know why - if it was a coincidence, luck or mental shift that opened their cervix. All I know is all four of those mamas would have had a c-section if I hadn’t made a stink about doing a check. I had bad opposition from a nurse in one of those cases who kept saying there was “NO WAY” she had dilated and was refusing to check her. But I pushed and encouraged my clients to push for it and low and behold - she was 10 cm!
I hope these techniques help you and remember, being a doula is years of learning. I was a more efficient doula deeper into my practice in terms of helping clients have the birth they wanted. It just comes with experience and time. Love to you.
If you enjoyed this article, please join us for case study reviews each month where I’ll be discussing births in depth and how I handled them with my dear friend, mentor and colleague Shannon Padlog. There is so much more to talk about and each birth is individual and complex. Find out more information here.