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Induction with Cervidil: Tips from a doula and childbirth educator

Induction with Cervidil: Tips from a doula and childbirth educator 20

What is Cervidil:

Cervidil is a medication used in the induction of labor. In the most basic of descriptions it looks like a tampon with gel on the end of it.  Its generic name is dinoprostone.

When is it used:

Care providers will often use Cervidil as the first step in an induction.  If a woman’s cervix is not dilated or dilated only a little, cervidil can be used. 

How does it work:

Cervidil is inserted vaginally.  Some women report a discomfort with this process.  It stays in and is usually removed 12 hours later or if regular labor contractions begin.  Sometimes it will fall out.  Usually moms stay in bed or in a chair during the 12 hours, but can get up and go to the bathroom.  Most care providers monitor women while they have cervidil (this means contraction and fetal monitoring).  In some areas of the world, providers have sent women home with cervidil inserted and have them return for removal (this doesn’t seem to be the norm).

Download this helpful guide and don't miss out on the detailed information.

 Tips and other information 

  • Most care providers insert the cervidil at night so that mom can sleep for the 12 hours that it is in. It is important to eat a good dinner before you arrive at the hospital for the insertion.   
  • Sometimes cervidil causes regular labor contractions. (yahoo! This is the goal of an induction. If you have a doula, give her an update!)
  • Sometimes cervidil does nothing. This means the cervix is the same before and after the cervidil. (very annoying to most women)
  • Sometimes cervidil dilates the cervix a bit. (yahoo! This means mom is closer to the goal of 10cm)
  • Usually cervidil only softens the cervix. This means that a woman’s cervix is more effaced/thinned after cervidil. (in my experience this happens most of the time)
  • Occasionally cervidil causes extreme contractions (uterine hyperstimulation) that are right on top of each other. In this case you should alert your nurse and care provider. They usually can remove the cervidil if this happens.(this does happen! I've witnessed it)

 

My Doula Dreams are Coming True! 0

 

I've pinched myself a few times over the past 24 hours and I can verify that this isn't a dream.  The American College of Obstetricians and Gynecologists have recently released a statement titled "Choosing Wisely: Five Things Physicians and Patients Should Question" where inductions were mentioned in 2 of the 5 items!

From the statement:

1. Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age.

2. Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.

Number 1 isn't too shocking.  The March of Dimes and their awesome campaign has really seemed to limit scheduled inductions and Csections prior to 39 weeks.  Its number 2 that is the one to really pay attention to.  ACOG is saying that inductions shouldn't be done if the cervix isn't favorable!  YAHOO!!  They even go on to say "Ideally, labor should start on its own initiative whenever possible."  Can you see me dancing?  ACOG is finally making a statement saying that it isn't just waiting until after 39 weeks, but that it should be done if mom's body isn't ready.  Of course I would really be dancing if it would have said something like "let labor begin on its own whenever possible", but I'll take "unless the cervix is deemed favorable".

Could this mean that we see a decline in inductions for convenience?  Could this mean that I won't have another client being sent for an induction when her cervix isn't favorable? 

I am so hopeful that this statement will make some changes to induction policy and maybe we can eventually see the csection rate decrease.     

What will you do with this information?  I encourage you to get the word out...blog, tweet and do a Facebook post about it.  Tell your clients and students about it.  It's big news.  Let's make the most of it.

IV Fluids and Newborns 1

Nearly one and a half years ago (August of 2011) a team of Canadian researchers published a study in the International Breastfeeding Journal that linked the fluid intake which a mother may receive in labor with excessive weight loss in her newborn.  The study concluded that it takes about 24 hours for babies to correct their fluid state and therefore a true birth weight should be done at 24 hours.  I don't know about your area of the world, but this is NOT being done where I live.  Not only is this not being done, but there seems to be NO knowledge about this research.  Sure...the doulas and the IBCLCs know about the study...but not the pediatricians who are often quick to suggest formula for excessive weight loss.

How do we get this research into the hands of the birthing mothers and their care providers?  My suggestion is to send this information to your clients. Make them aware of the situation so that they will have the information with them before birth.  Help them prepare for this possible scenario!

Below I have listed my favorite posts about this research.  The study was reported by a variety of people and news organizations.  They range from a Lactation Consultant's blog to an online news feed for pediatricians.  Share your favorite one with your clients or share them all!

The Journal Article: From the International Breastfeeding Journal - An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss

A Lactations Consultants View: From Santa Barbara Lactation - Newborn Weight Loss and IV Fluids in Labor

The News Reporter: From Science Daily - Maternal IV Fluids Linked to Newborns' Weight Loss

The Breastpump company: Hygeia - IV Fluids Linked to Early Newborn Weight Loss

The University where the research took place: University of Ottawa - Maternal IV fluids linked to newborns' weight loss

A Medical News website aimed at Pediatricians: Helio.com - Newborn weight loss associated with maternal IV fluids

Medical School News: Stanford Medical School -Study shows link between maternal IV fluids and weight loss in newborns

 

 

Lessons from Acorns 0

My son and I enjoy going for walks in our neighborhood and he especially enjoys visiting a neighbor that has a whole yard full of acorns. We usually pick up several and bring them back to our house where they entertain him for a good 10-15 minutes. His favorite nuts were the ones still wearing “hats” (actually called a involucre or cupule)

One day while we were playing with our loot I started wondering why were some acorns still wearing their hats while others were not. All of the acorns started growing about the same time. They had all been gestating on the tree for the same amount of time yet clearly some were ready to go onto the next phase of their life (germination or food for another animal) and others needed more time on the tree.

As a birth professional, it is only fitting that I draw a comparison to childbirth. I have a firm belief that some babies need longer in the womb then others. Some mothers give birth at 39 weeks and others not until 42 weeks. I see it as simply as I the nuts in this picture.

I recently had a conversation with a pregnant mom about her OB and how he practices. She said that he likes to induce his patients at 39 weeks for two reasons. 1) Because the baby is a bit smaller and will therefore be easier to birth and 2) Because the final weeks of pregnancy are hard on moms and they will have a bit more energy for labor if induced earlier. This conversation shocked and frustrated me. How could someone really think that those were good reasons to induce? How could his patients think these were valid reasons and worth the risks associated with induction?

Why do we feel that at the very end of the process that we know better? Why do we feel that our bodies no longer know what to do? Babies seem to know what they are doing. They grow hearts, livers, brains and even fingernails without our help. Our bodies create placentas and umbilical cords without our assistance.

My question to the care providers in the world is why can’t we honor mother nature and let babies choose the day of their birth? Give the baby a chance to tell us when it is ready. Have you ever tried to take the ‘hat’ off a green acorn? It’s nearly impossible. Give the acorn a few more days/weeks and it easily falls off by itself. Try to induce a mom with a low bishops score and you are bound to have a difficult time getting labor started. Give her a few days/weeks and she will go into labor on her own.

Come on people..Don’t give up on mother nature!