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Thursday
Feb032011

Really? REALLY?

I was talking to a childbirth educator of many years (over five), a woman teaching one of the big three methods, so it isn't some obscure type none of us have ever heard of, and she said something that made me audibly gasp.

We were talking about birth plans (common theme lately) and the one we were looking at said on one bullet point,

"No induction. No Cytotec."

I explained that putting that on a birth plan was irrelevant because the induction discussion is with the doctor in the office (or during an NST) and by the time she presented on the L&D floor, she was either in labor or being induced; induction was a moot point.

She asked about the Cytotec and I explained it was only used for inductions and hemorrhages after the birth, that if the mom presented for an induction, she absolutely needed to say NO CYTOTEC if she didn't want it -and I encouraged actually looking at what the nurse was putting in her vagina to be sure it wasn't that tiny white pill. But, this was, again, an induction question/discussion for the doctor.

She asked about Pitocin (pit) and I said yes, they do use it for induction as well, but that, from what I knew, at least 80% or more of women end up with pit sometime in their labor. If we count postpartum, too, probably 99.9%. She asked why, if a mom wasn't being induced, why she would get pit.

I said, "Because they very often augment with pit, even when they haven't induced."

She looked at me blankly.

And then this childbirth educator who has a steady stream of clients started asking questions that demonstrated she wasn't sure what the term augmentation meant. No. She didn't know what the term meant, at least with regards to birth.

"But, if her labor is going, even if it's slow, why do they need to induce?"

"They don't 'induce,' they augment."

silence

"Augment means to move it along, even if it's going well. Induce means starting from zero and pushing things, making it go."

"So, if a mom's water breaks and she doesn't have labor, when she goes into the hospital, she is going to be induced because she has no contractions. But, if she is having contractions, but labor is very slow, she will be augmented."

I could tell by her demeanor she was still baffled, but we needed to move on to other parts of the birth plan. I told Sarah it was like I was making confetti for a football game, my going through the plan. There was just so much extraneous bullet points and then, the language used was the birthing style's froo froo language.

If you don't want your birth plan laughed at, don't call your contractions "lovely gentle rivers of sparkling water splashing on the rocks" (that's not what this one said, but you get the gist); call it a contraction.

Maybe I need to do a county-wide Birth Plan In-Service for the cbe's in San Diego. I'll bring the 4x6 cards.

Reader Comments (17)

Wow! Just shaking my head.

February 3, 2011 | Unregistered CommenterNatalie St. John

I don't think that is going to cut it.... how can you be a CBE and not know what augmentation is??????

February 3, 2011 | Unregistered CommenterNicole

Okay, backup. A childbirth educator - teaching classes - did NOT know what augmentation was? Are you serious? How can that be possible?!? I practically had to write a dissertation on EVERYTHING I could possibly ever need to know about L&D for my certification. That makes no sense at all.

February 3, 2011 | Unregistered CommenterTheFeministBreeder

OMG! I'm taking a CBE course right now and actually, after reading your post I realized there was quite a lot about inductions but zilch on augmentation. However, if you've doula'd a bit, you see them pretty often and just the term "augmentation" is pretty self-explanatory. I guss I've spent too much time doing research on pit and on the links with cesareans...

I agree there is a real need to teach how to write effective birth plans. The mellow-sweet stuff you get in most pregnancy books just doesn't cut it with hospital staff...

February 3, 2011 | Unregistered CommenterElodie

I've had clients who thought they did not get Cytotec (in a prior birth) because the staff called it "just a little miso tablet" (love that as much as "a whiff of pit") Mom didn't know she had Cytotec cause she didn't know the drug name. I make sure they all hear Cytotec/miso/misoprotesol is all the same thing!

February 3, 2011 | Unregistered CommenterSonya

wow! and she was a childbirth educator???

February 3, 2011 | Unregistered Commentermommymichael

Surely if you aren't familiar with the term 'augment' you aren't really educated enough to educate others about childbirth? But 80% augmentation - ye gods!!! That's high!

February 3, 2011 | Unregistered CommenterLiz

I just wanted to say that "lovely gentle rivers of sparkling water splashing on the rocks" made me laugh for quite awhile. Thanks for the humor and for providing your area CBE and students with a seemingly much needed reality check.

February 3, 2011 | Unregistered CommenterStef

I believe it. I remember a discussion on a board for doulas and CBE's once where a long-time doula didn't know that the uterus and cervix were all one unit. She believed that the uterus sat on top of the vagina and cervix, like putting a hard boiled egg on top of a glass bottle opening. The anatomy of a woman's reproductive organs is information a 13 year old girl should have before she gets her first period, let alone a woman supporting birthing women!
I get upset when I get locked out of teaching CBE in my area because I am not an RN but when I hear stories like this I can semi-understand.
Maybe a course in A&P and medical terminology should be required of CBEs and doulas?

February 4, 2011 | Unregistered Commentermomto9

I am literally EMBARRASSED to be an aspiring CBE. How in the WORLD could she not have already known and understood this? No wonder we get such a bad rap sometimes. FFS.

February 4, 2011 | Unregistered CommenterDou-la-la

I don't find this out of the ordinary for here either, because birth language here is very simplistic and somewhat out of touch. I hear a lot of people say "I was induced with pitocin" and various other things. What's surprising is how many OB's are completely ignorant of Bishop scoring as well... sigh, and I suppose many health care prof's probably don't clarify what is happening either. Personally as a doula it took me quite some time to figure it out myself what the difference was between the two myself (nevermind nursing school, it really wasn't covered at ALL in our syllabus).

Definitely think an inservice needs to happen. I really wish that local "trends" would be something that gets passed around as well, like what typically is offered for pain meds, if the staff are good with birth plans and following them, etc... there really are local "traditions". Here it's things like "how many people can be with you in the birth and who they should be". Anyhoo, that's digressing.... but it didn't surprise me and I was really quite annoyed a few weeks ago when I thought of how many people just don't know the difference and had been given these medications or procedures with no idea about what was truly happening.

February 4, 2011 | Unregistered Commenterrhonda

Wow. That is sad. And wrong. I don't understand how a CBE could not know these things.

Though, in our area, if mom have pre-labor rupture of membranes and pit is used to start contractions, it is still considered an augmentation, not an induction because of ROM.

February 4, 2011 | Unregistered CommenterCatie

Oh now that is just sad. Talking to you was probably really good for her. She needs some education and perhaps to actually visit some births. Seriously - I think every CBE, whether they've given birth themselves or not, needs to witness all types of births and as often as possible before they dare teach a class.

February 5, 2011 | Unregistered CommenterJoy

Rhonda, inductions can absolutely be done with pit. If the cervix is already ripe, there's no point in cervical ripening agents like cytotec, cervidil or prepidil.

February 7, 2011 | Unregistered CommenterKatie

I suggest strongly to my clients that they only choose childbirth educators that routinely go to births. I have found that some of the hypnosis based childbirth education programs in my area, are taught by instructors who have never been to a birth, or rarely go and they do not understand the implications of birth in a modern hospital, or the challenges of labor, even if the mom is birthing at home.

February 8, 2011 | Unregistered CommenterTreesa

Thank you, Katie... I meant to answer that about the pit being used for inductions. Thanks for clarifying.

And Treesa, I'm starting to see that, too... that there are instructors who either don't go to births at all or who haven't been to a birth in for-EVER. In this "political" birth climate, I don't know how they can speak on the topics without a frame of reference.

Maybe we should also have an Interview the Childbirth Educator questionnaire?

February 8, 2011 | Registered CommenterNavelgazing Midwife

As a childbirth educator that is mortifying!! I did want to speak of my experience with putting "No induction (unless medically indicated)" on my birth plan for my 3rd son (which I left at home on my bed during a semi-rush to get the hospital LOL). I did this due to an experience I had birthing my second son.

I had PROM (on my actual EDD) and drove myself to the hospital not sure if I'd peed my pants or if indeed my membranes ruptured. Fast forward a few hours later and still no labor, no contractions, however, being GBS positive I was concerned I wouldn't get through the evening without caving to induction and sure enough after about 5+ hours of declining induction, I gave in.

Once I became pregnant again, had my GBS screen and passed, I expressed relief that I wouldn't have to face that scenario again, but my doctor told me he and every doctor on call at the hospital I was birthing at had an unwritten policy of giving "pit" to any woman with PROM regardless of GBS results if labor doesn't start within 2hrs of membranes rupturing and the nurses are told to start pushing to induce you the minute you hit the L&D floor. I was really shocked he was telling me this, but grateful at the same time. I felt armed with that knowledge and put it on my birth plan, told my boyfriend this so he'd know how to help me. I should note however, that my nurse was AWESOME..and extremely supportive of my vision to birth naturally, and so was the doctor on-call. I was fortunate in this regard.

February 12, 2011 | Unregistered CommenterPatrice

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