Photo Courtesy of and Copyright to M & J Edgley, FOOTPRINTS & RAINBOWS, Dec 2008
I did what I usually do, I advised of the risks, the benefits, that the estimated weight was not “Big” at all and many women birth babies even bigger than that vaginally and after spontaneous labour with no issues at all, and reassured the mum-to-be to follow her heart – in that if it didn’t feel right then tell her doctor that she didn’t want to be induced and would wait until baby decided to arrive on his/her own.
This kind of question is becoming more and more common these days, women being told they are having “Big Babies” estimated to be between 9 and 10pd (which isn’t “big” as such, it is just another variation of normal size) and will be induced between 37 and 38 weeks gestation because of that. These women are apparently not being given any choice in the matter, they are being told it WILL happen, that they NEED to be induced as if they don’t their baby will get stuck (shoulder dystocia) and die because it is too big to be born vaginally.
For the record, this is not evidence based medical practice, this is fear mongering and scare tactics and outright lying by medical professionals in order to get an expectant mother to do what THEY want her to do. A 9-10pd baby is not big, 11+ pounds is “big”. 9-13pd babies are born all around the world all the time without any issues when the mother is able to move around in whatever way she finds comfortable and as a result assist the baby in manoeuvring through the birth canal. In these cases there is no respect for a mother’s decision making, no allowing the woman’s body to do what it was made to do, preventing the natural physiological process of birth from occurring when the time is truly right and making women around the world afraid of a natural body process. To add to this a small baby is just as likely to get stuck as a larger baby if baby’s position and mothers position while birthing are not ideal. There are ways to prevent it and to reduce the chances of it happening, and early induction is not one of them and has a higher chance of shoulder dystocia by preventing the mother from adopting natural birthing positions due to the CTG monitoring and in many cases an epidural as well when the induced contractions become too much for the mother to bare and increasing the chances of baby being malpositioned when artificial rupture of the membranes (amniotic sac) is done as part of the standard practice of induction, traumatic physical and emotional intervention with the use of ventouse (vacuum), episiotomy, forceps and physical pressure on the mothers abdomen, and fetal distress from the induction itself resulting in either the above mentioned interventions or an emergency cesarean occurring.
But what I've mentioned just above is not what prompted this blog post. What prompted this is the lack of up to date knowledge in obstetricians and other mothers who were “fans” of this particular page and answered this particular question.
These “fans” were promoting induction at 37 weeks with no major risk factors or true need, stating that it was “term” and “baby would be fine”. This information is incorrect, not only have the WHO and ACoG, within the last 12 months, updated their guidelines of when “term”, “full term” and “post dates” are, but an induction at 37 weeks for no reason other than an ultrasound weight estimate (proven to be inaccurate in the majority of cases) shows that baby is measuring larger than average. The new guidelines state that “term” is now from 39 weeks to 39+6 weeks after recent research showing that a lot of important brain development occurs in-utero between 37 and 39 weeks and babies who stay in longer have less physical issues than babies born before 39 weeks gestations (eg feeding issues, regulating of body temperature issues etc), “full term” is now from 40 weeks to 42 weeks gestation, and “post dates” is now from 42+1 weeks onwards.
What does this mean for pregnancy and birth and going past 41 weeks gestation? Well frankly it means that every woman should now have a much higher chance of being able to go into labour naturally when their baby and body are really ready without the need to be induced, whether it is at 37 weeks that their baby decides that he or she is ready, or at 43 weeks, AS LONG AS all obstetricians and doctors follow the ACoG and WHO guidelines, which unfortunately for all of us women is not the case. Sadly most obstetricians and doctors do not follow these guidelines, they follow their own guidelines and the hospitals outdated policies on “management” of pregnancy and labour. And “management” it is, they are “managing” us like animals, inducing when they want, cutting us open when they want, giving us medication when they want, telling us what we can and can’t do, scaring us and putting the fear of death into us, only telling us what they want us to know and not what we need to know, essentially taking away our basic human rights and preventing us from making our own truly informed choices and decisions by not providing all of the information and only telling us what they want us to hear.
There are of course exceptions to this, there are some wonderful and truly amazing obstetricians and doctors out there who treat women with respect and dignity that they deserve and do everything that they can to inform women of ALL of the risks and benefits, accept a woman’s choices without trying to change her mind, support her unconditionally in those choices and go out of their way to try and give the woman the birth that she desires. They are few and far between, a dozen or so in every state, a few hundred or so in every country out of a hundred thousand or more obstetricians and doctors around the world that are trained in high risk pregnancy and birth.
“So what?” You might say, “They are trained in pregnancy and birth, they know what they are doing.” Yes, they are trained, in “HIGH RISK” pregnancy and birth, the types of pregnancies that might be dangerous for mum and/or baby. They are NOT trained in natural physiological childbirth, they are not trained in the kind of birth that does not need drugs to make it start, that does not need intervention or constant monitoring, that does not result in a mother on her back in a bed unable or "not allowed" to get up and move around and physically help her baby to get into a better position for birth, they are not trained in allowing a woman’s body to do what it was made to do and treat every woman the same as if they have the same risks as every other woman. Every woman, every body and every baby are different with different risks and different needs, we do not all fit into same mold (eg not everyone has a 12 hour or less labour just as not every woman has a very long 55+ hour labour), but obstetricians and doctors are trained to fit everyone into the same mold with the same risks regardless our own individual risk factors, body shapes, histories, abilities and needs.
How can we change this? How can we make pregnancy and birth an individual thing again? How can we make obstetricians treat us with the respect and dignity that we deserve? How can we make them respect our decisions and choices without trying to scare us or bully us into what they want us to do? The answer is that every woman and every man must make the decision to stand up for themselves and their partner, to say NO, to make obstetricians and doctors understand that it is NOT a medical professionals or hospitals decision to make on when a baby comes into the world, to make obstetricians and doctors stop scaring women with generalised risks and outright lies, to make the maternity system in whatever country you live in stop and listen and change its policies for the benefit of ALL women, to make pregnancy and birth about the woman once again and not about the medical side of things. Women everywhere need to take their bodies back, to make sure that everyone knows that SHE makes the decisions regarding HER body and HER baby, and that hospitals, obstetricians and doctors are NOT the ones to make the decisions. Even in a life or death situation the mother has the right to decide what is to be done and should be given the chance to do so, even if there is only a minute available for her to make that decision that will affect her and her family for the rest of their lives, she should be the one to decide, not someone else who doesn’t have to live with the consequences.
So there you have it. We live in a medicalised world that is slowly trying to remove all natural bodily autonomy from women, that is trying to stop women from being able to choose if she has an induction or cesarean or waits until her baby and body decide that it is the right time, a world where women are being scared and bullied into inductions and cesareans instead of being given the right information and support to make a truly informed decision over their bodies and method of birth, a world where women are ridiculed for their decisions, denied good care, denied the right support that they need and are traumatised on a regular basis when they are in the most vulnerable state and position.
Can you imagine a world where women are supported personally in a way that fits their individual needs and wants and are empowered in the process? Can you see a world where a woman is able to choose whenever she wants if she has a home birth, an unassisted birth, a hospital birth, an induction or a cesarean without being judged, ridiculed or traumatised in the process? Where she is truly informed about the risks and benefits of every procedure instead of only informed that the medical professional feels is all she needs to know? Where she can birth however she wants without being lied to or scared by medical professionals? Where she can trust those who are caring for her and supporting her to give her the power to make her own decisions regardless of where she lives, her body shape, her previous history, or what she looks like? I can, I can see that world, our world can become that world. If we all worked together to make changes, if we all supported one another in our individual decisions regardless of what they are, we can create that world and make it ours.
Student Birth Doula
FOOTPRINTS & RAINBOWS