Creative Commons photo by Flickr user Striatic

I’m not afraid of labour.

I’m not afraid of the intense pressure of my uterus contracting, tightening, pushing…

My cervix slowly dilating… Once open zero centimetres and currently stretching to a whopping 10 centimetres? Bring it!

I’m not even scared about pushing my baby into this world and the likelihood of my vagina tearing.

What I am terrified of is being induced.

There are a couple ways of inducing labour which, when applied to a healthy mother with a low-risk pregnancy, usually happens because she has gone over her “due date.” From what I can tell, more often than not, they cause problems for both the mother and baby.

The most common medical ways to induce labour is with synthetic drugs oxytocin and prostaglandin. Prostaglandin-mimicking drugs like Cervidil and Prepidil are used to thin the cervix and oxytocin-imitating drugs like Syntocinon or Pitocin are used to bring on contractions through intravenous injection.

Some of the reasons why I have no interest in being induced this way:

• While Cervidil is inserted like a tampon and Prepidil is a gel, Syntocinon and Pitocin are given intravenously. Being hooked up to an IV limits mobility making natural pain relief (bath, shower, moving around) more difficult.
• Pain relief is especially important after an induction because as if natural labour didn’t hurt enough, these drugs cause unnaturally strong contractions, often leading to what is known as the cascade of interventions.
• Induction in this way can cause fetal distress (depressed fetal heart rate patterns and decreased oxygen availability.) This often results in the use of forceps, vacuum extraction or C-section—all part of the cascade.
• The unnatural contractions means a woman is more likely to use pain medication (ie: an epidural, a common next step in yes, the cascade…)
• Having an oxytocin drip like Syntocinon or Pitocin, will usually mean continuous fetal heart monitoring. This makes going into the shower or tub for some natural pain relief (warm water) impossible.

I think when my baby’s ready to come out, she’ll come out. They predicted she’d be six pounds at birth, so I would be more than happy to give her a little more time to bake in this oven. If there is plenty of amniotic fluid left, and the baby is not under stress, there’s no need for her to be born so immediately.

It’s important for people (hello, grandparents!) to realize the due date means very little and is only an estimate. It assumes that all women run on a perfect 28-day cycle and that we all ovulate at the same point in that cycle. But that’s not the case.

Only something like three to five per cent of women deliver on their anticipated due date, and most of the time doctors will wait  between seven and 10 days before insisting on induction.

At my last appointment , I talked to my doctor about what would happen if I went over my due date (February 9 — yesterday!). She said she’d give me a week and after that, yes, she’d like to hook me up to an IV, and likely give me Syntocinon.

She was pretty responsive when I asked if there were alternatives to an intravenous intervention. We sorted out the fact that I did not want to be hooked up to an IV unless it was absolutely necessary and she said the alternative could be Cervadil. But if Cervadil’s job is to thin my cervix; at 37.5 weeks it was already 80 percent effaced, I’m not sure what the point is.

I was also surprised and hugely relieved when she told me I could, of course, decide not to have the induction so soon, bringing me closer to 42 weeks if I wanted. I would have to schedule regular non-stress tests to make sure everything was okay in there, which was fine by me.

Not every woman realizes that while the doctor might like a patient to deliver no later than a week after her due date, and if there are no medical complications that would make induction necessary to save the baby/mother’s life, whether or not to be induced really is the mother’s decision.

Luckily, sex is the best drug

There are perfectly natural ways to rustle up a little prostaglandin and oxytocin. Why not bring on labour the way this whole pregnancy thing started?

Semen is the most concentrated source of prostaglandins that exists. The synthetic Cervidil and Prepidil can’t compare. These prostaglandins that occur naturally are not associated with the host of potential problems that come along with the other stuff—won’t cause fetal distress, a ruptured uterus, unnaturally painful contractions etc. Getting some semen on your cervix will help it thin—a necessary step in labour.

Breast stimulation, which goes quite nicely with intercourse, releases oxytocin. Orgasms do the same. When oxytocin is released the uterine muscles contract! That sounds a little more fun than an IV.

In the end, the baby will usually come out when she’s good and ready. Who would want to leave the comfort of a warm, cozy womb anyways? Take your time, baby.

Sources: Ina May’s Guide to Childbirth. While this book has largely succeeded in helping me feel worse about delivering in a hospital as opposed to at home, it has been a great resource, one I relied on heavily for much of the information in this blog post.

Never, right? Doctors are our go-between, the ones who prescribe and manage our health, who pay attention to developments in pharmaceuticals, and we generally have to trust them to know what we need. While many provinces are increasingly giving power to pharmacists to renew and consult on prescription drugs, we’re mostly at the mercy of the GP.

But should we cut the distance between us and our drugs? If we’re locavores in the sense of what we ingest food-wise (how many times have you heard the virtues on consulting your local farmer?), why not go right to the source for our pills too. Sure, they’re not always made in our backyard, but no one knows better what goes into our drugs than the makers.

Of course, this will never happen. Big Pharma wants to sell us what they’re developing, not always what we need. But the Canadian Medical Association has an idea that might bring us closer—or, rather, bring drug makers and medical insurance companies closer.

The piece quotes Bob Nakagawa, an assistant deputy minister of pharmaceutical services in British Columbia:

Payers like the BC government “want to see innovative products for significant health care gaps… we are more and more squeezed to live within the allocation government provides us…. We want a return on investment in terms of health outcomes and a sustainable model.”

So the report suggests the drug makers and government medical plans work together on developing and prescribing pharmaceutical treatments. This way, pharmaceutical companies would spend their time developing drugs that we actually take.

But while it might seem advantageous to pair insurance and Big Pharma in theory, I’m skeptical about the effect on the patient. While most of us know that some GP’s are influenced by sponsorship and speaking deals, what happens when those who approve or deny our coverage stick their hands in the pot?

If this idea were to catch, instead of tempering the development of unnecessary drugs, we’d just see more options available to us. And in health care, more is not always better. While governments say they would be able to influence pharma company research, I fear it’s most likely to go the other way. We’d have more options, more prescriptions and we’d continue to be an over-prescribed and medicated culture. We need regulations, not partnerships.