High Dose Pitocin Inductions

Apparently high dose pitocin inductions are becoming all the rage. Hospital in the big city number 2 at which I work is doing a study on them.

Color me unimpressed.

"The Literature" says women deliver more rapidly with HDPIs and that HDPIs decrease the number of C-sections. I'm skeptical, I can't wait to read the studies.

This was my first, and only I should add, experience with an HDPI.

Mom was a first timer, barely "past dates" (she was due on a Friday, we started the induction on Wednesday after her due date), she was given cervidil, a cervical ripening agent, overnight, which caused mild cramping but not much else. I placed the cervidil and BOY was her cervix posterior! I could barely reach the posterior fornix, the little pocket just behind the cervix, and I had a very difficult time trying to get to the opening of her cervix, the os, to check her dilation. In otherwords, her body had very few indicators of being ready for labor. In fact, her Bishops score, which we use to measure a woman's "inductability" was 2, not impressive.

So she recieved her cervidil overnight and pit was started, at FOUR MILLIUNITS AN HOUR, the next morning. Apparently in some places they're starting it at six milliunits an hour!

If we use the analogy of labor being like running a marathon, think of an induction as being tied to a car with which you must keep up in order to reach the finish line. Most times, the car would start slow, walking pace, like two miles an hour, and over the course of the day, the car (pitocin) would go a little faster, and a little faster, 'til you're finally running along at a good clip, and hopefully not being dragged behind the car! With HDPIs you sort of get pushed out of the car when it's already going 25 miles and hour and you just go faster from there.

When I took her the next afternoon, her pitocin was already up to 30 milliunits, which is pretty much the maximum recommended dose for any laboring woman, she couldn't feel it though because of course she had an epidural, not that I blame her a bit, I doubt I could take a pit induction that high myself without some pharmaceutical help.

Unfortunately, such a high dose caused, surprise surprise, hyperstimulus of the uterus so baby was having deep decels, and her uterus wasn't relaxing between contractions and she was contracting every minute.

We cut her pit in half and she started having a nicer labor pattern, but every so often baby would have a very deep variable deceleration. We suspected the cord might be wrapped around something at that point.

We started easing the pit back up again, this time using a low dose protocol, and soon her water broke with clear fluids. Whew! Despite the stress, baby hadn't pooped inside of her. Good.

Her uterus seemed to be pooping out (not suprising that she wasn't maintaining contractions with all the pit pumped into her from before, this is pretty common) so we kept increasing the pit.

About an hour after her water broke, we started seeing meconium, the baby's first bowl movement. Thick, thick, pea soup mec.

Finally, she was complete, we had her start pushing. The baby was having fewer variables, but his baseline had risen, which can indicate fever, or stress in a fetus, I was afraid he was on the verge of pooping out completely and he'd be plummeting down, and we'd be headed for a section.

After an hour an forty minutes of pushing, a pretty average time for a first time mom, the baby was born, covered head to toe in thick mec, floppy, dusky as all get out, with that glazed unfocused very not-present look. Yeesh. He had his cord wrapped around his neck AND his left had, which because of the cord was tucked up along side his head when he was born. I am so so thankful the Neotal Nurse Practitioner was there, I would not have wanted to try and resucitate that baby myself. She intubated him twice, and he didn't give his first small cries until four minutes after he was born. His apgars were five(!) and eight. Yikes. Yikes. Yikes.

So, what do I think about HDPIs so far. It seems like an impossible induction to do without drugs, I think it's a good set up to stress out babies, as well as leading to hyperstimulation of the uterus, which in turn could cause the uterus to rupture. The dreaded abruption.

Ladies, do your research, advocate for yourself, and if you can't, get a doula who will advocate for you.

First Day of School and a Miraculous Recovery

What a bittersweet day! Although I am happy to get a bit of downtime now that Sage has gone back to school, one can't help worrying about the new teacher, wondering if there will be bullies, and of course, the concern of a mother for her profoundly dyslexic son.

I had always envisioned homeschooling my kids, little did I know what the Universe had in store for me. Sage has always been a bright kid, very socially outgoing, engaged and interested in the world around him. But even as a little kid, he seemed to have problems processing information in a way that showed up as "good" test scores. He's brilliant when it comes to politics and framing a photograph, but he reads at a first grade level and is currently entering fourth grade.

Last year his phenomenal teacher, Mrs. Gonzalez, was incredible, never has anyone advocated for him so well, never had anyone seen his great potential and how deeply dyslexic he is. And having only been diagnosed officially at the end of 2nd grade, there was a LOT of catch up to do.

Nevertheless, he actually chooses of his own accord to read out loud to my husband and I sometimes. I think he's proud of what he's accomplished and so he should be. He's worked hard and though I know school will probably always be somewhat of a struggle, he's finally getting some building blocks with which to create his world of education.

Really though, I can't say enough good things about his school. It's a public school with a fine arts focus, they teach violin AND Spanish starting in first grade. The walls are COVERED with murals created by the students depicting civil rights activists and abuses. And the school is very, very mixed. I believe thirty percent is African American, thirty percent is Latino, and the remaining thirty percent is a mixture of native born Caucasian, Hmong, Somalian and "other" students. As the Caucasian mom of a multi-racial child this is SO important to me. It's like the hospital I work at, a gorgeous mixture of races, cultures, and ethnicities.

So, I finished up my four-shifts-in-three-days and am enjoying the day off before I go back tomorrow evening. Just four or five more shifts until I have the option of going on maternity leave! (which I won't, but at least I have that option and I can thereafter make my own schedule. Whoopee!)

Yesterday was another day in the nursery. A sort of steady stream of babies. One little guy was SO hirsute! He was such a cutie, but sadly he'd had thick mec at so all that hair was coated in poo. Another baby yesterday was pretty "mec-y" and though I KNOW that our protocols about washing babies so quickly is all balderdash I really couldn't wait to wash and comb all that stuff out of his lovely fuzzy hair. One thing about me is that I have a real aversion to gunk in peoples ears so I ever-so-gently took a few swabs and wiped out his wee ears. I did NOT however get aggressive with his vernix. At least I'm that savvy.

But the real kicker yesterday was when a woman, a victim of the recent bridge collapse who had been pregnant at the time, came down to visit the nurses who cared for her baby for the last month while she teetered between life and death. What a miracle! I won't say much except that she looks great and her child is fat and happy. I wanted to cry I was so overjoyed for her recovery. I think that kid must be destined for something great.