Category Archives: Medications/Epidurals

Medication in Pregnancy: Doing Without Knowing

Posted on March 6, 2013 | 10 Comments

I just finished reading a short article about the use of Odansetron (Zofran), a medication often given to pregnant women to help them when they have nausea and vomiting. While this medication has been WIDELY prescribed for nausea and vomiting in pregnancy it is NOT approved for this purpose. 

Zofran (Odansetron) IS approved by the FDA for the prevention of nausea and vomiting associated with cancer chemotherapy and for the prevention/treatment of nausea and vomiting after surgery.  What this means is using Zofran for pregnant women is an “off label” use.  Off label usage of medication is nothing new and it happens all the time. While I do understand this, I believe that we need to be MUCH more cautious and careful when working with pregnant women.  We need to do better about understanding the risks profile of a medication before putting it widely into practice.  Doing without knowing is NOT okay.

From the article “Although most often used as an antiemetic following chemotherapy, ondansetron frequently is used off-label to treat nausea and vomiting during pregnancy. However, few studies have assessed the safety of ondansetron when used for this indication. A report in the New England Journal of Medicine [1] used Danish national data to determine the impact of ondansetron on risk for spontaneous abortion, stillbirth, major birth defects, and other perinatal outcomes.”

After reading this article, I couldn’t help but think about the horrors of thalidomide.  Sold in the late 50’s/early 60’s, thalidomide was given to pregnant women in off label use for morning sickness. It was untested and after a few YEARS of use and massive birth defects were noted, it was pulled from the market. This was all in the name of stopping nausea and vomiting, which BTW is a NORMAL part of early pregnancy and can even be normal throughout pregnancy if weight gain and fetal growth are appropriate.  But I digress and that’s a topic for another post. My point today… Doing without knowing is NOT okay.

We introduced the electronic fetal monitor (EFM) in the 1960’s in the name of preventing birth defects. The use of the fetal monitor quickly became widely used nation wide without research. It is the number one intervention on labor and delivery units today even though it is common knowledge among birth professionals that EFM has not and does not create better birth outcomes. And in the face of research that shows continuous EFM increases c/sections and intermittent monitoring is safe and effective at detecting fetal distress we continue to use electronic fetal monitors nation wide! In this case we initially did without knowing. Now we know better but since EFM has become such a part of our maternity culture that we still do even though we shouldn’t.

Honestly, this is really is just a little rant. Reading the first part of the article irritated me.  I’m continuously like… SERIUOSLY?!?!  When will we stop experimenting with women and our unborn children.  This article goes on to say that the researchers found no increase in birth defects, miscarriage or still birth. This article highlights however that we still casually do without knowing and this is NOT okay. Doctors and midwives prescribe medications and procedures all the time either without full knowledge of the risks or without full disclosure of the risks. It’s not fair to women and its NOT okay.

The take home message:  Please remember ALL substances that you take, whether it’s a vitamin or hard drugs and everything in between… ALL of them DO in some way, and in some amount, cross the placenta and get to your baby.  Whenever you are prescribed a medication… ask a question. Find out if there is a better/different option. Ask about waiting until later in pregnancy. Ask. Ask. ASK.  Don’t assume everything they give you is necessarily safe, or that it is even necessary.  What medications did you take during pregnancy? Would you take it again?  Share your experiences…

In Birth and Love
Nicole (Dont forget to follow me on twitter @SistaMidwife)

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Women’s Herbal Workshop in Louisiana

Posted on April 24, 2012 | 2 Comments

Do you want to learn how to make your own herbal Infusions, Tinctures & Salves?  Do you live in OR are you willing to travel to Louisiana?
If you answered yes to these questions this is for YOU!

Join Divine of Supreme Wellness for a Women’s Herbal Circle Workshop:
Infusions, Tinctures & Salves for the Pre-Natal Period & Beyond

This workshop will be held in Opelousas, Louisiana SATURDAY MAY 5, 2012 11AM-2PM

Topics Covered include:  *Anemia *Sore Muscle Healing *Weak Cervix *Miscarriage Prevention *Hemorrhage Prevention *Perineum Healing *Water Retention

This will be a full HANDS  ON  experience.  Every student will leave with their own tincture, infusion, & salve. All supplies & herbs will be provided.

ALL PARTICIPANTS MUST PRE-REGISTER – Registration is ONLY $35

For more info: Contact Divine via email: supreme_wellness at yahoo dot com or hit her up on twitter @SUPRMWellness.

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The Marathon/Childbirth Discussion: Why Don’t We Celebrate Both??

Posted on August 9, 2011 | 9 Comments

One of my favorite cousins is a runner.  She ran in high school.  She ran in college.  She runs now.  I admire people who run.  Their determination and focus.  Their endless goal setting for a faster time or a further distance.  Their passion for running only truly shared by other runners.  It is to be admired.  

I on the other hand am no runner.  I will walk a few miles in the name of exercise and personal fitness, but running has never been me. I remember vividly when I was a little girl, I ran a race in the middle of the street, as I tried out for the track team at the neighborhood park.  I fell.  HARD.  I scrapped my hands, my knees, and my ego. I was so embarrassed.  I don’t think I ever ran another street race, and I certainly never grew to like the sport/activity.  Regarless of my lack of interest in running, when I hear someone is training for or interested in running a marathon;  I am happy for them and admire their fortitude. I will admit however, running a marathon is NOT on my personal bucket list.  

What IS on my “bucket list?” Experiencing a successful full term pregnancy and home birth.  I do want the experience of birthing in a way that leaves me exhilarated, empowered, and full of pride.

Its well documented that “The sense of personal empowerment, accomplishment and achievement that comes with it is simply amazing.”

Yes, its hard work:  “You have points where you want to sit… and cry.  Points where you don’t think you’re going to make it any further…  But when… you’re able to say ‘I got through it and I’m OK,’ there’s no feeling of accomplishment like it in the world.” 

I recently read someone say:  “I haven’t found any other experience in life that bestows the blending of mind, body and spirit in as positive and powerful a way… It changes people’s lives”

But wait a minute…  What exactly am I writing about here?  Is this about birth or about running a marathon?  Well BOTH actually.  You see, the quotes above, each came from a recent article I read about running a MARATHON!!  As I read the article I was reminded that I promised my cousin, the one mentioned above, that I would write a quick post re: the comparison between running a marathon and giving birth without the aid of medication.

I mentioned to her during a previous conversation that posts and articles about this topic were plentiful. In fact, I just googled “Natural Birth Marathon” and got over 20,000,000 results and the first page is full of great articles. Unfortunately, while the preparation, the attitude, the mental capacity, the final feelings of accomplishment and elation have long been compared, the disparity of responses to each continues.

When individuals announce “I am going to run a marathon.” They are greeted with hugs, cheers and congratulations.  At the same time, women who say “I am going to have an un-medicated birth” are often laughed at, discounted and some are even shamed as they are asked “WHY on earth would you do that?!?!”

What’s most interesting to me are the women who run marathons themselves yet simultaneously think that an un-medicated birth is a crazy idea. I met such a woman a number of years ago in California.  The woman was being admitted for an induction.  She let me know she was DEFINITELY planning to have an epidural.  She told me about her friend who had a natural birth and she could not understand why her friend would put herself through so much pain.  I had recently read an article comparing natural child birth to a marathon and I mention this article to her. She then admitted that she had run not one, but TWO (maybe 3) marathons!! I was like REALLY!!?? In my opinion I told her jokingly… YOU are the crazy one.

I won’t go into detail about the endorphins that are experienced and used by both marathon runners and women in labor alike to endure pain and experience a life changing experience. 

I will not go into detail describing the physical and mental preparation, the need for focus, determination, and a support system and a plan.  I won’t discuss the way mind over matter makes them both a reality.  I will not go into detail about the potential for pain, injury and disappointment that comes if the desired outcome is not realized.  i.e. the marathon is not finished  or the birth ends in cesarean. 

Instead, I will refer back to the quotes above. The ones that came from an article on running a marathon and at the same time can be used easily to describe natural birth.  My favorite:  “I haven’t found any other experience in life that bestows the blending of mind, body and spirit in as positive and powerful a way… It changes people’s lives”    REALLY??!!  Obviously that person has never experienced or witnessed natural child birth which I would argue can do all of that and MORE!

What I really want to do is challenge you to change your opinion of women who desire “natural” child birth.  Celebrate them as you do the marathon runner. Embrace their goals like you do the marathon runner. Support their efforts like you do the marathon runner.  Tell them you are proud like you do the marathon runner.  

Women who choose un-medicated birth are no more “crazy” than the individual who chooses to run a marathon.  Just as I can appreciate the hard work, dedication and preparation that goes in to running a marathon, it’s time we celebrate the hard work and effort that goes with an un-medicated birth.

Somehow I believe if men could birth babies and chose natural birth, it would be looked upon differently.  I believe like the marathon, the triathlon, the decathlon, and the iron man it would be celebrated and not made into a societal joke.  That’s really sad, because the reality is, with no disrespect to Marathon runners:

“I haven’t [witnessed] any other experience in life that bestows the blending of mind, body and spirit in as positive and powerful a way… It changes people’s lives.”  And I am talking about childbirth!!!

Did you have an un-medicated birth? Have you ever run a marathon? Which one was more difficult? Share your story!!

Nicole

Lets connect on Twitter I’m @SistaMidwife

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Posted in Lessons from BIRTH, Medications/Epidurals, Pregnancy & Birth

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Pitocin is NOT Always Poison

Posted on December 8, 2010 | 5 Comments

As a rule, I am in favor of natural birth:  a birth that among other things, starts on its own, includes non-pharmacological forms of pain relief, avoids medical augmentation, and allows a woman to be free to eat, drink, walk, and move during labor.

While I am in favor of natural birth, I also understand that sometimes interventions are necessary, can be helpful and do save lives AND… if you chose a provider, and a plan for birth that employs medical management of labor, what may, under different circumstances, be something I would advise against, all of a sudden can become something I am completely in favor of.

As an example… I am not in favor of randomly using Pitocin.  I understand that in the wrong hands Pitocin can create a very difficult and even unsafe labor.  I understand that Pitocin is over used and its dangers are often understated.  In spite of that understanding, there are times when Pitocin can be the difference between a cesarean section and a vaginal delivery.

The Scenario:
You enter the hospital in spontaneous labor.  You opted for an epidural and your water bag was broken artificially.  You progress at a slow normal rate getting vaginal exams/cervical checks every 1-3 hours. First you are 3-4cm. Two hours later you are 4-5cm.  Six hours and a few vaginal exams later your cervix is “stuck” at 6-7 centimeters dilated.  For some reason, Pitocin was never started or the nurse who was giving your Pitocin did not know how to titrate the drug.

You are told:   “On average we expect you to dilate 1.2cm each hour and here you are 6 hours later and you have only dilated 2 centimeters.  Looking at the monitor you seem to be having adequate contractions and I just don’t think this baby is going to fit.  You have a fever and your baby’s heart rate is now higher than normal. At this point I recommend that you have a cesarean section,” and your cycle of primary to repeat c/section has begun.  I have seen this scenario twice recently.

Mother #1:
Pitocin had never been started on this mother and I tried to advocate for a trial of Pitocin. She was “stuck” at 7-8cm and I had learned in report that the MD had been saying all day… “I don’t think this baby is going to fit.”  While her contraction pattern may have been “adequate” for a mother who was walking during labor and using other techniques i.e. nipple stimulation to increase contractions and to move her baby to optimal birthing position, she had opted for an epidural.  She was having what we call a “coupling” pattern to her contractions. This pattern is often associated with a posterior presentation, a slower labor, and what we call a “dysfunctional pattern.”   Anecdotally, Pitocin can help create a more “effective” contraction pattern in order to help dilate the cervix. This mother’s pelvis felt more than adequate to birth her 6 pound baby. The FHR was fine and my exams showed small but definite progress in the 2 hours that I was her labor nurse.  I thought if only I could give her a little bit of Pitocin.  Unfortunately, the MD disagreed and instead opted for a primary c/section. I later discovered the MD was going out of town in the morning and I believe based on previous dealings with this MD that under a different travel schedule he would have managed this patient differently. (He gives Pitocin to EVERYBODY!!)

Mother #2:
This mother was also progressing at what would be considered a slow pace.  She also had an epidural and her water bag was broken.  She received Pitocin but the initial nurse increased the Pitocin minimally and the mother remained 6cm dilated. At shift change the new nurse was told the MD was considering a c/section. She immediately began to increase the Pitocin (SAFELY) keeping a watchful eye on her contraction pattern and baby’s heart rate.  In less than 2 hours, she was completely dilated and birthing her baby vaginally.

Pitocin may have worked for mother #1 and definitely worked for mother #2.  However, while Pitocin is not always poison, sharing this information was not meant to give you the impression that Pitocin is always the missing ingredient or that Pitocin will be the answer to your delivery question. What I do want you to know is when used appropriately and at the right time, Pitocin can be the difference between a vaginal birth and a cesarean section.  Can Pitocin change your outcome?? YES Will Pitocin always be the answer? NO… it won’t be. Ask questions. Know your options and get informed BEFORE you go to the hospital in labor. By the time you sign your admission consents, it may be too late.

In Birth and Love
Nicole ~ On Twitter @SistaMidwife

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A Quiet Shero for Women and Babies… A Woman’s Intuition Saved us from Big Pharma in 1961

Posted on September 14, 2010 | Leave a comment

I learned of this story from a FB friend.  She sent me a wonderful article about a quiet hero that really made me think about the way we use drugs in pregnancy today.

There was a time, not too long ago when there were almost no regulations for bringing new drugs to the market. New medicines were sent to doctors to try out. Pharmaceutical agencies applied for a permit, and within 60 days the drug was on the market untested and often with unknown risks.

That was the way until Dr. Frances Kelsey worked for the FDA in 1960 and got intimately involved in the application process of a new drug. The William S. Merrell Company of Cincinnati wanted to sell a drug under the trade name Kevadon. At the time, the drug was very popular in Europe as a cure for morning sickness.  The more common name for Kevadon:  Thalidomide, today a CLEAR Pregnancy Category X medication.

While it was never approved for sale, Thalidomide made it into the US population as samples, for “experimental use only.”  Unfortunately the number of doctors with the medication, and the number of women who took it where far greater than initially believed. As a result, THOUSANDS of infants were severely affected.

Times Magazine 1962:  “All this added up to the greatest prescription disaster in medical history. Thanks to the intuition of the Food and Drug Administration’s Dr. Frances Kelsey,* the U.S. has got off lightly because the drug was never licensed for general use… the drug was obtained from abroad… Even so, the testing and marketing of new drugs in the U.S. are now almost certain to get close federal regulation.”

Fifty years later, Dr. Kelsey is being honored for her work. In the current NY Times article about her recognition, they report that Dr. Kelsey had a feeling something was not right. Things did not add up and she continued to research until she found the truth.

“Dr. Kelsey demanded better tests for thalidomide.  She also distrusted Merrell, a company that had a history of confrontations with the F.D.A. …  “I had the feeling throughout the day,” she wrote after a meeting with company executives, “that they were at no time being wholly frank with me and that this attitude was obtained in all our conferences, etc., regarding this drug.” (for a little more about her investigation read the 1962 article here)

While many safeguards where put in place after the Thalidomide incident, in recent years we have seen the FDA move to faster approval of drugs. This has created increasing debate as drugs are approved today, only to be found to have deadly side effects and be removed from the market a year or two later.

“The inauguration of the Kelsey award may also be a telling sign of where Dr. Hamburg stands in a series of internal agency struggles. For much of the past two decades, the F.D.A. has emphasized speed over certainty in its decisions — an industry-friendly stance that plays down safety concerns in favor of getting potential cures to the market as swiftly as possible.

But a series of drug, medical-device and food-safety controversies have led some agency medical officers to insist on better information before approving products and to lobby internally for risky products to be pulled from the market, putting the speed-oriented old guard on the defensive. A celebration of Dr. Kelsey, the patron saint of the agency’s safety-first faction, is bound to cheer those calling for greater caution. “

I hope that this does jog the memory of officials in office and reminder them of the dangers of what can happen when we use and approve too many medications, too often, too fast especially in pregnancy.  Interesting note:  When Dr. Kelsey was hired, they thought she was a man because of her first name.  As history has shown, men have not routinely fought very hard for female issues. I wonder how many babies would have been affected if SHE had been a he.

In Birth and Love
Nicole

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