If there's one thing I truly don't understand it's why people continue to spend their money on care providers who they are either dissatisfied with or scared of.  Come on, they're called care providers because they are supposed to provide us with care.

It seems I hear these types of scenarios all the time: A mother hiding the fact that she hadn't weaned her baby from her pediatrician.  Another lying about how long her water has been broken when arriving at the hospital.  Yet another abandons her birth plan when the doctor yells and belittles her choices. 

We need to speak with our dollars.  The medical community shouldn't be any different than any other industry.  When you go to buy a car and the salesperson is incredibly offensive and rude you leave.  At least I hope you would.  If a restaurant wouldn't give you the food you wanted you would demand your money back and never return.  Why should doctors, hospitals, midwives, and nurses be any different?

Withholding your dollars from care providers you don't agree with will send the strongest message.  First of all, it's not really fair to withhold your true opinions from your care provider.  They don't know how to help you if you don't make it clear what you want.  If you're going to be asking for a professional medical diagnosis then they need all the information.  When enough patients stop going to a rude or inflexible person, then that person will have to change or become unemployed. 

As an example, when hospitals started losing money to out-of-hospital birth centers and home births, they changed the labor and delivery rooms to look more home-like.  They installed labor tubs and bought birth balls.  There's no reason why consumers can't continue to push for what they want.

Walking into a medical office or hospital shouldn't make us lose our backbones.  They're not our bosses; they're our hired help.  That's not to say medical professionals aren't smart or skilled, because I'm sure most of them are.  The point is that they need to remember not only the ethical considerations of things like personal autonomy, but also the economics of pleasing the customer. 

I hope you never feel like you have to do what a medical person tells you to do.  Get information from them, weigh your options, and then make the choice that is best for YOU.  After all, you're the one who has to live with the consequences of the choices you make for yourself or your child.

Hopefully, you've had wonderful, empowering experiences in the medical community and have no idea what I'm talking about.  If so, here are just a few stories where patients should have spoken with their money and hired providers that treated them with respect.
Improving Birth
Mother is Forced to Have C section
Mother is Refused a C section

Maybe you're thinking, "But what if the patient makes a bad decision and the care provider gets blamed for it?"  You should read my post about personal responsibility.  In short, they shouldn't.  We shouldn't sue when a care provider does what they were hired to do.  Let's remember that they're not gods, and tragedy can happen no matter what.  It's better if we own our tragedies. 

Oxytocin is a multipurpose hormone our bodies produce at times of pleasure.  It makes us feel good.  Specifically, it makes us feel connected, bonded, and it's called the "love hormone".  It plays an important role in birth, lactation, and sex, as well as sharing a meal with a friend or receiving a hug.  In babies, it is involved in brain development.  They grow up to become social creatures partly because of oxytocin.

When it was discovered that one effect of oxytocin was to produce uterine contractions the obvious use for a synthetic version was clear.  The oxytocin molecule is actually not very complicated, so laboratory versions were produced to help start and speed up labor.

Today, synthetic oxytocin, called Pitocin, is used extravagantly to induce and augment labor.  Pitocin and oxytocin are spoken of interchangeably, but they are not the same thing.  It seems like such a wonderful thing to be able to create useful contractions with the drip of an IV.  There are questions, however, that have either not been adequately answered or not even asked about its effects.

The Blood/Brain Barrier
Oxytocin made by the body is produced mostly in the brain.  There is something called the blood/brain barrier which keeps some molecules in the blood stream out of the brain.  When Pitocin is given it is through an IV, so although it acts on the uterus it doesn't affect the brain.  This can make it harder for a new mother to adjust to motherhood.  The oxytocin that would normally be released increases mothering behaviors.  Could this lack of oxytocin in the brain contribute to postpartum depression and lack of bonding between mother and baby?  It's certainly something to be considered.

Effects on Baby
We know that Pitocin does not have the same effect as oxytocin.  For instance, oxytocin is released in small pulses, which is why contractions only happen every 3-20 minutes for only about a minute.  Pitocin is released in a more steady drip, causing contractions to be stronger, longer, and closer together.  This is what the goal of an induction or augmentation is, after all.  These increased contractions can be too much for the baby to handle.  Sometimes the uterus can even become so stimulated that it can't relax.  Without the breaks between contractions that allow blood flow to be restored the baby is in danger of being stressed and being rushed for an emergency C section. 

Contractions and Only Contractions
When mice who didn't have oxytocin were studied they showed much less maternal behaviors than normal mice.  This includes not being able to feed their pups.  The strange thing is, they were able to deliver their pups normally.  This lets us know that oxytocin has a role in labor, but it's not the hormone that kicks it off.  Our modern understanding is that proteins from the baby's lungs begin the complex labor process once they're ready.  Ironically, modern obstetrics is using it for the one thing it does NOT do, which is begin labor!  This explains why so many inductions actually fail.  Your chances of a successful induction improve with a favorable cervix, which Pitocin does not do.

Long-Term Consequences
There are definitely consequences to both mom and baby in labor with Pitocin, but what about effects in the long run?  In Oxytocin Pathways and Evolution of Human Behavior by Carter, there are startling if not altogether unexpected consequenses of oxytocin given in large doses, especially at a young age. 

"There also is increasing evidence that the effects of exposure to exogenous oxytocin are not
necessarily associated with increases in positive sociality. In prairie voles a single low-dose oxytocin
injection given on the first day of life facilitated pair-bond formation in adulthood. However, high
doses of oxytocin had the opposite consequences, producing animals that preferred an unfamiliar
partner (Bales et al. 2007b). Repeated exposure to oxytocin early in life in pigs also disrupted
subsequent social behavior, under some conditions producing piglets that were less capable than
normal animals of appropriate and reciprocal social interactions (Rault et al. 2013). Oxytocin
given intranasally to prairie voles during adolescence also did not reliably facilitate social behavior
and, once again, at some doses disrupted the tendency of this species to show a partner preference
(Bales et al. 2013). "

This brings to mind the seemingly anti-social behavior many of us have noticed in the younger generation.  Could the huge doses of Pitocin around the time of birth interfere with brain development?  Perhaps the reliance on technology is a byproduct of a reduced ability to connect with other people.  It's at least plausible enough to consider.

Pitocin use in labor has been associated with autism, and those with autism show changes in their oxytocin receptors.  Since we know oxytocin acts on behavior, it wouldn't be surprising.  Labor where Pitocin was used increases a baby's chance of autism.  It's especially pronounced in boys, where the risk is 35% greater.  Hopefully these implications will be studied further.  It is important to remember that our bodies are very complicated, and adding a large dose of a hormone at a very sensitive time should definitely only been done if it has been thoroughly studied and the benefits outweigh the risks.

I'm not saying that an induction or augmentation is never warranted, or even that Pitocin isn't the best choise for it.  I mainly wanted to point out that PITOCIN IS NOT OXYTOCIN.  It's a drug, and should be used with the same level of informed consent as any other. 

What is gestational diabetes?
During pregnancy glucose (sugar) is released at higher levels into the blood stream.  This makes sense, because the developing baby uses this sugar as an energy source for development.  One of the more common diagnoses during pregnancy is gestational diabetes.  About 7% of all pregnant women will be told they have it.  It's when you have more glucose circulating in your blood than we think you should.  (The exact “right amount” is currently unknown).  This is different from diabetes that existed before you were pregnant and has different outcomes. 

How is it diagnosed?
Some women are at such low risk they won’t be tested at all.  For most women, though, around 26 weeks you’ll be asked to drink a glucose-containing drink and your blood tested before and after.  If your level is high another, longer test is done and if two values are high the diagnosis is made.

How will it affect my pregnancy?
Often, a pregnant mother with gestational diabetes is counseled about her diet in order to bring her blood sugar numbers under control.  You likely will be asked to keep a food diary and learn to take your own blood sugar numbers at home with a finger stick.  If you can be strict about limiting carbohydrates you often won’t need any further medication.  If diet doesn’t work, insulin or other medications can be used.  These have side effects on the baby once born, but the benefits may outweigh the risks depending on how high your glucose is and your other risk factors. 

How will it affect my labor?
Likely, it won’t.  The most common intervention faced by women with gestational diabetes is pressure to induce labor early.  Since babies born to mothers that have gestational diabetes are on average heavier, the idea is to limit complications by delivering a lighter baby.  However, induced labors more often end in a cesarean and the risks of a premature or baby that is “not quite ready” should be weighed against the supposed benefit of avoiding a “big baby”.  Stillbirth may be increased in certain mothers with gestational diabetes (although this association is uncertain), and you can read more about that in another article.
 
As someone who has personally attended births of mothers with gestational diabetes who had a normal or even low-weight baby at term, I would make sure mothers understand the diagnosis does not guarantee a big baby and a big baby doesn’t even necessarily pose a problem.  The thing your doctor or midwife will be on the lookout for is shoulder dystocia, or where the shoulders get stuck once the head is born.  This is unpredictable, and most often is remedied by quick action of a trained attendant.

What about after pregnancy?
Women who were diagnosed with gestational diabetes are more likely to develop type-II diabetes later in life.  After pregnancy you’ll be checked to see if your glucose levels have returned to normal or are still high.  The bad news is that there’s about a 50% chance you’ll later have diabetes, but the good news is that there’s a lot you can do to prevent or delay it.  Diet and exercise are the first step in reducing your chances of developing diabetes, and in this way, your pregnancy may have given you a “heads-up” on ways to improve your future health!