Inductions of Labor, Babies Everywhere!

Will your doctor force you to induce your labor and have your baby? OR can YOU force them??! Who should have an induction of labor and what happens during them, Sara and Supraja have all the deets. 

Transcript

Supraja: 0:03

Hi,

Sara: 0:03

I

Supraja: 0:03

am Saraand I'm Supraja, and this is Gyn & Tonic.

Sara: 0:07

Welcome back to Intimate Convos with your besties.

Supraja: 0:13

All righty. All right. All right.

Sara: 0:15

All right

. Supraja: 0:17

Hi, Matthew.

Sara: 0:18

You know I finished the Matthew McConaughey book.

Supraja: 0:20

Oh, yeah. Green something. Green light. Was it good? Yeah. Oh, I,

Sara: 0:25

I, I mostly enjoyed it. No? Yeah. I mostly enjoyed it. Cheers. Cheers. What are we drinking?

Supraja: 0:32

Moscato.

Sara: 0:37

Okay. I'm glad that Moscato's just universally funny. Who made Moscato? Who do we think? I don't know. For some reason, I feel like I'm not cool enough to drink Moscato, but like,

Supraja: 0:49

I don't know how to describe it except it tastes like cotton candy made alcoholic

. Sara: 0:54

It's like Welch's grapefruit juice that was refined into a wine Welch's. Sponsor us.

Supraja: 1:01

And did we have other options? Yes. But did we choose Moscato?

Sara: 1:06

It's 'cause Yes. I, my liquor store, I went in one day they're like, we're doing it wine tasting. Do you wanna try it? And I was like, eh, why not? And so she's like, this is a fine bottle of Moscato from Italy. And I was like, really? From Italy? I was like, say no more. Sara. Say that you like, um, Moscato and Italian. Sca.

Supraja: 1:32

Moscato Moscato. Oh wow. That was good. Yeah. Yeah. All right. I kind of feel like your Italian accent is really top-notch.

Sara: 1:42

It's 'cause I'm trying to win over some Italian man's mother, you know, I need her to love.

Supraja: 1:46

Is it just one Italian man's mother?

Sara: 1:49

Anyone at this point, you know, whoever will take

Supraja: 1:51

me. Yeah, I can see you with an Italian man. You know they have some sort of like governmental deal where you can get a piece of land for cheap and like farm it. Yeah. But

Sara: 2:01

you have to live in like a really remote area. In Italy? No, I can't live anywhere remote. Is there a Nordstrom?

Supraja: 2:10

Maybe you can start it.

Sara: 2:11

I'm going to Italy on Friday.

Supraja: 2:13

Ooh.

Sara: 2:14

Very excited.

Supraja: 2:15

Hence, The talking with Italian accents.

Sara: 2:18

!Yeah. I, this is me promoting myself. If there's any single Italian men,

Supraja: 2:21

you're gonna walk in and be like, where's the mozerella

Sara: 2:26

Your mom will love me. No.

Supraja: 2:29

What? Mom doesn't love a SaraMcKenney. Honestly, though,

Sara: 2:31

I, I've had a couple.

Supraja: 2:33

Okay. But didn't we also talk about this?'cause you were like, that's my dream. I'm gonna find a guy you're based in America. So I, I'm concerned about what we're manifesting here.

Sara: 2:42

!I know, but maybe he'll wait for me or maybe

Supraja: 2:46

to return to Italy?.

Sara: 2:48

Actually, when I was in downtown this week, I was like looking lost Uhhuh, and this guy came up to me, oh, I could see he was looking at me and I was like, oh God. Oh God. Oh God. Yeah. And actually it's my dream Uhhuh that a guy will just come up to me and be like, I would love to take you out. Aw. Like you have to have dinner with me. Yeah. Like I want somebody to just randomly approach me. Okay. And so then this guy was doing it, but I was like,

Supraja: 3:10

I'm gonna find, if I ever find you a man, I'm just gonna be like, just pretend this didn't happen. You see her over there, walk up to her and be like, I would really love to take you.

Sara: 3:18

Or they like just start up a convo. Yeah. And then. This guy did that, but I was like, not you. Yeah. He came up to me, he's like, I'm so sorry. I'm so sorry. He's like, I'm about to go rock climbing right now. Would you like to join me? I'd love for you to join me.

Supraja: 3:33

Oh, he sounds hot. What? What was wrong with him? No, he rock climbed. Does he have strong arms?

Sara: 3:38

He wasn't. I just pretended to be like a damsel. I was like,

Supraja: 3:43

that happened to me one time. I was like walking on the street and some guy came up to me and was like, Hey. Do you? Do you wanna go get a drink with me?

Sara: 3:51

Oh, that's my dream.

Supraja: 3:52

That's my thing to do that to me. I said, no, though. And he was actually really hot, but I was, I don't know, I think I was so taken aback. I was like, haha, next time. And he was like, what? Next time? We are just gonna like, walk back and forth on the street like what's happening. But I kind of, not that I, like regret it 'cause hopefully I would've just ended up here with Adam anyway. But I do sometimes wonder like, huh, that was really bold of him and he was actually a very attractive person

Sara: 4:19

one time somebody airdropped me when I was on the T what I was like, my face was focused on my cell phone, uhhuh, and then all of a sudden I get an airdrop and it was a text message. And I was like, Hey, how are you? And I was like, somebody on the train was airdropping me a message. Wow. And I was like, pretend you didn't notice. Pretend you didn't notice. Walk off the train now. And then I walked off the train and I was like, why? Why did I just message back like,

Supraja: 4:44

which one are you? Raise your hand.

Sara: 4:46

It's like those, it's like those memes where you're like praying to God. I was like, God, I keep praying you for a. A decent man.

Supraja: 4:51

He is like, and then God sends you a freaking airdrop on the T where there's no service. He's like, I'm sending, he's like the underground metro if you guys are not in Boston.

Sara: 5:02

He's like, I'm sending you guys on the T. I'm sending you guys to go rock climbing with. Like, what do you want?

Supraja: 5:08

I know someone asked me that the other day, 'cause I am always telling everyone that we need to find you someone. And they're like, is it, is, is it that she doesn't like the people that she's meeting or , she's just not having luck on their side. And I was like, no, no, she just doesn't like anybody.

Sara: 5:22

That's not true.

Supraja: 5:23

I feel like it's, it's often true.

Sara: 5:27

Is this an intervention. No, I think

Supraja: 5:30

your standards are where they should be. Well, do I think your standards are where they should be? They should be. I don't know. I feel like you lower your standards for the wrong people.

Sara: 5:38

!Remember when I did that week of like, I'm gonna date kind of guys that I never traditionally date.

Supraja: 5:42

Okay. What you mean by that is you were like, I'm gonna go out with people I already think are unattractive. Which is not,

Sara: 5:49

it didn't work though.

Supraja: 5:51

Yeah, but that's like not giving someone a chance Who might have one that was like you were picking men who you were like, I'm not at all attracted to him. Kind of, actually feel uncomfortable in his presence, but maybe I will give him a chance

. Sara: 6:03

I did.

Supraja: 6:03

That's not

Sara: 6:04

three times in one week with different men.

Supraja: 6:09

I think you should go with someone you find attractive, but may, I mean, if you find someone super hot, go for them too. You should just bring it down like two degrees, not like 10. Yeah. You know what I mean? All right. Broaden. But don't just be like, anyone, come on in.

Sara: 6:23

All right. That'll keep trying. Well, what are we talking about today

? Supraja: 6:27

I don't know why I have so much advice for you though, but I, I think you're doing great. You can ignore everything I just said.

Sara: 6:32

No, no, no, no.

Supraja: 6:33

We're talking about inductions.

Sara: 6:36

Inductions of labor. Labor,

Supraja: 6:40

yes. So we're gonna talk about that thing that happens when your doctor tells you, or you decide with your doctor, you have to go in and have your baby even though you're not in labor.

Sara: 6:51

Yep. So it's essentially admitting you to the hospital, and giving you medications to get your labor going.

Supraja: 6:57

Mm-hmm. There's so many different reasons that can happen, and some of them are medical indications, like things like your blood pressure is going up, or you have diabetes in pregnancy, or we're worried about your bleeding, or you're not feeling the baby move. So all those sorts of more urgent things we sometimes recommend inductions for just because it's a calculation of whether or not you and your baby are safer with the baby inside or on the outside,

Sara: 7:29

and sometimes we can anticipate an induction is gonna be happening and I tried my best to give people advanced notice. Like if I know somebody has high blood pressure even before the pregnancy, I will let them know, you know, for this condition we traditionally induce around 39 weeks so that the patient's prepared. But there are instances where it happens. All of a sudden you come to a visit and. Your blood pressure is now high for the first time, or your, , diabetes medications, your insulin is no longer working or you're not feeling the baby move no matter all the things we do. And so sometimes it can be all of a sudden and that can be really overwhelming to patients.

Supraja: 8:06

Yeah, the paradigm around inductions has shifted so much and people get information from all sorts of places. So also people have a really range of emotions about it. Some people are like, , I cannot be pregnant any longer. Let's get this baby out. Other people they just really don't want any more interventions than they absolutely have to have. Yeah, and that's a really painful thing for them to imagine.

Sara: 8:29

I'll definitely get people begging for inductions. Yeah. By like 40 weeks, even. 37, 38 weeks. But then I'll have other people Yeah. Sob once I tell them, I do think you should be induced. Yeah. And they're really upset by it.

Supraja: 8:41

Yeah. And of course it's always like an autonomous decision of like, it's your body, it's your baby. No one can force you to do anything. Mm-hmm., and it's also really important, for people to really understand the recommendation because. Pregnancy and especially the end of pregnancy, I think gets like so scary for people. It's like such high risk. I've also really, sadly, had a lot of people tell me later, like, friends, , be like, you know, I kind of felt pushed into it. Like I thought I could have waited longer. And then they'll tell me the story of, what happened, like my blood pressure was going up, but it wasn't that high. And I, and I'll have time as a friend to be like, Actually, you know, that's , that is what's recommended for all these reasons. This is what we're scared is gonna happen and they'll be like, oh, well if they said that, I would've felt way more comfortable, but I just felt like I was kind of pushed into a decision. And then they have to live with it. Yeah, they have to live with everything that came out of something when they're not sure if that was the right decision for them. It's really important to like recognize you're always within your power to ask questions and understand, ask about the pros and cons, ask if there are any other options. And really feel good that you're coming to the choice that, you know, you're gonna look back on and be like, I did this 'cause this is what had to be done.

Sara: 9:52

Yeah. And I, and I always tell people that , you're the boss. You make the decisions. My job is literally just to give you information. You make the decision based on what you think is best for you and your family. And I will be very honest with people, but like I'm really concerned actually some people will say, can we stretch it a few extra days? And you know, sometimes we can. And other times I'll say, I really don't recommend that. We obviously can, but these are my concerns and we'll talk about those.

Supraja: 10:18

Yeah. And so some of what we were saying is that there are these medical conditions, and that's not an exhaustive list, but that's some of them where it's safer to have an induction than to stay pregnant both for you or for the baby., but then there's also what we. Used to call it elective inductions. Now sometimes we say risk reducing inductions. That all came out of this thing called the ARRIVE trial. Yeah, so essentially, which I love the name of that

Sara: 10:43

ARRIVE

, Supraja: 10:43

ARRIVE,

Sara: 10:44

but essentially, This study was really helpful because , one of the things that used to counsel patients on is, you know, your best chances of having a vaginal delivery is if you come in in your own labor versus me inducing you. Mm-hmm. This study kind of helped change that original thought

Supraja: 11:00

and showed for certain group of people at least, Actually having a risk reducing induction might lower your C-section risk.

Sara: 11:09

Yeah.

Supraja: 11:10

And it's hard to know how to generalize that because it is so different than a lot of the information we were taught before that, but it was like a really good trial with some strong evidence. So, Sara, remind us who was in this study?

Sara: 11:23

People in this study were women between 23 and 24 years old. It was their first time having a baby and their gestational age was somewhere between 39 weeks and 39 weeks and 4 days.

Supraja: 11:36

So this is like so specific.

Sara: 11:37

It's very specific. So, you know, can we apply this, these same results to somebody like me, 35 years old? They had very specific. Parameters in terms of who could be included in this study. Mm-hmm. So I think this study was great because it made me feel more reassured about inducing certain women. But I don't know if we can necessarily apply that to all groups of women, but it's, it's exciting to know,

Supraja: 11:59

because what it showed was that it actually showed a decrease in C-section rates and inductions over spontaneous labor and the induction arm, there's only 18% C-section rate versus 22 in the spontaneous labor. And that there was also a reduced risk of other complications like respiratory support needed for the neonate. And also A big one we think about a lot is maternal outcomes, especially of hypertension, like developing hypertensive diseases of pregnancy. So, I feel like, especially with people whose like blood pressures are kind of labile or creeping up, this study just helped support we should probably just get delivered , sooner than we used to think because we've always kind of used this induction interval and people who don't have a medical reason to get induced sooner between 39 and 41 weeks., after 41 weeks, your risk for both the mom and the baby start to go up and at 42, like really significantly, including the risk of intrauterine fetal demise,

Sara: 12:59

like a stillborn. Yeah. I think this was a great study.' cause people worry, well, if you induce me and my body's not ready for it, Is there a higher chance I'm gonna have a C-section? And I think that's what I had always been grilled into me as a resident. Yeah. And then when this study came out, I felt more reassured saying, actually no, not in certain specific groups.. Studies like this are cool because we I love stuff like this.

Supraja: 13:23

Yeah.' it's hard when there's conflicting evidence, Just do what's right for you then. But I think that's what, there's no wrong answer, you know,

Sara: 13:32

but I think that's what's very unique about obstetrics. Mm-hmm. It's not textbook it, there's a lot of things that are very. You know, some, the way we practice is based on our experience and who trained us and the population we work with, there's so many things that come into play. Mm-hmm. That there's not one specific answer for every

Supraja: 13:51

person. Some things there objectively gonna put your baby at a lot more risk. So some things it's like, no, but. Other things it's way more gray. Yeah. Yeah.. Okay. So I wanna talk about what happens during an induction because people don't always have it clearly set out of like, this is what happens and this is what happens, and this is what we do and this is what we do. And it's actually pretty straightforward. There's just a few things and those are our tools and we use them every time. So method of induction, which tool you start with and how you progress depends on a lot of different things. Like if you've had a baby before, What your cervical exam? I'd say that's the biggest one, what your cervical exam is. Any other medical conditions that might preclude certain things, but say it's like your first baby and you have like a one centimeter cervix because you're trying to go from closed to 10 people start on the side closer to one usually, and then at 10 is when you start pushing. Um, so if that's the case, we'd start with ripening agents. That basically make your cervix softer and more willing to change. And people have heard of it, I think it's like misoprostol. Yep. Is the, the most common one. It's a prostaglandin

Sara: 15:03

tablets that we put into the vagina, very small white tablets.

Supraja: 15:07

Mm-hmm., there's also like, Dinoprostone there's like a few variations of that. But there are prostaglandins and the one people use most commonly, the misoprostol, you get a little tablet goes in the vagina, and then you can do that every four hours for like a max of 24 hours, oftentimes it's not the whole 24 hours and some people will start contracting with that and get more painful, but a lot of people not that much. Like the point of it is really to ripen the cervix, get it ready to change.

Sara: 15:34

Yep. Okay. And then while you're using the misoprostol, you can combine it with other things. So misoprostol is a medication, but you can also combine it with like mechanical methods as well. Mm-hmm. Like a balloon. Um, and I think there's always a lot of word, because sometimes I'll say balloon and people will be like, no, I was told not to get that one. Yeah. I'm like, who told you that? Lemme talk to them. Oh, no.

Supraja: 16:00

One of my friends said that was like the most excruciating part of her labor. Like, not even having it, just the placement Yeah. Can be tough. And other people like, People in some places get it done outpatient, go home with it. So like everything, any more invasive procedure, the breadth of experiences is really diverse. If you're someone who's really sensitive that's something to consider or consider if you need any pain control for it. But basically that idea is that you have a balloon placed through your cervix to sit on top of the cervix to literally like act like the baby's head. Pushing on the cervix to manually dilate it enough that the balloon's gonna come through.

Sara: 16:40

Because when it falls out, which usually takes anywhere from like four to eight hours, sometimes longer, sometimes shorter, the cervix can go anywhere from one centimeter to three to four centimeters. Mm-hmm. So it saves time in your induction, it speeds it up. And it also means you can stop the, the cervical ripening medications like the Misoprostol because. You don't need to be ripened anymore. You've already been dilated and you can switch onto the next medication.

Supraja: 17:05

Yep. And the next medicine is one I think people talk about a lot, which is Pitocin. And Pitocin is a medication that goes in through your iv. It's the synthetic form of oxytocin, which is the hormone your body makes to make you have contractions. Just the version of that we put in through an IV so we can control. How strong your contractions are and how often you're having them. Um, and that for most people tends to like run until you have your baby. I mean, there might be times where it's turned off or turned down, but in general, that's the mainstay of the rest of the induction. And I, I think And augmentation. Sometimes I'll get a little pushback from, you know, patients or concerns. You know this, I don't want that medication. It's gonna make me uncomfortable. And I tend to let the patient know you are 100% correct. This medication is going to make you uncomfortable.'cause its whole purpose is to mimic the natural hormone that your body produces to put you into labor. And unfortunately, labor is uncomfortable. Mm-hmm. And what's uncomfortable is you're now starting to have regular contractions that are painful because it's usually regular painful contractions that get your cervix to open up to ideally 10 centimeters. Um, yeah. And so that, that's the whole intent of the medication, unfortunately. Yeah. That's just labor. I know. I always feel so bad when people are like, oh, I'm in a lot of pain in labor. And I'm like, oh, really? And then I was like, oh, wait, sorry. I know that. I know that's not like a positive thing, but it just means hopefully your cervix is changing. It's a weird thing being on labor and delivery or it's like when babies pee after they're born, we're like, yay. They're peeing. Like, okay.

Sara: 18:39

But the other thing I tell people'cause, I think some people wanna really minimize how much medication they're using for many reasons. Sometimes people just get one inducing agent, one tablet, and they go into their own labor. Sometimes you just get a little Pitocin and you go into your own labor and then we don't need those medications anymore. Sometimes that's not the case, but sometimes it is, and only time will tell what your body does in response to these medications. Yeah. So committing to an induction does not mean you are getting medications the entire time you are being induced. Sometimes you just need a little bit of medication to, jumpstart your body.

Supraja: 19:10

Yeah. Although a lot of people do. Correct. Yeah.'cause I think too people are like, I wanna do it naturally. Even just the use of the word naturally kind of bothers me.

Sara: 19:20

'cause I'm like, I hate the word natural. Right? Yes., Supraja: it just is all natural. Like you're having a child, we all take medicine at different times, you know? It doesn't reduce the experience to have modern medicine like that. I don't feel that way, but I understand other people have different feelings, but especially if you come in for an induction, you're kind of saying you want some interventions for whatever reason to have your baby. So, the term natural. It doesn't always like, it doesn't necessarily make sense. Natural to me means you're birthing in a field. Yeah. Like, I don't know what natural means. Like there's nothing, I live in a home that's made by bricks. Yeah. By other who made, but like, it's not natural, like, right. And so, and to me it's, it's upsetting because I, I, I then see women who come in with experiences where they're disappointed in themselves because they didn't have this natural delivery. Mm-hmm. And that makes me sad when my patients, when they feel. Stigmatized or pressured by what expectations of other people are. You know, I just tell people my goal is just to have a healthy mom and healthy baby and the birth experience that you want. But like, the word natural. It really like, it riles me up.

Supraja: 20:25

Yeah. Like there's a way that's more correct, or it implies that there's less risk. Or that you allowed the system to be more important than like you and your baby. I just think all of those judgments are crazy, but Okay. Types of induction methods. So we've said prostaglandins, which are the softening agents, Pitocin balloon. And then the last tool that we have is breaking your water. So that we try to usually do around the time of

Sara: 20:49

actually when I was on call when you were on call, one of the maternal fetal medicine doctors told me you can do it earlier yeah. Because that big study had just come out.

Supraja: 20:59

Yeah. I always learned for a multip that's like all they need. You wanna do that right away. Relatively and that pushes them over. But even in someone who's not a multip.

Sara: 21:10

Correct.

Supraja: 21:10

So even in someone who hasn't had another baby yet, that we should be going toward doing it sooner versus later. And that might really improve people's time to delivery.

Sara: 21:19

And it's kind of funny when you share. Stories with people, like friends at other hospitals. Yeah. They're like, no, we rupture everybody at two or three centimeters. And I'm like, I don't rupture them until there's six to seven centimeters and it just goes to show it's also cultural. Yeah. It's cultural where, where you work, it's, there's no standard way. Yeah. And so I always tell people like, just talk to your doctor. Ask what the options are, what, what you can do.'cause there is no one golden way to do something.

Supraja: 21:43

Right. Okay. And then people are always scared of the risks of induction. Is there gonna be some sort of crazy emergency? That means that I have to have a C-section immediately And I think. It is possible just in labor in general. It's very unpredictable, but for a lot of these tools, we have ways to fix problems that might show up. Pitocin, for example. It's very short acting. We can just turn it off and we can give you a medicine called terbutaline, which stops your contractions. There's things like giving you fluids, giving fluids back into the uterus through something called an amnioinfusion. There's positioning the, birthing person differently to allow the baby to, you know, if they're on a cord or something to get moved off the cord. So there's lots of solutions and I think the thing is , sure induction is making something happen that hasn't started, but you're going through the process you would be going through even if you went into, into labor on your own. Like it's not stressing it out more than. The reactions you would be having if it had started on its own. Yeah. It's like mimicking the spontaneous labor. It's just using interventions to mimic that. Yeah. Yeah. Okay. So , okay, Sara, how do we decide if it's not working? The induction is unsuccessful,

Sara: 22:57

so, you know, when do we say like, okay, that's it. Like, so we have some guidelines that help us.'cause ideally a patient is making progress. They're going from two to four to seven centimeters, 10 centimeter. But sometimes that doesn't happen actually. Yeah. And so how long do you give somebody at a certain cervical dilation? And one, you wanna make sure you've tried like every method to induce this patient. Some of those methods include making sure you've broken their bag of water, because sometimes the medications aren't gonna be enough and you gotta do that as well. And, Uh, we tend to say the patient should have had their bag of water broken for at least 18 hours before you say this has been an unsuccessful induction, and they need a C-section. Mm-hmm. Other things you wanna do , in addition to that is make sure they're on pitocin specifically, for at least 12 hours after they've broken their bag of water. Um, and then while they're on the,, Pitocin, you wanna make sure are they having the kinds of contractions we would expect. And if they are, they probably don't need as much time as somebody else because if they're contracting well and regularly, maybe it's something else that we're never gonna be able to change, such as like the way their bones are shaped, or how the baby is coming down, or the size of the baby. Those things are out of our control. If the patient is having inadequate contractions, meaning we just can't get them strong enough no matter how much medication we're giving them. You can give them a little bit longer, but technically you don't have to stand by these specific hours. Like I have definitely gone beyond these hours for patients when you know, we are both motivated to have a vaginal delivery and the baby and the mother look well. There's no concerns for, either one of them being in danger and additional time is safe in that situation.

Supraja: 24:41

Yeah. And maybe there's a factor that changes, like maybe the baby's coming down with the head in one way and then it, you're able to turn it, or the baby turns on its own. It's now in a different position slightly, and that makes things, that changes the whole ball game. Or maybe you think. It's been four hours and you're about to say it's failed, but then you have a huge amount of progress. You know, there's always individual factors that tweak it. People are always asking me is there a time? Yeah. Where it's like it's over and I'm like, honestly, no. People especially ask if I break my water at home, is there a time period where I have to have a C-section? And I'm like, honestly, no. 24 hours after your water has broken, if we're not moving towards delivery, because you don't want things to get infected. You don't wanna wait for distress in the baby or the mom. But there's no hard and fast cutoff. It's individual. Yeah. And, and it's a joint decision again.

Sara: 25:36

Correct. We're, again, we're just giving you information based off what the average person does, but there are people who sit on either side of that bell curve. And I've definitely, learned so much from those patients where I'm like, wow, I waited double the time. I would've normally waited. And that patient had a vaginal delivery. Thank goodness we waited. Mm-hmm. You know, we, we had reassuring signs the whole time. And I think things like that make me feel reassured and teach me, every patient's, just individual. You have to just take each patient as an individual in many scenarios. It's safe to keep going unless the baby does not look well on, the fetal monitor, and you're, you're worried or the mom suddenly doesn't look well. She has a fever that she can't break. Her blood pressures are uncontrollable. You know, there's many things for either, either one of your patients that could change, the time you're gonna allot to keep going for the induction.

Supraja: 26:25

Yeah, I think that's a great point. There are some situations where we know if it's a true, true emergency. The time from that emergency to having the baby delivered is really important. But those things are true emergencies and less just a general understanding of, oh, this started however many hours ago. Yeah. Um, okay. And then if you have to have a c-section, What's that like? You know, I remember my first week being on L&D as an intern, that's a first year resident. One of the nurses came up to me , and was like, your hips are really small. You're definitely gonna have a C-section.

Sara: 27:03

I've had people say that to me too,

Supraja: 27:05

that's so rude. And it has stuck in my head. I don't wanna even give her that much power, but I feel like she's shaped how I've envisioned my labor. I'm like, crap, I'm not gonna be able to do it.. And I know better than to think it's all even about that, or even that predictable. Like you'll have like the tiniest hipped people come in who like push out their baby.

Sara: 27:24

I've had multiple people say that to me. You're too skinny, you're ob, you have narrow hips, you're obviously gonna have a C-section. Like, like what? Well, and okay, what if I do?

Supraja: 27:33

Yeah. What if I do? And also, you know nothing about it. And like,

Sara: 27:37

I just think it's mean. Yeah. Really. I'm, what, what are you getting out of telling me this? Do you feel better about yourself? I, I'm projecting now. I'm just like, now my resentment's coming out crazy. But I just think it's so unfair for people to make those, I don't know.

Supraja: 27:48

Like, just to put that in your head, the assumption is that there's a right way to do it. Yeah. And that you will not be able to because of what they're assuming about your body. Like all things are incorrect in that, in that schema that we're presenting, but Yeah. But anyway, if I do have a C-section, that'll be fine.

Sara: 28:07

Same

, Supraja: 28:10

but we never want, I mean, I don't really want it for anybody.

Sara: 28:13

No, never.

Supraja: 28:14

Who wants to have a major surgery when you don't have to.

Sara: 28:16

Yeah,

Supraja: 28:16

but we, I guess we also just know like sometimes. I just, I just think having a baby is magic. We try to predict it, we try to understand it, but we just at the end of the day, don't have that much control over how people come into the world. Like we just don't, um, and always are valid ways. Yeah.

Sara: 28:35

And I just stress to my patients , this is just like you said, out of our control. I'm so glad, , You and your baby are here. You're both. Well, yeah. Like, that's my, that's my ultimate goal at the end of the day., and you know, c-sections save lives. Yeah. They really do. And we're so fortunate that we have all the resources we need to be able to do them here. Yeah. And so, um, but yeah, so if you do end up needing a c-section, That's okay., it's generally done on the same floor where your induction was being done, usually labor and deliveries have their own operating rooms., they usually take about an hour. You are awake. They give you an epidural if you don't already have one. Very uncommonly, do they need to put you under general anesthesia?

Supraja: 29:14

Mm-hmm. Yeah., if you had a vaginal delivery after delivery, you're usually in the hospital for one to two days. Yeah., if you had a c-section somewhere between two and four days,

Sara: 29:24

I always tell myself I'd just, you know, go home after 12 hours.

Supraja: 29:28

We used to discharge people, after 24. I'm just like, I wanna sleep in my own bed. I don't wanna sleep in this bed. I don't wanna sleep in., yeah, but you're not gonna know, like babies aren't always,

Sara: 29:38

my mom will stay with the baby. Okay. I'm just kidding.

Supraja: 29:42

Sara's mom will stay with your guys' babies if you feel like you wanna go home.

Sara: 29:46

She's for hire if you need a night nurse. Okay. I'm just kidding.

Supraja: 29:49

Oh my God. A night nurse just gets better and better. Maria's all talented.

Sara: 29:54

I mean, she's a, she's the best Peruvian there ever was. Aw. She's taken care of me.

Supraja: 29:58

She was such a cutie. Okay. So, However this went. I would say every pregnancy is different. Doesn't necessarily mean that you have to get induced again if you end up having a C-section. Doesn't necessarily mean you need another one. But there's lots of individual factors that change it, and certainly it is true that like when things happen one way, the risk of them happening again is increased, but just increased from baseline. That doesn't mean it goes from like 1% to like 99%, you know? It's still just conversations to be had

. Sara: 30:28

Yeah

. Supraja: 30:29

All right.

Sara: 30:30

All right.

Supraja: 30:31

Okay, we're gonna go down this bottle of Moscato. Come over later. If you wanna hear us talking in horrendous Italian accent.

Sara: 30:43

I'll bring up my family guy. Italian accent.

Supraja: 30:45

How do I say goodnight?

Sara: 30:46

eNote

Supraja: 30:47

eNote.