As inductions went up, so did C-sections.

I am a reality show watcher. I love E!, especially. The shows are so bad that they are good. My husband and I (okay, I) love yelling at the screen when people do really stupid things. But over the holidays, I was doing more than yelling. I actually started to cry. The show: Kendra, the spin-off of The Girls Next Door. The problem: they induced her a little early, resulting in a C-section. The entire time I was watching, I was telling at the screen: “Don’t do it! Inductions rarely work! You’re going to end up with a C-section.” Which is exactly what happened.

I’ve written about this before. According to the National Vital Statistics Report by the U.S. Department of Health & Human Services, the rate of inductions more than doubled over the past 20 years. It was 9.5 percent in 1990. It was 22.3 percent in 2006. I’ve also recounted the stats that The March of Dimes is trying to get out there: that babies shouldn’t come out until they are ready. Late preterm infants (babies born between 34 and 37 weeks) are:

• 6 times more likely than full-term infants to die in the first week of life (2.8 per 1,000 vs. 0.5 per 1,000)
• 3 times more likely to die in the first year of life (7.9 per 1,000 vs. 2.4 per 1,000)
• Often weigh between 4½ and 6 pounds, and they may appear thinner than full-term babies.
• Remain at higher risk than full-term babies for newborn health problems, including breathing and feeding problems, difficulties regulating body temperature, and jaundice
• More than three times as likely to develop cerebral palsy and are slightly more likely to have developmental delays than babies born full term.

But doctors continue to do scheduled inductions and, when those inductions fail, C-sections at 37 weeks. Some just skip the induction entirely and do the C-section from the start at 37, 38, 39 weeks. (And The March of Dimes and researchers says 38 and 39 weekers aren’t a good idea, either. Check out this great March of Dimes feature: Why The Last Weeks Count.)

Right now I’ve got a friend who is pregnant. She was due on January 7. She had a C-section with her first baby. Now she’s trying for a vaginal birth after cesarean (VBAC). Amazingly, her doctor is letting her go one week post-date. He knows that most first-time moms are a little late. (And since she never delivered vaginally, as far as her cervix is concerned she’s a first time mom.) I am so impressed with that doctor and with my friend. She’s been done for a while. She’s got a 19-month-old, and running around after him tires her out. But she wants to have a third baby, and she doesn’t want to take on all the risks that a second and third C-section entails. So she’s waiting. And the doctor isn’t pressuring her or pushing her.

I wish Kendra Wilkinson’s doctor was as kind. I wish he let her body do what it needed to do. Yes, her baby was large, but that doesn’t mean she wouldn’t have been able to deliver him. Or maybe he would have been one of the 15 percent of people who the World Health Organization expects will have C-sections. (Yes, that’s right. The WHO recommends that countries set a goal of a 15 percent C-section rate. Sort of stinks that, right now, the U.S. rate is 31 percent.) But she’ll never know, will she? In the meantime, if you’re reading this please think good thoughts for my friend. She’s only got 24 hours before her scheduled C-section.

Are you a mom? How did you deliver your baby? Did you have a choice? Did you ever feel pressure to do one thing over the other? Talk about it below.

Being born is hard enough. We need to give our babies the best chance possible.

I’ve written about it before: Both my kids were a week late. And both times my midwives and the doctors they worked with were pressuring me to induce. (Well, the second midwife not-so-much, but she did say she had to induce if I went past that weekend.) One high risk doctor told me he would have induced Keira, my youngest, at 37 weeks. If he had, she would have been classified a late preterm birth, one of a growing category of preterm babies here in the U.S.

You might not think a baby born at 37 weeks would be considered preterm, but it is. And unfortunately, even late preterm babies are at risk for a host of problems, according to the March of Dimes. Late preterm babies are:

• 6 times more likely than full-term infants to die in the first week of life (2.8 per 1,000 vs. 0.5 per 1,000)
• 3 times more likely to die in the first year of life (7.9 per 1,000 vs. 2.4 per 1,000)
• Often weigh between 4½ and 6 pounds, and they may appear thinner than full-term babies.
• Remain at higher risk than full-term babies for newborn health problems, including breathing and feeding problems, difficulties regulating body temperature, and jaundice
• More than three times as likely to develop cerebral palsy and are slightly more likely to have developmental delays than babies born full term.

That’s why, while it’s easy to be tempted into letting a doctor or midwife induce, it may not be in the best interest of moms or babies.

November is Premature Awareness Month. Want to learn more about why you should hold off whenever possible with artificial inductions? Here’s a quick Q&A with Janie Wilson, MS, RN, Women & Newborns Director of Nursing Operations at Intermountain Healthcare in Salt Lake City, Utah, a not-for-profit hospital system that is responsible for delivering 53 percent of all babies in that state. Recently, the organization implemented a program to reduce unnecessarily early labor inductions with amazing success.

KB: Why are so many women delivering via induction today?

JW: It’s a combination of doctors and women. Women don’t want to be pregnant anymore after 36 or 37 weeks. Meanwhile, if a doctor selectively induces you on Thursday morning, he or she won’t be at the hospital at 2 a.m. on a Saturday night.

KB: What’s the risk of inducing before 39 weeks?

JW: We, as a country, are electively inducing women at 39 weeks when their cervix isn’t ripened. But if you do this, those same women may have a long, protracted labor, along with an increased risk of C-section and morbidity.

KB: What has your hospital done about this?

JW: We’ve got a guideline that says we do not electively induce a first-time mom until they pass the 39-week mark and have a Bishop’s score of 10 out of 13. This score takes into account five components of a vaginal exam: cervical dilation, effacement, consistency, and position along with fetal station — how far down the baby’s head is. We require both because due dates are just an estimate.

KB: What would you tell an expectant mom who is consider induction — whether it’s coming from her or her doctor?

JW: Some women will go wherever the provider will lead them. But this is not like scheduling your nail appointment. You have to make your own decisions. There are associated risks and costs that go along with inducing early. If you wait until your body is actually ready to deliver you will generally have a much better outcome.

Just look at what we’ve accomplished. Since 1999, our percentage of all inductions before 39 weeks has dropped significantly, from approximately 28 percent to only 3.4 percent. We’ve also seen a 90-minute drop in the average length of labor in electively induced patients, with fewer emergency cesarean sections and other medical complications associated with deliveries. Our average length of stay has dropped three hours. Today, our primary C-section rate (the rate of first time moms) is almost zero. We have really changed our culture for the better. Women should demand the same outcomes for their own births.

The March of Dimes this week released its Premature Birth Report cards. Alarmingly, the majority of states received an F; not a single state got an A. One state — Vermont — got a B. To learn more about prematurity, or to get involved with changing this dangerous paradigm, join the March of Dime’s National Advocacy Network by clicking here.

I got the flu not once but twice when I was pregnant with Little Girl. I coughed almost non-stop from January through March. It was horrendous. All that coughing lead to leaking. It was so bad that I tried using panty shields, pads, wash cloths, but nothing worked until I sent my husband out to get Depends. I was crushed. Wearing Depends in my 30s. How could this be? I spoke to my midwife who told me I would get better once I stopped coughing. It was stress incontinence, she said. She also said that — once the rather large baby wasn’t in there pressing down on my bladder — I’d stop even the little leaks, too. Little Girl was a big baby, but her older sister, who clocked in at 8 pounds, 5 ounces, had stretched the muscles of my pelvic floor. It was almost a given that I would leak when I coughed.

The pelvic floor muscles, which hang like a hammock from the public bone to your coccyx bone, support your internal organs, holding up your bladder, uterus, and bowel. They also control the muscles that open and close the anus, vagina, and urethra. Mine were obviously a little loose. Think about taking a rubber band and holding it in one place for ten months. Once you let go, it’s going to sag. And I had issues with my bladder before pregnancy, too. As someone who is very, very flexible, my muscles weren’t as tight as they could have been. I am definitely not alone, since one-quarter of all women — and one third of older women – report having issues with their pelvic floor. So what’s the cure? Here are a few ways to tone your nether regions.

• Kegel exercises. Simple Kegel exercises — tightening and releasing the pelvic floor muscles — can help strengthen everything down there, and get it working again. But you have to be consistent. I often forget to do my Kegels, because, as I have found, they can be really difficult to do. That’s why the easiest place to start is on the toilet. Stop and start your urine stream when you go to the bathroom. Once you identify the movement, which is sometimes described as pulling your vaginal muscles up and in, you can do it out of the bathroom, too. You don’t want to squeeze your butt or abs. You’ll know if you’ve got it because you’ll see a difference in your “response” time when you try and stop the flow. Plus, you may even feel a little sore in your lower abdomen. I will honestly say I barely got one or two in when I first started after having Little Girl because I couldn’t get my muscles down there to work. But if you keep it up, it does work. An October 2009 study found that 83 percent of women who did Kegel exercises reported a decrease in urinary incontinence. (Note to pregnant women: Kegels while pregnant can reduce the length of labor, and help prevent urinary incontinence, according to two separate studies.)
• Physical therapy. If you hurt you arm, you’d see a physical therapist to help rehabilitate it. PTs can also help women rehabilitate their pelvic floor muscles when they don’t want to do it alone. A recent study found that women can get wonderful results with this method. The physical therapist, who should have special training for this type of work, can help you find different exercises to strengthen your pelvic floor. You can find a practitioner by checking out FindaPT.us, and selecting Women’s Health in the pull-down menu.
• Biofeedback. I actually tried biofeedback when I was writing a story for Marie Claire. You get a device that looks like a small radio attached to a t-shaped probe. The probe goes where you think it would; you hold the radio-looking thing in your hand. You have to try and get a set of lights to light up by squeezing on the t-shaped thingy. The lights move up based on the amount of pressure you apply, and stay lit up based on duration. The stronger your muscle, the higher the lights will go, and the longer they will stay on. I can tell you when I did this experiment, I found that my muscles were sore after the first week! Doing Kegels correctly, which is essentially what I was doing, is really hard! But worth it. And now that I’ve met my deducible with my health insurance, I think I’m going to get a biofeedback machine of my own.
• Having an orgasm. One of the least-invasive ways to start strengthening your pelvic floor again is by having sex, and having an orgasm, according to Dr. Lauri J. Romanzi, a uro-gynecologist I have interviewed in the past.  “Orgasm and arousal brings blood into the region and promotes healing. The contractions of an orgasm help strengthen the muscles and help bring muscle tone back into the area,” she explained. While you’re probably going to need to do one of the other three options, it’s good to know you can get started improving things by taking matters into your own hands. (Or your partners, as my husband wanted me to point out.)
• Meditation. This one surprised me. According to a study from Loyola University, you can visualize and meditate to improve bladder control. “[Patients] then listen to an audio recording with a series of relaxation and visualization exercises at home twice a day for two weeks. Patients track the number of incontinence episodes that they experience in a pre- and post-therapy diary. The majority of patients, including Raisor, experienced a substantial improvement in symptoms.”  Wow. And cool! I’m looking forward to trying it out soon!

Have you had issues with incontinence or pelvic pain? How did you treat it? How long did it take? I’d love to hear about it.

Also, if you suffer from this problem, you might want to check out AccidentalSisterhood.com. To celebrate National Bladder Awareness Month, 3,000 copies of The Accidental Sisterhood book will be available on a first-come, first served basis during the month of November. Women may log on to www.AccidentalSisterhood.com and enter the promo code SOLUTION, or they can call 1-866-549-3250 to receive a free copy.

Day Two: I've got more bruising.

Well, it’s Day Two of my huge eye. Just to catch you up: I worked until 2 a.m. on Thursday night. Walked out of my office into the hall. Kept the lights off so I wouldn’t wake anyone. Remembered that I left my new magazines by the top of the stairs. Bent over to pick them up. Wham! My eye met the round ball at the top of the banister. Now — an ER visit and 36 hours later — my eye isn’t just cut and bruised, it’s starting to swell up, too. Lovely. Got me thinking, though. As I look back over my 30-something years on earth I realize I had a lot of these stupid injuries. Thankfully, few were — to quote Raymond of Rain Man — Serious Injuries. Most were painful and annoying. Oh, and most were embarrassing. I figured I’d do public service by listing them, along with the lessons I learned, so all the parents out there can warn their kids not to be as clueless as I was.

Here goes:

1. Seven stitches in chin. I was in sixth grade — in Little League. I had sold all my raffle tickets, and I was running home along Bunker Avenue. I couldn’t wait to tell my mom. Unfortunately, I was running with my head down. Wham! My body and a parked car made contact. Hard. Aside from the bruised knee (I actually dented the side of the car), I had a nice gash under my chin, too. The lesson: Head up, eyes ahead.
2. Broken wrist. A few years later I was working in the Bellmore Townhouse diner. I was near the kitchen doors. I dropped my pen. Bending to pick it up, I put my hand on the Out door. Wham! Someone kicked open the door. It could have been a lot worse. It could have hit me in the head. The lesson: Watch your surroundings. The door that says out is probably going to open in your direction. (You’d think I would have learned this lesson when I was five after getting stitches in my lip because I ran in front of the big metal horse swings at Wantagh Park.)
3. Huge goose-egg on head. This one is probably the stupidest one ever. I was dating A-hole. (Sorry, I know this is a family blog, but that’s what he was.) He got mad at me and, like he had before, he put his hands on me. This time, he was strangling me. My cousin and her boyfriend rushed out to stop him, and he let go. What’s that law of physics that says an object in motion? My head kept traveling and hit my cousin’s hip bone. The result was a baseball-size lump on my head. Blue and nasty. It went away eventually, but I still have a small calcification above my right eyebrow from it. This story could have started with a broken nose, too. He slammed the door on my face once.  Lesson learned: The first time someone puts his or her hands on you, they are OUT of there. A hitter is probably ALWAYS going to hit you. No excuses, no amount of talking is ever going to stop them. Hear that, @Rihanna?
4. Ten stitches in foot. I was in the shower shaving my legs. (Sorry, TMI.) I was in a hurry, so I perched my toes on the first thing I saw: The little washcloth bar on the outside of the built-in soap dish. Crack! The porcelain broke off, nicking the bottom of my second toe. The lesson: Always leave yourself enough time to do what you need to do without rushing around.
5. A gazillion stitches to the nether regions. I wanted to give birth sitting up. I knew that. But for my first daughter I let the nurses and midwife tell me what to do. They wanted me lying down. Even though I knew supine position is NOT the way to get a baby out, (“Infants born to mothers in nonsupine positions were delivered with significantly less tearing of the perineum and less vulvar edema”), I listened to them. I pushed for two-plus hours. All eight pounds, five ounce giant head Katelyn came whooshing out at 2:37 p.m. that day. By then, I was very swollen and just ready to tear, according to my then-midwife. (Again, TMI, I know, and I am sorry.) The lesson: Don’t let anyone push you around, and understand that you need to be your own advocate — or find someone who will act as one for you. With Keira, I had a new midwife and more confidence. I wanted to give birth in a birthing room sitting up. I was very vocal about this. In fact, I wasn’t going to have it any other way. My amazing midwife Diane Lucks wasn’t going to have it any other way, either. Keira slipped out after only three pushes, and did minimal damage on her way out.

What’s the stupidest injury you’ve ever had? What was the lesson you took away from it? Would love to hear about it. (Misery loves company and all…)

Another healthy baby delivered by a midwife.

“I wish you would go to a real doctor.” We were standing in the kitchen. My mom had only found out I was pregnant a few days prior, and she was already haranguing me about my choices.

When I had Big Girl, I had a midwife. I also had a mental block, and an 8 pound, 5 ounce baby with a giant head. So while my labor was pain-free, my birth experience was not what anyone would wish for. I was sore and bruised for weeks. I was anemic after tearing and losing quite a bit of blood. I looked like hell. I know my mother, remembering what I had gone through, was blaming my midwife.

This time, she had more to worry about. I had a midwife—someone new– but I also had a high risk pregnancy, and my mother was afraid that I would literally die because a doctor wouldn’t be the one catching the baby. She didn’t understand that my midwife, who I absolutely adore, was working hand-in-hand with several doctors the entire time making sure I had the best care possible. In fact, she made my pregnancy, labor, and delivery even better than it could have been if a doctor delivered Little Girl.

My midwife let me deliver at 41 weeks. Big Girl was a 41-weeker, too, so while she carefully monitoring me and the baby, she was prepared to let my body do what it was supposed to do. (Although I must admit that she told me on Friday, the day before I delivered, that if I wasn’t in labor by Monday she was going to induce.) Meanwhile, my high-risk specialist had been pushing for induction at 37 weeks. To this day I truly believe that my midwife’s simple trust in me and the process helped me avoid a C-section and a small baby since Little Girl was only 7 pounds, 3 ounces when she was born. She also fought to get me into a birthing room, and helped me have a delivery that I look back on with nothing but pride.

Still, my mom, like most other people, didn’t know what a midwife does—or even what a midwife actually is. If she had maybe she would have been a little more confident about my choices.

Do you know what a midwife does? Here are five facts that I wish everyone knew about midwifery.

1) A certified midwife (CNM) goes through a rigorous training program, which includes a hands-on internship.

A CNM is an advanced practice nurse. She must first attain a nursing license, which is a B.A. or a B.S. in nursing, and then undergo what is essentially a master’s program in midwifery. Once she completes the program, she must take a national certifying examination administered by the American Midwifery Certification Board (AMCB) to become a CNM. The program is unique because CNM candidates spend time interning—much like a doctor would—with other CNMs.

2) Midwives can—and do—spend more time with their patients.

“We do what doctors can’t,” says Jane Crawford Peterson, CPM/LM, who runs a midwifery practice called In the Beginning based in Iola, Wis. “We spend long periods of time at prenatal visits, which means we can hold a woman’s entire story. Our prenatal visits are often scheduled for an hour, so we talk not only about how the baby is doing, but what the woman does throughout the day. We can understand her goals for her birth. It’s not just about taking blood pressure. Clinical signs can be ascertained in 15 minutes. We’re focusing on more than just physical health.”

I know one of the things I loved about having a midwife was—unlike my friends who labored with a random labor nurse they had just met—she was prepared to stay with me the entire time I was in labor. I like to be alone during labor, so she went off to sleep for a bit, but she was the one who checked my progress. And she was there the entire time I was pushing. She was also the one who delivered my baby. Plus I knew there wouldn’t be any bait and switch nonsense going on. The person who gave me my prenatal care was the person who delivered my babies, unlike many of my friends who had to take whichever doctor happened to be on call when they went into labor.

3) Midwives have a lower rate of Cesarean sections.

It may be because doctors don’t think C-sections are a big deal—a recent study found that “sixty-five percent of midwives considered the rates of cesarean section in their hospitals to be too high compared with 34 percent of obstetricians.”  Or maybe it’s because doctors induce labor far more often than midwives, or that they are more likely to prescribe epidurals. Whatever the reason, fewer women cared for by midwives have C-sections.

4) Midwives respect and work with doctors—and most doctors respect them, too.

“I have 18 physicians who I routinely consult with. I stand firmly in liking the fact that I hold hands with physicians so that smooth transitions can occur in the event that something unexpected pops up during the pregnancy or birth,” says Crawford Peterson. (And as crunchy-granola as I am, I wouldn’t work with a midwife who didn’t have this type of arrangement.)

5) Midwives can do everything a doctor can except prescribing medicine and ultrasounds and doing operations.

When I ripped giving birth to my first, my midwife was the one who sutured me up. She was there for all my prenatal exams. She looked at my lab work. She did my postpartum followups. I felt taken care of, respected, and heard. It was a wonderful thing. Plus, since she works directly with a group of wonderful doctors I knew that, in the event of an emergency, I was in great hands no matter what.

It is for these reasons that I would tell anyone: No, midwives aren’t doctors. Sometimes they’re better than doctors! Maybe you should give one a try?