“Pit to Distress”

I’m sharing this in several places because it needs to be shared!! You want to trust your doctor or midwife right? Everyone does. Take heed to this story!! It frustrated me so much yesterday that I had to stop reading and start cleaning. I didn’t hear about “Pit to Distress” until yesterday while researching some things. When searching for a doctor or midwife, find one that respects you and your God-given talent to birth a baby. Find one that practices evidence based medicine. This is a reblog.

“Pit To Distress”: A Disturbing Reality July 8, 2009

Dear NursingBirth,


I just saw a couple of posts about “pit to distress” on Unnecessarean and Keyboard Revolutionary’s blogs. Can you comment on that as an L&D nurse?! Is the intent really to distress the baby in order to “induce” a c-section?  I’m distressed that such things may actually happen, and am holding out a little hope that it’s a misunderstanding in terms….







Dear Alev,


I wish I could put your heart and mind at ease and tell you, from experience, that this type of outrageous activity (i.e. “pit to distress”) does not happen in our country’s maternity wards but unfortunately it does.  I know that it does because:


1) I have read and heard stories from other labor and delivery nurses who have worked with birth attendants who practice “pit to distress,”


2) I have read and heard stories from women (and their doulas!) who have personally experienced the consequences of “pit to distress,”


and, most importantly…


3) I personally have worked with attending obstetricians who subscribe to this philosophy.


Before I start my discussion on this topic I would like to quote a blog post I wrote back in April entitled “Don’t Let This Happen To You #25 PART 2 of 2: Sarah & John’s Unnecessary Induction”.  This post is actually the first post I ever wrote for my Injustice in Maternity Care Series.  It is a TRUE story (although all identifying information has been changed to adhere to HIPPA regulations) about a first time mom who was scheduled for a completely unnecessary labor induction and the following excerpt is a good example of how “pit to distress” is ordered by physicians, EVEN IF they don’t actually write it out as an order (although some actually do!)




“…At 1:30pm, right on schedule, Dr. F came into the room.  After some quick small talk he asked Sarah to get into the bed so that he could perform a vaginal exam and break her water.


Sarah: “Umm, I was hoping we could wait a little bit longer to do that, until I am in more active labor.”


Dr. F: “Well, if I break your water it is really going to rev things up and put you into active labor.”


Sarah: “I’d really rather wait.”


Dr. F: (visibly frustrated) “Well I at least have to check you!”


(Oh lord, I love the “have to”!)  Dr. F’s exam revealed that Sarah was 4 centimeters!  Yay!


After helping Sarah to the bathroom and back to her rocking chair, I stepped out the catch Dr. F at the desk.  “Thanks for holding off on the amniotomy, it was really important to her birth plan,” I said, trying to “smooth things over” and (gently) remind him that the patient was in charge!  “Yeah well I’ll be back around 4:00pm to check her again and if she hasn’t made any progress I am going to break her water,” he said, grudgingly.


He started to walk towards the elevator but then turned around to me and said:


Dr. F: “You have the pit at 20 right?”


(Note: The way pitocin is administered for induction in my hospital (and many others) is that you start the pitocin at 2mu/min (or 6mL/hr) and increase by 2mu/min every 15-30 min (or more) to a maximum of 20mu/min (or 60mL/hr) until you obtain an adequate contraction pattern (or, 3-5 contractions in 10 minutes).  So what does that mean?  That means that you do NOT just crank the pitocin until you get to “max pit,” rather you TITRATE it until you get 3-5 contractions in 10 minutes that are palpable and are causing cervical change.  However, this is not what many physicians I work with ask you to do.   Bottom line is everyone is different.  I personally could take a whole box of Benadryl and not so much as yawn while my husband can take one tablet and all but hallucinate!  It is no different for pitocin.  Some people are extra sensitive and only need a little bit, and others tolerate “max pit” very well.  I seem to have this same “fight” with physicians all the time at work.  They insist you “keep cranking the pit” when all you are going to do is hyperstimulate the uterus and cause the baby to go into distress.  But I digress….)


Me: “No, I have her at 10mu/min.”


Dr. F: (sarcastically)  “What!?  What are you waiting for?! 


Me: (said while biting my lip so I didn’t say something I would regret)  “She is contracting every 2-3 min and they are palpating moderate to strong.  She has to breathe through them.  And the baby is looking good on the monitor.  I want to keep it that way!”


Dr. F:  “But she’s not going anywhere!  You have to keep going up if you want her to progress.”


Me: “But she has changed to 4 centimeters…”


Dr. F:  “I was being generous!”


Me: “So you lied…”


Dr. F:  (annoyed) “Listen, keep going up on the pit, even if she is contracting every 2-3 min.  They aren’t strong enough.  Keep going up.  If we hyperstimulate her, we can just turn the pit down.”  (Note: These were his exact words.  I know this because I was so flabbergasted that he said it, I wrote it down in my notebook that very moment!  The fact is sometimes the baby is in so much distress after hyperstimulating the uterus that just turning the pitocin down isn’t enough!  And it really bothers me when doctors start sentences off with “Listen…”  Grrrrr.)


Me:  (jaw dropped, completely dumfounded) If I turn the pit up anymore, I am GUARANTEED to hyperstim her.”


Dr. F: “We’ll cross that bridge when we get to it.  I’ll be back around 4:00pm.”


By this point I was more than annoyed with Dr. F.  I explained the situation to the charge nurse and told her that I would not be cranking the pit on room 11 unless Dr. F wrote me an order that read “Regardless of hyperstimulation or contraction pattern, continue to increase pitocin until the maximum dose is reached.”  (By the way, he wouldn’t’ write me that order).  She basically told me to do what I felt was right because it was my license at stake too.”





Ladies and gentleman the account that you have just read is called “Pit to Distress” whether the pitocin order was actually written that way or not.  What Dr. F gave me was a VERBAL ORDER to increase the pitocin, regardless of contraction or fetal heart rate pattern, until I reached “max pit,” which he acknowledged would hyperstimulate her uterus.  This goes against our hospital’s policy and the physical written order that this doctor signed his name under.  However, like some other doctors I work with, none of that mattered to him.  What he wanted was for me to “crank her pit” regardless and from my experience with this doctor, at the first sign of fetal distress we would have been crashing down the hallway for a stat cesarean!


Hyperstimulation of the uterus (more appropriately called tachysystole) is harmful and dangerous for both mothers and babies:


“If contractions are persistently more often than 5 contractions in 10 minutes, this is called “tachysystole.” Tachysystole poses a problem for the fetus because it allows very little time for re-supply of the fetus with oxygen and removal of waste products. For a normal fetus, tachysystole can usually be tolerated for a while, but if it goes on long enough, the fetus can be expected to become increasingly hypoxic and acidotic.


Tachysystole is most often caused by too much oxytocin stimulation. In these cases, the simplest solution is to reduce or stop the oxytocin to achieve a more normal and better tolerated labor pattern.”

Electronic Fetal Heart Monitoring” by Dr. M. J. Hughey

The truth, however, is that many times stopping tachysystole is not as easy as just shutting the pitocin off.  Although the plasma half-life of pitocin is about 6 minutes, it can take up to 1 hour for the effects of pitocin to completely wear off.  And for a baby in distress, one more hour in a hyperstimulated uterus is too much!  So guess what?!  The physician has two choices:


#1 Administer yet another drug (like terbutaline) to decrease contractions and wait and see (unlikely to happen), or


#2 Administer yet another drug (like terbutaline) to decrease contractions while heading to the OR for an emergency cesarean section (much more likely to happen.)


Because in the end…who wants to “sit” on a compromised baby?!



What is also unsettling is that my encounter with Dr. F regarding the most appropriate administration of pitocin for that mother was downright pleasant as compared to some of the other encounters I have had with much more intimidating and hot-headed physicians.  Labor and delivery nurses all over this country (including myself) have been bullied, yelled at, cursed out, and down-right humiliated by birth attendants who want you to “keep cranking the pit” regardless of maternal contraction or fetal heart rate patterns or in general, refusing to be a part of or questioning other harmful obstetrical practices.


I once had an obstetrician, while in the patient’s room, call me “incompetent” in front of the patient and her entire family because I had not continuously increased the pitocin every 15 minutes until I reached “max pit” and instead, kept the pitocin at half the maximum dose because increasing it anymore caused my patient to scream and cry in pain and her uterus to contract every 1 minute without a break.  Who wants a nurse to take care of them that was just called “incompetent” by their doctor??!?


Another time I had a physician (who via this program called “OBLink” can watch her patient’s monitor strips from her own home or office) call me on the phone from her house to chew me out about not having the pitocin higher.  When I explained that I had to shut the pitocin off an hour earlier and start back up at a slower rate because the baby started to have repetitive and deep variable decelerations despite position changes, IV fluid bolus, and 10 liters of oxygen via face mask, I was told that the decels “weren’t big enough” to warrant such a “drastic measure as shutting of the pitocin” and I was “wasting her time” because “at the rate [I] was going [her] patient wouldn’t deliver until after midnight.”


I had yet a third doctor tell me once that he wished that only the “older” nurses on the floor would take care of his patients because they aren’t “as timid” and “are not afraid to turn up the pitocin when a doctor orders them to.”  That younger nurses like me are “too idealistic” and don’t understand “how the world really works.”


And yet another time I had a physician tell me that I needed to “crank the pit to make this baby prove himself either way” and that if I couldn’t do “what needed to be done” for his patient, then he would ask the charge nurse to “replace me with a nurse who could.”


And guess what, when I came in the next day and read the birth log, I discovered that 3 out of those 4 patients ended up with cesarean sections after I had left that night for “fetal distress.”




Although not one of these physicians actually wrote in black and white “Pit to Distress” and they didn’t have to; their words and actions speak to their true intentions.  These physicians are smart in the fact that they know that actually writing “pit to distress” like some practitioners do can land them with a law suit if an adverse outcome happens and they find themselves in court.  So while it is true that one’s medical record might not show “pit to distress” on the order form, it doesn’t mean that it didn’t happen to you!  What these doctors do instead are bully nurses into to doing their dirty work for them.  (And I would like to note that just like Dr. F, I have yet to encounter one physician who will actually physically put their hands on the IV pump and turn up the pitocin themselves when I refuse to do it!…..They know better!)



As a registered nurse my practice must adhere to the American Nurses Association Code of Ethics for Nurses.  Here is an excerpt:


“The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.  The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.”


What these practitioners don’t realize is that when they work with nurses like me (and there are many out there!!), they are working with someone who values the health and safety of women and babies (as well as their nursing license) much more than a fake cordial kiss-ass relationship with some high-and-mighty doctor!  But let me tell you, its really frigging hard to work like that!  That is, to constantly battle with practitioners who have such a different philosophy about maternity care than you do!  I mean, even the best nurses will start to doubt themselves if they are constantly being bullied and told that they “can’t cut it” or are “incompetent” if they don’t follow the status quo!  Like many other nurses, sometimes I just don’t have the energy to argue and fight.  Sometimes I have down right lied to a doctor over the phone about how high the pitocin really is (telling them it’s running at a much higher rate than it actually is).  Other times I just “forget” to turn up the pitocin for hours at a time.  One time I actually disconnected the pitocin and discretely ran it into the floor!


Women of this earth…TAKE BACK YOUR BIRTH!!!  We need YOUR voice!  We need you to choose caregivers that practice evidenced based medicine, and BOYCOTT ones that don’t!  We need you to HIT THEM WHERE IT HURTS….in their WALLET!!  We need you to DEMAND better care!!  We nurses, birth advocates, doulas, childbirth educators, midwives, etc. etc. can’t make change without YOU!!


Thank you, Thank you, THANK YOU to Jill at Keyboard Revolutionary and Jill from The Unnecessarean for their blog posts on this issue!  I second their anger, outrage, and voice for change!!!


Are you an L&D nurse who has ever been ordered to “pit to distress?”  Are you a mother who has ever experienced the consequences of a birth attendant who followed a “pit to distress” philosophy?    Please share your story with us!!


In closing I would like to say that I am NOT anti pitocin, but like ALL labor & delivery interventions, I speak out and advocate for the appropriate, evidencedbased,and safe use of them!



Keep Moving Forward


I love this song! It inspires me to keep moving forward, to keep looking for the things that need to be changed in my life. For the past two years, I’ve felt like I’ve been trying to beat down a steel wall. I’ve been doing things all wrong. I’ve been putting my focus in all the wrong places. No matter how often I prayed, I didn’t realize that I had put myself in a “box” for the past two years. This “box” is the thing that has been holding me back from receiving the training I need to pursue my true passion!

When I started Wonderfully Birthed it was so I could help bring awareness to the many choices that we do have no matter what some health care professionals try to tell us. I just wasn’t sure how to go about doing it. Wonderfully Birthed has really been on the back burner. I wasn’t sure how to go about sharing what I know. I also haven’t really had any official training in what I want to do.

While essential oils will now be put on the back burner so I can focus on Wonderfully Birthed, the journey I’ve taken with essential oils has brought me to where I am now. My frustration from not earning a true income from my direct sales company has pushed me to find what it is that will help me bring in an income for my family as well as bring my husband home.

I’m working on several things that I hope to release to my followers at the end of this month/middle of September!! I’m really excited about what’s to come!





The picture above is clickable. It’s linked to the movie website. VAXXED is now available to rent for online streaming! If you aren’t able to make it to a Gather showing, you can pre-order the DVD or rent it online! I’ve seen it twice now. It isn’t an anti-vaccine film at all! it talks about how the MMR affects toddlers and questions the safety of it. This film is for the single dose of Measles, Mumps, and Rubella instead of the combined shot. It also gives us a call to action at the end! Please take the time to watch this movie and do the call to action that’s at the end!


Back to School!

It's Back to School Time!!

Are you ready for your kids to go back to school? If you homeschool do you have all that you need for your homeschool room?  Or do your children go year around and they are starting back after taking a few weeks off?

Even though I homeschool, this time of year always seems to creep up on me. My oldest daughter went through preschool on up to just a few weeks into second grade before we started to homeschool her. I pulled her out of the DOD school she was in and frantically started searching for some curriculum. When I pulled her out it was a decision that we made after long consideration of many things. Ever since then I’ve never felt completely ready when the time to transition her to a new grade came. She is now in high school and is starting her 10th-grade year tomorrow! It’s hard to believe that I’m old enough to have a teen!

Like many other families, we spent this weekend buying school supplies to take advantage of the no tax weekend. I’m a sahm, wahm, and homeschooling mom, so of course, I love deals! Especially when it comes to homeschooling.

Over the years I’ve found some great websites that have inexpensive curriculum to use for our daughter. Some of these links are affiliate links.

EasyPeasy – Is a free online curriculum created by a homeschool mom. It covers all grades.
CurrClick – This is a website that has products that start out at free and go up!
Educents – This is another great website to buy curriculum on sale! This website always has a deal going on.
SchoolhouseTeachers – This website has a low monthly subscription fee. It offers classes from preschool on up to high school!

I hope that you all have that you need to make this year an amazing year! Have fun!

The Truth About Midwives


Truth About Midwives

My midwife, Kate, examining my son. 


This is brought on by a discussion I had earlier today. It rather annoyed me. I’m all about empowering women with knowledge of evidence-based prenatal care and birth practices. That’s what started Wonderfully Birthed. Being so frustrated with the misconceptions out there. I want to make a change, I want to be a part of the evidence-based community when it comes to our health care. I want others to empower themselves with knowledge. After all, Knowledge is Power, right?

So here is the hub. Midwives. Are they quacks? Do they really know what they are doing? Are they trained? How will they know how to spot an emergency? What do they have by way of equipment? I could go on and on with these questions. First, midwives are not quacks, they do know what they are doing. There are 5 ways to become a midwife, Certified Professional Midwife (CPM), Certified Nurse-Midwife (CNM),  Certified Midwife (CM), Direct-Entry Midwife (DEM), and Traditional Midwife.

I could go on and on with these questions. First, midwives are not quacks, they do know what they are doing. There are 5 ways to become a midwife, Certified Professional Midwife (CPM), Certified Nurse-Midwife (CNM),  Certified Midwife (CM), Direct-Entry Midwife (DEM), and Traditional Midwife.

Midwife comes from middle English meaning “with woman”. They are with women throughout the birthing process. They are at their sides the whole time cheering them on. Guiding them, letting them know that their bodies are made for this. They give them strength when they feel that they can’t go on any longer. Midwives are there specifically for the mother as well as the baby.

Now to answer the questions above. Let’s start with Quackery. The meaning of quackery is fraudulent or ignorant medical practices. Let’s compare that with midwifery. A midwife goes through nursing school and then midwifery school before becoming certified. She is taught the practice of midwifery in a University of all places! On top of the schooling they go through they also have to stay certified and keep up with their training. Just like doctors, midwives have to be up to date on their training. When you are in the care of a midwife, she takes urine samples, has blood test ran, ultrasounds done, GBS testing, and more. She offers the vitamin k shot, as well as the eye goop.



Equipment that midwives use are as follows:
*Cylinders of Entonox and the Entonox Head with mouthpieces and a mask.
*Cylinder of Oxygen, a bag and mask for helping a baby and a bag and mask for an adult.
*An IV giving set and IV fluids.
*Lots of inco pads (large absorbent pads)
*A TENS machine
*Pethidine and the antidote Narcan
*Syntometrine, Ergometrine and Syntocinon (Forms of Oxytocin)
*Blood bottles and blood-taking syringes.
*Syringes and needles
*A sphygnomanometer and a stethoscope.
*Baby weighing scales.
*Cord scissors cord clamps and cord ligatures.
*Episiotomy scissors.
*Suturing materials and local anaesthetics.
*Baby drugs – konakion (vitamin K)

This list may vary from midwife to midwife, but the point is they come prepared! Is that quackery? Is that crap? I really don’t think so.

Next, are they trained? Here is a list of schools that train midwives.
Schools that offer Baccalaureate Degree (BA/BS) to RN and CNM
*Case Western Reserve University
*Columbia University
*East Carolina University
*Marquestte University
*Ohio State University
*Oregon Health Sciences
*Rutgers Biomedical Health Sciences
*Seattle University
*Stony Brook University
*University of California at San Francisco
*University of Cincinnati Nurse-Midwifery
*University of Illinois at Chicago
*University of Michigan
*University of Minnesota
*Univeristy of Pennsylvania
*Vanderbilt University
*Wayne State University
*Yale University


Is that not good enough for the skeptics?

Here are websites for midwifery.


Another resource that I love to read through is Ina May Gaskin’s website.

When thinking about midwives and home births or natural births in general, don’t assume that it’s not evidence-based. Do your own research. Make sure what your doctor or midwife is telling you is evidence-based. You need to know all the in’s and out’s in order to make a truly informed decision.

Here are a few more resources to help you find evidence-based care.
Improving Birth
Birth Without Fear

Midwives are very knowledgeable. Don’t discredit them just because you know of one bad midwife. You will find good and bad midwives, just like you will find good and bad doctors. When you find a bad doctor you don’t scream quackery, you leave the practice and look for a good doctor. That’s how you should treat midwives. Search until you find one that you can trust. If you can’t trust them then you won’t get the care you are looking for.

Okay midnight rant over.😉