Jenne --
To begin with, I met Kmom a couple of years ago when she was speaking at a conference, and I was impressed with her knowledge. A plus-sized woman herself, she has written an
article with helpful information on how big women can minimize their likelihood of cesarean.
In the second place, while I rarely come out and say to do or not do something (my mantra is helping women make informed decisions based on the best evidence), I make an exception for misoprostol (aka "miso"; trade name Cytotec). Do not agree to a Cytotec induction. Here is what the FDA has to say about this drug:
"Cytotec can induce or augment uterine contractions. Vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony. A major adverse effect of the obstetrical use of Cytotec is hyperstimulation of the uterus which may progress to uterine tetany [uterus contracts and doesn't let go] with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism [maternal and infant mortality rate is very high from this]. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia [profound slowing of the baby's heart], and fetal and maternal death have been reported.
"There may be an increased risk of uterine tachysystole [contractions coming too fast], uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec; including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity [usually defined as more than four births] also appears to be a risk factor for uterine rupture.
"The effect of Cytotec on the later growth, development, and functional maturation of the child when Cytotec is used for cervical ripening or induction of labor have not been established. Information on Cytotec’s effect on the need for forceps delivery or other intervention is unknown."
In cases where induction is truly warranted and the cervix is not ready to labor, prostaglandin E2 (aka dinoprostone; trade names Cervidil, Prepidil and probably others) works just as well at ripening the cervix, although not as quickly, and prostaglandin E2 is FDA approved for the purpose. Whenever possible, though, even when induction is indicated, it is much more likely to work when the cervix is ripe.
I'm afraid, though, you have even bigger problems than the soundness of your midwife's recommendations, although those are problems enough. As you have realized, you have a midwife who almost certainly thinks you will not be able to birth your baby unless you follow her recommendations and probably not even then. Her lack of faith in you is likely to affect her judgment, which means you will not be able to trust her judgment in labor, not to mention how vulnerable laboring women and their partners can be to a negative atmosphere. Is there any chance of finding another care provider? I assume this midwife is hospital-based. Have you considered a home birth? Home birth midwives are much less likely to be biased against plus-sized women. If you can't change providers, do you have a doula? She can give you the support and encouragement you will need to counteract your midwife's pessimism. Here, too, are some ideas of mine to help you avoid an avoidable cesarean:
- Begin labor spontaneously.
- Stay home until in active, progressive labor. If you go into the hospital and it turns out you are still in early labor, go back home.
- Stay active in labor.
- Push in an upright position so that gravity is working for you.
- Use pain coping techniques other than an epidural so that you can stay active and push effectively.
- Refuse a cesarean based on arbitrary time limits for making progress.
-- Henci