Natural Birth and Baby Care.com

Labor and Birth Interventions

A woman laboring today is probably - and unfortunately - going to have to fight birth interventions.

It may be next to impossible to labor without interference in some settings and with some care providers.

You should be aware of all the common medical procedures and how they may hinder your labor plans.

Many of these procedures are so routine that you'll have to go to great lengths to avoid having them - and some you may not be able to avoid.

Be sure that you talk to your care provider before you go into labor (preferably when you hire him or her). You may also need to speak with the hospital if you plan to give birth there.

You can prepare yourself to cope with any interventions by learning birth skills that will help no matter what the circumstances. I recommend The Pink Kit to teach yourself (and your birth support) these skills.

Induction

Inducing labor can cause a "cascade of birth interventions" - meaning that induction can lead to an intervention, which leads to another, etc. etc.

Induction is in itself an intervention because it forces the body into beginning labor when it was not ready.

I've detailed induction in a more complete article on the site.

Briefly, chemical induction is an unnatural state that causes your body to be flooded with synthetic hormones. This causes contractions that are more painful than natural contractions. They also cause more stress on your baby.

Using synthetic prostaglandins to ripen the cervix can cause over stimulation of the uterus as well. This over stimulation can lead to uterine rupture, maternal death, and death of the baby.

Induction requires other interventions such as IV lines and continues electronic fetal monitoring. You'll probably be stuck in bed and unable to move around.

There is also risk of iatrogenic prematurity - meaning your baby may be premature because the doctor made a mistake and thought you were farther along than you really are - then started birth interventions and ended up with a preemie.

IV Lines

Most hospitals routinely use IV line birth interventions. Usually they do this because they forbid food (and sometimes drink) during labor. This has negative consequences above and beyond the IV.

Having the IV inserted is painful for many women. The cold fluids can cause pain and irritation. The IV pole limits movement. Excess fluids can cause you to have to go the bathroom constantly. If there is too much fluid for you to excrete, it can cause your lungs to fill up. Some women have convulsions.

The baby can also be affected by IV fluids. They can disrupt the balance of a baby's blood. Respiratory distress and seizures can be side effects of IV fluids given to the mother because of the risk flooding the baby's system.

Limiting food and drink in labor leads to the IV birth interventions. You'll have more energy during labor if you're not restricted from food or drink. It makes no sense to require you to do extensive and exhausting work with no food or drink! IV lines do not solve this problem and create new problems.

Gowning, Shaving, and Enema

When you arrive at a hospital you may be asked to remove your own clothing and put on a hospital gown. This can be demeaning for many women. The gowns are thin and flimsy and often have the hospital's logo emblazoned across them.

You should bring your own clothing if at all possible. Bring a comfortable nightgown. Or bring clothing made especially for giving birth, which is stylish and functional for labor. This allows you to avoid embarrassing and uncomfortable hospital gowns.

Most hospitals have abandoned the practice of shaving the pubic area (bikini line). Birth centers and homebirths don't require this at all.

Ask if your hospital still does this and request that it not be done to you. There is no evidence that it does the baby any good at all, and it can be uncomfortable for you.

Routine enema has also been abandoned at most hospitals. There are some women who'd like to have an enema and it can sometimes aid labor. If you don't want one refuse to have one. If you'd like one there is no harm in it.

Routine Continuous Electronic Fetal Monitoring

In hospitals it is almost universal to strap belts and sensors around your abdomen, leave you in bed, and watch the monitor to see your contractions.

Many women say that they feel like everyone forgets them. Nurses and even labor partners are too busy watching the screen and printouts.

Continuous electronic fetal monitoring has a high false positive rate - meaning that it often says that a baby is in danger when the baby is doing just fine.

Often if a baby's heart rate drops a simple change in position will bring it right back up. Unfortunately the fetal monitor leaves you stranded on your back in bed.

There have been studies showing that continuous monitoring does not significantly improve birth outcomes for women and babies. The United States Preventative Task Force recommends against the routine use of continuous monitoring in low-risk women.

Because of the high false positive rates continuous fetal monitoring puts you at greater risk for cesarean section.

There is also a possibility of your labor being slowed or ineffective because you're unable to move. You may feel more pain because you are unable to work with your body.

The inability to change position may cause your baby to get less oxygen than he or she should. If you are hooked up to an internal monitor, infection could be introduced to your birth canal and uterus. Your water will have to be broken. And your baby will have a monitor screwed into his or her scalp, causing significant pain.

To learn more about electronic fetal monitoring and birth interventions, pick up Henci Goer's book The Thinking Woman's Guide to a Better Birth.

Rupturing the Membranes

Rupturing the membranes is the technical term for breaking your water. It involves your doctor or midwife using a small tool, called an amniohook, to pierce and break your bag of waters.

This procedure is most often done because of the belief that it will speed up labor - and it occasionally does. It may also be done in order for an internal monitor to be screwed into your baby's scalp.

Rupturing the membranes opens up the area surrounding your baby to infection, and could possibly introduce germs via the hook or the attendant's gloves (though they are presumed sterile.)

In most hospitals, in some birth centers, and for some homebirths, ruptured membranes also require that a clock begin ticking - in other words, you must have your baby delivered within a certain amount of time after your water has been broken (this is often 12 hours at the hospital).

This regulation is in place to decrease the risk of infection; however, it could lead to unnecessary cesarean section or other interventions.

Breaking the waters also removes the watery cushion from around your baby's head. It may be more painful for you as your baby's head passes through your pelvis, or you could have back labor a little more strongly.

If your water breaks naturally, or if it is broken by your care provider, try to keep internal exams to a minimum. More exams mean more chances of infection.

Internal Exams

If you've had any pap smears done, you realize how uncomfortable a vaginal exam can be. During labor, they are performed to assess how dilated your cervix is (dilation goes from 0-10 centimeters).

Cervical checks tend to be very uncomfortable, especially during labor. A gentle and sensitive care provider can make a difference, but the checks are often hard to handle. They are very painful sometimes. Some women find them demeaning. A rough exam or an exam done against a woman's will can leave her feeling violated.

Research has also shown that different people will get a different measurement for dilation. This means that if different nurses, doctors, or midwives are tracking your dilation, the measurements may not be completely accurate.

Each internal exam also raises the chance of infection. If your water has broken this is an especially valid reason to decline internal exams.

You will know when you are close to being fully dilated, and a skilled care provider will also be able to tell. There is no reason to have countless exams or to endure the pain or the anxiety that may come from being told "you're not making progress."

It is best to work with your body and allow your skilled caregiver to notice the signs that you're close to the end of the first stage. You will also be able to tell because you'll begin to feel pushing urges.

You can also learn to check your dilation and assess where you are on your own - without a care provider. If you're interested in this I suggest you pick up The Pink Kit for home study. It will teach you how to work with and understand your body and allow you have a good birth no matter what situation you are in. It also teaches how you can check your own dilation and the decent of your baby.

Directed Pushing

Though it is not technically an "intervention" in that something is done to you, I list directed pushing here because it is an unnecessary intrusion in the birth process. Being forced to push in a certain way and certain positions can results in loss of control, extra pain, and can contribute to tearing.

Almost all television portrayals of women giving birth show a woman flat on her back with her legs in stirrups. She's surrounded by several nurses and perhaps her partner, all counting loudly "1, 2, 3 ... 10" as a way of instructing her how to push. They warn her to "pant, pant" when she shouldn't be pushing.

This intervention into the 2nd stage of labor is generally unnecessary - when you are fully dilated after a natural labor, your body will begin to push on its own. The urge will be undeniable. Pushing contractions are generally spaced out more than dilation contractions. You get a nice rest in between each one.

Many care providers try to rush this stage along by shouting at a woman to push forcefully and continuously. They give episiotomies to encourage the baby to come faster and in come cases resort to assisted delivery with forceps or vacuum extraction.

They may also use these invasive procedures when a woman cannot effectively push - usually because she is flat on her back and strapped into stirrups. There are far more effective positions to give birth in.

Active 3rd Stage Management

The third stage is the final stage of birth. Your baby has already been born and is in your arms. Now you must deliver your baby's placenta.

Most of the time the placenta will come within an hour or so of birth, and all on its own. The placenta is much easier than the baby - it has no bones and pretty much just slides out.

Some caregivers try to "actively" manage this stage of birth by pulling on the cord and pushing on the woman's abdomen. Jerking the cord around can cause tears and hemorrhaging - the very thing that the doctor or midwife is trying to prevent.

A perceptive midwife or doctor can watch the cord and notice signs that the placenta has detached. Often if the mother moves into a supported squat the placenta will easily be born.

Pulling on the cord and rushing the mother along can lead to complications and it can also rob the mother and child of their first few moments together.

Weigh Carefully

All interventions can and usually will change the course of your labor. One intervention tends to lead to another, and another, and another, until your birth morphs into something completely different than what you were hoping for. Reading articles and books such as The Thinking Woman's Guide to a Better Birth can help you be more prepared for your birth experience.

Birth is always unexpected. There are times when interventions are needed - but oftentimes (especially in hospitals) they just create problems.

They may have adverse effects on both mother and baby. Be sure to find out what interventions may be routine with your care provider and your place of birth. You may be able to negotiate, or you may realize that you need to seek another doctor or midwife.

There are also procedures that may be done on your baby. Read about the first few moments with your baby to learn more about these procedures.