Labor and Birth Interventions

Planning a natural birth? You need to understand birth interventions: all medical and childbirth procedures. Discover each one and how it impacts labor.

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Induction

Inducing labor causes a “cascade of interventions” – meaning that induction leads to an intervention, which leads to another, and another, and another…

Induction is in itself an intervention because it forces your body into beginning labor when your body and baby aren’t ready.  Chemical (medical) induction floods your body with synthetic hormones. This causes contractions that are more painful than natural contractions. They also cause more stress on your baby and on your baby.

Using synthetic prostaglandins to ripen the cervix can also cause over-stimulation of the uterus. In both situations this over-stimulation can lead to uterine rupture, maternal death, and death of the baby.

Induction brings other interventions such as IV lines and continuous 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 (so you have a premature baby you weren’t expecting).

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IV Lines

Most hospitals routinely use IV lines as birth interventions. Then they forbid food (and sometimes drink) during labor. This has negative consequences above and beyond the IV.

IV pole as a routine labor intervention

Respiratory distress, blood imbalance, seizures, and artificially-inflated birth weight are all dangers to your baby from IV fluids.

Having the IV inserted is painful for many women. The cold fluids cause pain and irritation. The IV pole limits movement. Excess fluids cause you to have to go the bathroom constantly. If there’s 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.

Fluids can artificially inflate baby’s birth weight, causing problems if you’re breastfeeding your baby.

You’ll have more energy during labor if you can have food and drink when you want them (you might not want to eat, but sip water between each contraction to prevent labor-stalling dehydration). It makes no sense to need you to do extensive and exhausting work with no food or drink if you want it! IV lines don’t solve this problem – they 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.

Bring your own clothing if at all possible. Bring a comfortable nightgown.  A large, old t-shirt is a great choice for laboring.  Check with your hospital to see what their policy on this is.

Most hospitals have abandoned the practice of shaving the pubic area (bikini line). Birth centers and home births don’t require this at all. 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 it. If you’d like one, there’s no harm in it.

Routine Continuous Electronic Fetal Monitoring

It’s almost universal to strap belts and sensors around your abdomen, leave you in bed, and watch the monitor to see your contractions when you birth in the hospital.

contraction log printout

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

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.

A simple change in position will often bring a low fetal heart rate 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 of c-section.

There’s also a possibility of your labor being slowed or ineffective because you’re unable to move. You 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.

Rupturing the Membranes

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

It’s done because of the belief that it will speed up labor, though research shows it only speeds up birth by 30 minutes or so. 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 (they are only presumed sterile.)

In most hospitals, in some birth centers, and for some home births, ruptured membranes start the clock ticking – in other words, you must have your baby delivered within a certain amount of time after your water has been broken (usually 12 hours).

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 feel stronger back labor.

If your water breaks naturally, or if it is broken by your care provider, keep internal exams to a minimum. More exams mean more chances of infection, and I recommend you refuse all internal exams if your waters have released (broken). Don’t worry, you know when it’s time to push – your body tells you!

Internal Exams

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

Cervical checks are uncomfortable, especially during labor. A gentle and sensitive care provider can make a difference, but the checks are still hard to handle. A rough exam or an exam done against your will can leave you feeling violated.

Research shows that different people will get a different measurement for dilation. This means 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 you should decline internal exams.

You know when you’re close to being fully dilated, and a skilled care provider can tell. There’s 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.”

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 can 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.

Directed Pushing

Though it is not technically an “intervention” in that something is done to you, I list directed pushing here because it’s an unnecessary intrusion in the birth process. Being forced to push in a certain way and certain positions can result 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 is unnecessary; your body usually begins to push on its own. The urge will be undeniable. Pushing contractions are usually 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 also use these invasive procedures when you can’t effectively push – usually because you’re flat on your 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. Next you deliver your baby’s placenta.

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 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. The placenta comes easily at this point, especially in a supported squatting position.

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.

The placenta will come normally and naturally if mother and baby are allowed quiet time to bond, skin-to-skin.  Blankets around you and baby keep you both cozy.

“No patting, no hatting, no chatting,” as midwife and teacher Carla Hartley says about keeping this time calm and quiet for you and your baby – care providers keep their hands off!

Weigh Carefully

All interventions 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. A good childbirth course (like our own online MamaBaby Birthing classes) gives you the info you need to be ready for your birth experience.

Birth is always unexpected. There are times when interventions are needed – but they usually just create problems.

They have adverse effects on both mother and baby. 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.

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References

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Chantry, C. J., L. A. Nommsen-Rivers, et al. (2011). “Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance.” Pediatrics 127(1): e171-179.

Coco, A., A. Derksen-Schrock, et al. (2010). “A randomized trial of increased intravenous hydration in labor when oral fluid is unrestricted.” Fam Med 42(1): 52-56.

Garite, T. J., J. Weeks, et al. (2000). “A randomized controlled trial of the effect of increased intravenous hydration on the course of labor in nulliparous women.” Am J Obstet Gynecol 183(6): 1544-1548.

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Noel-Weiss, J., A. K. Woodend, et al. (2011). “An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss.” Int Breastfeed J 6:9.

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Watanabe, T. / Minakami, H. / Sakata, Y. / Matsubara, S. / Tamura, N. / Obara, H. / Wada, T. / Onagawa, T. / Sato, I. Effect of labor on maternal dehydration, starvation, coagulation, and fibrinolysis. Journal of Perinatal Medicine. Volume 29, Issue 6, Pages 528–534, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2001.073, June 2005

Photos by koadmunkee (first, third) and soccerkrys