It may be next to impossible to labour without interference in some settings and with some care providers.
You should be aware of all the common medical procedures and how they may change your birth plans.
Many of these procedures are so routine in hospitals that you’ll have to go to great lengths to avoid having them – and some you may not be able to avoid.
You can prepare yourself to cope with interventions by reading up about them and empower yourself with the knowledge of how and when they should be used. Be sure that you talk to your doctor or midwife at the time you see them for the first time and during your pregnancy. You may also need to speak with the hospital if you plan to give birth there.
Remember, you are the customer, and it is not you that have to fit in with their customs and preferences. They have to respect your wishes within the scope of practicing safe medicine. You can change doctors during any time of your pregnancy.
And you have to keep reminding yourself that pregnancy and birth is not a medical event but a natural process.
Induction
Inducing labour can cause a cascade of birth interventions or have a snowball effect – meaning that induction can lead to another intervention, which leads to another, etc. etc.
Induction is in itself an intervention because it forces the body into beginning labour when it was not ready.
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.
Induction can take place in many ways, with the most common being ripening the cervix by using synthetic prostaglandins and/or an intravenous induction by infusing the mother with a synthetic hormone called Syntocinon (Pitocin as used in USA). Because the contractions of the uterus are brought on artificially, you and your baby will have to be monitored continuously. Induction requires other interventions such as IV lines and continues electronic fetal monitoring and you’ll probably be stuck in bed and unable to move around.
Augmentation of labour is similar to induction, with the only difference being that it happens when you are already in labour. Augmentation is done when your doctor feels that you are not progressing fast enough and that you need assistance to get things going faster. If you are progressing well enough in labour and your are dilating, even if it is slow, but your baby is not in distress, leave good enough alone!
The snow ball effect is the same as that for inductions. It could be the start of many other interventions to take place.
Amniotomy or Rupture of Membranes
Artificially breaking the amniotic sac or rupture of the membranes is done routinely at many hospitals to speed labour up, get labour going, to test the fluid or to get it out of the way so that an internal monitor can be hooked into the baby’s head. This is done with a long thin plastic hook called an amniohook. It was believed that breaking the water would speed up labour by 30 to 60 minutes but the only randomized control trial done disproved this. This procedure can cause cord prolapse, a serious complication for the baby and increases the chances of an infection. With less amniotic fluid in the uterus during labor, the baby has a greater risk of cord compression problems leading to foetal distress and malpositions of the head.
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.
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 impractical and open at the back.
You should bring your own clothing if at all possible. This allows you to avoid embarrassing and uncomfortable hospital gowns. Cotton clothing is preferred as it can breathe and is more comfortable than synthetic materials.
Most hospitals have abandoned the practice of shaving the pubic area. 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 for this being done and it can be uncomfortable for you when the hairs start growing back!
Routine enema has also been abandoned at most hospitals, although some hospitals still do this procedure routinely. No research proves any benefits for the mother or baby. Home birth and natural birth advocates recognize that for the vast majority of women, the process of labour will empty the bowels.
Immobility
It is impossible to move around when you are flat on your back. It’s even more difficult if you have internal and external fetal monitors attached to your body, an IV running into your arm and after a narcotic drug was given to “take the edge off.” It goes without saying, that if you had an epidural, you would not be going anywhere at all as your legs would have no feeling and even “walking epidurals” are misleading because even if you are able to walk, the equipment makes it too difficult and odds are the staff would never allow it.
Some hospitals encourage walking and moving around. Others do not like you to be out of your room, which may be quite small and loaded with equipment, making any real walking about nearly impossible. Studies have shown that moving about and being upright and changing positions can shorten labor.
Intravenous Therapy Drip
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.
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.
Episiotomy
An episiotomy is a cut made in the perineum (the skin and muscle between the vagina and anus). Although some people believe that an episiotomy is necessary to have a baby to prevent damage to the baby’s head, prevent trauma to the mother’s perineum and the cut will heal faster and prevent 3rd and 4 degree tears, no research supports these myths. Shiela Kitzinger writes that as many as 9 out of 10 American women will have an episiotomy with her first baby although in Holland, only 2 or 3 out of 10 will. The facts are that episiotomy is a cultural phenomena. Research shows that episiotomy is done because the doctor was trained to do it, not because it was a necessary procedure. It can be avoided by using more physiologic positions to give birth (not lithotomy or semi-sitting), pushing only when mom feels need to, giving birth gently, slowly to the head, preparing for the birth by doing perineal massage and Kegel exercise, avoiding forceps delivery.
A slight tear is always better than a cut and will heal must quicker. Research has shown that tears heal better than cuts.
Forceps and Vacuum Extraction
Forceps are obstetrical tools which are shaped like large spoons have been in use since the 1500’s. Years ago, forceps were used for many problems which are now handled by cesarean section. Today, most forceps deliveries are low forceps, which means they are applied when the babies head is low in the pelvis and birth is imminent. According to Henci Goer, “There is no research to support the elective use of forceps.”
The risks to the mother are perineal trauma, extensive episiotomy, possible extension tearing from episiotomy, hematoma and nerve damage. Lasting effects of forceps or vacuum extraction to the mother may be anal incontinence in spite of a repaired third degree tear. The baby may have damage to the head, eyes, the nerves that lead to the face and neck and arms.
Vacuum extraction is a newer technology that sometimes takes the place of forceps. As with low forceps, the baby’s head must be very low in the pelvis before the suction cup can be attached. It has the benefit of not requiring an episiotomy and maternal perineal trauma is less than with forceps, but the baby still has the possibility of trauma to the head and face. Chiropractors also recognize that pulling a baby out by the head changes the spinal alignment, although this is not recognized in any medical texts.
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.
Because of the high false positive rates continuous fetal monitoring puts you at greater risk for caesarean 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 hooked into his or her scalp.
Internal Examinations
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.
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.
Directed Pushing
Though it is not technically an “intervention” in that something is done to you, we 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 – kneeling, on all fours, leaning forward on a bed or in water.
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 after birth, and all on its own. The birthing of 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 giving the mother an artificial hormone injection in her leg and then pulling on the cord and pushing on the woman’s abdomen. Their reasoning behind this is to prevent bleeding and to allow the uterus to contract so that the placenta will release. You can aid this on your own by allowing your baby to suckle at the breast, which will allow your body to release the hormone necessary to contract the uterus. Allowing the placenta to detach from the uterus on its own will also prevent any bits of the placenta left behind in the uterus, which can cause excess bleeding.
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 Up your Care 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.
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.