A story of intervention
A first time mom chooses to give birth at a birth center. She is excited; she plans a natural birth in a quiet setting. Still pregnant ten days after her due date, an ultrasound checks on the well-being of the baby. As she sees her little one in utero, the technition announces that there is too little amniotic fluid and she needs to be induced immediately. After a teary call to her midwife, she is told to go to the hospital at 12:30 pm.
Once there she is hooked up to Pitocin. There is nothing else that can be done, she must stay in the bed hooked up to the machine. Her water is broken and a fetal monitor is screwed into her baby’s head in utero. Hours pass and her contractions become excruciating. She is dilated only 4 centimeters and everyone is worried that she is not progressing. Pain relief is offered and she agrees to a shot of Stadol. After an hour, the pain has increased, the mother feels dizzy and she has not progressed beyond 4 centimeters. She talks with her midwife who suggests an epidural to give her some pain relief. The mother agrees. 8 hours after her induction started, the epidural takes effect and the mother is able to rest. An hour later and at 10 centimeters of dilation, the mother begins to push. Because she cannot feel anything below her waist, the baby is delivered using a vacuum and an episiotomy.
This planned natural birth became a technologic birth. While the mother’s body still pushed the child out, she did not feel like she did any of it. After this experience, the mother had no confidence in her ability to birth a child. She had never felt a single natural contraction. The baby slept for almost 24 hours after birth and the mother had a difficult time nursing her at first. Finally, she felt like the peaceful birth she had imagined had been stolen; she later learned that amniotic fluid levels can be calculated differently when the ultrasound is performed by second technician. Additionally, if the mother is dehydrated, her fluid levels can be low. Rather than being hydrated and monitored, she was told she needed to be induced that day or the baby could die.
Three and a half years after the birth of my older daughter, I became pregnant with my second child. I decided to avoid all interventions if possible. I educated myself about interventions. I’m sharing with you what I learned.
The most common interventions are IV fluids, continuous electronic fetal monitoring, Pitocin, epidural, breaking the amniotic sac, and episiotomy. While there are instances where these may be necessary, they each have side effects and are often used inappropriately or prematurely.
At some hospitals a woman is given an IV upon admittance. The reasoning is that a woman labors more easily when she is properly hydrated. In most situations this can be achieved through food and drink. Unfortunately most hospitals do not allow a laboring woman to eat or drink. This is due to the miniscule chance that she will require a c-section with general anesthesia and that the breathing tube is inserted incorrectly. This protocol of not allowing a laboring woman to eat or drink is based on one study from 1949.
Continuous Fetal Monitoring is supposed to help doctors detect fetal distress. In theory it sounds great, but unless the pregnancy is high risk it often does more harm than good. Laboring women are often asked to wear “belts” which are the external fetal monitors. These tie the woman to her bed and keep people from focusing on her during contractions (it is not uncommon for people to check her machine or the print out before they check with her). Finally, studies have shown low risk mothers are twice as likely to end up with a c-section if they have continuous fetal monitoring.
Pitocin is synthetic oxytocin. This drug is supposed to increase uterine contractions by replicating the hormone that is responsible for producing the contractions. Unfortunately the reason oxytocin is often not produced by the mother’s body is because the body is not yet ready for the contractions to strengthen. The result is very painful contractions that have little “break” time in between, tiring the mother out and stressing her body. Pitocin also usually requires an IV, and the breaking of the bag of waters for internal fetal monitoring where an electrode is placed into the baby’s scalp through the cervix. This very invasive procedure requires the amniotic sac to be ruptured and can cause the scalp of the baby to become bruised or infected.
If she is in a lot of pain, a woman may ask for an epidural, an injection into the spine to block the pain. Epidurals usually provide excellent pain relief but also make it more difficult for babies to move and rotate to fit through the mother’s pelvis. An epidural also makes it hard for a woman to walk or move the lower half of her body. With an epidural she is usually unable to change her position to facilitate labor; she is confined to her bed. She also has difficulty feeling the need to push and responding to that need. This often leads to a longer pushing stage and a much higher incidence of the use of forceps or a vacuum to facilitate delivery.
The amniotic sac is the bag of waters that surrounds the baby in utero. Doctors may break the water (artificially rupture the membranes) to speed up labor or to assist with another intervention. The bag of waters usually ruptures on its own during active labor. Before it ruptures it protects the baby and the umbilical cord from the pressure of contractions and from germs. It may also help the baby rotate as it travels through the pelvis. Once the sac is broken the mother may experience more pain. The woman is now also on a time line; most hospitals have a policy that the baby must be born within 24 hours of the bag of water being ruptured.
An episiotomy is a cut made to enlarge the opening of the vagina. Sometimes during delivery woman will tear in the perineal region and episiotomies were believed to help a woman heal more quickly after labor. Since many women do not tear at all or have minor tears, an episiotomy may cause a more serious wound. They also can cause damage to the muscles in the region leading to incontinence or other issues. There are methods to help the perineum during labor, and those should be tried before an episiotomy is performed.
Finally, I would like to talk briefly about informed consent. Before a procedure is performed, the doctor is supposed to let you know the benefits and risks of that procedure. In practice, the laboring woman is often not told of the potential risks of each procedure. To counteract this it is important to inform yourself, your labor partner(s) and doula of your wishes for each procedure in case you are not able to voice your thoughts at the time.
Some questions you may want to ask yourself before you agree to a procedure are:
- Why is this needed?
- What is involved and what are the risks?
- Is there an alternative?
- What happens if we do nothing or wait?
- Will this necessitate other interventions?