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Intervention Education

August 22, 2010

Photo: Christy Scherrer

I didn’t decide to have a natural birth just because of the risks associated with epidurals. It was a starting point to get me thinking. I ultimately chose to plan and prepare for a natural birth because I wanted a totally different birth experience. When you choose to have an epidural you’re choosing to be okay with some other things that often come with it. Things that a lot of women don’t know about.

Let’s talk about the medical interventions that often come with getting an epidural. I don’t share any of this to ‘scare’ you into choosing natural birth. My only intention is education. I think it’s necessary because, in my experience, most women don’t know much about these interventions and rarely know about the risks they carry.

IV Fluids

Before you get an epidural you are required to get a bag of IV fluids. This increase in fluids can disturb your body’s hormonal balance. This means your body’s own natural Oxytocin levels (responsible for making your uterus contract) are diminished which slows your labor. A woman who has preterm labor is most often treated with a saline solution being pumped into her body.

Pitocin

According to a study published in Evidence-based Obstetrics and Gynecology, the administration of IV fluids lends to an increased need for the labor-augmenting drug Pitocin. Pitocin labor is typically more painful than a natural labor. The natural hormone Oxytocin is secreted in bursts, regulated by a woman’s body. Synthetic Pitocin is continuously pumped through the IV. The increased risks associated with pitocin include fetal distress, uterine rupture and cesarean section. Even if you think you didn’t have Pitocin with one of your births, check your hospital record. It is often hooked up to your IV without your knowledge.

Fetal Monitoring

Now that you have saline solution and pitocin being pumped into your IV and epidural medication being pumped into your spine, you must have continuous fetal monitoring in case one of those things bothers your baby. At most hospitals this means you will be confined to bed so the nurses can get the most accurate readings. You no longer have the benefit of gravity to help get your baby delivered. To get the most accurate monitoring a doctor will want to break your bag of waters (amniotomy) so they can insert an intrauterine pressure catheter and/or screw a scalp electrode into your baby’s head to trace the baby’s heartrate more accurately.

Amniotomy

Or they may break it because women and their doctors are always wanting to speed up labor and this is one way to do it when the epidural and/or IV fluids slows it down (although it doesn’t always work). The bag of waters protects the baby and mother from infection. It provides cushioning between the baby’s head and a laboring mom’s cervix, making labor more comfortable for mom (and still effectively helping her cervix dilate). It keeps the baby happy as it prevents compression of the placenta, baby and umbilical cord. When the water is broken the cord can slip out ahead of the baby; this is called cord prolapse. The supply of oxygen is stopped and the baby must be delivered by c-section immediately. In addition, most hospitals and doctors have a maximum 24-hour window for you to deliver after your water is broken. If you don’t deliver by their deadline you will be taken back for a c-section, regardless of the status of yours and your baby’s health at that point.

Episiotomy, Forceps Delivery & Vacuum Extraction

You’re finally fully dilated and the nurse tells you to start pushing! Hopefully you’re pushing well despite the fact that you can’t feel anything and you’re probably laying on your back with your feet up in stirrups. We talked yesterday about how an epidural can hinder a mother’s efforts to push her baby out. Laying on your back is a hindrance too. But what else are you going to do when you can’t feel your legs? Well, if you can, move to a side-lying position. Getting off your back helps to open up your pelvis by 30%!!! And why do our doctors have us laying on our backs during labor and delivery anyways? How many times have you heard while you’re pregnant that you should not sleep on your back so the baby doesn’t put pressure on the inferior vena cava, limiting blood flow to the baby? How does it make any sense then that you would try to push out a baby (sometimes for hours) while laying on your back? Don’t give the doctor a reason to do a c-section.

If any of these things causes you to have a difficult time pushing your baby out your doctor will eventually want to assist the delivery with an episiotomy, forceps or vacuum or some combination of those things. I’ve not had an episiotomy and from the stories I’ve heard from friends who have, I never want one. In addition, there are risks associated with forceps delivery and vacuum extraction for both mom and baby. In both cases the doctor attaches a device to the baby’s head and attempts to pull and rotate the head until the baby is delivered.

Cesarean Section

If the baby is still not coming out, or the baby is not tolerating the interventions at any point, you will be taken for a c-section. More risk. In the future I’ll write more about the risks involved with a cesarean section. If you would like to learn more about the risks now, I encourage you to read The Thinking Woman’s Guide to a Better Birth. It’s not just a simple surgery to get the baby out. It’s major surgery, there is major recovery time and there are definite risks to yours and your baby’s health.

When you sign up for an epidural (and the risks, however minimal) you also sign up for other interventions, which carry even more risk. These interventions aren’t necessarily a recipe for a c-section but it’s easy to see that there will be an increase in cesarean risk when these interventions are used.

Again, I didn’t choose natural birth because I was scared of all these interventions. I believe there is absolutely a time and a place for each of them. I’m thankful for medical intervention when it’s necessary. But I was not willing to make deliberate choices about my births that would increase the odds that these interventions would be needed.

I feel sadness for any woman that is scared into a natural birth because that can all-too-often lead to a traumatic experience. I was really glad I found researched all of this while I was pregnant. It was the stories of women actually embracing birth and even the pain associated with it that really helped me make up my mind to prepare for a natural birth though. I’ll share some of that story in the next few days. I hope you’ll join me!

This certainly is not an exhaustive list or description of medical interventions associated with hospital birth. If you would like more information I would love to direct you to some of the books listed on the Natural Childbirth Resources page.

As always, feel free to comment on this, or any of my blog posts. I’m always happy to answer questions you leave as well.

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3 Comments leave one →
  1. Jennifer permalink
    August 22, 2010 9:40 PM

    You hit the nail exactly on the head. The scenario here- this cascade of interventions you’ve laid out- is an all-too-common occurrence in hospitals… 😦

  2. August 23, 2010 12:25 PM

    great post! thank you for this.I’ll be adding this to Sunday Surf

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