WHY MEDICAL INTERVENTIONS MATTER

When your pregnancy goes from low-risk to high-risk, medical interventions are often good things that keep mom and baby safe. But when healthy, low-risk pregnancies end up in unnecessary C-sections, that is a different story. C-sections are frequently the end result of a series of unnecessary interventions. In this post we talk about why unnecessary medical interventions matter, and what you can do to prevent them.

Of course, emergencies do arise and require the full extent of medical technology to keep mom and baby safe. In these cases, we are very thankful for the modern inventions and methods that help prevent injury or death to mother or baby.

On the other hand, the natural process of birth - for which women’s bodies are designed - is often interrupted by one unnecessary procedure, which then necessitates another. Then another. And so on, until an unplanned, or unwanted, C-section results.

Understanding the difference between necessary and unnecessary interventions helps you plan your birth according to your preferences. Your one-page birth plan can list which interventions you do - or don’t - want in a non-emergency context.

When you and your care provider discuss what options you can use to replace common interventions, it helps you both be on the same page. It helps you know what to plan for in the event of health changes that might necessitate a shift in your birth plan. It may even change what you include on your hospital bag checklist.

A SHORT LIST OF COMMON MEDICAL INTERVENTIONS

ELECTIVE LABOR INDUCTION means voluntarily using a medical procedure to make labor begin, often for the convenience of doctor or mom. But it changes the natural function and progress of labor.

Inducing labor is often done for no medically-required reason, but it causes its own set of issues. Here are the main ones:

Pitocin/oxytocin is a common form of labor induction. The issue is, it does just what it should – accelerates labor.

But the contractions are faster and harder than they would naturally be. Women have less time to learn to ride each one and to ease into the intensity.

Sometimes, the induction fails. When that happens, contractions don’t establish at regular intervals or are ineffective at dilating the cervix. If induction fails you could try again, but for most first-time mothers, the next step is C-section.

b. The cervix isn’t soft/ready when labor is induced because the other biological factors for labor aren’t ready. Consequently, a cervix softener drug is necessary. If you’ve had a previous cesarean, these drugs aren’t available to you because of the risk of uterine rupture.

Cervical softening can also be done with a laminaria or a catheter that forces the cervix to expand. Ouch!

c. Get stripped (also called “sweeping the membranes”) by having your amniotic membranes manually separated from the wall of your uterus. This will sometimes impel your body to produce prostaglandins that start uterine contractions.

Occasionally, sweeping the membranes breaks the amniotic sac without starting contractions (called premature rupture of membranes, PROM) and may leave baby open to infection.

d. Risk - Inductions are so common many people never consider there is risk associated with it. Just so you know, inductions can cause:

Mother or baby infection
Uterine rupture
Increased chance of having C-section
Fetal death

2. EPIDURALS - more than 60% of women today get one for labor pain. It’s a shot in or around the spine that removes sensation so you don’t feel labor pains, but often confines you to bed.

Not walking during labor deprives women of a lot of benefits for bringing baby down. Hanging out for hours in bed can create poor contractions, discomfort, slow cervical dilation, longer labor and failure of baby to descend. It also makes second stage (pushing) longer, which easily slides into having a C-section for failure to progress.

3. ELECTRONIC FETAL MONITORING (EFM) measures how baby’s heartbeat and your uterus handle the labor contractions. It can be done either externally or internally.

External monitors are strapped around your belly. Internal monitors are screwed into baby’s scalp. Internal monitors can only be used if the bag of waters is broken. We talk about AROM (artificial rupture of membranes/breaking your bag of water) in another post.

Either way, you are confined to bed and can’t move too much. It’s common for this to snowball into a series of effects that end up requiring a cesarean section.

EFM can give false results. False negatives say there’s no problem when there really is. False positives say there’s something wrong with baby when there isn’t, which leads to forceps/vacuum extraction of baby, or … you guessed it, cesarean section.

4. EPISIOTOMY “The little snip” is the single most common labor intervention – a whopping 35% of women get this. It’s supposed to help prevent tearing during delivery of baby’s head.

But it can cause severe perineal lacerations and pelvic floor dysfunction.

Here’s why: the straight line of a surgical cut is less able to stretch than just letting the body find its own way. That little snip can tear straight down into the anus.

A big baby is a big baby, period. Sometimes, mom’s perineum is going to tear so baby can come through. Perineal preparation and carefully managed, slow delivery of the head can minimize the tear as much as possible.

Afterward, the scar is irregular and more able to stretch at the next birth just because all the stress isn’t on one plane, in one line. The straight line of an episiotomy scar is much more likely to rupture and tear again during the next birth.

5. DIRECTED PUSHING or PUSH HOLDING means telling mom to ignore her body and push according to directions. Whoa, that is exhausting!

In extreme circumstances it could be necessary. But normally? Not so much. Opting out of this and following your own urges is a preference you can state in your birth plan.

There’s a host of reasons not to do it, and to follow your body’s natural urges instead. Letting your body and baby lead the way results in:

shorter second stage of labor
a small reduction in vacuum or forceps-assisted birth
fewer episiotomies
less chance mom will report severe pain
fewer abnormal fetal heart rate patterns
a small increase in second-degree lacerations (in the upright group only)
an increase in estimated blood loss, although research shows there was no evidence of serious or long-term problems from the extra blood loss (Gupta, Hofmeyr, & Smyth, 2004)

6. THE AMAZINGLY FREQUENT CESAREAN SECTION is skyrocketing in the U.S. – 32.7% of women get them. The current U.S. rate shot up 60% in a little over a decade. Much of it was elective.

If you look at all the interventions above, most of them lead to this end. Common as it is, C-section is major surgery that takes mom weeks to heal from, and affects every birth after this one.

Even if you forget about the pain and prolonged postpartum discomfort, it’s important to consider some serious consequences of the common C-section:

Can increase the risk of maternal hemorrhage
Can increase the risk of uterine rupture
Are 69% more likely to cause fetal death than vaginal birth

Dr. Jeffrey Ecker, Director of Obstetrical Clinical Research at Massachusetts General Hospital says, "It has been difficult to demonstrate that the rise of the C-section rate over the past decade has been associated with any meaningful improvement in babies' or mothers' health”.

Elective cesarean means baby does not have the full time to develop in utero, before labor starts naturally. While a day in your life may seem like no big deal, a day in baby’s life before birth can be a very big deal developmentally. For little ones still building their lungs and defense systems, every uterine day counts.

High rates of asthma, breathing difficulties, feeding problems, a struggle maintaining body temperature, and future obesity can result from being prematurely born.

In our post about failed inductions we show how some of the medical community elect to perform a C-section too soon, because they are operating under the principals of old standards or routine procedures. Except under emergency circumstances, there are a multitude of options to try before resorting to C-section.

When you and your midwife or doctor discuss your birth preferences ahead of time, you can learn what options are open to you.

7. BIRTH TRAUMA can result from any medical intervention.

Whether trauma comes from unnaturally fierce contractions created by Pitocin induction and that lower fetal heart rate, or from being pulled out by the head with forceps, or breathing difficulties from a C-section that eliminates lung stimulation from a vaginal delivery, baby is the one who feels it most.

Since you have the choice, consider allowing baby to come into the world slowly, being squeezed well through the birth canal so their lungs are primed, and landing on mama’s skin immediately, to soothe them after all that work.

The most thoughtful birth plan can, and likely should, be laid aside for emergencies. But when you and your care provider are on the same page, your birth can avoid unnecessary medical interventions that could progress into more invasive ones.

Talk to your care provider about the various options open to you. And make sure a copy of your birth plan is on your hospital bag checklist so it goes into the bag you take with you.

With your care provider’s support and your own clear choices, your birth plan will help your birth team help you bring baby into the world in the best way possible.

¹ http://www.acog.org/Patients/FAQs/Labor-Induction

² http://www.acog.org/Patients/FAQs/Labor-Induction

³ http://www.ncbi.nlm.nih.gov/pubmed/11405964

⁴ http://www.ncbi.nlm.nih.gov/pubmed/18515514

⁵ http://www.acog.org/Patients/FAQs/Labor-Induction

⁶ http://www.nlm.nih.gov/medlineplus/ency/article/007413.htm

⁷ http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000484.htm

⁸ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647734/

⁹ http://www.winchesterhospital.org/health-library/article?id=101291

¹0 http://www.webmd.com/baby/electronic-fetal-heart-monitoring?page=3

¹1 http://www.webmd.com/baby/electronic-fetal-heart-monitoring?page=3

¹2 http://www.healthline.com/health/pregnancy/external-internal-fetal-monitoring