Medical interventions during birth are overly used. It's a shame, honestly. Medical Interventions have a specific use, so overly using them makes it hard to know when to say yes and when to say no.
Oh, wait…Did you know that you have a choice when a provider presents you with the use of medical intervention? It's called patients rights.
Your provider should present you with a few key facts every time they present you with an intervention.
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- Your Provider should fully describe the intervention.
- They should let you know that you have a key role in the decision.
- Then they should inform you of the risks.
- You should be presented with alternatives to the plan or medical intervention.
- After 1-4 is completed, they should assess whether you understand everything and see if you have any questions.
Why I am here and who I am:
Hey mama, I am Trish— AKA Labor Nurse Mama. I am a labor and delivery nurse with over 15 years of high-risk OB experience. I am also a mama to 7 kids and have given birth to 6. This means I am quite familiar with the postpartum period and how to navigate it. I am the online birth class educator for Calm Labor Confident Birth and The VBAC Lab birth classes and the mama expert inside our Calm Mama Society, a pregnancy & postpartum membership community! I am passionate about your birth and motherhood journey! You can find me over on IG teaching over 230k mamas daily. I am passionate about your birth and motherhood journey!
We make a small commission from some of the links (you don’t pay any more for using our links); however some of the recommendations, we do not earn anything; we love ’em and want you to know about them. Click here for our full disclosure. Thank you!
Click here to get my free download called the BRAIN! It is a directed form, helping you ask the right questions each time an intervention or choice is made in pregnancy and birth.
Unintended consequences to intrapartum interventions make it imperative that nurse educators work with other professionals to promote natural childbirth processes and advocate for policies that focus on ensuring informed consent and alternative choices.
7 Common Medical Interventions Used in Birth
Let's talk about the most common interventions used from the moment you walk through the door.
Restricted Movement
When you are admitted to the hospital, guess what happens? We put you into bed, and we strap you to monitors.
Why we do it:
Um…It makes it easier to monitor the fetal heart, contractions, and starts an IV.
Why it isn't the best or needed in labor:
Restricted movement in labor causes:
- Increases pain.
- Increases your contraction quality.
- Slows dilation and effacement.
- Prolongs labor.
- It doesn't help your baby descend.
- Also can decrease the blood flow to the placenta.
- Increases the odds of more interventions.
Unrestricted Movement in Labor results in:
- Fewer interventions
- Decreased pain
- Unrestricted movement allows you to find the right and most comforting positions for YOU!
- Increases maternal-fetal circulation
What does ACOG (American College of Obstetricians and Gynecologists)
Frequent position changes during labor to enhance maternal comfort and promote optimal fetal positioning can be supported as long as adopted positions allow appropriate maternal and fetal monitoring and treatments and are not contraindicated by maternal medical or obstetric complications. ACOG
Compromise:
If you are a low-risk patient, then ask for intermittent fetal monitoring, freedom to walk during labor, and freedom to move in general.
If you must have a fetal monitor continuously, then as for a wireless if available, you can have freedom of movement.
IV and IVF
Iv: Intravenous and IVF: Intravenous Fluids are medical interventions during birth. We use IVs to give fluids, medicines, or to induce labor.
We use a needle to guide the small catheter into your vein, and then we remove it, and a small little flexible tube is left behind.
Why we do it:
- Hydration
- In case of emergency
- To administer medications
- Required if having an epidural anesthesia
Why it isn't the best or always needed in labor:
- Restricts movement
- Decreases your confidence by making you “feel sick.”
- may over-hydrate mothers (hypervolemia), causing swelling in you and increased fluid in the baby
- Some research suggests it causes lower blood sugar in the baby
- Increased issues with breastfeeding if over hydrated
Compromise:
As with all medical interventions during birth, this is based on lower risk and not needing medications. If you plan to get an epidural, then you will need one at that time. I recommend asking for a “saline lock'. Basically, you will have an IV place; nothing is connected. Allowing you to move, shower, and not be strapped to the IV pole.
If you choose to ask for no site or a saline lock, you can't just say, I Don't want an IV. It would help if you had a plan. So let your provider know that you understand the importance of hydration. Therefore, you will hydrate through oral intake. Sister, do not slack on this one. Be sure to take drinks in between contractions. If you find this difficult to do, then ask for IV fluids. Dehydration during labor is a beast.
Fetal & Contraction Monitoring
The next medical interventions during birth and one of the most common is fetal monitoring. We will discuss both external and internal.
External fetal monitoring is an ultrasound device. It is strapped to your abdomen and traces the baby's heart tones. The other monitor is tracing your contractions; an external monitor for contractions can only tell us when and how long the contractions are happening. Not how strong.
Your provider uses an internal fetal monitor when there is difficulty tracing the fetal heart, OR the baby is in repetitive distress. The internal fetal monitor is a small coiled wire twisted into the out layer of skin on the baby's scalp. The best use is if you were dilated some, and your water has to be broken. There is a risk of injury to the baby and infection to the baby/amniotic fluid. It should only be used in certain situations.
The internal uterine pressure catheter's purpose is to monitor contractions internally. A thin catheter is inserted into the cervix around the baby's head into an amniotic fluid space. There is a slight chance for infection and that the uterus can be punctured. We use this device- to check the contractions' strength to see if they are adequate to change your cervix. It is also used to infuse fluid back into the uterus.
Why we do it:
- To monitor the baby's heart rate and variability. Both of which tell us how well the baby is handling labor and staying oxygenated.
- To monitor how the baby is handling medications given to the mother.
- To monitor contractions frequency & duration.
Why it isn't the best or always needed in labor:
- Restricts movement.
- It isn't always necessary when done continuously.
Compromise:
If you are a low risk, then tell your provider you want intermittent monitoring. Intermittent monitoring is usually 20 min out of every hour. It is way better than continuous. If high risk, ask for wireless to compromise. This is one medical intervention during birth that you can ask for a reasonable compromise that works for you, while still having it used during your birth.
If internal monitoring is suggested, you should receive adequate information to make an informed decision. It should not be done just because and without your consent.
Sterile Vaginal Exams
Why we do it:
Cervical or vaginal exams are performed to assess for a few things.
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- Dilation: How much your cervix is opened. It is measured in CM, 0-10cm.
- Effacement: This is how thinned out your cervix is. It is measured in percentage. 0-100%.
- Station: Station is the baby's position with the ischial spines of the pelvis, measured in pluses and minuses. A baby at zero station is said to be engaged while a baby in the negative numbers is floating. The positive numbers are the way out of the pelvis toward birth.
- How soft your cervix is. This is like saying if it is soft, then it is ripe for labor.
- Fetal Position: A cervical exam can reveal the presenting part and how it is positioned.
- Cervical Position: The cervix is like a satellite and will move to point towards the opening of the vagina as labor progresses. This is referred to as posterior, mid-position, and anterior.
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- Convenience for the provider
- Curiosity for the mama
Here's the deal mama, a cervical exam is all fine and dandy for information. But it can not tell you when labor will begin or how well it might go. It can be assessed to tell you how well an induction will go. If they do an exam at 37 weeks, no one is factoring in the hormone relaxin, released during labor, which helps open the pelvis.
A cervical exam can not tell you if your pelvis is not adequate for the baby to fit. NO! This is not accurate. Again the hormone relaxin helps open the pelvis, as do many labor positions. Those can not be discredited.
Why it isn't the best or always needed in labor:
It increases the risk of infection each time it is done. Remember that even though this medical intervention used during birth is common is is still an intervention of sorts.
There is also a risk of rupturing the membranes or breaking the water by applying too much pressure on the cervix. When researching for my new course, The VBAC Lab launching soon, I spoke with a reader whose provider did this while checking her cervix during her pregnancy. It ultimately led to her cesarean and a load of PTSD from her birth.
Obviously, it is needed. But I like to say when it is indicated. During pregnancy, it is not indicated. Unless your provider is itching to induce or schedule a cesarean before 40 weeks, it will most likely discourage you and make you fearful. We all know fear is no good for labor hormones.
It is also not needed every two hours during labor, as some places/providers like to do. That is OVERKILL. A good birth professional can take a look at you and gauge where your cervix is. I'm not kidding. It's a skill, peeps.
Compromise:
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- Tell your provider you want your first exam at 40 weeks. (IF you can wait, trust me, it's better to think 40 weeks throughout your pregnancy).
- Ask that cervical exams are not performed throughout your labor unless indicated. By this, I mean, one when you get to the hospital is needed. They need a baseline. Other indications would be an emotional change in you, a big change in your pain level, or a fetal indication.
Assisted Delivery
Another medical intervention during birth would be a category called assisted delivery. This includes forceps, vacuum, and episiotomy.
Not many providers use forceps anymore, but those who do are usually pretty good at using them—mostly old school docs. So you probably don't need to worry about this one.
Forceps look like two large, metal spoons. Seriously, or even big shoe horns.
This pair of metal instruments may be used to guide your baby out of the birth canal when there is an issue.
Sometimes a vacuum is used to help the baby move down the birth canal or speed up birth. Sometimes this is necessary and needed. There are TONS of guidelines, and most providers do not overuse them. A vacuum is used to help lift the baby out of the pelvis in sorts.
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- A small plastic suction cup is placed on your baby's head.
- As you push, your baby is guided out of the birth canal.
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Your baby may have swelling and/or bruising where either forceps or a vacuum touch the baby.
Another assisted delivery method is an episiotomy. It is used to make more room for the baby to come out. Sometimes it is needed as the baby is in distress, and mama can't push the baby out. A small incision is made in the perineum, and boom, the baby is out. But this should never be done to save time otherwise. Providers have mostly moved away from this unless they are old school and stubborn.
Again, there are legitimate times that assisted delivery is needed. But it not to be for convenience.
Why it isn't the best or always needed in labor:
Assisted delivery used to be more of an issue when providers had fewer “rules.” I don't see this as often.
The risks:
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- Wounds on the scalp.
- A risk of the baby's shoulder getting stuck after the head has been delivered (called shoulder dystocia).
- A skull fracture.
- Bleeding within the baby's skull.
- Infections for mom (episiotomy).
- Pelvic floor damage (episiotomy).
- Nerve damage (episiotomy).
Compromise:
Tell your provider you do not want an assisted delivery unless ABSOLUTELY NEEDED! One way to avoid assisted delivery is to avoid beginning to push too early. If you can wait to push until the baby is in a positive station in your pelvis, you will be less likely to have assistance.
For example, if you have an epidural, ask to labor down! Add these things to your birth plan, and don't be wishy-washy, be assertive. Having trust in your provider is key here. (Download my BRAIN sheet to assist you when presented with interventions or alternate plans during pregnancy & delivery)
Amniotomy
This medical intervention is often done so quickly that you don't even know you have a choice.
Amniotomy is when your provider breaks your water. The bag of water is a cushion of sorts for your sweet little nugget. Many providers will break your water almost immediately after you are admitted for labor or induction of labor.
The normal scenario goes like this:
Labor: You come into the hospital in legit labor. Your laboring along, and your provider comes in and says, “Let's break your water to get things going faster.”
Induction: You are admitted late at night for cervical ripening, aka Cytotec or Cervidil. The next morning the provider rounds on the unit and comes in to see you. They do a cervical exam and yep…say, “I am going to break your water to get things moving.”
Why we do it:
“To speed up” or augment a labor.
Why it isn't the best or always needed in labor:
The fact is, it is almost always not the best choice unless you are in active labor with an established pattern. I highly recommend you say NO to this intervention.
The Cochrane review in 2008 found NO BENEFIT to rupturing your bag of water to speed up labor. NONE!!!
The risks:
- Prolapsed cord
- An injury to the baby
- Maternal infection due to prolonged rupture of membranes
- Fetal infection (same as above)
- A clock is started once they break your water, increasing the need for further interventions.
The bag of water is in place to cushion and protect the baby from the force of the contractions and protect the inside of the womb from the outside.
Prolonged labor after your water breaks increases the chance of infection, fetal distress, and therefore increases your chances of a cesarean.
Compromise:
Tell your provider you do not want your water broken artificially during labor. If you compromise, ask that they do it when your labor pattern is established, and you are in active labor.
Cesarean
Did you know that a cesarean is a medical intervention used during birth? It is not a birth choice. Well, at least it wasn't meant to be an alternate birth choice. It was meant to be a last resort when vaginal birth chances were exhausted.
The United States has ridiculous cesarean rates, around 31%. That is outrageous. The World Health Organization (WHO) recommends rates around 10-15%.
WHO has states that many cesarean surgeries are performed for these reasons:
Maternal Preference
Providers who are inexperienced (Doctors & Nurses)
Fear of Lawsuit
Ineffective Prenatal Education (Click here for Loving Your Labor Academy)
There is a clear implication here for childbirth and prenatal educators to be more proactive in educating women about cesarean surgery risks.
Why we do it:
- Elective: non-medical reason
- To save lives
- Prolonged Labor (see recommendations above)
- Fetal Malposition (baby isn't head down properly)
- Birth Defects not conducive to vaginal delivery
- Repeat Cesarean (According to the American Pregnancy Association, about 90% of women who have had a cesarean are candidates for a VBAC, vaginal delivery after cesarean, if this is you check out my new VBAC complete birth course and support community)
- Cord Prolapse
- Mom has a chronic health condition.
- CPD (cephalopelvic disproportion) (can not be diagnosed through a vaginal exam).
- Mom is pregnant with more than one baby (not reason alone)
- Placenta Previa or other placental issues
- Large baby
Why it isn't the best or always needed in labor:
OVERUSED! Let's say that for the people in the back: IT IS OVERUSED!
It is major abdominal surgery and it is a medical intervention used during birth! With surgery comes many risks!
Increased Risks to Mama:
- Blood loss (postpartum hemorrhage)
- Infection
- Bad reaction to anesthesia
- Blood clots
- Injury to other organs
- Cesarean increases risk for a future pregnancy
- Adhesions and scar tissue formation
- Longer Hospital Stay
- Longer recovery time
- Maternal morbidity risk increases
Increased Risks to Baby:
- Respiratory issues
- Lower Apgar scores
- Injury to the baby, nicked, or cut accidentally.
- Delated Mother-infant bond
- Increased risk of asthma
- Breastfeeding difficulties
- Increased risk of NICU admission
Compromise:
Here's the best ways to avoid a cesarean
12 Eat healthy foods
11 Stay active during pregnancy
10 Choose a provider with purpose and wisdom
9 Read childbirth books
8 Avoid induction unless medically necessary
7 Wait until Active labor to get your epidural
6 Believe in your incredible body
5 Release your fears
4 Hire a doula or virtual doula
3 Stay home laboring as long as possible
2 Do not let them break your water until active and established labor, or at all!
1 Take a VBAC Birth Class like VBAC LAB.
Some other medical interventions commonly used during birth:
- NPO/Clear Liquids
- Oxygen Administration
- Foley Catheter
- Lithotomy Position
- Guided Pushing
NPO/Clear liquids are super common, especially on the east coast. It's done “just in case”. Girl, you're about to run a marathon. you need fuel! I suggest you ask to eat during labor. Be firm. Unless you are high risk, then stick to clears and remember this. Clears include things like broth, jello, and anything you can see through. Try things like coconut water and Gatorade.
Oxygen Administration will be administered if either you or the baby show signs of low oxygen. I wouldn't fret over this one. If you avoid other interventions like Pitocin, this might not be an issue. Remember, the best breathing for labor is rhythmic deep breathing.
A Foley Catheter will be placed if you have an epidural or cesarean. This can't be avoided with the two, as you can not empty your bladder otherwise.
Lithotomy Position this is your typical pushing position. It is on your back with your feet in the stirrups or leg rests. It prolongs the pushing stage and makes it much harder. Think about it. Would you poop lying down? NO! Insist you push in more natural positions that use gravity to help you. Think things like Squatting, Birth stool, hands and knees, and more.
Guided Pushing is when your provider or nurse tells you to push during a contraction. They will usually insist you hold your breath and they will count to ten. This type of pushing has been known to be both stressful to mama and baby. The better option is for you to push when you feel an urge and make whatever noises you want. It may prolong the pushing stage a little but it decreases a lot of other issues. Listen to your body!
Ok mama, I am going to reiterate this fact and drive it straight home:
Education is the most important step you can take to an empowered birth. You must understand each medical interventions during birth to make a wise choice.
My main goal to empower you to be able to make informed decisions before and during birth. Be sure to follow me on Instagram, where I educate and empower women on a daily!
