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Common Interventions in Hospital Birth

There are a number of possible procedures that can happen during birth, especially in hopsital settings, but it is important to remember that only you determine your preferences and make choices for your birth. This birth is not about the midwives, doula, nurses, or doctors that are supporting you. It is only about you and your family. These procedures are never necessary in a normal birth when the mother is relaxed, hydrated, and has a care provider who works hard to avoid interventions. When you choose a care provider who does not respect your decisions in your birth, then you may be accepting many of unecessary interventions as part of yours and your baby's experience. A gentle, normal birth is possible for 95% of mothers, but unfortunately, a typical American hospital birth will include at least five of these interventions. The decisions that you make prior to an during you birth will have a tremendous impact on your experience. Alternatives to these common interventions are almost always available to you, but may not be offered to you depending on the preference of your attending care provider.

Possible Procedure Advantages Possible Disadvantages
Hospital “Johnny” (Hospital gown that open in the back with snaps on both shoulders.) Easier access to veins. Snaps on shoulders allow for easier breastfeeding. Mom doesn’t have to clean up her clothes if they get dirty. Often makes mom feel more like a “patient”. Drafty If open in the back, baby misses the skin-to-skin contact if baby is placed on mom’s chest after delivery.
No food or drink during labor (usually ice chips are allowed) Prevents asphyxiation if a c-section is necessary and mom vomits due to anesthesia reaction This is a policy in most hospitals and it leaves dangerously little energy for the hard work of labor. Lack of fluids can lead to dangerous medical conditions. Ice chips do not provide fluid nor quench thirst. May increase odds of cesarean.
IV Fluids (Needle inserted in vein, taped and hooked to IV stand for fluid intake.) Provides hydration. Maintains blood pressure when anesthesia is used. Allows immediate access to vein. Restricts movement. May cause swelling. May cause distended bladder. Many hospitals require and IV in VBAC moms and you may wish to decline or switch birth locations to avoid this.
Artificial Rupture of Membranes (AROM) (Small hook inserted vaginally and used to break bag of waters.) Many providers believe it may start or speed up labor but there have been no studies to prove it does when performed before 8-9 cm. Care provider is able to check color of amniotic fluid. May not be successful in starting or speeding labor, which can lead to other interventions. Higher risk of infection, which leads to other interventions. Reduces cushion of baby’s head on cervix, which may result in stronger contractions. Higher possibility of cord prolapse and cesarean. You may wish to decline this or swich birth locations if this is routine.
Continuous External Fetal Monitor/EFM (A paddle monitor placed around mom’s belly to measure baby’s heart tones) Allows care provider to hear baby’s heart beat continuously and assess baby’s well being. Provides a continuous record of heart tones. Not always accurate and significantly increases risk of cesarean birth. This is standard in nearly every hospital, particularly in the second stage of birthing. If misread, can lead to more extreme interventions. Restricts movement. Requires adjustment. Exposes fetus to ultrasound. Has not been associated with a better outcome of mom and baby (in fact it is associated with worse outcome). Care provider and others may pay more attention to monitor than mom.
Internal Fetal Monitor/IFM (Probe screwed into baby’s head during labor and taped to mom’s leg to measure heart tones and contractions.) Allows for assessment of fetal well being. More accurate than an external fetal monitor, but should never be routine. Provides a continuous record of heart tones. Requires AROM. Restricts movement. Requires adjustments. May cause infection of uterus or fetal scalp. Interpretation of results varies per practitioner. Has not been associated with better outcome of mom and baby. Care provider and others may be more attention to monitor than mom. May be painful for baby.
Intra Uterine Pressure Catheter (Small diameter hollow plastic tube with a flexible probe is inserted vaginally, through the cervix and rests next to baby to measure intensity of contractions) Provides information on frequency and intensity of contractions. Requires AROM. Restricts movement. Can be painful as it passes through the cervix. May cause infection of uterus. May scrape or injure baby. Interpretation of results is only for one “pocket” of space and results may not be accurate. Care provider may pay more attention to monitor than mom.
Prostaglandin Gel (Horse sperm gel inserted to cervix to start dilation.) May cause ripening of cervix. May start uterine contractions. May not work. Higher risk of infection. May have intense contractions. May increase risk of further intervention and care provider will usually follow this with pitocin.
Stripping the Membranes (Care provider manually pulls cervix away from bag of waters.) May cause labor to begin. May not work or may cause labor before baby is actually ready to be born. May rupture membranes, potentially before your body is ready to give birth. Bloody discharge possible. May be painful.
Pitocin induction (Synthetic hormone added to IV to start uterus contracting.) May cause contractions. May speed up a slowed or resting labor. Increases intensity and frequency of contractions. Requires constant EFM. Often requires narcotic pain medication due to increased intensity of contractions. Increases incidence of newborn jaundice. May substantially increase risk of cesrean birth if Mom and/or baby are not ready for birthing (and some moms and babies aren't ready until well past their "due date".
Cytotec (A gall bladder disease medication not FDA approved for labor and delivery. Tablet is manually cut and a portion of the tablet is placed at or near mom’s cervix to dilate cervix.) May cause cervical dilation. Not approved for labor and delivery. No measured amount available. May cause tectonic contractions. Rarely leads to uterine rupture. Can be fatal when Mom is bleeding in labor.
Internal Exams (Care provider inserts hands to check cervical dilation, effacement of cervix, station and position of baby’s head.) Provides information about current status of mom and baby and labor. Can lead to higher risk of infection. May cause premature rupture of membranes. Moms can be psychologically affected depending upon “status”. May cause a great amount of discomfort, causing a stall in progression. Note: in my experience, hospitals rarely attempt to minimize vaginal exams, even when this has been requested.
Demerol, Nubaine, Staydol, Morphine (pain medications) May reduce sensation of, or caring about, pain. May allow mom to rest and relax. Causes extreme drowsiness. Mom may not realize she has given birth. May cause disorientation, hallucinations, nausea and vomiting. May cause respiratory distress in mom and newborn. Slows labor. Lowers blood pressure. Baby’s heart rate is less reactive. May alter baby behavior. May interfere with breastfeeding.
Forceps (Metal tongs placed on either side of baby’s head to help pull baby out.) Can be used to rotate baby to anterior position. Allows for more rapid delivery of baby. Assists in delivering baby when mom can’t feel the push sensation due to anesthesia. Usually requires an episiotomy. Usually requires regional anesthesia. May badly bruise baby’s head and face. May bruise or tear vaginal tissue. May cause permanent birth injuries.
Vaccuum (Small suction cup placed on top of baby’s head to help pull baby out.) Requires less space than forceps. Helps with descent of baby’s head. May cause bruising or swelling of baby’s head. Not helpful in rotating baby. May bruise or tear vaginal tissues. May cause birth injuries.
Delivery on bed in supine position (Pushing and delivery of baby is often on a hospital bed with mom laying on her back.) Allows care provider to see perineal area. Can slow 2nd stage/pushing stage. If done, Mom should always have one butt cheek raised with a folded towel. Doesn’t use gravity. Can cause compromised blood flow in mom and baby. Can slow 2nd stage/pushing stage. Higher incident of broken tail bone. Mom often feels far away from what’s happening between her legs.
Episiotomy (A cut made on the perineum usually at the time of delivery.) Provides more space for forceps or vacuum. Enlarges perineal area. Pain – while being cut, while being sewn up and possibly for months while healing. Does not enlarge birth canal just perineal tissue area. Can cause pain with intercourse, urination, and/or bowel movements for months and even years after delivery. Can be traumatic and cause problems with self-image.
Early Cord Clamping May prevent blood mixing if mom is Rh- and baby is Rh+ Allows care provider to give pitocin for mom without pitocin going to baby. Faster signal given to placenta to separate with possibly less maternal blood loss. May prevent sepsis (infected blood) in moms have been given antibiotics during labor. May prevent any adverse affects on the baby if general anesthesia has been given to the mom. If clamping is done immediately, baby stops receiving life giving oxygen via umbilical cord. Baby won’t have the opportunity to receive the extra cord blood (20 to 60% more) which helps prevent hypovolemia (decreased blood volume). LCC (late cord clamping) baby receives many maternal antibodies, additional stem cells, hormones, vitamin K from the additional placental blood supply. Loss of this volume of blood is equivalent of “subjecting an infant to a massive hemorrhage.” LCC babies weigh an average of 2 oz more at birth. Studies show higher breastfeeding rate possibly because baby has more strength and/or early contact with mom. LCC reduces incidence of iron deficiency anemia; provides about 50 mg of additional iron to baby. Results in increased hemoglobin and hematocrit levels. Reduces respiratory distress syndrome in premature infants. Twenty minutes to one hour is ideal. Baby may experience therapeutic, mild jaundice from LCC.
Doppler (Machine used to listen to a baby’s heart rate.) Allows care provider to listen to baby while mom is in any position. More sensitive than fetoscope. Allows others in the room to hear the baby. Does not provide continuous record. Exposes baby to ultrasound. Not proven safe for mom or baby.
Manually assisted extraction Some light downward traction may help “sticky shoulders”. Does not allow baby to follow normal movements of restitution and external rotation. Can injure baby’s vocal cords, neck muscles and potentially cause paralysis. Can cause perineal tearing.
Bulb suction Can stimulate baby to breath via irritation. Gets fluid out of baby’s mouth and nose. Can push fluid down babies trachea if not used properly. Very irritating for baby.
Warmer Keeps baby at body temperature. Allows baby to be “worked on” if necessary. Removes baby from mom. Can cause dehydration.
Cord Traction Moves 3rd stage of birth process along. Light traction may help a “sticky” part of the uterus. If placenta is off the wall of the uterus and lying against the cervix, traction will allow placenta to descend the canal and be expelled. Can pull umbilical cord off placenta requiring a manual removal. Can cause inverted uterus. Can cause placental hemorrhaging.
Vitamin K injection May be necessary if baby has blood clotting disorder and has had a traumatic birth. Painful for baby Not necessary for all babies unless blood clotting is an issue
Eye Goop/Erythromycin Prevents blindness if mom has gonorrhea and passes disease onto baby. Prevents baby from seeing mom. May sting eyes for a short time
Hepatitis C injection Starts the immunization process for Hepatitis C – a blood disease usually caught from infected needles or infected sexual contact. Painful for baby. Most babies are not at risk. May be difficult for baby’s immature immune system to cope with a vaccination that has a disease and the vaccination preservatives.
Newborn bath Cleans your body fluid off baby and allows hospital personnel to touch baby without gloves. Most babies don’t like being cold during the bath. Babies get cold during the bath and are required to get warm under the warmer before being returned to mom. Babies are not dirty.
Nursery Observation Allows baby’s heart rate and breathing to be monitored via electronic fetal monitor. Separates mom from baby. Separates baby from being held or touched after being “held” for 9 months in the womb. May interfere with breastfeeding if medical personnel do not bring baby to mom or use other feeding/pacifying means in nursery.