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You may be planning a natural birth, but there are times when your health-care provider must intervene for health and safety reasons. Or you may find that standard hospital practices often include medical interventions. In either situation, it’s important that you be involved in the decisions related to your care. You can do that by asking questions and openly communicating your desires to everyone in attendance.
When a medical intervention is suggested or presented as routine procedure, ask about the benefits, risks, alternatives and whether you can do the procedure later – or not at all. Most important, trust your intuition. Everyone, including you, should stop and think before an intervention is suggested.
Research shows that many times interventions are done more for convenience sake than for medical reasons. Being well-informed about the common interventions that might arise will enhance your ability to make crucial decisions. Educate yourself, communicate your preferences well in advance and stay involved in all decisions related to labor and birth. Your choices will be critical to the health and safety of you and your baby.
ELECTRONIC FETAL MONITORING
What: Electronic Fetal Monitoring (EFM) is used to evaluate uterine contractions and the baby’s response to them. There are three types of monitors. External monitors have two belts that use ultrasound and a pressure transducer. Telemetry units allow the woman more movement, so she’s not “tethered” close to the machine. If there is some reason that the above are not taking accurate measurements, internal monitors can also be used.
Why: For a long time, listening to a baby’s heartbeat has been used to assess how the baby is tolerating labor. Low-risk women can be monitored intermittently, while high- risk women may be monitored nonstop. Continuous monitoring has not improved outcomes for healthy women having normal labors; instead, it has proven to increase the rate of cesarean. And it has affected women’s ability to move and change positions as needed. There are times when continuous monitoring is necessary in low-risk women, for example, if your labor is induced or augmented with Pitocin, or if you have an epidural. If your baby’s heart rate changes, or you or your baby have a health problem, you also may be monitored continuously.
Lower your risk: The American College of Obstetricians and Gynecologists (ACOG) supports periodic monitoring (once every 30 minutes in active labor) via EFM or auscultation, which is “listening” to what’s going on with the baby and the contractions using ultrasound. If that’s not an option in your hospital or birth center, talk with your nurse about being upright (such as in a rocking chair or on a birth ball) when being monitored, as opposed to laboring in bed. Or, ask for a mobile monitoring unit so that you may continue to walk, go to the bathroom, stretch or slow dance. Try not to labor in bed for long periods. Don’t be distracted by the monitor – turn it away and lower the sound. Remind your support team to focus on you, not on the machine.
What: An artificial way to start labor using one of the following induction methods:
1. Membrane stripping or sweeping via your health-care provider’s finger to separate your cervix from the tissue around your baby’s head.
2. Rupture of membranes using a sterile hooked instrument.
3. Cervical ripening with the insertion of either a prostaglandin gel or a balloon-like catheter.
4. Pitocin, a synthetic hormone given through an IV drip in steadily increasing amounts to stimulate contractions.
In addition, some non-medical induction methods may be suggested, including acupuncture, homeopathy and/or herbs, sexual intercourse and nipple stimulation. Discuss the pros and cons with your health-care provider. If you do try one of the above, keep him or her updated on your progress.
Why: ACOG recognizes various medical reasons for inducing labor. However, the number of inductions in the United States is on the rise, due to a recent trend of inducing for non-medical reasons. These include the mother’s desire to plan the baby’s birth date, to minimize end-of-pregnancy discomfort, or to have a favorite health-care provider attend the birth. In addition, many women are induced because their health-care provider suspects the baby is large. According to ACOG, this is not a medical reason for induction. Studies show that the birth of a big baby is not affected by inducing labor versus letting labor begin on its own.
Lower your risk: Unless there is a clear medical reason for induction, it is far less complicated and far more healthy for you and your baby to let labor start on its own. Going into labor naturally is the best way to know that your baby is ready to be born and your body is ready for labor. If a medical concern does arise, spend as much time as possible with your health-care provider weighing the benefits and risks of each labor-induction method.