Every woman wants the best possible labor, delivery, and birth experience. For most of us, this means avoiding unnecessary labor interventions and newborn procedures, especially if we want a natural childbirth.
Some people might think that there’s no harm in a few labor interventions to “move things along.” However, each and every unnecessary intervention puts you at a much greater risk for more, and increasingly risky, interventions.
Having said that, each birth is a mystery. Despite my desires, I did end up having a “hit of Pit” (Pitocin) with my first birth. It ended up helping, and probably prevented me from a forceps or c-section delivery. The point is, we want to use birth interventions judiciously and avoid unnecessary interventions.
Labor Intervention #1: Induction
Induction is one of the most common labor interventions recommended when it’s not medically necessary. Whether a mom is past her due date, the baby is “too big,” or the doctor is on a tight schedule, the standard attitude towards induction is pretty relaxed. Another reason for induction is low fluid levels. Be sure to stay very well hydrated throughout your pregnancy, but particularly during the last 4 weeks. (Some moms will measure low in fluid, then they’ll drink a few quarts of water, get remeasured in the morning and their fluid levels will be fine.)
The truth is induction is a serious intervention that should be discussed at length with your practitioner.
Although we don’t know a lot about the precise cascade of events that initiates labor, we do know that signals from the baby’s lungs play a role in getting the process started. Therefore, induction of labor, even using natural induction methods, when baby and mom may not be ready can cause problems.
One study found that inducing a woman with a bishop score below 5 would fail 84% of the time. Eighteen percent of all the women studied would have a failed induction (ending in C-section), and that number is even higher for first-time moms. Sometimes induction is necessary when the life of baby or mom is in jeopardy.
Alternative: If you or baby are not in a health-threatening situation and still need to be induced, be sure your bishop score is 8 or above. You can calculate your score here.
Labor Intervention #2: Continuous fetal monitoring
Another common and almost standard labor intervention is continuous electronic fetal monitoring. Electronic fetal monitoring (EFM) may seem harmless, however, it is not evidence based for low risk women (the vast majority of women fall into this category). In fact, continuous EFM is associated with an increase in pain medication use, cesarean sections and instrumental vaginal births.
In a Cochrane review, continuous EFM has been shown to reduce newborn seizures (a rare occurrence) but does not reduce the risk for cerebral palsy, infant mortality, low Apgar scores, cord blood gasses, admission to the neonatal intensive care unit, or low-oxygen brain damage.
Alternative: If you or baby are not in a health-threatening situation, request Intermittent Auscultation (intermittent heart monitoring with a handheld doppler) instead of EFM. This is the evidence based choice for fetal heart rate monitoring.
Labor Intervention #3: Pitocin
If stripping membranes, cervix ripening agents, rupturing the membranes, or other induction methods don’t work effectively, Pitocin may be ordered to get contractions going.
Pitocin is synthetic oxytocin, the hormone that signals the uterus to begin contracting. When labor doesn’t go as fast as practitioners would like (especially after induction) Pitocin is used. However, it doesn’t cross the blood brain barrier like natural oxytocin does, which means the body won’t respond in the same way by sending a natural pain killer- endorphins.
This means that Pitocin augmented labor can have the potential to be much more painful. It can also cause fetal distress since contractions are artificially regulated and baby can’t slow them down if labor becomes too stressful. This in turn can lead to an emergency c-section.
Alternative: If you or baby are not in a health-threatening situation, request nipple stimulation instead of Pitocin. Most hospitals will have medical grade breast pumps you can use during labor, but manual breast massage (resembling hand expression of breast milk) is actually more effective than using a pump, so this tool is pretty low-tech. This is a great evidence-based choice for boosting contractions. I know from experience that nipple stimulation is very effective!
Labor Intervention #4: Epidural
Sometimes when Pitocin is used and contractions are much more painful than usual, a mom needs pain relief to keep going. Unfortunately epidurals have their own set of risks.
Epidurals interfere with the normal cascade of hormones. Oxytocin isn’t released to create contractions and signal endorphins so you need more Pitocin to continue with labor. Baby may become distressed. Dilation may stall for a variety of reasons–changes in the nervous system that occur after an epidural often space out contractions. Likewise, since the woman has an epidural, her freedom of movement is usually inhibited. Any position restriction for the mother affects the baby’s ability to navigate what is already a tight squeeze through the pelvis.
If dilation doesn’t stall and baby continues down the birth canal it may be more difficult for mom to push, because she’s numb. Some providers will turn down the epidural so mom can feel when to push. Since mom hasn’t been making her own oxytocin to signal endorphins she is likely to be in a tremendous amount of pain.
Having said that, epidurals can help to fully relax the pelvic area, which can help some moms birth their babies. In this way, epidurals can actually help a mom prevent a c-section.
Alternative: Try getting into the tub. In studies, water can be as effective as narcotics in reducing pain. You can also try counterpressure, acupressure or ice/heat.
Labor Intervention #5: C-section
Thank God we have caesareans as they do save lives. I was a c-section baby myself and probably wouldnt’ be alive today without this surgery. However, unnecessary c-sections can have very negative consequences.
The cesarean rate in U.S. hospitals is near 30% for low risk women. In contrast, the c-section rate for women under midwifery care is around 5%.
World Health Organization recommends a cesarean section rate of approximately 10-15% as being optimal for outcomes for mothers and babies; and this includes high-risk births like triplets.
So why the huge number of c-sections?
Some people blame women for choosing elective cesarean births and for being older and more overweight. Others believe it’s due to hospital and practitioners’ fear of liability.
Neither of those explanations are quite right. In reality, cesareans among all age groups of women. And liability fears account for only a small amount of the huge rise in c-sections.
A likely cause is the medicalization of birth and routine, overuse of unnecessary labor interventions, which can lead to more interventions. Induction increases likelihood of Pitocin; which increases likelihood of epidurals; which increases the risk of c-section (hence the cascade of interventions!)
Alternatives: If you or baby are not in a health-threatening situation, you can try laboring longer to see if baby makes progress. Try changing positions, walking and squatting. Remember that active labor, particularly for a first time mom, doesn’t begin until 6cm. That means that any progress before then is not expected to be remotely fast or linear. Be sure to also do your optimal exercises during your pregnancy to get baby in the best position for birth.
How to avoid unnecessary labor interventions
Avoiding unnecessary labor interventions will give you the best chance for a unmedicated, vaginal birth.
(And don’t beat yourself up if you need one or two interventions. This is not about perfection! And, this doesn’t mean that you’ll end up with all of the interventions.)
Here are some tips that may help you avoid labor interventions.
Develop a belief and understanding of birth
Fear of birth is one of the biggest reasons that women need labor interventions. Fear stalls birth and can make it more painful.
Believe that your body can give birth. Believe that nature will take its course. Be positive. Expect the best. And trust that your birth team will help you make the right choices should complications arise.
Write a birth plan
Writing out your desires for your birth can create a positive vision. We know that birth is unpredictable and that you can’t plan it out but knowing what you would choose in any given scenario is a great way to feel less out-of-control and at ease with childbirth.
It’s also helpful to have it written down so that your practitioners know what you want, and therefore don’t have to interrupt you during labor.
Here’s a free visual birth plan that you can download and customize.
Take childbirth classes
Childbirth classes are an excellent way to reduce fear and become empowered to birth your baby. The right birthing class will help you trust your body and your baby to come when, and how he’s ready.
Of course, we’re quite partial to the Mama Natural Birth Course. Which is online, on-demand, and on your own schedule.
In the course you will:
- Discover the #1 key to achieving a natural childbirth
- Learn how to avoid the “cascade of interventions” that we are talking about here!
- Get the 411 on optimal pregnancy nutrition
- Discover natural remedies for common pregnancy concerns (swelling, back pain, insomnia, placenta positioning, GBS, etc.)
- Practice the best exercises to position your baby and prepare your body for childbirth
- Equip your mind and spirit with practical tools, techniques, and visualizations to help you achieve a peaceful birth
Click here to learn more about the birthing class.
Work with a midwife
Midwifery care reduces a woman’s risk for interventions. Midwives usually work at birthing centers or at the mother’s home, which reduces access to typical labor interventions.
Interview potential midwives so you can choose the right one for you. Here’s a list of midwife interview questions for you.
Consider a doula
If you do give birth at a hospital, know that a natural birth is possible. Here are some tips to help you increase your odds. You will definitely need a doula by your side as she’ll help prevent unnecessary labor interventions.
Studies show that women who had continuous support from a doula were less likely to have any pain medication, epidurals, vacuum or forceps-assisted births, C-sections, or negative feelings about childbirth.
Interview potential doulas to find the right one for you.
Best wishes for an empowered and awesome birth!
The fact that you’ve read all the way through this article is a good indicator that you are preparing and doing your homework. Keep it up, get educated, assemble a good team, and go out there and rock your childbirth! However it unfolds, you will be informed, empowered and respected for your choices.