Lamaze Healthy Birth Practice #4: Avoid Routine Interventions for Non-Medical Reasons

The topic of interventions–during labor and at birth–can be controversial. Everyone has an opinion to share, and as an expecting mom those opinions can be overwhelming. It can often be the case that questions rather than answers arise when hearing the past stories of laboring women. The neighbor down the street just had a drug-free, intervention-free birth and tells everyone how it is the only way to do it. The coworker in the next cubicle swears that her epidural was a lifesaver and there is no way she could have labored without it. The manager of the local grocery store talks about her induction before the holidays to avoid giving birth on Christmas and what a blessing that option was for her family. Each story touches your heart in a different way but causes you to wonder what choices you will make as your time to give birth draws near.

Will you need an intervention? What about routine interventions? Are those helpful?

Birth is a natural process. We want to limit interfering with the vital hormones that regulate pregnancy, labor, birth, breastfeeding and attachment. While it can be critical to use the available interventions to improve an outcome during labor, how do routine interventions play a role?

Lamaze’s 4th Healthy Birth Practice is to Avoid Routine Interventions for Non-Medical Reasons.

Our bodies are amazing, and we are gifted with several hormones that help the birthing process move along to eventually give us a baby. Oxytocin is one of these phenomenal hormones. Oxytocin (sometimes called the love hormone) increases both the strength and efficiency of contractions. When Oxytocin levels are high, endorphins start pumping out. The way you view and handle contractions becomes easier. Oxytocin is your friend.

Catecholamine is another beneficial hormone during labor. At the end of labor it can produce the ejection reflex that quickly allows mom to birth baby. If you have a high level of both oxytocin and catecholamines at birth, you will find that you are more alert and your baby is ready and eager to start breastfeeding. The goal is to not interfere with or disrupt the normal process that is occurring. Unfortunately routine interventions–done for non-medical reasons–can do just that. As a result, these interventions increase the risk of complications.

Pitocin (the synthetic form of oxytocin) comes into play as an intervention when it is used to replace or augment these hormones that our bodies rely on for labor. Pitocin does not cross the blood-brain barrier and as a result endorphins will often fail to release. Pain without endorphins can often become difficult. Due to this, management for the discomfort is often requested. In some cases pitocin is critical in revving up a stalled labor or even in starting one, however in unwarranted situations it can brew up a cascade of interventions.

The same can be said for epidurals, also an intervention in the natural course of labor, which do provide excellent pain relief, but come with the risk of causing natural levels of oxytocin to drop. Its relaxation of the pelvic muscles can make rotation and descent of baby more difficult. The use of epidurals very often leads to more aggressive interventions to assist with birth and to a possible longer second stage (pushing baby out). There is also a decrease in the likelihood of spontaneous vaginal birth and early use increases the risk of persistent fetal malposition. Epidurals can also readily increase the risk of maternal fever and increase risk of breastfeeding issues.

It is important to have a healthy understanding of these interventions, and to use them only when medically necessary. Below is a list of other common interventions that–like pitocin and epidurals–should be discussed with your provider before using them as a routine part of you labor:

Intravenous Fluids

1. Can cause symptomatic fluid overload, which can decrease uterine contractility.
2. Can cause hypoglycemia in mom and baby due to glucose in the fluid.
3. Can cause Breast Edema which can negatively affect breastfeeding.

Electronic Fetal Monitoring

1. Introduced in the 1970s to decrease Cerebral Palsy and perinatal mortality
2. Quickly became a standard of practice even without evidence
3. Studies have found no difference in infant outcomes
4. Causes women to more likely have a C-Section or instrumental birth when not needed
5. Restricts movement
6. Limits access to comfort measures

Augmentation

1. Amniotomy
   1. Artificial Rupture of Membranes (AROM)
   2. Risk with umbilical cord
   3. Risk with fetal heart rate and Routine amniotomy is not recommended.
2. Pitocin – 30 percent of women have their labors augmented with pitocin.
3. Stronger, harder contractions are difficult for moms to manage and put additional stress on the uterine muscle
4. Epidurals are often required to handle the contractions

Episiotomy

1. 17% of women have episiotomies
2. No evidence to support routine episiotomy
3. Causes more pain than spontaneous tears
4. Causes more healing complications than with spontaneous tears
5. No effect on neonatal outcomes
6. Does not preserve pelvic floor functioning
7. May contribute to urinary and anal incontinence

With any decision you make, there can be risks and benefits. The benefit of having access to these interventions during a medical emergency is monumental. We are blessed that we live in a day and age when interventions like these exist. However with all good things there must come a balance; knowing how to keep that balance is important. Discuss these different interventions with your provider and find out whether they perform them routinely or only when medically necessary.

Hire a doula to help you navigate through the birthing process and take a childbirth class to help you become more informed on what will be occurring at your birth so that you can feel like you are the driver and not the passenger during your most memorable event.

By Nella Goho

(All information used in this blog post was gathered from the Healthy Birth Practices #4 Essay written by Judith A. Lothian, Phd, RN, LCCE, FACCE)