Birth Preparation Tips & Tools

Interventions – Are they Helpful or Hindering?

Possibly my most favourite episode of ‘How I Met Your Mother’ ever!!!

When it comes to birthing, I believe it’s every woman’s hope to have the best possible birthing experience.  That’s why you’ve found yourself here, to learn as much as possible in the hope of practically applying it when the time comes.  One woman’s perception and expectation of the best possible experience differs to another.

What is an ‘intervention’?

To intervene is to get in the middle of something.  But it’s more than just getting involved, it’s getting involved with intent.  To change something.  The intention is generally to change something for the better, according to the intervener’s opinion.  Of course this opinion is based on their experience, education and training, personal beliefs and preferences.  The act of ‘intervening’.

Intervention is defined as:

“Involvement in a difficult situation in order to improve it or prevent it from getting worse; the act or fact of becoming involved intentionally in a difficult situation.”

A ‘birth intervention’ is an action taken by a midwife or doctor that literally means that they intervene in the birthing process to assist in the delivery of your baby.  An intervention occurs when it becomes clear that you will be unable to give birth without some kind of assistance or your baby is in distress and needs to be born more quickly.” (Source: Pregnancy Birth & Baby)  At least, those are the reasons an intervention should be used… but this isn’t always the case.  There are natural births without intervention and there are births with one or multiple interventions.

I’m not looking to get into any sort of a debate here because certainly at times interventions are absolutely necessary and save lives.  There are women whose bodies simply don’t dilate sufficiently for a natural birth, babies who become distressed, women whose pelvises simply weren’t formed or can’t respond as needed, babies who have well over-stayed their time in utero etc.

If we didn’t have these interventions… well, we’d be back in the days of old where fatalities during childbirth, of both mother & baby, were all too common.  We are so fortunate to be living in the age we are with technology, research, science, facilities, dedicated medical professionals etc.

I love how the class booklet for Calmbirth® by Peter Jackson puts it: “Despite the best intentions and thorough preparation couples will sometimes face pre-existing, unforeseen and/or unexpected challenges to deal with during pregnancy, labour and childbirth.  There will be times when medical intervention is inevitable, in fact, it will be lifesaving.  The knowledge, care and expertise provided by obstetricians, doctors, midwives and other health professionals is essential in the rescuing of some mothers and their babies who are experiencing medical problems during pregnancy and childbirth.  Calmbirth® is not just about normal birth.  It is about helping you prepare and deal with everything from the normal to the unexpected in childbirth.” (Pg. 27, 4th edition).  Remember, even in this day and age, growing and bringing a child into this world is very risky business.

Yes, I am absolutely pro natural birth.  But I realise this is not always possible.  So I’m not disputing that interventions have a place and I certainly don’t want you rueing them should they be necessary in your birthing journey… hopefully you’ll be able to find yourself in a place of grateful acceptance and appreciation, perhaps relief.  For some, a period of grieving may also be necessary and I encourage you to read my article on when all doesn’t go to plan.  The most important thing you need to be confident in though is the fact that you have not failed.  There is no failure here.  Acknowledge and accept.  Surrender.  You are still about to, or you have, met your precious baby.  That’s what this journey is all about.

There are times though when we interfere when it really isn’t necessary to do so and we actually negatively affect the birthing experience.  That’s why I’ve written this article.  There’s a sequence of events called the ‘cascade of intervention’ which I would never have known about if I hadn’t been informed prior.   I’m sure I would have just gone with the ‘flow’, accepted everything and anything and done as I was told.

Various interventions can lead to such issues as labour being slowed hence taking longer (epidural), contractions may be intensified (due to Pitocin or Syntocinon), you may need to be less mobile & hence can’t use gravity as effectively (due to monitoring and/or pain-relief), you may be unable to feel the urge to push once fully dilated (epidural)… the list goes on.  Every time we interfere, we add risks.

“As with all bodily processes, occasionally things might deviate from normal, and intervention becomes necessary.  However, in the birth process, this is typically the exception and not the rule.  Most births, when properly facilitated in a safe environment, will unfold without complication or need for intervention.” (Source: Belly Belly)

Let’s discuss just a couple common birthing interventions that take place regularly today – both planned and unplanned.  (If you’d prefer to jump ahead, click here: ‘What can I do if faced with a birthing intervention?’).

 

Induction

“In natural, spontaneous labor your body, your baby and the placenta enact a series of complex changes in the days leading up to labor.  The cervix shortens and softens, while the uterus develops sensitivity to the hormone oxytocin which your body will produce.  Your brain’s hormone control center and the uterus engage in a complex feedback mechanism to control the length, strength and closeness of contractions.

During an induction, this mechanism is not engaged.  Instead, the delivery of Pitocin (or Syntocinon, a synthetic form of oxytocin) is increased mechanically through an IV.  The speed with which the contractions intensify varies according to each institution’s Pitocin administration policies and each labouring mother’s individual physical response.

Many women report these labors as being particularly painful.  This may also be because their ability to move freely in response to the growing strength of labor is severely limited, since induced mothers will be connected to at least one IV pole as well as various monitoring devices.  It is therefore not surprising that induced women commonly have epidurals.  These, in turn, increase their chances of a vacuum or forceps delivery, which can cause injuries leading to long term problems such as urinary and fecal incontinence.  Studies have also associated inductions with damage to the cervix and amniotic fluid embolism (a very rare but serious life threatening complication).”

(Source: Thoughts on Induction: The Benefits of Letting Your Baby Choose Their Own Birthday By Mayri Sagady Leslie)

Ideally, babies should be left to come at their own time, when they are fully ready.  Inducing them before, unless it’s for either the mother or baby’s health, is not ideal.  So whilst the temptation may be there: you might be ‘over it’ (be it due to discomfort for e.g. from your size or back pain, the heat in the middle of summer etc), or it may be convenient for yourself, your partner or your doctor that you schedule baby’s birthday, if you have it within you, it is strongly encouraged that you give bub every possible chance to kick things into motion themselves.  Obviously there will come a time post your due date, usually between 7 – 14 days, where your medical team will insist on an induction.  Speak openly and honestly with them and ask if they will leave it for as long as safely possible.

 

Drugs during childbirth

Whether or not you use any medical pain-relief during childbirth is a very personal decision and either way, I respect it.  If you’ve read my story, you’ll know it was never a consideration for me quite simply because I didn’t remotely need it.  My births weren’t painful and it never crossed my mind.  There was nothing ‘heroic’ or ‘superhuman’ about it.  Other women do make a very conscious decision to labour unmedicated believing it to be the best scenario for both themselves and their child.  Doing so is often significantly challenging for them, though ultimately, also extremely rewarding.  Still others are quite happy to accept any form of relief available to ‘assist’ them in their experience, as I thought I would be when I was still in my fearful, apprehensive state.

So again the information outlined below holds absolutely no judgement whatsoever.  It is intended to be purely informative and factual, sourced from The Better Health Channel.

Medical pain relief options for childbirth

“The three main medical pain-relieving options for labour include:

  • Nitrous oxide
  • Pethidine
  • Epidural anaesthesia

Nitrous oxide

Nitrous oxide, known as ‘laughing gas’, is mixed with oxygen and administered to the mother through a face mask or a tube held in the mouth. The gas takes a few seconds to work, so it is important to breathe from the mask as soon as a contraction starts.

Nitrous oxide doesn’t stop the pain entirely, but takes the ‘edge’ off the intensity of each contraction. Many women prefer nitrous oxide because it allows them direct control – you can hold the mask yourself and take deep breaths whenever you feel the need.

Nitrous oxide doesn’t interfere with contractions and it doesn’t linger in either the woman’s or the baby’s body.

Possible problems with using nitrous oxide include:

  • Nausea and vomiting
  • Confusion and disorientation
  • Claustrophobic sensations from the face mask
  • Lack of pain relief – in some cases, nitrous oxide doesn’t offer any pain relief at all (this applies to around one-third of women).

 Pethidine

Pethidine is a strong pain reliever (related to morphine and heroin), usually injected directly into a muscle in the buttock. It may also be administered intravenously (directly into a vein). Depending on various factors, the effect of pethidine can last anywhere from two to four hours. Pethidine can make you feel sick, so anti-nausea medications are usually administered at the same time.

Possible problems with pethidine for the mother include:

  • Giddiness and nausea
  • Disorientation and altered perception
  • Respiratory depression (reduced breathing)
  • Lack of pain relief, in some cases.

Possible problems with pethidine for the baby include:

  • The unborn baby is exposed to the drug via the umbilical cord and may experience respiratory depression at birth, particularly if several doses are given or the baby delivers soon after a pethidine injection. This effect can be reversed by an injection given to the baby.
  • The baby’s sucking reflex may also be depressed, as well as other normal reflexes. Debate persists over the effects of pethidine on newborns.

Epidural anaesthesia

Epidural injections are the most effective pain relief available. They are used for vaginal births and also for caesarean sections, because they allow the mother to stay awake and alert during the baby’s birth. Anaesthetic is injected into the lining of the spinal cord through the back, which makes the mother feel numb from the waist down. Your baby’s heart rate will be monitored continuously.

Possible side effects and complications of epidural anaesthesia include:

  • The anaesthesia may not be complete and you may still experience some pain. This may require the procedure to be repeated.
  • After the epidural has been inserted, your blood pressure may drop, causing you to feel faint and nauseated. This may also cause stress to your baby. This is treated by giving intravenous fluid.
  • An epidural often causes some muscle weakness in the legs, so women who have had an epidural anaesthetic may be confined to bed.
  • The lack of sensation in the lower body means that you will not be able to tell when you need to urinate. A urinary catheter will be inserted in most cases.
  • Epidurals can lengthen the second stage of labour.
  • The likelihood of having a normal vaginal delivery is reduced.
  • If you are unable to push effectively, due to altered sensation and reduced muscle strength, the baby may have to be delivered by forceps or vacuum cup.
  • Around one per cent of women experience headache immediately following the procedure.
  • Some women experience itchiness after having an epidural. This can usually be effectively treated using antihistamines.
  • Some women experience pain or tenderness where the epidural was injected.
  • Around one in 550 women experience ongoing patches of numbness on the back near the injection site.
  • Very rare complications include infection, blood clots and difficulty breathing.”

So you can see that sometimes the use of pain-relief medication can actually be quite unpleasant and have side effects for the mother, can lengthen labour, may lead to further interventions and bub may also be exposed.  They are available, but be wise and make an informed decision if possible.

 

Caesarean or C-Section Births

Unless a mother is high risk, caesareans/c-sections are more risky than vaginal births.  Not to mention that it’s major surgery, a longer hospital stay for yourself and a greater chance of your baby spending time in the Neonatal Intensive Care Unit (NICU) plus a long and slow recovery for you (painful, restricted movement, no driving for 6 weeks, no carrying a load of washing or a toddler etc) and a significantly increased chance that subsequent births will also be via the same manner.

Even so, a large number of our medical professionals don’t seem to be too concerned about caesareans/c-sections.  They are becoming more and more ‘common’, hence accepted and largely unquestioned.  Approximately 1 in 3 mothers are giving birth by caesarean and scheduled caesareans for non-medical reasons have been rising.  I believe it is important to note that the World Health Organisation believes that only 10-15% of births should be taking place via caesarean section (being for significant medical reasons – it is meant to be a life-saving procedure and is certainly very effective for this said purpose).

“Interventions in labor are closely linked with having unplanned caesareans.   The phenomenon where one intervention increases the likelihood of others used to monitor, prevent, or treat side effects is known as the ‘cascade of intervention’.  This cascade frequently ends in an unplanned caesarean section.   Among first-time mothers with term births who experienced labor, those who had both labor induction and epidural analgesia were six times as likely to have a caesarean section (31%) as those who had neither intervention (5%).”  Source

I find this just fascinating:

 So now that we’ve looked at a few common interventions, let me remind you of what a cascade may look like:

Induction increases the likelihood of Pitocin or Syntocinon; which can cause contractions to be quick and intense which increases the likelihood of an epidural; which increases the chances of a vacuum or forceps delivery or risk of a c-section.

 

But I’m having a ‘big baby’…

I hear this all the time.  And people comment on it all the time.  They look at the size of a woman’s pregnant belly and comment that she must be having a large baby.  Good on you, what a great way to concern an expectant mamma.  Even though the physical size/appearance of the woman’s swollen stomach really provides next to no indication of what the baby’s size will be.  Medical staff of course regularly monitor bubs in utero and may comment on whether a baby is tracking on the smaller or larger side, but even for them it is incredibly difficult to calculate how large a baby will be at birth.

This is a great article on 7 Reasons Why Belly Size Doesn’t Always Equate to Baby Size from BellyBelly.

I’ve heard that virtually all babies are born with a head circumference of within 1cm of each other.  So that’s really no big deal (especially if you’ve been using the Epi-No).  And yet that’s what everyone stresses about, the size of a baby’s head.  Remember, the plates in their heads are flexible, and so is your pelvis.

If anything, it’s the width of the shoulders.  The length and weight of the baby really don’t matter when it comes to a normal vaginal birth.

In all honesty, in my humble opinion, the issue of talking about the possibility of a big baby is that the mother can develop fears and it’s those fears that will hamper her labour efforts.  Not necessarily the actual size of the baby.  She will have been walking around with those fears, creating more and more self-doubt, possibly for weeks or months leading up to the birth.  She panics about the ‘pain’ she may experience.  Her confidence may take a massive hit as she starts doubting her ability.

Should you find yourself in this position, please apply everything you have learnt.  Read this website from top to bottom.  Stay calm.  Be confident in the abilities of both yourself and your baby.  Rest assured knowing that birthing is a natural process and your body is incredibly designed for it.

 

What can I do if faced with a birthing intervention?

If your medical team start talking about any form of intervention, be mindful enough to ask about it.  You are completely entitled to – this is your birthing experience after all.

When faced with an intervention, use your brain!

The BRAIN Method empowers you to ask your medical professionals the following:

Benefits – what are they?

Risk – what is it?

Alternatives – are there any?

Intuition – how do you feel about this?

No or not now – what if I said?

So essentially you’re asking, why is this necessary?  What are the benefits and risks involved?  Do I have any other options?  What is my gut telling me?  And what if I were to say, “No I don’t want it.  At least not yet…” What would their response be?

Now let me be clear, they’re not always going to like you asking questions.  It very much depends on the style of professional they are, how inclusive or traditional they are, whether they take it personally and feel you are challenging or questioning them etc (so be careful/considerate with your wording and tone).  They might try to dismiss you, fob you off, blindside you… but be persistent.  It’s your body, and your baby.

I know first-hand this isn’t easy.  I was surprised how willing I was to just go along with whatever the doctor said without even questioning why it was necessary.  With my firstborn my contractions weren’t overly intense and didn’t last very long (and I also honestly didn’t realise how much you do physically need to bear down/push your baby out) so at one point he whispered in my ear that he was going to arrange a shot of Syntocinon (Pitocin) for me as things were taking a bit longer than he would have liked.  I just nodded, not really comprehending or taking in what he was talking about.  I never ended up having it (so obviously things really were progressing just fine) and it wasn’t until after-the-birth that my midwife confided how mad she was with him for even considering it because I was doing great and it wasn’t needed.  That’s the point I realised I was going to be given an intervention that wasn’t necessary.  And also how some midwives and other supporting staff can, in some situations and depending on who the overseeing doctor/obstetrician is, perhaps not be willing to voice their opinion even if they don’t agree with their superior.  Which you can totally understand given they’re the ones who need to work with them day in and day out and, let’s face it, who likes their authority challenged?  But you are not an employee.  And you are more than a patient: you’re a client, a customer, and you have a right to ask and know.  So make sure your support person/s know to enquire if you don’t.  There is no harm in asking for more time or whether there is an alternative.

I’ll never forget my Calmbirth® facilitator saying that if it truly is an emergency, you’ll have no say anyway.  They will do what needs to be done to keep both you and bub safe and your ‘control’ will be removed – understandably and thankfully so.  Unless this eventuates though, you are well within your rights to query/decline.  Please do remember that they are the professionals, and as such, do deserve our trust and respect.  Even when things don’t go the way we’d hoped.

I can’t stress this enough:  Always, always, of the utmost importance is the health and wellbeing of both mum and bub.  In the end, it doesn’t matter how bub is born.  If both you and your baby are safe, then that is a successful birth.

At my 6 week check-up my obstetrician (who was unavailable when I delivered my firstborn) advised that I had laboured longer than they ‘liked’, by all of 6 minutes!  A ridiculously insignificant amount of time to me for someone who barely felt like she laboured at all.  I didn’t know I was having a baby till about 7am and he was born at 9.07am.  Two hours generally is their limit for the pushing phase but mine was so easy, I never broke a sweat, and initially I probably wasn’t pushing hard enough!  So I’m very glad I was able to ‘do my thing’ and not have it interfered with – it truly was the most incredible experience of my life!  Birthing is a very serious medical situation though and they are obviously concerned about bub becoming distressed etc so of course we are always thankful to be closely monitored and observed.

 

******

P.S. Have you had a caesarean before?  Did you know that you don’t necessarily have to have one next time?  You are able to request a VBAC – a vaginal birth after caesarean.  This is not always possible and not all medical personnel will be open to the idea, but if it’s something you’re passionate about and would like to try, by all means ask (just be prepared that you may need to ask more than once or try a number of medical professionals until you find someone who is happy to support you in this).

 

P.P.S. Breech baby? This doesn’t necessarily have to mean a caesarean, though many doctors will automatically sign you up.  If you’re interested in trying for a vaginal birth, ask around your area and see if there are any doctors who specialise in this and/or would be willing to work on this with you.  There are never any guarantees, but you might like to enquire.

2 thoughts on “Interventions – Are they Helpful or Hindering?

  1. Love this Carinya! I found this article really informative (together with info from a birth course we went to recently) when my OB suggested I be induced on my due date and I really wasn’t keen on it. Thanks for sharing!

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