We all hope that childbirth will go smoothly. Most women are dreaming of a nice, quick labor and birth. However, some women will have complications or require interventions due to issues like induction. Some of these interventions include: IV, fetal monitoring, breaking your water with an amnihook, forceps or a vacuum extractor. Here is information on these practices in labor and birth, including what they are and how to try to avoid them.
1- Your Birth Choices
Sometimes interventions are used because it is the common thing to do and not because it is absolutely necessary. This is where a birth plan, a good relationship with your doctor or midwife and informed consent comes in. These ingredients are important for you to be able to make the best decision for you and your family.
There is also an effect known as the cascade of interventions. This basically states that once you have one intervention it makes more interventions more likley to be needed. To minimize the effects of the cascade of interventions one needs to be able to try and pick and choose only the interventions really necessary and to actively work to counteract potential side effects from the intervention when possible. Your doctor, midwife, nurse or doula can help you figure out how to minimize side effects from the interventions used in your labor and delivery experience.
2- IV Fluids in Labor
There are many reasons why an IV might be used in labor and birth. For low risk mothers, an IV might be used if you are having an induction or epidural anesthesia. A high risk mother might be requested to use one for a just in case manner.
You can still get up and move around with an IV. You simply need to request a pole that has wheels. This means that you can maintain your mobility and still assume comfortable labor positions.
Alternatives to an IV include oral hydration by eating ice chips or by a normal diet or special labor diet of clear liquids and light foods.
3- Breaking Your Water (Amniotomy)
This is the artificial rupture of membranes. It is supposedly done to “speed up” labor, though most studies say that this is not true for most women. 75 of the time your water will break past nine centimeters. Amniotomy may also be used to assess if the baby has passed meconium or to allow the insertion of internal fetal monitoring.
It is done by placing a amniohook (looks very similar to a long crochet hook) inside the vagina during a vaginal exam and scratching the bag until it ruptures.
Drawbacks to this can include:
- Increased risk of infection
- Lack of cushion for the baby’s head
- Increased intervention, and limited mobility
There are other ways to speed labor, including walking, nipple stimulation, position changes, etc.
Amniotomy may also be used as an induction technique.
4- External Fetal Monitoring – Electronic Fetal Monitoring (EFM)
Fetal monitoring is a catch all term to talk about how we watch your baby during labor. Fetal monitoring is done by both a midwives and doctors at home births, birth center births or hospital births.
The type of monitoring you will need for your labor will depend on where you are giving birth, who your practitioner is and how complicated your pregnancy and labor are. There are several types of monitoring:
- Auscultation with fetoscope
- Hand held doppler device
- External electronic fetal monitoring by ultrasound
- External electronic fetal monitoring with or with an internal uterine pressure catheter (IUPC)
You may require fetal monitoring due to the added risks to the baby if you have anepidural, pitocin, induction or other high risk situations like meconium staining, which may indicate fetal distress.
Monitoring a low risk woman is less intensive than the woman with a high risk pregnancy. Though in general, studies have shown that an increase in monitoring, particularly for low risk women, has not improved pregnancy outcomes, but it has increased the intervention rates, like cesarean section.
5- Internal Fetal Monitoring (IFM) – Continuous Electronic Fetal Monitoring
Internal fetal monitoring is used for high risk births or during a normal birth where the birth team is having trouble keeping the baby on the monitor or the baby’s reaction doesn’t look great on the less accurate form of external fetal monitoring (EFM).
With internal fetal monitoring the mother’s bag of waters must be broken. If it has not broken on it’s own then an amniotomy will be performed to break the water. A fetal scalp electrode is placed by screwing a tiny sire into the top layers of the baby’s scalp, then relaying the baby’s heart rate to the fetal monitor. This is more accurate because it does not use ultrasound.
At the same time an intrauterine pressure catheter (IUPC) can also be placed inside the uterus.
It goes between the uterine wall and the baby. This also allows the midwife or doctor to know the exact force from the contractions, rather than a simple graphical representation given by external monitoring. This is very useful in the case of induction.
Internal monitoring can also prevent an unnecessary cesarean for fetal distress if it shows the baby is healthy, compared to the less accurate external monitoring. Though there are risks associated with the internal monitor:
Risk of infection for mom and baby
Restricts movement of the mother
Reduction in movement can cause more pain
6- Intrauterine Pressure Catheter (IUPC)
The Intrauterine Pressure Catheter (IUPC) is often used in labor induction to help measure the exact force of the contractions during labor. This can help your doctor or midwife determine the amount of pitocin (labor inducing medication) to use. The IUPC may also be used when internal fetal monitoring is used.
To use the IUPC your water must be broken.
7- Forceps in Labor & Delivery
There are several shapes and sizes of forceps, but they do look remarkably similar to salad tongs. These are slipped, one at a time, inside the mother’s body and then locked around the baby’s skull. The practitioner will then pull with the mother’s pushes. This can sometimes bruise the baby and the mother.
Forceps are used in a graded system: high, mid, and low or outlet forceps. When you hear of the forceps horror stories it was usually from the high forceps, which has now nearly universally been replaced by cesarean section.
Mid forceps has mostly been replaced by the use of vacuum extraction and cesarean, leaving only low or outlet forceps to be used.
Forceps have different properties than the vacuum extractor:
Can be used to turn a baby in a different position (i.e. posterior baby)
Can cause more trauma to mother’s tissues
Can cause less trauma to baby
8- Vacuum Extraction – Labor & Delivery
Vacuum extraction is a cup like device that is either attached to a suction device on the wall or by a manual suction pump. It is placed on the back of the baby’s head and the suction is increased so that the practitioner pulls with the mother’s pushes.
Vacuum extractors have different properties than the forceps:
Can be used higher than forceps
Can cause less trauma to mother’s tissues
Can cause more trauma to baby
Alternatives may include changing the mother’s position, including the use of a deep squat or the use of forceps or cesarean section.
9- Epidural Anesthesia
Epidural anesthesia is a common form of medicinal pain relief. Knowing what there is to know about epidural basics as well as the policy of your hospital and practitioners is an important part of making your epidural a pleasant experience.
Using an epidural does increase the necessity of certain interventions like the IV, fetal monitoring and others. You may also be at a higher risk for the need for an augmentation of labor (speeding labor up), internal fetal monitoring and potentially a cesarean section.
Choosing an Epidural
Epidural Anesthesia (Step-by-step)
7 Reasons You Can’t Have an Epidural
After an Epidural – Postpartum Recovery
Epidurals & Childbirth Classes
Epidural Birth Stories
10- Cesarean Section
A cesarean section is also known as a c-section, which is sometimes also written as c/s. This type of birth is done by a surgical incision in the abdomen and uterus to allow a baby or babies to be born safely when a vaginal birth is not the safest route. The current cesarean rate in the United States is over 30%, which concerns the majority of experts, including the World Health Organization (WHO).
Giving Birth by C-section
Cesarean Surgery Step-by-step
Family Centered Cesarean
After a Cesarean – Postpartum Recovery
What will I feel during a cesarean?
Why would I need a cesarean?