TheHolisticParent.ORG Intervention Misconceptions

The Holistic Parent.ORG

Intervention Misconceptions

This section is dedicated to the possible interventions out there. The majority of
the time they are overused, unnecessary, and even harmful, but in rare cases,
they may be advised. Hopefully, this will help you navigate your way through the
wealth of information out there, so you can make the best choices for you and
your baby. Remember too that you have the right to refuse anything the hospital
may throw at you. You do not have to say yes to everything, and it’s a good thing
to ask questions. A point worth knowing is that when I am referring to these
interventions, I am specifically writing this geared towards normal healthy labors
in low risk women. If you have a high risk condition, a lot of this can still apply to
you, but there are some different considerations that may change your
circumstances. It will be my intention to eventually include information on
complications of pregnancy.

Amniotomy

This is also known as rupturing the membranes or breaking the bag of waters
artificially. Is it used as a method if induction or in an attempt to help speed labor
up or keep it going. In some cases, it does help to get a labor going or make a
labor go faster. It is performed way too often though and is not without risks.

An amniotomy should not be performed unless the baby’s head is well
descended into the birth canal. You’ll hear hospital personnel referring to the
baby’s head being well applied if it is. The term used when the baby’s head is
not well applied is ballotable. This means the baby’s head still floats away or
moves during a vaginal exam. The bag of water should not be broken in these
circumstances. It means that there is the possibility of the cord coming out
before the baby’s head. This is called a cord prolapse, and it is a true medical
emergency. It means the baby’s oxygen supply is being cut off. It warrants an
immediate Cesarean section. So, be careful before agreeing to an amniotomy.
Gather the facts and ask questions.

If you’re in the hospital, breaking the bag of waters puts you on a time clock so to
speak as well. It may speed up your labor a tiny bit, but it may not. It will also not
start your labor spontaneously all by itself unless you were going to go into labor
by yourself anyway (then of course it would be unnecessary, wouldn’t it). But
once your bag of water has broken, the hospital will insist you be delivered
within 24 hours or your risk of infection due to the bacteria in your vaginal track
will be too great. I have heard of some midwives that allow their patients to wait
up to a week after the bag of water breaks before an induction becomes
necessary, but that’s another topic.

Therefore agreeing to an amniotomy too early before you’re in active labor can
be problematic and increase your risk of the “need” of other interventions such
as medication to keep your labor going. I can assure you that your bag of water
will break when it is ready. It can do it all by itself, and it is okay to have the
patience to wait and allow it to do so. It’s beautiful when it does it on its own.
Interestingly, it doesn’t even have to break for the baby to be born. Chances are it
will, but a rare baby does get born with the sac still intact. It’s not any riskier for
you or your baby, just break it once baby comes on out.

Group Beta Strep

Also called Group B Strep or GBS, this is a bacteria that lives in the vaginal track
of 1/3 of women. It is normal for it to be there. You can have it one pregnancy and
not the next. It is not harmful to us, but has the potential to be harmful to your
baby. Your baby can potentially contract the bacterium and get sick from it with
such illnesses like pneumonia and meningitis. In extremely rare circumstances
a baby can die. The risk of a baby contracting an illness from the bacterium is
exceptionally rare and dying from it occurs almost never. But it is still a very small
possibility.

Therefore, it is a standard protocol in some hospitals to treat women who have a
positive lab result for GBS with penicillin during labor. This practice is
controversial and has been stopped in some hospitals. The necessity and merit
to the treatment have been widely criticized. For the treatment to be considered
effective at least two doses of penicillin must be administered before delivery,
preferably before the bag of water breaks. The dosage of penicillin must also be
given every four hours until delivery to be effective. This rate of administration is
calculated based on how fast the medication is metabolized in the body. If a
dose gets missed near the time of delivery or two doses do not make it into the
body, the treatment is thought to not be effective.

The infant does not contract the bacterium during labor, but only by passing
through the birth canal. This is why it is important to have this drug in the mother’
s system at the time the baby passes through the birth canal for the treatment to
be considered effective. I generally do not support this treatment based on my
own personal research I’ve done, but this is just my opinion. I am not alone
however. Many midwives do not treat GBS during labor, and hospitals have
started abandoning this protocol as well. I generally do not support the use of
medication, and I especially feel uncomfortable with the widespread use of
antibiotics.

Many feel the treating of GBS does more harm than good. Antibiotics kill good
friendly bacteria as well. It makes a yeast infection or thrush more likely following
delivery. This can present problems for breastfeeding. Remember too that
medications taken during labor pass to the baby as well.

I personally didn’t even get tested for GBS during my pregnancy. I just kept my
eye out for evidence of infection in my baby following birth. Even then, I wasn’t too
concerned. I trust in the body’s self healing innate ability. I give my body the best
nutrition, and I believe it will take care of itself. I encourage you to do your own
research before deciding either way.

Continuous Electronic Fetal Monitoring

This practice is quite controversial. Research has not shown improved
outcomes from the use of continuous fetal monitoring. On the contrary actually.
Continuous fetal monitoring can put you at greater risk of a Cesarean section.
The monitor can pick up what appears to be fetal distress, though isn’t actually
so. The mother is then rushed back for a Cesarean section when the baby was
fine the entire time.

This area is very hotly debated. It is routine in most hospitals. If you plan to have
a natural labor, it is okay to skip the continuous monitoring. Research has
documented it is safer to periodically check the baby’s heart rate during labor.
This can be done with a Doppler, which is much less invasive. The laboring
women will then be free to continue to have unrestricted movement.

If you agree to continuous monitoring, you will be more likely to be stuck in the
bed. Each time you move, the monitors will have to be readjusted. It can be quite
frustrating to have that as a continuous distraction while you are laboring. There
is a rare few women who may be able to “stay on the monitor” and still stand or
sit in a chair or on a birthing ball. This has to do with the shape of your belly, but
for most people the monitors can be a nightmare.

Now, this only applies to normal natural labor. If you add medication such as
Pitocin or an epidural, then I wouldn’t recommend forgoing the monitoring. Most
hospitals won’t allow it either. Medications change normal labor, sometimes
drastically. They make it more likely that the baby will have difficulty tolerating the
labor, thus making continuous monitoring important.

Pitocin

Pitocin also known as Oxytocin is a nasty medication. There I’ve said it. There
are some very rare instances where it can be important, but on the whole, it is
extremely widely overused. There are some hospitals with a 98% rate of Pitocin
administration! Do women really need that much help with labor?! Absolutely
not. How ridiculous.

If you birth in the hospital and spend “too long” there, you will almost certainly be
offered or pressured regarding Pitocin. It’s a dirty little secret of the maternity
wards. The truth is there is a hugely wide range of what is normal in labor. You
do not have to fit into a prescribed model of one centimeter per hour or
something like that. You are unique. I have seen a women give birth having one
contraction every ten minutes through her whole labor. They never got closer
than that. She’s a rare one indeed, but it’s possible. I have seen a women give
birth with the strength of contractions lower than medical science says is
possible to give birth, but guess what, she did. Labor is definitely not a linear
process. I’ve seen a woman stay 3 centimeters dilated for 20 hours, and then
she went from 3 centimeters to having birthed her baby in 45 minutes.

The fact is labor can follow many patterns. It is even common for labor to stall
out or stop. It’s not dysfunctional. It will start up again when the time is right.
There are a great many things that can affect labor progress as well, especially
a whole psychological perspective that is very poorly understood by medical
science. Being in a strange environment, frequent visitors, interruptions,
strangers, etc. all play a part in the progress of labor. Mainly, all those things
have the capability of slowing labor. A woman has to feel comfortable in her
environment to give birth. It’s the fight or flight response. It is our natural instinct.
It’s even possible for the cervix to decrease in how wide it was opened. This too
is normal.

Pitocin comes with its own set of risks. For one thing, it makes contractions
unbearable for most women. It doesn’t allow for the natural progression of
contraction strength to build up. That doesn’t mean that as soon as the
medication turns on that you will be in excruciating pain. The medicine may have
to be increased for while, but usually it is like all of the sudden. Bam! Then you
start feeling it and strongly I might add. One moment you’re not in pain and a
moment later, you may be in a lot of pain.

Pitocin labor pain is a lot harder to cope with. Don’t believe it when hospital
personnel tell you the contractions will have to get stronger before you deliver, so
you might as well just add Pitocin to help them out. This is false. Pitocin
changes normal labor. You may be having very strong contractions due to the
Pitocin and not be anywhere near giving birth. That’s hard to handle for long
periods of time and causes many women to break down and get an epidural
when they would have been handled natural labor just fine. The natural
progression is set up beautifully so that when it is real intense, you are right
near the end.

You will also be required to have continuous monitoring when you are being
administered Pitocin. This will restrict your movement and make it much harder
to cope with already stronger contractions. A bad combination.

Due to the nature of Pitocin and the fact that it is designed to increase the
strength of contractions, there are many more instances of babies not handling
labor well. This is usually referred to as fetal intolerance to labor, though it would
be more correctly labeled as fetal intolerance to Pitocin. When babies are
labeled as intolerant, it means that they are having trouble with keeping their
heart rate up. This happens when the baby is not getting enough oxygen. The
period of time between contractions is when the baby regroups and fills back up
with oxygen. The baby does not get much oxygen if any during a contraction. So,
when contractions are longer and stronger, it can be very rough for the baby.
This is why there are more instances of emergency Cesarean sections with
Pitocin administration due to a large drop in the baby’s heart rate that may not
come back up quickly enough.

There is also not a set dose of Pitocin. There are protocols for using it of course,
and hospital personnel cannot give you an infinite amount, but the amount can
vary. The same amount can produce very different results in different people.
That’s why it can be dangerous. What works fine for one mom and baby can be
disastrous for another. There is no way to know this beforehand or predict when
complications may arise.
So before you decide to let the hospital staff rush you out of your room because
they need it for another patient, consider if Pitocin is truly right for you. If you have
the patience to trust in your body, your body will do its job.

Stadol

Stadol is a narcotic pain medication given to women routinely in labor. It is not
an anesthetic and will not work as such. It will not take away labor pain or
sensations completely. It just ‘takes off the edge”. It lasts for about an hour. You
can only get it every three hours. It works mostly by making you sleepy. The
strength or effect of it works differently on different people. Some may feel no
relief at all. Some women may feel too much relief. Many women complain they
do not like how it makes them feel. Others feel like it made labor manageable.

You cannot get the medication past 8 centimeters dilatation. Any narcotic
medication poses a risk for breathing trouble in the infant. This is why you
cannot get the medication too closely to delivery. If delivery occurs too quickly
after Stadol is administered, the infant can have a great deal of trouble breathing
and may require resuscitation. Remember, any medication you take in labor
also goes to your baby.

Scheduled Cesarean Sections

Unless there is a strong medical indication to schedule a Cesarean section, it is
important not to do so. A Cesarean section is a major abdominal surgery. It is
difficult on your body. It is not part of holistic, natural living unless there is no
alternative. Just because you have had a prior Cesarean section does not mean
that you should automatically have another. Cesarean sections are covered in
greater detail in a section devoted just to them.

Internal Monitoring

Internal monitoring is continuous fetal monitoring on the inside of your body.
Instead of monitors attached by bands on your abdomen, monitors are inserted
through your vagina into your uterus. Your bag of water has to be broken for this
to be possible. If you do not have an epidural when these monitors are placed, I
guarantee that it will hurt.
The monitors usually allow the baby’s heart rate to stay visible at all times and
are thought to be a bit more accurate. One monitor is for the baby’s heart rate.
The other monitors the strength of the contraction. It allows the physician or
nurse to tell exactly how strong a contraction is. These monitors will make it
impossible to take breaks from monitoring, go to the bathroom, or really even
get out of the bed.

The way the monitor is attached to the baby’s head is like a screw. It is a small
piece of metal that pierces the baby’s head. Denying that the baby doesn’t feel
this or that it doesn’t cause the baby pain is just plain ignorance. Of course, the
baby feels it. Internal monitoring is extremely invasive and largely unnecessary.

Early Cord Clamping

This topic just really gets to me. Research has shown undoubtedly the
importance of waiting to clamp the cord at least until it has stopped pulsating.
Up to one third of the baby’s blood can be in the cord, and it is extremely
important that the baby get its blood. This should be a routine standard of care in
hospitals, but it is not. In many circumstances, the cord is clamped immediately
following the baby’s birth. Many doctors are not even aware of the benefits of
waiting to clamp the cord. How sad. Clamping the cord early can cause a whole
host of problems for the baby from anemia to brain hemorrhaging. There is now
suggestion of autism being linked to early cord clamping.

If the cord is not clamped immediately, there is no risk to the infant of being
deprived of oxygen because the baby will be receiving oxygen and blood via the
cord. Early clamping can also put a women at risk for greater blood loss. If you
wish to have your baby rightfully receive all its blood, you will have to ask. Make
sure the cord is not clamped early. It will not be done automatically.

Intravenous Therapy: The IV

This practice is not evidence based, meaning backed by research, yet it is
instituted for every woman in labor that sets foot in the hospital. It gives hospital
personnel a way to hydrate you when they restrict your food or beverage intake,
and it also gives them easy access to give you medications. It can be beneficial
to have an IV in place if an emergency arises, but they are largely unnecessary.

Despite the belief of some, it is possible to give birth to a baby without one. If you
want an epidural or are having a Cesarean section, then an IV is required. If all
you’re doing is pushing out a baby, then no, they’re not required.

You have the option as well of letting an IV be placed, but not connecting any IV
fluid to it. This is called a Heplock or Saline lock. It is a good compromise if you
don’t feel comfortable forgoing an IV completely.

The use or better misuse of IV fluid can have risks of its own. One IV bag of
fluids is a whole liter. This is the same amount some people drink in a whole
day. Once your bag of IV fluid is empty, you’ll automatically get another bag. No
one is keeping track of how many bags of fluid you receive however, and
receiving too many can create such complications as fluid overload, fluid moving
to you or your baby’s lungs, and jaundice in your baby. How much is too much?
There’s not an exact formula as each person is different, making this practice
even riskier. Skip the IV fluids and just eat and drink as desired.

Vaginal Exams

Vaginal exams in labor occur incredibly frequently. They are used to check how
many centimeters a woman is dilated, and thus to help determine how far along
in labor a woman is. There may occasionally be a need. The most common one
being to help determine when the physician should come for delivery.
Physicians certainly do not like to miss deliveries; they do not get paid! You may
feel it necessary to agree to a vaginal exam several times during your labor,
especially if it is very important to you that your doctor be present for your birthing.
There are other signs however that are just as good or better indicators of your
progress in labor, and a skilled attendant should be able to recognize them. It is
certainly possible for a baby to be born without a woman having even one
vaginal exam! It seems medical personnel forget this. You certainly do not need
to be checked every hour as is common in some hospitals. There are risks
associated with vaginal exams such as an increased risk of infection and pain. It
is also an invasive procedure.

Food and Beverage Restriction

Food or beverages may be restricted during your labor. This is unnecessary.
This restriction is enforced in an attempt to prevent stomach contents from
traveling into the lungs, known as aspiration, in the event that general
anesthesia would need to be used. Enforcing this restriction certainly does not
ensure that a woman’s stomach is empty. In addition to this, research has
shown that the risk of aspiration have more to do with the technique of the
anesthesiologist than with food in the stomach. The jury’s in on this one: you
can safely eat and drink during labor.

Laboring on Your Back or Restriction to the Bed

This section can be short. It is not evidence based nor common sense based to
stay in one place or on your back during your labor. It is a ridiculous idea that can
add complications. It is harder for your baby to receive oxygen when you are lying
on your back. There is a greater likelihood that your baby will be in a more
difficult position for labor and birth. You will not have the assistance of gravity if
you’re lying in a bed. Labor is usually a whole lot more difficult when on your
back, so just skip it. Get up and Move.

Pushing in the Lithotomy Position

This position is when you are lying in bed on your back with your legs in stirrups.
It is a very unnatural position in which to push a baby out. It is not done for the
benefit of the laboring woman, but for the convenience and ease of the doctor. It’
s a crying shame this is so extremely commonplace in our society. Many people
believe this is the only way a baby can be born because that is how it is done
and accepted in our culture. Some doctors are even afraid to help deliver (the
woman delivers her own baby after all) a baby unless the woman is in that
position.

When a woman lies on her back, it changes the shape of her pelvis and leaves
less room for a baby to pass through. On average, a woman’s pelvis can be
30% smaller when lying on her back. This makes for a more difficult birth. The
baby may have difficulty fitting or properly rotating its head for delivery. A woman
may have to push longer. The baby is more likely to be in a posterior position
(with the baby’s back against your back, so the baby will be facing up when
delivered) which makes birthing more difficult when a woman is lying on her
back. There is also more risk of a baby not being able to maintain its heart rate
while a woman is on her back due to a decreased oxygen supply to the baby.
There are times when this can be life-threatening.

Pushing in the lithotomy position increases the risk of tearing and injury to the
perineum. There can also be injury to a woman’s legs if they are pushed back
too far while she pushes. This position also increases the possibility of a
forceps or vacuum extraction delivery due to the woman not being able to
effectively push on her back.

Episiotomy

This is where a cut is performed on a woman’s perineum (the tissue between
the vagina and the anus) to “prevent” a messy tear. How is a cut better than a
tear, you ask? Well, it’s most certainly not. Research has not supported the use
of episiotomies. In my experience, an episiotomy is most usually performed
because the physician was not patient enough to allow the baby’s head to
properly stretch over the perineum. It is important to attempt to keep the
perineum intact and midwives go through great lengths to try to do this. So, why
on earth would it be beneficial to purposefully damage this tissue?

Some feel an episiotomy may at least be important during an emergency
situation where delivering vaginally would be preferred, but the baby needs to
come out quickly. This could be the only time an episiotomy may be justified, but
it will be rare. If you do end up tearing, it will most likely not be as bad as an
episiotomy. Episiotomies do require stitches.

Having an episiotomy performed will make your postpartum period and recovery
more difficult. Many women report lasting effects from the episiotomy including
pain during intercourse and urinary incontinence. Scar tissue from the
episiotomy can affect future birthing. The current rate of episiotomies in our
country is 1 in 3. Now that should speak volumes. Your physician will most likely
not announce to you that they are now going to perform an episiotomy, so make
sure you make it clear to your physician that you do NOT want one.

Vacuum Extraction/Forceps Delivery

Both these methods involve assisting a baby to be born. Forceps is associated
with an increase in injury to the mother and baby and has become outdated.
Vacuum extraction has since replaced the use of forceps in most
circumstances, so the focus will be on vacuum extraction.

Birth with a vacuum extraction should be a rare occurrence indeed. It should only
be used for fetal distress in the last moments before a baby is born. A vacuum
type attachment will be placed on the baby’s head. Suction is applied, and the
baby is pulled from the womb by the physician. This is a rough way to be born
and is not without risks. The baby is at an increased risk for jaundice,
lacerations, blisters, hemorrhages, and cephalhemotomas (blood under the
scalp) just to name a few. The last two of these risks can be life threatening. The
mother is also at increased risk of injury. If a vacuum extraction is suggested at
least ask question to make sure it is absolutely necessary.

Coached Pushing

There is no need for a woman to pull her legs back, hold her breath, put her chin
to her chest, and push with all her might while someone counts to ten. There is
also no need for people to scream “PUSH!” The uterus does most of the work in
getting the baby out. In fact, the uterus is powerful enough to do it all on its own.
Most women with or without an epidural have the capability of feeling some
pushing sensation or pressure and are able to push the baby out. If a woman is
so numb that she cannot feel a thing when it comes time to birth the baby,
personnel from anesthesia need to come decrease the medication in the
epidural. It’s not necessary to be that numb! Pushing should be on the woman’s
terms. The body does know what it is doing.

Manual Placental Traction

This is where the umbilical cord has pressure applied to it by the physician after
delivery in a pulling type motion to facilitate the placenta coming out. This has
risks for the mother such as increased risk of hemorrhage. If the cord is pulled
to strongly or quickly it can rip off of the placenta. The physician will then perform
a manual extraction of the placenta. This is basically as painful as it sounds with
the physician reaching their arm up into the uterus via the vagina to scrap the
placenta away from the uterus and to make sure all of the placenta has been
removed. It can be quite horrific and is not the way a new mother and baby need
to be spending their first moments together. I assure you it is not necessary,
and yes potentially harmful. The placenta will almost always come on its own. It
can take a while in many cases, but this is not cause for alarm. The issue is
simply what physician wants to hang around for up to several hours waiting for a
placenta to come out.

Inductions

Inductions are performed much too frequently in the United States. Women are
induced for all types of reasons, most not being legitimate. An induction should
only be considered out of medical necessity should a complication arise or if a
woman is grossly past her due date. They have many risks, a major one being
increased risk of Cesarean section. Women who are induced are FOUR times
more likely to have a Cesarean section.

Induction for postdates (being past the due date) should only be considered at
42 weeks or beyond. There is a slightly increased risk of problems or
complications past the 42 week mark, but this risk is actually quite small and
greatly overblown by the medical profession. One way to minimize this risk is to
have excellent nutrition during the pregnancy (see our healthy pregnancy
section). Most problems past the 42 week mark involve the placenta (because it
does wear out and won’t last forever), but if it is nourished well during the
pregnancy, the placenta will last longer.

Despite popular belief, labor cannot be brought on by will. The start of labor is a
complex phenomenon poorly understood by medical science. There is such a
thing as a failed induction. This is where the medication administered to begin
labor fails to bring about labor. The options are to then wait for labor to begin on
its own, take a break and try the induction again at a later time, or perform a
Cesarean section. The Cesarean section is beyond a doubt the most common
choice following a failed induction.

An induction can take days, that’s right. DAYS. Most women coming in for an
induction do not understand this. If you agree to an induction for whatever
reason, you may be spending the next few days stuck in a hospital bed strapped
to a fetal monitor. Think about that the next time you’re tired of being pregnant. An
induction is not a simple matter.

Inductions complicate normal labor because of the very essence of what they
are. They are at the very core of creating the slippery slope of interventions. The
more natural labor is tampered with by technology, the more dangerous it
becomes.

There are certain things you can expect when getting induced. You will have to
have an IV for medication administration. You will need to have continuous fetal
monitoring because it will be important to be able to see your baby’s heart rate. It
is extremely common for babies to have trouble tolerating inductions.

Depending on how soft (ripe) your cervix is and how far you are dilated, there are
several types of medication you can be given. Cervical ripening agents such as
Cervidil may be the first medication administered to you if your cervix is very firm
and not yet ready to go into labor. It is placed up in the vagina and stays in for 12
hours. One may not do the trick either (which would mean another twelve hours).
Once your cervix is softer and ready for labor, you will be given Pitocin. Read the
section on Pitocin if you haven’t read it already. The Pitocin will be increased in
an attempt to start and maintain contractions with the goal of having your cervix
dilate.

A quick word on Cytotec. This is a medication some doctors use to induce a
woman. It is not FDA approved for this purpose. It is supposed to be used to
treat stomach ulcers. Cytotec is a medication with a lot more complications and
side effects and truthfully should never be used to induce a woman. There is a
great chapter devoted to this topic in the book Born in the USA. This is
something I would refuse without a second thought.

I could go on about inductions all day, but the bottom line is inductions should
not be implemented unless there is a serious medical need. Do your own
research. You’ll be startled at what you find.

The Holistic Parent.ORG

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