The Six Care Practices that Support Normal Birth (Part Three)

Posted on July 12, 2009. Filed under: Birth, Cesarean, Epidural, Lamaze 6 care practices, pitocin | Tags: , , , , |

In Part One and Part Two of this segment, I discussed why I believe in the six care practices and the first three of the care practices which include: labor begins on its own , freedom of movement throughout labor and continuous labor support. The six care practices that support normal birth are based on research and evidence based maternity care. This is the healthiest and safest way to have a baby in most cases. In a normal healthy pregnancy most women can and should deliver their babies vaginally and with few interventions. All this medicalization of labor and delivery is not only not necessary, it’s also causes problems.

The fourth care practice is no routine interventions.

No Routine Intervention

Routine interventions are anything that is done or not allowed at hospital that isn’t medically necessary. Evidence based maternity care through research has shown that these interventions are not only not necessary but can cause more harm than good when used routinely. Here is a list of the most common routine interventions.

Restriction on eating and drinking: Back in the day when women were knocked out with general anesthesia food and drink were not allowed in case the woman vomited and inhaled it. Rarely is general ever used any more but it’s still the policy at most hospitals. Women need food and drink to keep their bodies fueled and hydrated for the hard work of labor.

Use of IV fluids: Because of the restriction on drink, the IV fluids are given to keep the mom from getting dehydrated.  IV fluids are just not properly balanced in a way that gives the mom the energy she needs to labor. The intervention spiral tends to begin with the IV and it’s easy access to the vein and it also keeps you tethered and restricts movement.  The IV line does provide quick access to the vein in case of an emergency. One compromise is a heparin lock. It’s the little catheter that put in the vein and shut off without the IV line actually being connected.

Continuous electronic fetal monitoring:  In a normal low risk labor continuous EFM isn’t recommended. Intermittent monitoring, or 20 minutes out of every hour is just as beneficial. With intermittent monitoring the mom is allowed the freedom of movement. Continuous EFM increases the number of inventions without improving outcomes.

Speeding up labor: Artificial rupture of membranes and augmentation of labor:  Speeding up labor sounds pretty tempting but when the water is artifically ruptured (AROM) it increases the pain of the labor and removes the baby’s cusion to move around and get into a better position. Infection risks are increased and most hospitals have a time limit on how long the water can be broken before intervening.  Augmenting labor with pitocin can make labor go faster but it also interupts the normal flow of hormones and makes labor much more painful while increasing the risk of fetal distress.

Epidurals: Epidurals do take the pain away (most times) but can also cause a cascade of other interventions and problems. They increase the risk of an OP baby (sunny side up) because the pelvis is over relaxed and baby finds it harder to rotate and turn without the gravity because mom is stuck in bed. The risk of c section increases and the drugs do reach the baby potentially causing breastfeeding problems. Please see my post To Epidural or Not to Epidural for more details on the risks of epidurals.  There are many other ways to cope with labor. Preparing physically and mentally for labor, continuous labor support and avoiding routine interventions all help make labor an easier process.

Episiotomy: Routine episiotomy can be more harmful than tearing. Tears typically aren’t as bad as the cut would be and they heal faster. Episiotomy frequently causes more tearing and more pain. Avoiding epidurals and upright pushing positions reduce the risk of or need for episiotomy.

Medical need for interventions are occasionally necessary. Routine intervention should be avoided. Learning about the routine interventions and when they may become necessary and writing a birth plan can help reduce the chance of having routine interventions forced on a laboring woman. I think it is also very important for the partner to understand these procedures so that they can assist the mother as much as possible. Research is on the side of the mother when it comes to these routine interventions and discussing the written birth plan before the birth will help the labor go more smoothly.  Hiring a doula can also help keep routine interventions from being carried out as she can remind the mom of what the risks and benefits of the interventions are and of what her wants are.


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5 Responses to “The Six Care Practices that Support Normal Birth (Part Three)”

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I think that this third segment is the one everyone needs to read, Amy. These are the points I highlighted on my birth plan. the eating and drinking were the reason we stayed away from the hospital for so long after my water broke. We went out for breakfast and then lunch and only THEN, 18 hours later, went in for delivery. Birth really should be treated like an athletic event. I’ve run marathons and I’ve given birth drug free. For both I needed sleep, water, training and…FOOD! An IV does not provide the same effect that food does and it’s just not as satisfying. Ah, thank you, as always!

I think that these routing interventions probably have the biggest impact on how labor goes. I always talk about labor as something that should be trained for and I didn’t realize that I didn’t until I read your comment. IV fluids are definitely not balanced and do not give you the energy that you need. I will be attending a VBAC in Germany and I cannot wait. The birth culture there is so very different from both the US and Korea. They encourage mom to eat and drink and prefer to see (and I qhote the German doula my friend talked to) the mom try rather than just lay in bed and ask for an epidural. No wonder the cesarean rate there is only 12%!!!!

Looking back, I would’ve been MUCH smarter to stay at home for a while after my water broke, even though my hospital policy was to show up within an hour. I made the mistake of calling to see if I could still take a shower before my appointment that morning (lol) and they freaked out and made me go straight to L&D. I still think that, given time, my contractions might have started. Instead they threw me into labor with pit, thank you very much. And yes, the whole way to the hospital, I was drinking juice and eating a bagel, thinking that would be my “final meal”…

You did the best you could with in the info that you had at the time. Hindsight is always 20/20 and you lived and learned. Luckily you have also learned the risks and benefits for your next pregnancy and I have all the faith in the world that you will be able to have the birth you want. I might have to make another international doula trip;)

[…] are three more care practices supporting normal birth. I will discuss them in Part Three. Published Jul 13 2009, 09:10 PM by […]

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