InterventionsThis is a round up of the most common medical interventions most women who have hospital births encounter. In some labours, some of these interventions do become necessary, however, too many of them are used too often in births that would otherwise have progressed perfectly normally.
The use of one intervention generally leads to futher intervention - often referred to as a 'cascade of intervention' - as Drs try to remedy the problems that the previous intervention has caused.
The best plan all round is to aim to have none - BUT, if at some point you feel you need some sort of intervention, or intervention becomes necessary, you are more likely to feel satisfied with your birth experience if you fully understand what each intervention involves, including its specific risks & implications.
A great place to start looking for research about interventions & most medical aspects of pregnancy is the Primal Health Research pages run by Obstetrician Michel Odent. Just click on the subject you want to query & an abundance of research collated from all over the world will pop up on the page. The Primal Health Research Centre studies the long term effects of all sorts of medical interventions on babies & mothers.
____________________________________________________Active Management of Labour (AML)
AIMS have a brilliant article on this subject - 'Active Management of Labour - The Irish Way of Birth'
AML is the term used to describe the way in which Drs manage your birth progress. Just as everyone's periods differ, so do the natural rythmns of their labours. If left to 'get on with it' some women might labour for merely an hour, while others will naturally progress over a number of days. By letting your hormones dictate the speed at which your labour progresses you are more likely to have a normal labour & a better outcome for yourself & your baby.
When you sign up to a hospital birth, however, the Drs will attempt to override your body's hormones if they decide your cervix isn't dilating 'quick enough'. Why? Because hospitals need to know information on patient numbers so they can plan shift patterns and manage the occupation of their beds.
Now, that's OK if you're planning on executing a number of knee operations in a month, but the unpredictable nature of birth is of no use to a hospital manager - the hospital system can't cope with the chaos of not knowing that your particular body is going to take 3 days to expel a baby, or that the woman nextdoor's body is set at 24hours.
No. Hospitals & Drs need more order & therefore, they have decided that women's labours should last no longer than 12 hours maximum & all cervix should dilate at 1cm an hour. Anyone daring to go any slower from their false 'norm' WILL be intervened with - that is if they haven't already been induced.
Unfortunately, however, their cascades of intervention are not always beneficial to mother or baby - they are only truly beneficial to the hospital management.
Once again Marsden Wagner also tells it like it is.
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So, you're a few days 'overdue' and you've been told by a hospital Midwife that they're 'going to induce you at Term +10' - that is when you reach 10 days over your due date you will go into hospital to have your labour artificially started, instead of letting your body decide for itself when the right time has come to evict its tennant.
What's wrong with that you might ask? Well, for starters, WHY do they 'have' to induce you at all? Angela Horn's fantastic Homebirth Reference website sets out the researched statistical risks you are putting yourself & your baby under if you dare to go beyond the golden +10 days that Drs consider 'safe'.
The main medical reason for inducing women is because after 42 weeks gestation, the placenta can start to deteriorate. An alarming number of women wrongly believe they're induced because otherwise their baby will grow too big to fit through their pelvis - don't be silly now, you've got more chance of growing a beard than growing a baby so big, it won't fit through your pelvis.
Very little research has been done into the risks of continuing a pregnancy after 42 weeks, however, Angela Horn has uncovered a statistic that says the chance of your placenta malfunctioning before week 42 is about 1 in 1000 - after that time, the risk doubles - therefore giving you a risk factor of 1 in 500.
Now, I don't know about you, but I think 1 in 500 is fairly good odds that your body will go to it's own natural term without complications. Bear in mind that an amniocentesis has a miscarriage risk of 1 in 200, but I don't hear many obstetricians advising strongly against THAT procedure do you? And yet you've got a far greater chance of damaging your baby that way than if you choose to go beyond 42 weeks.
A study conducted in Canada in 1994 found that the stillbirth rate was approximately the same at 37 weeks (5.1 per thousand) as it was at 43 weeks (5.2 per thousand) of pregnancy. Also, the stillbirth rate was actually lower at 42 weeks (2.0 per thousand) of pregnancy than it was at 38 weeks (2.5 per thousand). This study also found that more than a quarter of the stillbirths were due to congenital abnormalities, not due to being born post dates.
The thing to note here is that you don't 'have' to do anything the Drs tell you - either before or when you're actually in labour. Their use of the English language can be highly misleading & you should be aware that you can refuse an induction, just as you can refuse any treatment they offer.
I suspect the reason hospitals have induction 'rules' for Term +10 or Term +14 is more to do with bed management & staff rotas than it is to do with the health of a mother & baby.
Let's also be very aware that due dates can be highly misleading. Drs have decided that ON AVERAGE women gestate for 40 weeks - in France the number is 41 (even 42 in some parts). So being Term +10 in the UK would actually only qualify you as being 3 days overdue across the Channel.
A particluar induction nasty to be wary of is syntocin (or oxytocin or pitocin if you live in The States), one of the drugs they can use to induce you (the one in the drip) that puts your body into full-on artificial labour, forcing your uterus to contract at an incredibly strong rate. It doesn't actually dilate your cervix directly - instead, its resulting powerful contractions effectively use the top of the baby's head as a 'battering ram' on the cervix. And because your uterus has gone from 'no labour' to 'hard labour' in an instant, without the gentle gradual build-up as would happen in a normal birth, as a muscle, it is prone to tiring quickly, leading to further complications and very often, a caesarean.
I know it's incredibly tempting to agree to an induction if you've gone to term & you're feeling fed up, tired & about as attractive as Bernard Manning, but even a so-called more 'natural' vaginal membrane sweep comes with its own set of minor problems & although many midwives & Drs will rave about it, I for one don't find anything particularly natural about having a midwife's hand shoved up your nether regions, fingering your cervix. And while they like to describe the procedure as 'uncomfortable', others might be more inclined to say 'it bloody hurts'. I also can not agree that a membrane sweep is a more 'natural' method of induction - nature doesn't provide a 'natural' way of artificially separating the membranes. I get a hunch that the body goes into labour after a membrane sweep because it thinks there's something wrong & needs to expel it's baby asap - obviously that's a purely hypothetical & unfounded opinion & not based on any research whatsoever, so take it or leave it, but I am left with the instinctive feeling that any form of induction, (unless it's for a good medical reason, such as pre-eclampsia for example), is the wrong way to start off your labour. You wouldn't take drugs or interfere in any other way with your menstural cycle to hasten your period if you're a few days late, so why mistrust your body in this circumstance?
It just doesn't make sense.
The best thing to bear in mind is that you're far more likely to achieve a normal labour if it's your body that decides when you're ready to meet your baby, not the Drs.
On a personal note , although I don't believe in induction unless it's for a good medical reason, I would agree to regular check ups if I went over 42 weeks.
And finally, just to round this off, here are some brilliant observations about membrane sweeps & inductions made by Angela Horn from the Homebirth Reference site, which I've copied & pasted from a recent homebirth message board:
"Spontaneous labour starts as a result of a number of triggers, not all of which are fully understood, but which include things like the baby's lung maturity and which can include the position of the baby's head. If labour has not started spontaneously, I think we should ask why, before going for membrane sweeps or DIY induction methods, let alone medical induction. It could be, for instance, that the baby's head is not well flexed and so not exerting much pressure on the cervix. The worry is that if mother and baby are not in a situation where labour has started spontaneously, then interventions like a sweep might trigger a weak sort of labour which doesn't progress well. It seems to be quite common when women have gone all-out with curries, pineapples, nipple-twiddling, castor oil etc.. that some contractions will start, but that there will be a lot of stopping and starting before true labour kicks in.
All this is hypothetical - I don't know if membrane sweeps are more likely to lead to drawn-out labours, and I'd be interested to hear people's views on it. As far as I'm aware there has not been any research on this particular issue and therefore these concerns should be treated as *questions* rather than *arguments* if you know what I mean".
This article gives you more information on induction in general from the National Institute of Clinical Excellence (NICE), but I recommend you also read the Homebirth Reference Site's page on being overdue, especially the link to 'DIY methods of induction'.
The Radical Midwives also have some great articles on post date pregnancies & a good discussion & advice on what to about about induction. Don't be put off by the term 'Radical' - their front page explains why they use that word. Their advice on DIY methods is also a good source.
Another website I rave about is Ronnie Falcao's Gentle Birth pages. This gives you lots of brilliant info on postdates.
And finally, watch out for another shocker that can't be forgotten here - Misoprostol- which is commonly used in private hospitals to induce women. It's currently licensed in the UK to treat stomach complaints but NOT licensed for induction. The reason? No research has been done to back it up as being a safe option.
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Epidural
Drs like to refer to this one as 'The Rolls Royce' of pain relief. Sounds great doesn't it? I think they're inferring it's the best of it's kind, but using this analogy can only make me think of an expensive inefficient polluting specimen from a bygone era.
Let's refer to (HRH) Marsden Wagner for his thorough rundown of the Epidural Epidemic - click on the link & scroll down the page until you get to 'Is Hospital Birth Safe in Australia'. Here's a quick taster of the article:
"A great deal of scientific research has shown that women receiving epidural block for normal labour pain will have a significantly longer second stage of labour. This, in turn, results in a four times greater risk of using forceps or vacuum extraction and at least a two times greater risk of caesarian section and these operative interventions during birth carry their own serious risks as well. While many women might be willing to take risks with their own bodies to gain pain relief, it is highly unlikely they are willing to put their babies at risk. One common complication in the woman after an epidural is started is sudden loss of blood pressure leading to a sharp drop in blood flow through the placenta to the fetus, resulting in mild to severe lack of oxygen to the fetus as shown on a fetal heart rate monitor. In another typical high-tech strategy of using a second intervention to try to stop the bad effects of the first intervention, doctors give the woman a great big dose of fluid through an IV to try to prevent the drop in blood pressure from the epidural but this does not always work. So lack of oxygen to the baby during the epidural remains a possibility and the American College of Obstetricians and Gynecologists reports that the electronic fetal heart monitor shows severe fetal hypoxia in eight to twelve percent of infants whose mother's are given an epidural block for normal labour pain".
This article by Dr Sarah Buckley sets out further information about the real risks of epidural for mothers & babies.
And Beverley Beech from AIMS has written Epidurals - Dead from the waist down - which also examines the researched risks & effects of an epidural on the mother & her baby. Beverley's also written a really helpful 'Advantages & Disadvantages' list at the bottom of this article.
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Other pain-relieving drugs
Diamorphine, pethidine & entonox (gas & air). It amazes me that for your entire pregnancy you're advised to not so much as glance at a soft boiled egg, lump of pate or glass of sherry & yet as soon as you go into labour, you're offered heroin by a medical professional. Yes, that's right, heroin - or 'diamorphine' as they prefer to call it.
Every single thing that enters your body through your mouth or your blood stream will cross through your placenta & straight into your baby. If you smoke, so does your baby; if you drink, so does your baby; if you take heroin, so will your baby.
This article from AIMS sets out everything you need to know about opiate forms of pain relief (pethidine & diamorphine) that they offer you in hospital. And this article gives you a thorough round up of the long term effects of opiate use on mothers & babies.
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Episiotomy
Ouch - don't remind me. This article sets out the Obstetric Myth vs Research - it's pretty hard going, but you can scroll down to 'summary of significant points' if you want to cheat. However, this one gives good advice on how to perform perineal massage to help avoid an episiotomy & tearing (I did perineal massage for 3 months & was gutted that I had to have an episiotomy with a ventouse - I'll still do the same next time round though
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Continuous Electronic Foetal Monitoring
From what I can gather, for perfectly normal pregnancies & labours EFM is completely pointless - there is no evidence available to suggest it in any way benefits you or your baby during labour. Continuous EFM is where they strap you up to a machine that monitors your baby's heart rate, leaving you unable to move off your bed or adopt good positions for birth, so the best advice is to refuse it unless there's a good medical reason. A midwife will check your baby's heart rate at regular intervals anyway, so what's the point of being tied to a machine that inhibits your natural movements? Being able to move around freely will be much more comfortable for your labour. Research has shown that lying on a bed on your back produces far more painful contractions as the pelvis is prevented from stretching & opening properly. Plus, when it comes to your baby finally leaving your body, it's actually working against gravity & being forced uphill. Birth International is a great website, packed with info on birth and this article gives a good overview of continuous EFM, but I shall endeavour to find something more substantial soon.
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Forceps & Ventouse
You have a much higher chance of an assisted birth if you've had an epidural. These articles on forceps & ventouse from Birth International. But you should also check out the Primal Health pages on forceps deliveries & ventouse.
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Caesarean
http://www.caesarean.org.uk/ is THE best website for information on caesareans & VBACs, so I'll let you go there & absorb.
Recent research has shown that mothers & babies are at a much greater risk with a caesarean rather than a natural birth.
And this recent study says that 1.1% of babies who are born via a caesarean are damaged during the procedure.
And if you want to know the long term effects of a caesarean on a baby, go to Michel Odent's Primal Health Research page on the subject.
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Ultrasound
You may be of the opinion 'ultrasound's been around for years, there can't possibly be anything wrong with it'. Well, unfortunately, just because the medical profession have been using a technique for some time, it doesn't necessarily mean it was fully researched & proven safe before it came into widespread use.
The problem is, no studies have been conducted into ultrasound that prove it's safe to use during pregnancy - either in the short or long term - & unfortunately, the little research that has been done found links, albeit small, between ultrasound & intrauterine growth retardation, miscarriage & autism. (see the AIMS articles below).
Ultrasound may be as safe as houses, but while the medical profession refuses to FULLY research the technique (what are they scared of finding?) it might be best to err on the side of caution & either keep scans to an absolute bare minimum or opt to have none at all.
Let's face it, if it was discovered one day that ultrasound did have definite harmful effects on babies, it wouldn't be the first introduction of a techinique or substance into medicine that lacked the backing of decent research. For example, the following extract is taken from Dr Michel Odent's Primal Health:
"There have been some spectacular drug withdrawals from the market. Everyone knows about Thalidomide, the drug which was aimed at morning sickness in pregnant women. It took several years to discover the link between horrifying abnormalities in babies' limbs & the taking of this drug during pregnancy. Many people remember the story of DES, a synthetic oestrogen which was supposed to prevent miscarriage. Many women took it during the 1940s & early 1950s. It was several years before a clever team in Boston discovered the girls born to mothers who had taken DES in pregnancy often had abnormalities in the cervix & vagina. The mothers who took DES probably had a greater risk of getting breast cancer. On top of this, the drug was absolutely useless in preventing miscarriage.........
......The risks involved in some diagnostic tests are rarely balanced against the expected benefits. For example, it has been said that 5 - 10% of cancers in European & American children are connected with the x-rays which pregnant women were given during the 1950s & 1960s".
Adding to this, I shall refer to The Wagner's wisdom once more - Marsden Wagner reiterates that there are no researched benefits to routine scanning. It's a great article & will give you a good grounding in most of the issues at hand. And if that doesn't get you thinking, try the following articles by Beverley Beech & Jean Robinson from AIMS - Who says ultrasound is safe? and Ultrasound: more powerful, more dangerous, more unethical
Perhaps the writing is already on the wall when it comes to ultrasound? The American Institute of Ultrasound in Medicine (AIUM) recently supported the decision of the US Food and Drug Administration (FDA) to deny a request that would permit over-the-counter (OTC) sales of certain handheld Doppler ultrasound fetal listening devices. Why? Because "although there are no confirmed biological effects on patients caused by exposure from present diagnostic ultrasound incidents, the possibility exists that such biological effects may be identified in the future."
And, just in case you didn't realise, the hand-held dopplers or sonicaids that midwives use to listen to your baby's heartbeat are also ultrasound. They don't have to use them - they can use a non-technical trumpet-looking piece of equipment called a pinnard, which all midwives were trained to use as students. However, dopplers have become such a mainstream instrument of convenience, midwives automatically reach for them. Personally, I insist on a pinnard at all times during pregnancy unless a doppler becomes necessary for a medical reason (a doppler may help to put your mind at rest, for example, if you're experiencing an unusual lack of foetal movement).