Do you want to understand common birth interventions that women face when giving birth in the hospital setting? Look no further, as I am about to dive deep and spill all of the tea on these common birth interventions, with their pros, cons, and potential alternatives.
My goal with this is not to tell you to not use any interventions for childbirth. I am not saying that birth interventions are evil and should be used under no circumstances. I firmly believe that modern medicine is a miracle and saves lives when used in the right setting. The problem comes when medicine that should only be used on a small population that truly needs it is used at a mass scale simply because it’s “routine.”
Because the fact of the matter is that there are many commonly used birth interventions that women are not given the full picture on. Often, they are not given true informed consent, and they are often coerced into interventions that are not truly needed, and can even do more harm than good.
The amazing thing is that as a patient, you have a choice to say “yes,” or “no” when a provider presents you with an option for the use of medical intervention. So, having the full picture on these interventions is really important so that you are aware of why you are saying “yes” to something, or why you are saying, “no.”
If a provider is not fully describing how an intervention works in a way that you can understand, informing you of the choice in the matter without using coercive language, informing you of the risks on both sides of the coin (i.e the risks of c-sections and not just of not getting a c-section), and is not presenting alternatives to this medical intervention, you are not receiving full patient rights of informed consent.
So without further ado, here are 11 common childbirth interventions that you deserve to understand in their fullness.
Birth Intervention # 1: Induction
Let’s start off with the birth intervention that aims to kickstart labor: Induction
I could write a whole lot about induction, so I will try to narrow it down and keep to the basics of what you need to know here.
What is induction?
Simply put, induction occurs when medical professionals use different medical techniques to start labor before a mother naturally goes into labor. Induction involves both thinning out the cervix and causing the uterus to contract strongly enough that the birth process can occur.
There are several different types of induction, and different indications for this birth intervention as well.
There is medical induction and elective induction.
Medical Induction
Medical induction means that there is a medical indication for induction to occur, such as preeclampsia or true intrauterine growth restriction. These are the cases where the mother or baby’s life could be at risk, and when I am very thankful for modern medicine, as it can save lives.
Elective Induction
In elective induction there is no true medical indication for the baby to be born early. Elective induction is extremely overused, and in my opinion should not be used due to the harm that induction can cause to both mother and baby. Elective induction as a birth intervention would be for any nonmedical reason such as upcoming holidays, or the mother being tired of pregnancy.
How Induction Works
Induction works through artificially starting labor with different medical methods involving things such as Cervidil to soften the cervix, medicine such as Pitocin to start contractions, or prematurely breaking of waters. These can also be used in combination. There are also other medicines and tools used, such as the foley bulb.
Common Reasons for Induction as a Birth Intervention
-Ultrasound and other testing indicate baby is struggling in utero
-Medical conditions: Preeclampsia, certain diseases or autoimmune issues, obesity, your baby is measuring big. (Ultrasounds are notoriously inaccurate in measurements. This is most often not a true medical indication.)
-Past due date
-Living a long distance from the hospital and fear of not making in in time.
-Not progressing as fast in labor as the doctor would like
-Gestational Diabetes
-Broken water without contractions
-Infection in uterus
-High blood pressure
Risks of Induction as a Birth Intervention
-uterine rupture
-fetal distress due to extreme contractions which can lower the baby’s oxygen supply
-postpartum hemorrhage
-increased medical interventions
-difficulty bonding with baby due to the blockage of real oxytocin
-C-section
-double peaking contractions
Reasons to Say No to Induction as a Birth Intervention
Unless there is a true medical indication where not being induced could threaten a life, there is really no reason to be induced, and it is a red flag if your provider pushes you to do otherwise. There are a lot of risks to induction, and not a lot of benefits.
Want to learn more about induction? Check out the book In Your Own Time by Sarah Wickham.
Birth Intervention # 2: Restricted Movement
In the hospital, it is very common to have restricted movement, which is pretty much exactly what it sounds like. From the moment a laboring mother enters triage, she is put in bed and strapped full of monitors.
Common Reasons for Restricted Movement as a Birth Intervention
Restricted movement is preferred in the hospital because it makes it easier for continuous monitoring of fetal heart rate and contractions. Restricted movement is also common in the case of an epidural.
Restricted movement is also very commonly used in the pushing phase of labor, which can cause complications to both mother and baby. This is done though to provide easier access for the doctor who plans to catch the baby.
Risks of Restricted Movement as a Birth Intervention
-Increased pain in labor
-Decreased oxygen to the baby/decreased blood flow to the placenta
-Slows labor progress
-Baby can take longer to descend as they fight against gravity
-Less room created in the pelvis
-longer pushing phase
-increased risk of tearing
-increased risk of more interventions
-Prevents the mother from following the instincts of her body
-increased risk of shoulder dystocia
Reasons to Say No to Restricted Movement as a Birth Intervention
Restricted movement is simply for no other reason than the convenience of medical professionals, and can cause more harm to mother and baby. It can make the laboring process more painful than it should be as mothers are forced to go against their instincts.
By simply saying no to be restricted in movement and changing positions frequently by listened to the ques of your body can allow for decreased pain, empowerment as you take ownership of your labor and connection with baby, increased oxygen and blood flow to the baby, decreased risk of shoulder dystocia, more progressive labor, and fewer interventions overall.
If in the hospital you can ask for intermittent fetal monitoring, a heplock instead of IV (or no IV/heplock at all), and can bring all the tools you need to switch positions and move freely in labor.
You can also discuss your birthing position with you doctor beforehand. If they are uncomfortable with you delivering in a position other than lithotomy (on your back), this may be a red flag.
(PS some women prefer giving birth on their backs. If that’s you, GREAT! The point isn’t to say you cannot be on you back, the point is you should be free to follow you instincts and get into the position that your body and baby want to be in!)
Birth Intervention #3: No Eating
Many hospitals have a policy that restricts a mother’s ability to eat and drink while in labor.
Mothers are often limited to clear liquids (que ice chips) and no solid foods.
Common Reasons for No Food Policies
In case a mother needs to have an emergency c-section, the limited eating and drinking is a precautionary measure. When a person is put into deep sleep and they have a full stomach, the fear is that aspiration could occur, however, this is very rare.
Risks of Not Eating as a Birth Intervention
-Maternal and fetal exhaustion from no energy
-Lack of minerals and electrolytes
-Dehydration
-Difficulty in initiating breastfeeding
-Increased risk of further interventions due to maternal exhaustion and fetal distress
Reasons to Say No to Restricted Eating as a Birth Intervention
If you are a low risk mother with a healthy pregnancy, you will probably have a better chance at lowering interventions if you eat small snacks throughout labor and drink mineral packed drinks. This will fuel your body for this intense process.
No one would tell a marathon runner to not fuel during their race just in case they wound up in the hospital. That would be crazy because not fueling for a marathon would lead to extreme hydration and an inability to finish the race. Labor is like a marathon, and it deserves to be fueled properly.
If you are worried about it, you can simply eat small snacks and drink fueling drinks prior to going to the hospital!
Birth Intervention #4: Intravenous Fluids (IV’s)
IV’s are placed in a mother’s arm during labor and can be used for providing fluid, medicine, and induction techniques in labor.
Common Reasons for IV’s as a Birth Intervention
There are many different reasons for the use of IV’s including hydration for the mother (especially when food and drink are limited), to administer medications or drugs such as fentanyl for pain relief, epidurals, or in case of emergencies in which having an IV previously placed creates easier access.
Risks of an IV as a Birth Intervention
-Restricted movement (which can lead to things such as greater pain in labor or slower progression)
-Nausea
-Fluid Retention
-Potential lowered blood sugar in baby
-increased fluid in the baby after birth
-Lowered confidence and comfort, leading to greater pain and slower progression of labor
-Greater likelihood of interventions such as pitocin
Compromises Instead of an IV
While IV’s are an incredible resource in high risk situations, they are not really necessary in low risk pregnancies and can even impede labor progression. A good alternative is to request a saline lock instead of a continuously connected IV. This way you will not be restricted in labor, but doctors can have easy access to your veins if anything comes up requiring an IV.
You can also simply say no to an IV, letting your provider know ahead of time that this is what you wish along with reasons why.
For example, you could say you wish to not have an IV or saline lock unless absolutely necessary because in the past getting IVs placed have made you feel woozy because you are afraid of needles.
Because of this, you think they will impact the progression of your labor. You can also emphasize that you understand how important hydration is, and present a plan for how you will hydrate yourself.
Hydrating yourself regularly can make a huge difference in labor outcomes. Have a doula or birth partner offer you liquids every 30 minutes or so, and take small sips in between contractions.
If you become dehydrated in labor, they can always place an IV then.
If your provider cannot respect these rational wishes, it may be a red flag.
Birth Intervention #5: Fetal Monitoring
There are different types of fetal monitoring, and in the hospital this monitoring is most often continuos, meaning it is done throughout the entire labor. This monitors the heart rate of the baby as well as contractions that a mother has.
Common Reasons for Fetal Monitoring
Fetal monitoring monitors the baby’s heart rate as well as variability in order to tell how the baby is handling labor. It ensures that the baby is receiving enough oxygen and is handling other interventions given to the mother.
It also monitors contractions to see how labor is progressing.
Types of Fetal Monitoring
There are a few different types of fetal monitoring that we will briefly go over:
External Fetal Monitoring
This type of monitoring is strapped to the mother’s belly and uses ultrasound technology to trace the heart tones of the baby. It also is tracing uterine contractions, but can only tell how long these contractions last for, but not how strong they are.
Internal Fetal Monitoring
This type of monitor is used when there is difficulty tracing fetal heart tones, often because the baby is in a difficult position to detect. In this case a wire is twisted into the baby’s scalp (OUCH!)
Internal Uterine Pressure
This is a catheter used to internally monitor the strength of contractions.
Continuous Monitoring
Most often used in hospitals, continuous monitoring means that there is some form of monitoring used throughout the entire duration of the labor. There is a wireless form of monitoring that can be used continuously so that the mother is not as limited in motion.
Intermittent Monitoring
A mother can request intermittent monitoring, meaning that the baby is checked on intermittently throughout the labor instead of the entire time. It is most often used for 20 minutes out of every hour.
Why Continuous Fetal Monitoring as a Birth Intervention Isn’t Always Best
-Restricted movement
-More painful contractions
-Discomfort and inability to truly relax in labor
-Greater likelihood of more intervention
-Greater stress to mother
-Continuous disruption in physiological birth
-Internal monitoring can cause infection
-Internal Monitoring causes pain to the baby
-there is a small chance for uterine rupture from the tools used
Compromises for Monitoring
You can request that intermittent monitoring is used instead of continual. If the provider does not want to do this for you, it is often because it makes their job slightly more difficult, and not because it causes you or the baby any danger in a low risk pregnancy.
If you are high risk or on an epidural, you can request continuous wireless monitoring so that you do not have to be stuck in your bed throughout the labor.
Often in out of hospital births, fetal heart tones are usually intermittently monitored through the doppler, which also has very good outcomes in healthy pregnancies.
Birth Intervention #6: Cervical Checks/Vaginal Exams
In a cervical check, the cervix is assessed by a provider using a gloved finger to determine different things about the progress of labor.
In labor vaginal exams are done for several reasons.
Why Cervical Checks/Vaginal Exams are Done as a Birth Intervention
In labor this intervention is done in order to assess the progression of labor.
In the hospital, a woman will probably receive her first vaginal exam upon entering triage. Most hospital policies require that a woman be 4 centimeters dilated before entering labor and delivery. After this, checks are done routinely until a woman reaches 10 centimeters, and is considered complete and ready to push.
Cervical checks are mainly for the convenience of the provider, but in a society that values time, they can help satisfy the curiosity of a mother.
A vaginal exam can indicate several different things.
Dilation
Most commonly known is dilation, which is how much a woman’s cervix is open. It measures from 0 to 10 cm. In the movies, a woman is portrayed as ready to push as soon as she reaches 10 cm, and this narrative transfers over into many medical settings. However, dilation is just a small part of what indicates progress in labor. A woman can be dilated to 8 cm for 4 hours, or she can go from 3 cm to 10 cm in 45 minutes. Birth is wild and unpredictable, but assessing dilation often puts it inside of a box.
Station
Station has to do with position in relation to the ischial spines in the pelvis. I baby with a negative station is floating, and a zero station is engaged in the pelvis. Positive stations mean the baby is descending the pelvis and headed toward birth.
Effacement
While dilation has to do with how open the cervix is, effacement has to do with how thinned out the cervix is. This is measured on a scale from 0% to 100%. Once the cervix is 10 cm dilated and fully effaced is a baby ready to be born. (Though waiting till there is an undeniable urge to push along with dilation and effacement should be considered as well.)
Fetal Positioning
This can indicate how a baby is positioned for birth. (aka breech, head-down, etc.)
Cervical Positioning
This determines where the cervix is in relation to the opening of the vagina.
Risks Cervical Checks/Vaginal Exams as a Birth Intervention
While cervical checks are routine throughout all of pregnancy and labor, there is not often a medical indication for them, and they come with risks that are often not discussed with the mother.
-Increased risk of infection
-Risk of rupturing membranes/breaking water
-Increased risk of other interventions
-Discouraged mother who is not as far along as she would like
-”failure to progress” is diagnosed
-increased pain in labor
-disruption of physiological birth
Compromises for Cervical Checks
It is important when going into pregnancy and labor to understand that all a vaginal exam does is provide information based upon inadequately studied formulas.
You can ask to wait on any vaginal exams till 40 weeks of pregnancy, or until labor begins. Once labor begins you can request that cervical exams are only performed if medically indicated.
If you want all the vaginal exams, get all of them, especially if it gives you peace of mind throughout labor. For many mothers though, it can disrupt the hormonal cocktail happening inside of their bodies and slow labor.
It is important to be in tune with what your own body needs, and find a provider who is aligned with your own desires.
A good provider who understands birth should be able to gauge where a woman is at in her labor simply by observing her actions and sounds.
Birth Intervention #7: Manual Breaking of Waters
Since we just discussed how vaginal exams could potentially lead to waters artificially rupturing, I think it’s an appropriate intervention to discuss next. Breaking a woman’s water, or amniotomy, is just what it sounds like. A provider manually breaks the bag of waters surrounding your baby, instead of allowing it to naturally happen.
Why Manually Breaking Waters as a Birth Intervention is Done
This is done for the convenience of the provider, to speed up labor, and is not commonly medically indicated, in fact, this intervention comes with a load of risks that are often not discussed.
Risks of Manually Breaking Water as a Birth Intervention
Maternal infection
Fetal infection
Cord prolapse
More painful contractions due to no cushioning
Greater likelihood of more interventions
Greater stress on a laboring body that was not prepared for labor to speed up
Increased fetal distress due to lack of cushioning
Compromises for Manually Breaking Waters
Make it clear to your birth team prior to labor that you do not want your waters broken. Ask for no cervical exams before or during labor, as providers will sometimes break waters intentionally or accidentally during these checks.
Work on labor progression through listening to your body instead. Sometimes labor progresses through movement, and sometimes labor progresses when a woman is at rest. Either way, relaxation is key to progression. Learn to listen to your body before labor begins.
Birth Intervention #8: People
I know this is a strange one, but people are an intervention in labor. Like all other interventions, people can be a positive or negative influence, depending on how they treat you in labor and what your needs are. People as an intervention could be your support person, doula, provider, people sitting in the waiting room, or even that text from well-meaning aunts wondering if the baby has been born.
Why People are a Birth Intervention
Birth is meant to be a sacred time in which a woman feels safest. If there is anyone in her environment that causes stress, this can stall labor. If she feels the need to care for others, this can prolong labor as well.
Often this is why mothers go into labor once their children are asleep. This intervention can be negative if there is a constant stream of medical professionals entering and exiting the mother’s hospital room. Limiting who enters and exits can make a big difference in labor progression.
What to Consider with People as a Birth Intervention
Really think about who you are inviting into your birth space, no matter where you are giving birth. If you know that a certain person will cause you stress, they do not have to be invited to your birth.
If you want to avoid texts, do not tell people that you are in labor. Heck, do not tell them your guess date (due date) just give them a general idea on the month your baby may be born in.
In the hospital, ask medical professionals to enter and exit your room quietly, and to direct questions towards your doula or support person. Ask them to only talk to you directly if they need your consent, if it is medically necessary, or if you speak to them first. It is not rude. You should be treated as the queen when you are giving birth.
Birth Intervention #9: Bright Lights
Similarly to people, I will briefly mention bright lights.
Why Bright Lights are a Birth Intervention
Bright, fluorescent lights literally disrupt hormonal communication in the body and will take you out of your state of rest, which is important for progression and relaxation in labor.
What to Consider with Bright Lights as a Birth Intervention
Bring fairy lights or candles to your birthing location and turn all other lights off. Birth providers who support you should be able to work around the darkness, using flashlights if needed. Obviously, if an emergency occurs lights should probably be turned on, but in a labor that is progressing, lights are not necessary, and can even impede labor.
Birth Intervention #10: Epidural
Epidurals are a very common intervention in the western world. I want to start out by saying, I am NOT anti-epidural. I think there is a time and a place for most interventions, and epidurals can be very helpful in specific situations.
I believe women should be able to choose how they give birth, but I also want to bring up a few things that are not necessarily disclosed to women in the hospital, so that you can be fully informed in your decision.
Why Epidurals are Given as a Birth Intervention
Epidurals are given as pain relief during labor. They can be very helpful in cases of maternal exhaustion, because they can help a mother to get sleep. They can also be helpful in allowing a mother to relax, if she is extremely tense and not progressing. Relaxation can speed up labor. It is more common in America to get an epidural than to not get one, and often women get it because it’s what is societally normal.
Risks of Epidurals as a Birth Intervention
-lowered blood pressure
-fetal distress
-Nausea
-Only works on one side of the body
-Limited positioning in labor
-inability to feel pushing
-Itching
-uncontrollable shaking
-Fever
-headaches
-Stalled labor, “failure to progress”
-lithotomy pushing position
-further interventions
-3rd/4th degree tearing
-blocked hormones between mother and baby
Compromises for Epidurals
Prepare, prepare, prepare!! In pregnancy, prepare yourself for a natural birth. Prepare physically, and prepare naturally. DO NOT just take a hospital birth course, take a natural birth course where you can learn many different techniques for managing labor.
Hire a doula to help you through the birthing process. Give birth outside of the hospital system. Make it clear to your birth team that you do not want to be asked if you want an epidural.
Birth Intervention #11: Forced Positioning (i.e Lithotomy)
Lithotomy positioning is the typical position that you will see in hospitals and in the movies. It involves lying on you back in supine position with legs up in stirrups or being held by others. This is commonly what medical providers will lead women into as they prepare for the pushing phase of labor, and it is also common when an epidural has been placed.
Why Women Give Birth on Their Backs
In some natural birth settings, women prefer to give birth on their backs, but this is very rare. In the hospital, it is often used as the pushing position because it is most convenient for the healthcare provider.
Risks of Lithotomy as a Birth Intervention
-Increased risk of tearing
-Higher rates of cesarean
-Increased risk of shoulder dystocia
-Increased risk of episiotomy and other assisted deliveries
-Lack of gravity to bring baby down
Compromises for Lithotomy
Try to work with gravity instead of against it by using positions that create more space in the pelvis. Lying on your back creates the least amount of space in the pelvis, and there are many other positions that can open it up and make an easier passage for the baby.
These positions include standing, squatting, using a birth stool, hands-and knees, side lying.
If you have requested an epidural, ask for a light one so that you can get into a position that works best with your body.
When you are first interviewing providers, ask them what their favorite position is. If they only support lithotomy, it may be time to shop for another provider.
Birth Intervention Recap
There are so many different things that can be considered a birth intervention, that it can be overwhelming. But this is just supposed to be a list that maybe broadens the idea of what is mainstream, because for everything that we opt into, we opt out of something else.
It is okay to ask your provider questions and get clarity. This is your body and your baby. You know them both best. You can also find an advocate, like a doula, to work with you through each of these interventions.
Want to learn about how a doula can support you? Check out this post.
