Healthy Birth Practice 4:
Avoid Interventions That Are Not Medically Necessary
Adapted from The Official Lamaze Guide: Giving Birth with Confidence
Although research shows that routine and unnecessary interference in the natural process of labor and birth is not likely to be beneficial—and may indeed be harmful—most U.S. births today are intervention-intensive. A majority of women surveyed for Listening to Mothers experienced one or more of the following interventions during labor:
- Continuous electronic fetal monitoring (EFM)(93 percent)
- Restrictions on eating (87 percent)
- IV fluids (86 percent)
- Restrictions on drinking (66 percent)
- Episiotomy (35 percent)
- Epidural anesthesia (63 percent)
- Artificially ruptured membranes (55 percent)
- Artificial oxytocin augmentation (53 percent)
- Cesarean surgery (24 percent)
Download the guide, Avoid Interventions That Are Not Medically Necessary, to learn why these interventions are usually unnecessary and sometimes harmful.
Interventions are like dominos. Often times, one intervention will lead to another and then another. Example: Using pitocin, means an IV, constant monitoring, and often times, an epidural...which adds frequent blood pressure checks, urinary catheters, etc. Learn how to keep your birth as normal as possible if you need:
- Continuous EFM
- An intravenous (IV) line or restrictions on food/fluid intake
- An episiotomy
- An epidural
- Artificial rupture of membranes
- Artificial oxytocin augmentation
- Cesarean surgery
Labor Tip: BRA
Although research shows that routine and unnecessary interference in the natural process of labor and birth is not likely to be beneficial - and may indeed be harmful - many women give consent to routine procedures such as vaginal exams, INT/hep lock/IV ports, and continuous monitoring. While each of these routine interventions are sometimes necessary, you may wish to ask WHY you are being offered such interventions. We recommend you consider the benefits, risks, and available alternatives (acronym: BRA) to any proposed intervention.
Medications for Labor
An epidural can be an extremely helpful tool to allow mom to rest, and in some cases, can actually speed up labor! However, an epidural does lead to a cascade of interventions including frequent BP checks, continuous IV fluids, continuous fetal and contraction monitoring, need for the use of a urinary catheter (which mom cannot feel because she is numb from the epidural), and the inability to move freely.
This video shows a laboring woman receiving an epidural. You may wish to skip this video if you have a weak stomach!
This video shows an animation of an epidural and explains how it is different from a spinal. Most hospitals do not offer spinals for labor (in 6 years as a labor and delivery nurse, I only saw ONE patient receive a spinal prior to her scheduled c-section).
Other medications that may be used for pain management are IV narcotics. The most commonly used medications are fentanyl, morphine, nubain and sometimes Phenergan. Phenergan is an anti-nausea medication that works synergistically with other medications. Fentanyl is probably used the most out of all the others listed because it is short-acting as well as quick-acting. It enters your blood stream quickly, but it also leaves your blood stream quickly (as well as baby’s). Anyone who receives narcotics within 4 hours of delivery will have extra nurses, etc. attending the birth, just to make sure baby is transitioning well. These medications can make baby feel very sleepy and be sluggish when born if they have been given close to delivery.