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Here is some information on some of the more common hospital procedures and interventions, including their benefits, risks and alternatives – it is still a work in progress so check back for additions. This is pretty basic information and I recommend doing additional research into the medical management of labor and it’s impact on childbirth. There are some excellent resources in my Recommended Reading section.
Laboring in Bed
Purpose
To cater to the misconception that women are safer in bed; provides a more convenient field of operation for care provider during the second and third stage (pushing and birth)
Benefits
None
Risks
Encourages fetal malpresentation; decrease in normal intensity of contractions resulting in a lengthening of labor; limits the mother’s ability to make herself comfortable; instrumental delivery and cesarean due to fetal malpresentation; a drop in maternal blood pressure which results in poor oxygen supply to the baby - laboring supine (flat-on-the-back) is the absolute WORST possible position for a laboring woman!
Alternatives
Remaining ambulatory and labor in a more upright position, allowing gravity to help increase the strength of contractions and dilate the cervix more efficiently, encourage optimal fetal positioning which will allow for easier decent and enable the mother a wider range of movement with which to make herself comfortable
Other interventions that may be required
Pharmacological augmentation; a desire for pain medication due to “back labor” often associated with an OP (occiput posterior) baby; instrumental delivery or cesarean due to fetal malpresentation
Continuous Electrical
Fetal Monitoring (EFM)
Purpose
Monitors fetal heart rate and maternal contraction pattern, indicates how the baby’s heart reacts to contractions, and how long, strong and close together the contractions occur; they also provide a permanent record; can be done both externally with sensors belted to the mothers belly and internally with an electrode attached to the baby’s scalp
Benefits
Theoretically, allows one nurse to monitor several patients at one glance of the screen; useful if intermittent monitoring indicates a possible problem
Risks
Very high “false positive” rate (indications of fetal distress when there isn’t any) thus resulting in unnecessary intervention, including surgical delivery; the signal is often lost when the baby moves or the mother adjusts her position; internal monitoring is invasive and introduces the risk of infection;
Alternatives
Intermittent monitoring with a Doppler; continuous telemetry (wireless) monitoring
Other interventions that may be required
AROM is required with internal monitoring; surgical delivery due to “false positives”
Routine IVs
Purpose
To replace oral intake of fluids; also provides easy access for medication
Benefits
Keeps the mother hydrated
Risks
Fluid overload, which can lead to fluid in both the mother’s lungs (pulmonary edema) and the baby’s lungs (neonatal trachnea); inhibits mobility; painful inflammation at the site (also a risk with *heparin lock); leakage from the punctures blood vessel resulting in painful bruising (also a risk with *heparin lock); increase of maternal and fetal blood levels to diabetic levels (hyperglycemia) when fluids contain glucose (referred to as “dextrose IVs”)
Alternatives
Fluids (and foods, if possible) by mouth during labor; *heparin lock
Other interventions that may be required
Treatment for problems caused by fluid overload, infection at IV site and hyperglycemic conditions in mother and baby
Artificial Rupture of Membranes (AROM)
or Amniotomy
Purpose
To induce or augment labor (removing the cushion of fluid and allowing the baby’s head to press directly against the cervix will theoretically aid in opening it) and check for meconium staining of the fluid (an indication of fetal distress); it is also necessary to rupture membranes to place an internal monitor (an electrode attached to the baby’s scalp) when indicated
Benefits
Shortens labor by 1-2 hours and may reduce the use of Pitocin (synthetic oxytocin)
Risks
Cord prolapse, fetal heart rate abnormalities due to lack of fluid (when done early in labor), maternal infection,
Alternatives
Conserve membranes; less invasive methods of stimulating labor, such as walking, nipple stimulation, acupressure, relaxation and visualization if augmentation is indeed necessary; waiting for labor to occur spontaneously
Other interventions that may be required
Amnioinfusion (replacing fluid via catheter); pharmacological induction or augmentation in cases of prolonged rupture of membranes; cesarean for cord prolapse
Labor Induction
with Misoprostil (Cyotec)
Purpose
To ripen the cervix and stimulate labor
Benefits
Cheaper and proven more effective than the PGE2s (Cervadil or Prepidil) and Pitoin
Risks
Significantly increases risk of uterine hyperstimulation and fetal distress; significantly increases risk of uterine rupture in VBACs (from 0.54% in spontaneously occurring labor to 2.45% with prostaglandin inductions); once administered, cannot be stopped; there is no standard dosing protocol and it is not formulated (nor indicated by the manufacturer) for use in inducing labor
Alternatives
As with any method of induction, less invasive methods of stimulating labor, such as walking, nipple stimulation, acupressure, relaxation and visualization if augmentation is indeed necessary; waiting for labor to occur spontaneously
Other interventions that may be required
An internal monitor due increased stress on the baby may be necessary, thus requiring AROM; emergency cesarean due to uterine rupture; hysterectomy
Labor Induction and Augmentation
with Pitocin
Purpose
To “jump start” a stalled labor or initiate labor before it has begun
Benefits
Usually effective in inducing or augmenting labor; can be stopped if adverse reactions occur
Risks
Restriction of movement due to IV; more painful labor; uterine hyperstimulation (contractions that do not stop) which can result in fetal distress; increases risk of uterine rupture in VBACs (from 0.54% in spontaneously occurring labor to 0.77%); may increased postpartum blood loss and incidence of newborn jaundice; increases risk of cesarean
Alternatives
Less invasive methods of stimulating labor, such as walking, nipple stimulation, acupressure, relaxation and visualization if augmentation is indeed necessary; waiting for labor to occur spontaneously
Other interventions that may be required
An IV Will be necessary; an internal monitor due may be necessary, thus requiring AROM; due to a higher intensity of contractions, the mother may be more inclined to request pain medication; cesarean for fetal distress
IV Medication (Injected Narcotics or Analgesics)
Purpose
To dull or “take the edge off” the pain of labor
Benefits
Do not require a needle in your back, continuous EFM or a catheter; quick relief (there will be little delay in receiving it after you request it), do not slow labor or interfere with the second stage
Risks
Nausea; a drop in maternal blood pressure; respiratory depression in mother which may result in fetal distress due to inadequate oxygenation; interference with newborn behaviors, including suckling reflex; neonatal respiratory distress
Alternatives
An environment that is more comfortable, familiar and conducive to relaxation; a care provider with a less interventive approach to childbirth; a doula (statistically proven to reduce the use of pharmacological pain relief); hydrotherapy; massage; acupressure; guided relaxation; visualization; patterned breathing techniques; movement and changing position often; vocalization; TENS (transelectronic nerve stimulation); sterile water papules
Other interventions that may be required
anti-nausea medication; rescue measures and possible resuscitation in cases of neonatal respiratory distress
Epidural Anesthesia
Purpose
To eliminate the sensation of pain during childbirth
Benefits
Usually eliminates the sensation of pain, allowing the mother to relax and sleep; MAY encourage progress of a “staled” labor by promoting relaxation; allows a mother to remain awake and alert during a cesarean
Risks
Tends to slow labor; risk of infection at injection site; increases the risk of instrumental delivery and cesarean; risks postpartum include maternal fever, temporary urinary incontinence, nerve injury, hematoma, spinal headache and a considerable drop in blood pressure; increases the risk of much more serious complication including maternal convulsions, reparatory paralysis and cardiac arrest; may have adverse effects on newborn, both short and long term
Alternatives
An environment that is more comfortable, familiar and conducive to relaxation; a care provider with a less interventive approach to childbirth; a doula (statistically proven to reduce the use of pharmacological pain relief); hydrotherapy; massage; acupressure; guided relaxation; visualization; patterned breathing techniques; movement and changing position often; vocalization; TENS (transelectronic nerve stimulation); sterile water papules
Other interventions that may be required
Pharmacological augmentation if labors slows; WILL require electronic fetal monitoring, precautionary IV and possibly a bladder catheter (consider the risks associated with these procedures and the intervention “domino effect”); instrumental delivery or cesarea
"Purple Pushing"
Purpose
To expedite the second stage of labor/the pushing stage; to provide women who are medicated and unable to feel “the urge” instruction on when to push
Benefits
To provide ONLY those who are medicated and unable to feel “the urge” instruction on when to push
Risks
Contributes to maternal exhaustion; increased likelihood of tearing; compromises fetal oxygen supply
Alternatives
Spontaneous bearing down or pushing with the urge; breathe or grunt or moan your baby out
Other interventions that may be required
Instrumental delivery or cesarean due to maternal exhaustion
| Choosing a Care Provider | Choosing a Birth Environment | Building a Birth Plan |
| Your Labor Support System | Pain Management | VBAC | Common Interventions & Procedures |
| Breastfeeding | Birth Stories | Recommended Reading | Doula Services (Denver)
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