Interventions & Complications

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Antibiotic Eye Ointment

Antibiotic eye ointment is routinely applied to the baby’s eyes upon birth to combat and prevent eye infections commonly caused by gonorrhea or clamidyia.  This procedure is routine, even for mothers who have negative STD testing.  While the eyes are very sensitive, especially at birth, the necessity for this procedure is highly questionable, especially for low risk moms who have no history of STDs.

PKU/Other Blood Testing

Many hospitals will also do a heel prick to test the baby’s blood for a number of metabolic disorders, including PKU.  Many of the disorders tested for are treatable and if caught at an early age can mean the difference between lifelong health problems, or generally normal development.  The necessity of these tests is debated, especially for babies born to mothers with low risk factors, or those who have already had genetic testing.  For more information about this, it is best to discuss what testing is done with your provider in an effort to make a decision about whether or not you feel this is necessary for you. 

Additional practices are:

  • Suctioning Of Baby After Birth: When baby comes out of the womb it is common practice to help the baby breathe for the first time by suctioning the mouth but this has some debate around it. Read more
  • Placement of Baby Immediately After Birth - Many hospitals have different protocols for where baby should be placed immediately after birth for follow up exams and testing. Read more
  • Cord Clamping, Pulsing and Cutting: It is routine for most hospitals to immediately clamp the cord upon delivery. Read More
  • Vitamin K Injection: Vitamin K injections are routinely given to newborns to prevent the rare risk of bleeding in the brain due to a newborn’s low vitamin K levels.  Read more

 

 

Published in Newborn Care
Friday, 27 April 2012 11:17

The Truth of Cesareans

Cesarean Sections, also known as a c-section, is the surgical removal of the baby directly from the uterus.  While many women now elect to skip labor altogether (and their practitioners usually oblige,) others are determined to avoid a c-section at all costs. C-Sections are major abdominal surgery despite the short duration of the procedure.  An epidural or spinal block is typically administered, although in a true emergency the mother will often receive general anesthesia and be completely sedated for the procedure.  The baby is usually born within the first 15 minutes of the procedure and another 30-45 minutes are spent closing the incision.

Maternal risks involved with having a c-section include blood loss, adhesions, organ damage, infection, and extended recovery time.  Many mothers who have had a vaginal birth and then a c-section report significantly increased pain and healing time.  Having a c-section also increases the risk of needing a c-section for subsequent births.  VBAC (vaginal birth after cesarean) is a hot topic among the birthing community.  Many OB’s will encourage a mother who has already had a c-section to elect to have another one rather than attempting VBAC citing risks for uterine rupture.

Babies born via c-section are at an increased risk for lower APGAR scores, breathing difficulties, and injury from the procedure.  Elective c-sections (performing the procedure before labor begins) also increase the risk of premature birth, since gestation is an approximate estimate rather than an exact science.  Some mothers carry all of their children past 42 weeks and go on to have natural deliveries with healthy babies.  Other moms go into labor naturally around 38 weeks and have the same outcome.  Waiting for labor to begin decreases many of the risks to the baby because the hormones from both the mother and baby work together immediately before and during labor.  It is suggested that in a healthy pregnancy, the baby in some way triggers labor (possibly when her lungs have matured enough) through a biological process that we have yet to determine.  Electing for a delivery before the baby has finished gestating is likely to increase complications after birth.

It should be noted that cesarean section may be the best option in a few circumstances where it is best for the safety and wellbeing of the baby, the mother, or both.  Some of these situations include placenta previa, placental abruption, uterine rupture, cord prolapse, fetal distress, preeclampsia, and active genital herpes in the mother.  There are a number of other reasons for a c-section, (including gestational diabetes, baby being in the breech position, failure to progress, and previous c-sections) but these reasons alone are not often reason enough to elect for a c-section prior to the onset of labor.

Many moms who are having c-sections are speaking to their provider of having an assisted-cesarean where the mother assists bringing the baby out of the uterus.

For more information about VBAC, please visit ICAN, VBACFacts, and Improving Birth. The risk of catastrophic complications from a VBAC are significantly lower than the risk of a repeat cesarean. Please do your own research and decide what is the best decision for your situation. 

Friday, 27 April 2012 11:08

Purple Pushing - What is It?

"Purple Pushing" (or directed pushing), is commonly used for women who have had pain medication and are not able to fully feel their body’s natural urge to push through the contractions.  Purple pushing is directed by the nurses and the OB who will tell you to begin pushing as a contraction begins and count slowly to ten while telling you to keep pushing for the duration of the contraction.  While this type of directed pushing can serve a purpose for a mother who is unable to feel anything below her waist, it often leads to an increased need for an oxygen mask, quicker exhaustion, increased chances of assisted delivery, and increased risk of tearing because the mother isn’t able to “listen” to her body by way of backing out of a push when it feels appropriate and stop when her body needs time to stretch and rest.

Planning a hospital birth can be a daunting task, especially when you are a first time mom.  Even for moms who already have children, the planning and preparation mentally, physically, and logistically can be an overwhelming experience.  If you are planning on having a hospital birth there are many procedures that are considered “routine” that may be performed without your explicit consent because these are deemed as necessary and typical in a hospital.  

As with any medical procedure, you have a right to be informed and consent or decline anything your doctors suggest, or even push for you to agree to.  Knowing what these interventions are and the purpose of such procedures before you go into labor will help you make an informed decision prior to being overwhelmed by the imminent arrival of your bundle of joy.  Unfortunately, here in America labor and delivery are viewed by the medical community as an accident waiting to happen and many of the interventions are aimed at reducing the chances of problems, as well as convenience for the staff.  Don’t get me wrong, I’m not bashing the hospital staff: there are many OBs and nurses who will respect your wishes.  By educating yourself and adding your choices about interventions to your birth plan, (and hiring a doula,) you stand a much better chance of having your wishes respected.

So what is an “intervention”? 

Interventions are defined by the dictionary as “to come between two things, to modify or hinder” (paraphrased from www.dictionary.com).  Many people in the birthing community define birthing interventions as anything that is not a natural part of the labor and delivery process; interventions are often pushed by hospital staff for the presumed ease of managing labor.  Many people also feel that even minor interventions can create a domino effect leading to more interventions.  For example, a woman who is in first stage labor and is not dilating may have her membranes stripped.  Contractions from the stripping of membranes are often reported by women as being more intense than contractions that began naturally.  The intensity of the contractions leads to a pain and the consideration of an epidural, which has the potential side effect of slowing early labor.  If labor does not progress, the hospital staff may begin to push for a c-section and cite the increased risk of infection and fetal distress.  These reasons are understandable in theory; however, had the mom been allowed to labor naturally as her body needed to, the increased risk of infection and fetal distress would not be a concern.  It’s a slippery slope, and unfortunately the farther down one travels, the more quickly the onslaught of interventions may be deemed “necessary” by the hospital staff.

I have compiled a list of many of the common interventions and a brief description of the benefits and drawbacks from each.  A Google search will also yield a number of results, however be careful when reading about these interventions on medical websites.  I’d like to believe that OB’s have the best interest in the mamas and babies they are trying to help, but some OBs and hospitals who provide the information may provide misleading information.  As usual, I’ve included links to various sites for you to read more.  While I’m not usually a Wikipedia person, I found that the description of various medications I discuss was much more understandable for those without medical training than some of the medical sites.

Early Labor

  • Enema Procedure: The enema is occasionally suggested to clean out the laboring mother’s bowels in an effort to avoid exposure of feces to the baby once she is born.  Read more
  • Pubic Shaving: This is another intervention that is done under the guise of encouraging a hygienic labor, but the reality is that this is unnecessary to prevent any risk to the baby from germs. Read more
  • Fetal Monitoring - External Fetal Monitoring involves a big strap around the mother’s abdomen that monitors the baby’s heart rate and strength of contractions. Internal Fetal Monitoring is often suggested when the staff feels that a more accurate assessment of the baby’s heart rate is necessary. Read more


Induction

There are a few different methods of induction that may also be used as procedures to quicken a slow to progress labor.  With all forms of medical induction, EFM or IFM is highly recommended (and usually required in hospitals) due to the increased risks of uterine rupture and fetal distress.  

  • Pitocin: A Pitocin drip is one of the most common methods used as induction and to speed up a slow labor.  Pitocin is a synthetic form of Oxytocin, the body’s natural hormone that facilitates contractions throughout labor.Read more
  • Cytotec (Misoprostol): Cytotec is also known as Misoprostol, is also used for induction and is either given orally, or placed directly on the cervix.  It causes the uterus to contract and the cervix to ripen and begin dilating. Read more
  • Cervidil: Cervidil is a prostaglandin gel applied to the cervix to “ripen” it which leads to increased contractions and dilation. Read more
  • Sweeping of Membranes: Sweeping of Membranes involves a procedure where an OB or midwife uses a finger to sweep the membranes just inside of the cervix to separate the amniotic sac from the cervix. Read more
  • Artificial Rupture of the Membranes: (AROM) involves the use of a tool that looks much like a crochet needle to puncture the bag of waters.  Breaking the waters stimulates the labor hormones to increase. Read more


Interventions During Labor

There are a number of interventions that may be used once labor starts.  While EFM and IFM will continue throughout the duration of labor (if done at all), the following interventions are common during active or second stage labor.

  • Vaginal Exams and Cervical Checks: Vaginal Exams (VEs) are a common way for the OB to determine how labor is progressing.  Once the cervix has opened 10cm, it is assumed that the mother may begin pushing. Read more
  • Antibiotics for Mothers who are Group B Strep Positive: If your provider is an OB, you will likely be tested for Group B Strep (GBS) between 35 and 37 weeks by swabbing the vagina and rectum. Read more


Pain Management

Perhaps the most intense topic, (aside from c-sections) about labor and delivery is the management of pain.  Many moms who birth without pain medication will report that the experience of labor and delivery is intense, but was easier to manage by their ability to remain medication free so they could walk through contractions, get in a birth tub or pool, and find a comfortable position on their own.  With almost any pain medication, an IV is typically required to ensure the mother remains hydrated and that medication can be administered quickly to counteract any adverse reactions to the medications.  The mother will also typically need to remain within the confines of her hospital bed in order to monitor the baby for distress (a potential side effect of pain medication).

  • Epidural: The epidural is the most common form of pain management for laboring women in America.  A catheter is inserted into the epidural space in the spinal canal (just outside of the spinal cord).  Read more
  • Spinal Block: A spinal block is similar to the epidural but without the catheter.  Medication is injected into the spinal fluid.  Read more
  • Narcotic IV Medication: Some women chose to have narcotic medications administered through an IV or a patient controlled pump because the medications (if administered in appropriately small doses), can reduce the pain without eliminating all feeling the way an epidural or spinal block can. Read more

Interventions During the Pushing Phase

Can you believe we are only halfway done with common hospital interventions?  Well we’ve made our way through most of the common labor interventions and we’re on to interventions that usually occur late in labor or during the pushing and delivery phase.

  • Episiotomy: Routine episiotomy is performed less frequently in many hospitals now and is not recommended as a routine procedure during childbirth by the ACOG.  An episiotomy is an incision made in the perineum, the skin between the vagina and anus.  It is intended to widen the vaginal opening to facilitate birth.  The risks of this include an increased risk of greater tearing, sphincter muscle dysfunction, pain during intercourse, increased risk of infection, and increased pain and healing time after delivery. Read more
  • “Purple Pushing”: "Purple Pushing" (or directed pushing), is commonly used for women who have had pain medication and are not able to fully feel their body’s natural urge to push through the contractions.  Read more
  • Assisted Delivery By Vacuum or Forceps: There are two common tools used to “assist” delivery when the head of the baby is near the vaginal opening; the vacuum and forceps.  Many practitioners will perform an episiotomy before using one of these tools unless you explicitly request otherwise.  The vacuum is a suction device that is placed on the baby’s head and used to “gently guide the head.” The forceps function the same way, but are shaped like tongs.  Read more
  • Cesarean Section: Cesarean Sections, also known as a c-section, is the surgical removal of the baby directly from the uterus.  While many women now elect to skip labor altogether (and their practitioners usually oblige,) others are determined to avoid a c-section at all costs. C-Sections are major abdominal surgery despite the short duration of the procedure. Read more

Newborn Interventions

There are a number of procedures that are common to perform on newborns.  While this is not a complete list, these are many of the common procedures performed in hospitals that may or may not occur without your explicit consent.  Having a birth plan and discussing these with your OB, the hospital staff, and pediatrician before birth will help you ensure that your wishes are respected.

  • Suctioning Of Baby After Birth: When baby comes out of the womb it is common practice to help the baby breathe for the first time by suctioning the mouth but this has some debate around it. Read more
  • Placement of Baby Immediately After Birth - Many hospitals have different protocols for where baby should be placed immediately after birth for follow up exams and testing. Read more
  • Cord Clamping, Pulsing and Cutting: It is routine for most hospitals to immediately clamp the cord upon delivery. Read More
  • Vitamin K Injection: Vitamin K injections are routinely given to newborns to prevent the rare risk of bleeding in the brain due to a newborn’s low vitamin K levels.  Read more
  • Eye Ointment: Antibiotic eye ointment is routinely applied to the baby’s eyes upon birth to combat and prevent eye infections commonly caused by gonorrhea or clamidyia.  Read more
  • PKU/Other Blood Testing:  Many hospitals will also do a heel prick to test the baby’s blood for a number of metabolic disorders, including PKU.  Read more

Wow!  All this can happen in the matter of one day, perhaps even just a few hours for a mother and baby who have a short labor!  While this is not a complete list of every intervention used, it should give you a good starting point about what to discuss with your provider.  Many people don’t see some of these things as true “interventions,” such as placement of the baby after birth or suctioning.  Those in the natural birth community understand and recognize that there are instances where some of these things may be necessary to protect both the mother and baby, but routine use of these interventions may be inappropriate because “routine procedure” discounts a mother’s right to chose what is best for her and her baby.  Also, all mothers, babies, pregnancies, and labors are different. 

Even if you are not sure about what you want to choose for some of these things, I hope it gave you food for thought.  The first few hours of life are a critical period for the baby while he transitions to life in the outside world.  The more opportunity the baby has to spend skin to skin in peace with his mother, the more positive his first experiences of life and bonding will be.  The less we intrude and insist on poking and prodding this precious little life, the more he will be able to rest and allow his body to continue to work with his mother’s to help him adjust to his new life in the outside world.

Go back to Step #4: Developing a Birth Plan

Go ahead to: Step #6: Preparing for Life with a New Baby

Go to: Birthing Methods Menu

 

Friday, 09 December 2011 08:01

An Introduction to Birth in the Hospital

There are many logistical reasons for choosing to deliver your baby in the hospital, all of which are valid.  Even if you would have preferred to deliver at home or in a birth center but are required (by insurance, care provider privileges, legal implications or distance challenges), you can still have a beautiful birth the way you would like.  The key is to educate yourself about your choices as a mother and a patient.  Regardless of where you birth, the experience is in your hands!  Planning and preparation is the key to a positive experience that ends in a healthy and happy mother and baby. 

The writings in this series will consist of information from my two hospital births, conversations with mothers who have had births in a variety of settings, as well as reading and research from a variety of sources.  I will include embedded links within articles to my sources, as well as list my sources at the end of each article.  If I am speaking from my own experience, or the experience of others I will indicate this as well.  I hope that through my experience and research that I may provide you with the tools you need to plan your birth the way you would like it to be.  There is no set way to birth that is foolproof or that works for everyone.  I had no idea how much I didn’t know until I stumbled upon various websites and Facebook pages that aimed to educate and inform women of their choices about birth.  It is my hope that through these writings, I may help you to better understand your options, especially those options you didn’t even know you had! 

Birthing in a hospital can provide a sense of security for both the mother and her partner by knowing that medical professionals are there to assist if complications arise.  However, it is important to remember that giving birth in a hospital comes with risks as well, including the risk that interventions may be encouraged by hospital staff.  Knowing the benefits, risks, and circumstances that would necessitate interventions beforehand will help you make informed choices if the time comes.  Knowledge is power, and a mother’s intuition is not to be discounted!

Birthing in a hospital provides the opportunity for elected pain management (epidurals, spinal block, IV medications,) fetal monitoring, newborn screenings and immunizations, and nurses to cater to your needs so your birth partner can focus on supporting you.  Also, in the event of maternal or fetal distress, birthing in a hospital allows medical professionals to quickly react accordingly such as performing a c-section or an instrumental delivery.  The availability of a hospital nursery may allow a new mom to rest and recover while her newborn is being cared for by the nurses.  Meals are delivered bedside and help is just a push of a button away.  Most hospitals also have a registered lactation consultant on staff that is available to aid in the initiation of breastfeeding.

Delivering in the hospital can also be a challenge.  Many mothers report pressure from the hospital staff to consent to fetal monitoring, IV’s, pain medication, and cervical checks against their wishes.  Mothers who intend to birth naturally and free of interventions often feel as though they are forced to allow monitoring, cervical checks, and feel pressured to consent to pain medications.  Mothers who delivered in a hospital also sometimes feel that the frequent vital signs checks are disruptive to post partum recovery. 

It is important for every pregnant mother considering a hospital birth to find out what the hospital’s general policies and procedures are, as well as make decisions about all aspects of her care prior to and during labor.  Developing a birth plan can aid in this process and further empower the mother and her partner to communicate their wishes to their care provider and the hospital staff.

Birthing in a hospital can be a beautiful and empowering experience with the right knowledge and support!  Information is power, and the key to having the birth experience you desire!

Go ahead to:

Step #1: Choosing a Care Provider Part 1: Obstetrician

Step #1: Choosing a Care Provider Part 2: Midwife

Go to: Birthing Methods Main Menu

Published in Birthing Places

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