When considering what kind of birth you want, every individual preference makes a difference, both during and after delivery. These are some common procedures and tests you will need to make informed decisions about in order to get the kind of experience you want or need and decide which path you will choose to go to ensure that is what you get in the end.
Common Tests and Procedures During Labor and Delivery
Intravenous Fluids (IVs):
A standard procedure in hospital birth settings. The purpose of this is to
(1) Provide the mother with liquids and/or calories instead of allowing her them by mouth,
(2) to administer medications,
(3)with an epidural, to increases blood volume to protect against drops in blood pressure,
(4) to keep a vein open in the event other medications need to be administered. In hospital settings this a 'required' procedure: It will be the first thing to happen after admittance into L&D. Can be waived by refusal and signing a legal waiver.
When are they medically indicated: Only when labor is extremely long, the mother is nauseous and dehydrated, will be receiving local or general anesthesia, or needing IV medications.
Disadvantages of IVs during labor: Can cause temporary blood sugar drops or electrolyte imbalances in both mother and baby after birth, fluid retention in the mother causing discomfort and problems nursing, and discomfort and is constricting during labor, and gets in the way after baby is born. If a mother drinks and eats during labor, an IV line is completely unnecessary unless a situation as above mentioned is present.
Electronic Fetal Monitoring (EFM):
There are two methods of EFM- external and internal. It is used to monitor the FHT (fetal heart tones) during labor and asses how the baby is responding, and is generally used along with monitoring the intensity, length and spacing of contractions.
When is it medically indicated: When labor is prolonged and pitocin is being considered, when a nurse, doctor or midwife is not with the woman continuously or frequently, when pitocin is being used to augment labor, or when there are doubts about the baby's well being.
Disadvantages of EFM: The mother is extremely constricted, More attention can be paid to the machine than the woman in labor, Interpretation of the printouts is extremely complex and even experts disagree about what different heart patterns mean and whether intervention is necessary, and EFM only monitors the FHT, not actual fetal distress. When a C section is done solely because of EFM tracings (the printouts) the baby usually shows no signs of having suffered fetal distress at all. Intermittent EFM is possible and more accurate by using a handheld Doppler, and this also allows the mother to move freely.
Artificial Rupture of Membranes (AROM):
To rupture the membranes (or break the bag of waters) a long thin instrument (amnihook)or a glove with a small hook (amnicot) is inserted through the cervix to snag and open the amniotic sac. Usually this results in contractions becoming more intense, which is the goal of this procedure. Also used to induce labor without methods such as prostaglandins or oxytocin, or to check the amniotic fluid for meconium (baby's first bowel movements) which is a sign of fetal distress, or for infection, bleeding or signs of other problems.
When is it medically indicated? To progress and aid in dilation and to intensify contractions when a labor is not progressing in a normal time frame, or if the mother is pushing and feeling uncomfortable with the pressure caused by a low hanging bag of waters.
Disadvantages of AROM: Frequently, it does not stimulate labor, (unless done at the correct time) The chances of infection ascending into the uterus rises by the passage of time and number of vaginal exams, removing the cushion of fluid on baby's head can increase pressure and cause distress, if the baby is malpositioned, there is very little chance of correcting it at that point, and if the baby's head is floating ( head is not settled into the pelvis) increases chances of a prolapsed cord. Another reason is that there is also a somewhat common placental abnormality called a velamentous cord (the umbilical cord comes off of the membranes instead of the placenta) that can rupture during AROM, causing the mother and baby to bleed out. It is not predictable by ultrasound, and very dangerous.
Induction or Augmentation of Labor:
Sometimes a labor needs a kick start or a stalled labor needs a little help. THIS HOWEVER DOES NOT MEAN SOMEONE AT 40 WEEKS NEEDS TO BE INDUCED. Inductions become needed at around 41.5 weeks. This can be done several ways:
Medically-(usually done as soon as the mother requests after 38 weeks) Stripping of membranes (a finger is inserted into the cervix and sweeps around the inside to separate the membranes from the lower segment of the uterus causing the body to release oxytocin. It can be very uncomfortable). AROM (breaking of waters), Prostaglandin gels, suppositories, or tablets to thin and ripen the cervix (Semen also contains prostaglandins), and IV administration of pitocin, the synthetic form of the hormone oxytocin. Pitocin is ran intravenously, and constant EFM is required. Induction by pitocin can be extremely painful and long. If the induction is done for medical reasons and the pitocin fails, Cesarean is the last option.
Homeopathically (and after 41.5 weeks)-Cervical massage (a more thorough and more effective version of the medical model 'stripping' or 'scraping' of membranes) Nipple stimulation (also releases oxytocin), Black and Blue Cohosh (triggers the uterus to start contracting), and finally Castor oil (an unpleasant homeopathic last resort that triggers intestinal cramps, which in turn trigger uterine cramps) . these are done step by step compiling oxytocin levels in the body throughout the day. if the mother does not go into labor by the next morning, then she will take the castor oil. Almost never fails.
If an induction is done for convenience because the mother is tired of being pregnant or is uncomfortable and the pitcoin fails, this also almost always ends in c section as well.
When is it medically indicated: A prolonged pregnancy going past 41 to 42 weeks has very high risk of the placenta calcifying and the baby is at risk, (NOT FOR SIZE) , When the mother or baby is at risk from medical problems such as high blood pressure or diabetes, When the baby is not thriving in the uterus, when the bag of waters has been broken a long time and labor has not started (most hospitals says 12-24 hours, but its more like 2-5 days) or the mother is positive for Group B Strep (GBS), When a labor is diagnosed as dysfunctional and the mother fails to develop and natural, normal labor pattern.
Disadvantages of Induction: Interventions required during an induction includes constant EFM, Iv fluids, and others, The woman can become incredibly tired and discouraged, when an induction is non medical such as convenience for the mother or caregiver, routine procedure for reaching the fortieth week without spontaneous labor, the mothers discomfort, or to plan when the baby will be born can lead to dangers such as slow labor and dilation because the baby and body were not ready to deliver yet, usually ending in a c section, the baby could not be completely ready to come out and have trouble breathing or functioning, Induced labors can cause contractions too intense for mother or baby to tolerate, leading to epidural and fetal heat distress. The chances of having a cesarean section increase by four times in first time mothers who have elective inductions, when compared to mothers who have labors that begin spontaneously. The timing of the induction can be bad for the baby who may be according to charts 40 weeks but really could be 38 weeks gestationally developed. This is why babies are fine to go to 42 weeks.
Epidurals:
Epidurals are a cocaine-based drug mixed with opiates that is injected into the epidural space of the spine, creating ideally a complete block of pain from the site down. This form of pain management is used by the majority of women in the USA, and by that I mean almost 90%.
When is it medically indicated? When the mother is so incredibly fatigued from labor and must sleep in order to have the stamina to go on and push (for example has been laboring for over 36 hours), ends up needing pitocin administered (more than the normal, manageable pain from normal labor), or when she is going to have a Cesarean.
Disadvantages of Epidurals: There are really way to many to go into detail about. The most important ones being: drops in blood pressure, epidural headache, extreme nausea, inability to move, catherterization, complete loss of vital bonding hormones and pain management hormones and chemicals, higher risk of fetal distress, trouble pushing, huge risk of Cesarean, problems nursing because the baby is affected by the epidural, and possibly even maternal death.
If you don't medically need it-don't do it. You can do it without drugging yourself and your baby, really. I promise. I will dedicate a whole post to epidurals later going into more detail.
Extractions During Delivery:
Vacuum and forcep extractions are very commonly used in a hospital setting. You will not see a midwife (unless she works in a hospital) use these. They are very invasive and cause a whole world of problems. However, if the mother is not pushing effectively and has an epidural and cannot change position, it becomes a necessity .
When is it medically indicated: When a mother needs an assist to hasten delivery out of the birth canal if fatigue or anesthesia has made her unable to push effectively.
Disadvantages of Extractions: vacuums frequently cause a fluid filled lump and a bruise on the baby's tender head, and serious injury is possible. Forceps usually require an episiotomy and extra anesthesia, may bruise and cut the baby's face or side of the head, can cause serious injury to the neck and head and can also cause damage to the vagina.
Ways to avoid these sorts of extractions are to not get anesthesia during labor so pushing is effective and you can change position. Flat on your back in stirrups is literally one of the worst ways to effectively push out a baby, especially if you cannot feel the urgency to push from an epidural. Also to eat and drink during labor to keep up your stamina and to reduce the risk of fatigue.
Common Tests and Procedures After Delivery
Suctioning
The baby's airway may contain mucous, amniotic fluid, meconium or blood. The most common form of suctioning is to use a rubber bulb syringe to suction the gunk out of the mouth and nose as soon as the head is born. In more sever cases, a Delee is used to do deeper suctioning (mostly used for meconium aspiration)
When is it medically indicated? If the baby is unable to breathe or has aspiration of meconium.
Disadvantages of suctioning: Is an immediate stress and panic for the baby and can cause much discomfort and injury to the mucous membranes. Usually suctioning is unnecessary as the baby can usually work out whatever is in their airways by themselves. If they are crying and responsive- they do not need suctioning. Regardless of that fact most babies are routinely suctioned after birth.
Cutting the Umbilical Cord:
Once the baby is delivered, the cord connecting the baby to the placenta is clamped and cut. I'm not going to give advantages and disadvantages for this one because the only advantage is if the cord is too short to reach the mothers chest. Otherwise- the cord should not be clamped until it has blanched, stopped pulsing and preferably until after the placenta is born. The cord contains up to 1/3 of the baby's blood volume. If it is cut immediately (as is the practice in the hospital) you would be depriving your child 1/3 of its blood volume. Look it up.
Eye Medication:
Most common eye ointment today is erythromycin ointment. It is used to prevent serious infection or blindness due to the bacteria from gonorrhea and chlamydia. These bacteria are in the vagina and can pass to baby during delivery. Hospitals give this to ALL babies after birth unless the parent refuses.
Purposes of EO: To prevent blindness and infection in the eyes of babies born to mothers with STDs.
Disadvantages of EO: It blurs the baby's eyes for the first hour or two in its life before It goes to sleep and its vision is the best that it will be for several more weeks-vital to the bonding between parents and baby. Also, it has been proven to cause more infection in a baby's eyes than if it hadn't been put in at all for babies born to STD free mothers.
Vitamin K Injection:
Required in most US states but very controversial and rarely used in homebirth situations, Vit K is usually administered within an hour after birth. babies are born without a clotting factor in there blood to aid in the passage of the birth canal, otherwise they would experience clotting around their brains. The baby's body will be able to clot blood by day eight (why the bible says to circumcise your sons on the eighth day). Some babies ( a very rare number ) have a disease called vitamin K deficiency bleeding , (VKDB). Giving this injection reduces their risk of bleeding and has since been given to babies as hospital policy.
Purposes of vit k injection: if a parent has a child who may have VKDB or plans to circumcise before day 8.
Disadvantages: Vit K, like almost all injections contain harmful ingredients, and also have a very high concentration of vit k-too much for a baby so young. It has also been quasi-linked to a childhood leukemia and jaundice.
There is also a natural, plant based oral vit k that can be used instead over a period of a month that also effectively helps prevent VKDB.
What You Should Know About The First Few Hours After Baby is Born:
Right after birth, baby needs to go directly onto moms chest, skin to skin. There the baby needs to stay for a period of AT LEAST one hour, preferably two as they get to know each other, for the hormones to start going crazy and the baby to begin nursing. Only then should the baby be removed for the newborn exam.
During the exam, make sure someone is there enforcing that the examiner be gentle with the child as they tend to be rather rough. After the exam is performed, the baby needs to go right back to mom or to dad, again skin to skin.
This is vital for the bonding process. It is beyond sad that this is usually kicked right out of the door in a hospital setting because everything needs to be done and cleaned up fast for the next birth. But it is not something you can ever get back if you miss, so be firm and enforce your rights.
I hope this gives a clear idea of what some of the things you will need to choose and make decisions for during your labor and delivery and the first moments with your baby. Its your baby- YOU need to research all sides, YOU need to be firm. Don't let others make the decisions simply because its easier on them, they could make more money or its policy. You have the right to protect and make decisions for YOUR family.
You want my personal opinion? Of course, as always I recommend homebirth. I did the hospital birth, remember? I had to literally fight tooth and nail while being in labor flat on my back with a posterior baby, being threatened with c section. And guess what? I did it my way and my baby hasn't had a health problem yet, and has only been sick once with a cold. And oh yeah, I don't vaccinate.
But if you do want all those interventions and procedures, You will have to go the hospital route. They'll be happy to oblige.
But remember- Your birth, your choice. But promise me you will make truly informed decisions. Only then will they truly be the right decision for your family. You let someone else choose for you and your rights as a parent are given up, right there. I hope i have enlightened some who needed it.
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