Labour procedures and what you need to know.

Childbirth, especially the first time around, is always full of emotions. Fear, excitement, doubt, joy and more. Many women are unaware of the sheer volume of decisions that they will have to make during this relatively short period of time. The purpose of this series of article is to display the pros and cons of procedures and tests offered during pregnancy, labour, birth and post partum to enable parents to make the best decision possible for their family.

This article focuses on the procedures and options available in the labour and birth stages of the journey to motherhood.

LABOUR:
Midwife assisted home birth:
Pros: You birth in the comfort of your home. It is a warm environment filled with objects that are familiar to you. You are able to rest in your own bed and eat your own food during labour and after the birth. There is no temptation to use drugs as none are accessible. Natural birth is encouraged and respected. You can have as many or as little spectators as you want. You can listen to the music you want, burn incense, watch your favorite TV shows while you are in labour. You also get personalized care during pregnancy. The routine visits during pregnancy last much longer than those with an OB/Gyn and some midwives will even come to your home.
Cons: You have to travel back to the hospital in the unlikely event of an emergency during labour or delivery. There is no access to drugs and you have to pay for care in most provinces.

 

Waterbirth:  Can be done within a hospital as long as you find a practitioner willing to allow you to birth in water. You may have to bring your own pool with you.
Pros: It's a soothing way to birth. The water's buoyancy helps you move around during delivery. The water also helps the vaginal muscles stretch reducing the incidence of tearing.14 Water is a natural relaxant which will help the mother to better focus on the task at hand. When she is relaxed she will reduce the tension in her body (from fear and pain) and dilation will occur much more quickly. This results in a shorter labour with less intervention and complications.14
Cons: Water must be maintained properly to prevent the growth of bacteria and to keep the water temperature at body temperature. The pool takes time to set up and clean up. www.waterbirth.org has some information regarding birth pools.

 

Midwife assisted hospital birth:
Pros: You can birth with a low intervention-practitioner who will encourage you and help you deliver naturally while being paces away from the hospital emergency room. You also get personalized care during pregnancy. The visits last as long as you have need.
Cons: You are still in a hospital where you can be influenced by the nursing staff. There may be added friction between the hospital staff and the midwife or your choice to have a midwife assisted birth. Drugs are more accessible therefore increasing the temptation to use them. You do still have to pay for care in many provinces.

 

Obstetrician/physician assisted hospital birth:
Pros: It free. The government covers the cost of hospital births. They are often very experienced and are an asset in highly effective in high-risk births.
Cons: The physician/OB that you spent time discussing your birth plans with may not attend your birth which makes you at the mercy of who ever is on call. You may get a doctor that you are unfamiliar with and that may have a high-intervention track record. The pregnancy visits are often impersonal and very short. Also, OBs are trained as surgeons and are much more likely to make an incision of any kind than other practitioners (including family physicians).

 

Doulas: Are the least controversial of all.
Pros: They reduce Cesarean rates by 50%, epidural requests by 60%, pitocin use by 40%, forceps deliveries by 40% and they shorten labour by 25%.15 They can increase the overall satisfaction in the birth experience.
Cons: May cause tension with hospital staff in there has been previous friction. They do cost money.

 

Chemical (pitocin/oxytocin) Induction: An IV containing pitocin (oxytocin) drips into the mother's blood stream and causes contracting of the uterus therefore starting labour.
Pros: The only pro is that is can start the labour process in overdue moms (meaning 41-42 weeks).
Cons: This drug is not indicated for elective induction.16 The contractions after an induction come on fast and furious and are extremely difficult to cope with resulting in increased drug use to cope with them. The incidence of intervention is quite high. for those using chemical induction. Anytime you use induction you put yourself at a higher risk of ruptured uterus or placental separation (both dangerous to mother and child).17 It is also potentially dangerous to the baby by increasing changes of fetal distress, jaundice, lower Apgar scores, permanent damage to the nervous system or brain as well as fetal death.17
Instead, I recommend natural alternatives such as Evening Primrose oil applied directly to cervix for weeks before the due date and consuming a 2 ml bottle of Castor oil once you are at least 411/2 weeks. You can blend the contents of the 2 ml Castor Oil bottle (can be purchased at Wal-Mart) in with a can of frozen concentrate orange juice. Drink it as a smoothie as fast as you can and wait to see if you go into labour. This part can take hours (my experience was about 12 hours of waiting before labour initiated). Castor Oil is a laxative. You must be cautious when using it. In my experience it gave me a stomach ache.

 

Rupturing the membranes:  In this procedure, a hook is inserted into the vagina and is used to break the waterbag (amniotic sac). The fluid cushioning under the baby's head gets released and the baby drops right into the cervix. This adds pressure to the cervix helping labour to progress and strengthening contractions.18 
 Pros: This procedure can help start labour or increase the strength of contractions.

 

Cons: The contractions can be more intense.

 

Epidurals:  A procedure where a needle containing a pain killer (narcotic based) in inserted into the area just outside the spinal cord. It is mostly commonly used as a constant drip that acts as a block (hence epidural block), preventing pain signals from reaching the brain.19
Pros: You can't feel a thing from below the nipples. You can easily sleep through your entire labour.
Cons: Sometime you can't feel the contractions and that makes pushing highly inefficient.21 The rate of interference (via C-section or forceps etc.) increases significantly. You are restricted to your back, which is the worst position for labour and delivery.20 The epidural also has side effects like migraine headaches, tingling legs, slowing of fetal heartbeat and much more.21 Anesthetists claim that it is very safe but I have heard multiple testimonies of it creating back problems and migraines in the future. It can also make breastfeeding difficult as babies don't seem to latch as well following births with high interventions.22

 

 

 

Narcotics and other painkillers:
Pros: They help numb the pain.
Cons: They all cross the placenta barrier making mother and baby sluggish. This harms bonding and makes breastfeeding more difficult. The baby may not suck if he is drowsy from the drugs and may have a lower Apgar score once birthed. Once labour gets intense the drugs can be too weak to mask the pain. Many of them have side effects such as drowsiness, nausea, a drop in blood pressure.23

 

 

 

Electronic Fetal Monitoring: It is a machine that monitors the baby's movements and heart rate.
Pros: It allows a doctor to see how the baby is handling labour; whether the baby is in distress or whether the labour can proceed without intervention.
Cons: The results of these monitors are open to the physician's interpretation. The use of this machine often leads to further unnecessary interventions.24 A better option might be a fetascope or a Doppler because if they are used to monitor the heart rate at regular intervals the natural fluctuations won't seem as pronounced.  It is natural to see fluctuations in the baby's heart rate and some doctors can read too much into the rising and falling.24

 

Internal Fetal Monitoring:  This is similar to electronic fetal monitoring except that the membranes must be ruptured to insert the monitor. The monitor is a small wire that  is "screwed" into the skin on the top of the baby's head.
Pros: It gives a good idea of how the baby is faring during this labour. This is especially so when the baby engages into the birth canal, making it harder to monitor the heart rate through external fetal monitoring.25
Cons: The monitor is physically screwed into the babies skin using a tiny probe like object. You have to break the membranes to do this procedure. See also the cons on Electronic Fetal Monitoring.

 

BIRTH
 

 

Episiotomy: It is an incision made with surgical scissors in the vaginal opening to enlarge the opening for the birth of the baby. This is done during crowning. This procedure is no longer recommended as part of a routine birth.26 Check with your Doctor on his/her episiotomy rates. It is also used when forceps or vaccum extraction is indicated.
Pros: It enlarges the opening possibly aleviating undue trauma or a caesarean birth.
Cons: It is often not needed. Episiotomies take more time to heal than a tear.27 The scar tissue can also make the stretching of the tissue more difficult in consecutive births resulting in more tearing. 27

 

Forceps birth and vacuum extraction: The baby is pulled out of the mother birth canal in order to quicken labour with the use of forceps (looks like large curved salad tongs) snuggly holding around his/her head or vacuum extraction (a suction cup that sticks to the baby scalps).28 This procedure is often used to avoid a C-section. The forceps can cause minor bruising on the side of the baby's head where the forceps were holding the baby. These are expected to disappear within the week.
Pros: This is done to help a tired woman when she has little strength left to push after a long delivery phase. It is also done when the baby shows signs of distress and must be born (and the baby is already engaged in the birth canal). It decreases the likelihood of Caesarean birth.29
Cons: Can cause trauma to the baby's spine if he is jarred awkwardly causing health problems in the future.30 Also, in order for this procedure to be executed you need to undergo an episiotomy. Otherwise the forceps cannot fit in the birth canal.

 

Caesarean section: An incision about 10-15 cm long is made in the lower abdomen. This cuts right through all the abdominal and uterine tissues and then the baby is simply pushed/pulled out through the incision.31
Pros: Helps women whose babies are unwilling to be birthed due to positioning, being too large for cervix size or simply because the mother's body has gone too far overdue without going into labour.31 Some women may have abnormalities in their hips that prevent a clear way for the baby to descend. Caesareans can save baby's lives in difficult births that may otherwise have disastrous effects. The World Health Organization states that hospitals should not have Cesearean rates above 15%,32 yet Canada's national average has been marked at the 24% mark.33
Cons: It takes longer for the mother to heal. It lengthens the time a mother and child have to stay in the hospital and does increase the risk of post-partum infection.34 It can also increase the chances of getting of post-partum depression and problems with breastfeeding and bonding.34 Do not be discouraged. With consistent effort these issues can be overcome.   

Article 2 of 3

Article 1: Pregnancy testing: http://www.squidoo.com/pregnancytest/

Article 3: After birth: http://www.squidoo.com/birthprocedures/

Positions for labor: http://www.squidoo.com/positionsforbirth/

To read my personal story about the surprises that came with my first days at home with my new baby just click here: http://www.squidoo.com/firstweek