Know Your Rights and the Routine Hospital Procedures During Labor & Delivery

After having one hospital birth and one homebirth, I have become an advocate for homebirth as I believe it is safer than the hospital and has the most favorable outcomes for mother and baby. Yet, I realize 95-98% of women in the United States choose to give birth in the hospital, and I want nothing less than for these women to have the best labor and birth possible. To do so, I highly recommend educating yourself on standard hospital procedures and recognizing you always have the choice to limit or refuse any procedure regardless of what anybody may tell you. Listed below are the routine hospital interventions and their descriptions. These typically include electronic fetal monitoring, at least a heplock and likely an IV, pain relieving drugs such as the epidural, an episiotomy and often times doses of pitocin to speed up the laboring process.

To sum them up--

Electronic fetal monitoring (EFM) is a way to monitor your baby's heartrate and your contractions while you are in labor. A nurse will strap a belt around your waist, which is connected to a machine, and depending on the hospital, you are required to wear it for 10-20 minutes or more out of every hour. Prior to EFM, a nurse would monitor your baby using a stethoscope as needed, which enabled the woman to choose her laboring position, but as the obstetrician of my first childbirth told me, "Electronic fetal monitoring isn't proven to be necessary, but it is hospital procedure because we just don't have enough nurses to monitor everyone individually." It appears the use of EFM is due to convenience rather than necessity, and there is great proof linking this and other interventions to the incredibly high cesarean rate in the USA (29.1% in 2004 according to Medical News Today, Nov 2005).

Apart from the high cesarean rate, one of my primary concerns is for a woman's ultimate comfort during the painful process of labor. While wearing the monitor, the laboring woman must be in her bed either on her back or in a semi-sitting position, which are the least productive and most painful positions during labor. I fully believe this is why I felt such excruciating pain during the labor of my first baby and felt the urge to push at 7 cm although you are not allowed to push until 10 cm. Of course labor is highly painful, but there are natural ways and positions to decrease the pain and make it more manageable. Laying in bed is most certainly not one of them. Even if you do not refuse EFM altogether, you can request for the nurse to reduce the amount of time you are monitored so you can be in bed for as little time as possible.

An IV is usually inserted into your arms to administer fluids or medication. Many hospitals continue to tell you IVs are necessary to administer fluids to keep you hydrated during labor. Do not believe this. It may be routine, but it is not medically necessary. What happened to sips of water or juice? I would much rather have a sip of a drink when I am thirsty than have a catheter in my arm with a long tube connected to a fluid filled bag, which will hinder my movement and positions. Women in labor want to focus and be free from distractions. The littlest things tend to bother you like your hair in your face and often even the touch of your partner. Imagine the interference of an IV you have to keep in your arm and take with you wherever you go.

A heplock is a small tube connected to a catheter in a vein in the arm for easy access. When I refused the IV during labor, I was told I had to have a heplock so they could have instant access to my veins in case I needed an IV. My sister advised me to accept it because the staff was already bothered by all my refusals, so I did to avoid being at complete odds with the nursing staff, but you can refuse this too. A skilled nurse should have no problem doing a quick IV if it becomes necessary.

An episiotomy is a surgical incision in the vagina to widen the birth outlet to prevent tearing. These are not as common as they used to be, but sadly in some hospitals they are still routine. You are told it is better to have a clean, straight cut rather than a tear, but we now know this to be false. When women tear, it is usually much smaller than the size of a routine cut, the pain is no different, and it can be stitched just as well. I tore during both of my labors and healed just fine. Furthermore, some women do not tear, and there are ways to prevent or at least minimize tearing, such as massaging the perineal area with oil, applying warm compresses, and slowing down the pushing as the head crowns. But again, it is inconvenient for a doctor or nurse to do these things. A cut is a much quicker solution.

Inducing labor is using medications or other unnatural methods to start labor. Hospitals commonly use pitocin because it is a synthetic form of oxytocin, the natural hormone in your body that aids in the laboring process. It is used way to often in my opinion and does not imitate the natural process. The doses given speed up your labor unnaturally, intensify your contractions, cause much more pain than the natural process, and almost always lead to an epidural because the pain is unmanageable. I have not yet met a woman who has been induced using pitocin and refused the epidural. In addition, if a woman chooses induction, she places herself under many unnecessary hazards, including doubling the likelihood she will get a cesarean. And please, do not be fooled into thinking a cesarean is no big deal or even easier than a vaginal birth. Although it may initially be quicker and less painful, it is surgery that carries many risks to mother and baby and long term negative outcomes for the mother.

Lastly is an epidural. This is very routine in hospital births, and you can ask your doctor for your hospital's percentage. I have found some to be as low as 40% and some as high as 90%. Most women consider an epidural for the obvious--pain relief. However, I wish we did not view pain relief as the ultimate goal during labor. Our bodies are made to give birth, and there is nothing in us that prevents us from being able to handle labor naturally except lack of knowledge and our own minds. Though an epidural is generally safe and may provide pain relief for the moment, it may cause a host of other problems such as prolonged labor and pushing, an increased likelihood of receiving pitocin and a cesarean, fetal distress, a drowsy baby at birth, poor sucking reflex which may interfere with breastfeeding, and many problems to the mother like nausea and vomiting, headache, fever, backache for months and even years after birth, and more.

Although I do not recommend a routine epidural for all laboring women, I do not claim an epidural is always a bad idea. A woman who has been laboring for hours upon hours is likely to get exhausted, and labor can be inhibited. In that case, an epidural can provide much needed rest and relief and actually enable her body to be more effective for the laboring process. And of course a woman for whom a cesarean is medically necessary is in obvious need of an epidural. It enables her to be awake during her delivery and to spend time with her newborn baby.

Similarly, each of the procedures listed above has its time and place of necessity. Although I am a strong advocate for homebirth and laboring naturally, I would never say all women should give labor as I prefer. Ultimately, the decision is yours. All I want is for women to be educated and informed in their decision making rather than blindly submitting to the decisions of the hospital staff. There is definitely a need for hospitals and the interventions they provide, but these interventions should never be routine. Labor can be extremely painful, like nothing we have ever experienced as women, but more of us could labor naturally if we could just get it in our minds that it is for a moment, and once our beautiful baby comes the moment is over. Like everything else good and beautiful in life, labor requires hard work and suffering, but the beauty far outweighs the pain. In addition, there are natural ways of having a shorter, more productive and less painful labor, ways that put women in control of something so seemingly uncontrollable, and in birthing your baby naturally there is an incredible strength only a woman gets to enjoy and one every woman needs as she begins her journey into motherhood.

SOURCES

Kara Dress, Record High Cesarean Rate in USA Contradicts Best Practices For Birth. Medical News Today

Robbie Davis-Floyd, Electronic Fetal Monitor. Birth Psychology

The Coalition for Improving Maternity Services, Problems and Hazards of Induction of Labor. Mother Friendly

The Coalition for Improving Maternity Services, The Risks of Cesarean Delivery to Mother and Baby. Mother Friendly

Kim James, Epidural Risks and Side Effects. Professional Labor Support Services

Sherri Urban, Alternative Methods of Pain Relief for Birth. Expectant Mother's Guide