Routine Care and Interventions in the Hospital, Birth Center & Home Birth Settings

First of all, and most important... Educate yourself on the risks and benefits of interventions you may encounter as routine. If you wish to refuse any intervention, that is your right. Just be sure to back yourself up with education, as you may encounter resistance from the hospital staff, and very definitely some surprise and lots of questions. Be prepared to sign and/or initial your chart and possibly a form that says you refused the procedure/intervention.

This article is by no means a full listing and explanation of all of the procedures and interventions you may encounter in any given birth scenario. Just those of normal, uncomplicated, low-risk birth in the home, birth center and hospital settings. This is a stepping stone to help you educate yourself. Remember that you, as the mother, are truly The only direct care provider of your baby, from conception to birth. Education is vital to informed consent and denial.

Remember, too, that this is only the basics, and your experience will vary due to the policies, philosophies, and experiences of each facility and care provider.

Tips on Labor

First thing I must say, is if you are birthing in a hospital, do yourself a favor, and take the tour of the maternity ward before you go into labor. Take it twice if you can. It is very disorienting when you arrive in an unfamiliar place when you are in labor. Taking the tour will give you at least some sense of familiarity with the place in which you will be birthing your baby. It will help you out in the long run. I tell you this from the personal experience of one who did not take the tour.

If you are going to be leaving your home to birth your baby, labor at home for as long as you are comfortable doing so. If you start labor in the middle of the night, get some rest. Sleep if you can, but at least meditate, relax, rest, or something to that effect. You will need it in the hours ahead.

Eat if you can, especially if you are birthing at a hospital. You have a lot of work ahead of you, staying nourished and hydrated is essential! Some hospitals still cling to the outdated policy of withholding food and drink from laboring women. This is probably the number one most preventable cause of maternal exhaustion.

Drink plenty of water, and remember to go to the bathroom often. Keeping your bladder empty is important. A full bladder can cause complications and if you don't empty it often you will have to be catheterized to help you empty it.

Relax during labor. This will help your cervix open, your baby descend, and your whole labor experience be more pleasant.

It is probably a good idea to get in touch with your doula if you have one, your midwife if you will be delivering at home or birth center, or the labor and delivery unit if you are birthing in the hospital. This gives them a chance to prepare for you and give you the best care possible.

Call ahead to the hospital L&D unit or midwife when you leave to go to the birth center or hospital. Call your midwife when you want her to come. If you hired a doula, call her to meet you at the hospital if she isn't with you already.

At the hospital, if you get there during the day, just use the main entrance, if it is the middle of the night, use the emergency room entrance.

Care and Routine Interventions for Normal Birth

Hospital: Risks: you have to leave a safe comfortable place during labor, More likely to have routine interventions/ procedures performed. Benefits: In the Extremely rare event that a complication arises, you are already at the hospital. The routine care and interventions and some of the risks and benefits are as follows:

During Labor:

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Leaving a Comfortable Safe Place While in Labor: Risks: Surrounded by sick people, Possible infection from foreign microbes, may slow labor due to the disruption of labor. Benefits: Possible convenience to everyone involved in the birth. If, in the extremely rare event a serious complication should arise, you are already at the hospital.

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Hospital gown: Risks: a sense of the unfamiliar may slow labor. Benefits: Keeps your own clothes from being soiled.

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Hep-lock/IV: Risks: Uncomfortable, possible route for infection, collapsed vein, hematoma or bruising, encumbers laboring mother - keeping her attached to an IV pole/bag. Benefits: Quick administration of medications if needed.

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External Fetal Monitor Risks: Laboring mother must remain in bed or close by machine, attention is diverted from laboring mother to the monitor, Limits mother's movement, cannot use tub or shower, can give false readings, reduces face to face care from nursing staff/doctors. Benefits: continuously monitors strength of contractions and baby's heartbeat, can be used in court by physician as defense in malpractice litigation, allows for overworked nursing staff to care for multiple patients at the same time.

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Temperature, Pulse, and Blood Pressure Checks Risks: disturbs laboring mother. Benefits: Establishes a baseline, Alerts care providers to rare, but possible complications before they become a serious emergency.

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Vaginal Exams Risks: Possible route for infection, invasive, uncomfortable, can lead to discouragement if mother is not progressing fast enough for hospital time line, accidental rupture of waters. Benefits: Lets care givers know cervical dilation and effacement, baby's position and station.

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Artificial Rupture of Membranes Risks: Route for infection, possibility for prolapsed umbilical cord, a rare but very serious complication. Benefits: May speed up a slow labor.

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Withholding of Food and Drink Fortunately a lot of hospitals don't withhold drink anymore, some allow mother to eat during labor. Risks: Dehydration, maternal exhaustion, low maternal blood sugar, further complications stemming from above problems. Benefits: Decreases the chance that mother will inhale vomit should she have to be put under general anesthesia. (so does pumping the stomach), though it is so extremely rare that this happens, that it should no longer be considered a benefit of withholding food and drink from a laboring mother.

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Routine Use of Antibiotics: Risks: Allergic reaction, Overexposure to antibiotics can cause resistant forms of microbes. Benefits: kills microbes that cause infection in mother and baby.

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Pain Medications/ Epidural Anesthetic: Risks: Maternal fever, low maternal blood pressure, slowed -possibly stalled labor, increased risk of forceps delivery, increased risk of c-section, fetal distress, sleepy lethargic baby, breastfeeding problems, accidental overdose (rare), allergic reaction to medications in mother and/or baby (rare), withdrawal symptoms in baby. Benefits: Relief of pain, allows mother to rest/sleep if very long labor.

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Pitocin to Augment Labor: Risks: maternal exhaustion, fetal distress due to compromised circulation of an over worked uterus, hemorrhage due to exhausted uterus/ maternal exhaustion, uterine rupture (especially if cytotech is used to ripen cervix). Benefits: Allows medical staff to manage labor, and keep it on Hospital time lines. Otherwise no real benefit, causes more harm than good

During Birth:

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Forced, Instructed Pushing: Risks: Perineal tears, maternal exhaustion, fetal distress due to excessive pressure on the head and compromised blood flow to placenta, Burst capillaries, hemorrhoids. Benefits: Only benefits if baby needs to get out NOW! Otherwise does more harm than good.

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Episiotomy: Risks: Cut may extend into a more severe tear, requires repair with sutures, infection, may cause pain during the healing process and after as well, may cause further problems with the pelvic floor. Benefits: Only very rarely necessary, creates more room for baby to birth in the rare event of a complication where getting the baby out fast is necessary, usually associated with the use of forceps or vacuum extractor.

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Delivery in the Lithotomy (flat on back, feet in stirrups or knees to ears) Position: Risks: Reduces slightly, the diameter of the pelvic girdle that baby must pass through during birth, Works against gravity, more likely to sustain perineal tear, Mother more passive during birth. Benefits: more convenient for doctor to perform procedures/interventions.

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Separation of baby from mother: Risks: Possible problems bonding later on, delayed breastfeeding, possible separation anxiety in newborn. Benefits: Only benefits if mother or baby is in danger or mother or baby needs resuscitation. Otherwise the separation of mother and baby immediately after birth does more harm than good.

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Immediate Umbilical Cord Clamping: Risks: Baby does not receive all of its blood supply, cuts baby's supply of oxygen and nutrients, infection Benefits: Only necessary if complications with mother or baby require separation of mother and baby, otherwise, no benefits.

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Routine Suctioning of Healthy Newborn: Risks: Damage to delicate mucous membranes, infection, may stimulate gag reflex, traumatizing to newborn. Benefits: The average healthy newborn baby clears nearly 45- 75 ml of fluid from its airway in the first 30 seconds of birth. The only benefit is to compromised newborns.

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Controlled Cord Traction to "Help Along" The Delivery of The Placenta: Risks: Uterine prolapse, cord separation, maternal hemorrhage, retained placental pieces. Benefits: Generally no benefits. Does more harm than good. Placentas come on their own time, as do babies.

Birth Center: Risks: You have to go somewhere during labor, In the extremely rare event of a serious complication, while your midwife has been trained to deal with these, you will have to be transported to a hospital. Benefits: Midwives tend to be more hands off than the staff at a hospital. You will be able to labor how you want, and if you wish to refuse or delay certain interventions you will be supported. You also have a closer relationship to your care providers and birth attendants than you would in a hospital setting,

During Labor:

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Leaving a Comfortable Safe Place While in Labor: Risks: Possible infection from foreign microbes, may slow labor due to the disruption of labor. Benefits: Possible convenience to everyone involved in the birth.

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Choice of Birth Attendants: Risks: sometimes too many people slow a labor. Benefits: Choice of your birth attendants means no strangers.

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Temperature, Pulse, and Blood Pressure Checks Risks: disturbs laboring mother. Benefits: Establishes a baseline, Alerts care providers to rare, but possible complications before they become a serious emergency.

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Vaginal Exams: Most midwives do these less often than hospital staff. Risks: Possible route for infection, invasive, uncomfortable, can lead to discouragement if mother is progressing very slowly, accidental rupture of waters. Benefits: Lets care givers know cervical dilation and effacement, baby's position and station.

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Artificial Rupture of Membranes In a birth center with a midwife's care, this intervention usually wont be used unless you request it and often only during a long labor to help speed things up a bit. Risks: Route for infection, possibility for prolapsed umbilical cord, a rare but very serious complication. Benefits: May speed up a slow labor.

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Intermittent Monitoring of Fetal Heartbeat by Fetoscope or Doppler: Risks: None. Benefits: Allows Midwife to monitor fetal well being.

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Use of Water for Pain Relief: Risks: Mother may become too relaxed and slow labor. Other than that easily reversible risk, no risks to normal pregnancy. Benefits: Easy to reverse if labor slows... Get out of water. No side effects, no withdrawal symptoms, allows muscles to work more efficiently, increases oxygenation of blood benefiting mother and baby, Relaxes mother.

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Unrestricted Movement: Risks: Rarely a mother may tire herself . Otherwise no risks. Benefits: Faster, easier labor, better blood flow to uterus and baby. Many, Many more... ( this is where the self education comes in! * wink, wink )

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Unrestricted Access to Food and Drink: Risks: None Benefits: Allows mother to stay nourished and hydrated, allowing her to withstand even the most arduous labor. Many, many more benefits ( again... apply self-education here! )

During Birth and immediately after:

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Mother and Baby Not Separated: Risks: None Benefits: Increased bonding, better breastfeeding, Many, many more....(again... :) self-education)

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Delayed Cord Clamping: Risks: None. Benefits: Baby gets all of its blood supply, extra source of oxygenated blood as the baby's systems switch from fetal, to newborn. Many, Many more.... ( I bet you know what I am going to say about this.....self-education!)

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Routine Suctioning of Healthy Newborn: Risks: Damage to delicate mucous membranes, infection, may stimulate gag reflex, traumatizing to newborn. Benefits: The average healthy newborn baby clears nearly 45- 75 ml of fluid from its airway in the first 30 seconds of birth. The only benefit is to compromised newborns.

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Have to Leave Birth Center After mother and baby are Stable and Doing Well: Risks: Same risks as getting into any car, Have to leave to get baby home. Benefits: Home feels really good when you get back to your own bed.

Home: Risks: In the extremely rare event of a serious complication, while your midwife has been trained to deal with these, you will have to be transported to a hospital. Benefits: Midwives are more hands off than the staff at a hospital. You will be able to labor how you want, and if you wish to refuse or delay certain interventions you will be supported. You also have a closer relationship to your care providers and birth attendants than you would in a hospital setting, you are in the place you are most comfortable, There is no enduring a ride in a care while you are in the midst of an intense contraction., you are surrounded by your own microbes, not foreign ones, therefore the risk of infection is less.

During Labor:

●

Temperature, Pulse, and Blood Pressure Checks Risks: disturbs laboring mother. Benefits: Establishes a baseline, Alerts care providers to rare, but possible complications before they become a serious emergency.

●

Choice of Birth Attendants: Risks: sometimes too many people slow a labor. Benefits: Choice of your birth attendants means no strangers.

●

Vaginal Exams Midwives do these less often than hospital staff. Risks: Possible route for infection, invasive, uncomfortable, can lead to discouragement if mother is progressing very slowly, accidental rupture of waters. Benefits: Lets care givers know cervical dilation and effacement, baby's position and station.

●

Artificial Rupture of Membranes With a midwife's care, this intervention usually wont be used unless you request it and often only during a long labor to help speed things up a bit. Risks: Route for infection, possibility for prolapsed umbilical cord, a rare but very serious complication. Benefits: May speed up a slow labor.

●

Intermittent Monitoring of Fetal Heartbeat by Fetoscope or Doppler: Risks: None. Benefits: Allows Midwife to monitor fetal well being.

●

Use of Water for Pain Relief: Risks: mother may become too relaxed and slow labor. Other than that easily reversible risk, no risks to normal pregnancy. Benefits: Easy to reverse if labor slows... Get out of water. No side effects, no withdrawal symptoms, allows muscles to work more efficiently, increases oxygenation of blood benefiting mother and baby, Relaxes mother.

●

Unrestricted Movement: Risks: Rarely a mother may tire herself . Otherwise no risks. Benefits: Faster, easier labor, better blood flow to uterus and baby. Many, Many more... ( this is where the self education comes in! * wink, wink )

●

Unrestricted Access to Food and Drink: Risks: None Benefits: Allows mother to stay nourished and hydrated, allowing her to withstand even the most arduous labor. Many, many more benefits ( again... apply self-education here! )

During Birth and immediately after:

●

Mother and Baby Not Separated: Risks: None Benefits: Increased bonding, better breastfeeding, Many, many more....(again... :) self-education)

●

Delayed Cord Clamping: Risks: None. Benefits: Baby gets all of its blood supply, extra source of oxygenated blood as the baby's systems switch from fetal, to newborn. Many, Many more.... ( I bet you know what I am going to say about this.....self-education!)

●

Routine Suctioning of Healthy Newborn: Risks: Damage to delicate mucous membranes, infection, may stimulate gag reflex, traumatizing to newborn. Benefits: The average healthy newborn baby clears nearly 45- 75 ml of fluid from its airway in the first 30 seconds of birth, by itself. The only benefit is to compromised newborns.