Childbirth is a natural process that sometimes requires intervention and sometimes doesn't. From a holistic approach, considering that all components of birth are interconnected, it's important to look at it from all sides.
What kind of interventions exist?
When are they necessary?
When are they a disruption to healthy birth?
What alternatives can I add to my tool kit?
What interventions do we see in hospitals today?
Frequently women are induced after going past their due date or because labor isn't progressing fast enough. Many women choose to get an epidural or some form of pain medication to cope with the intensity of labor. Some babies are pulled out with forceps or vacuum extraction. Some doctors may still routinely give episiotomies. Cesarean sections have become more popular for reasons like "failure to progress", the convenience of planning your birth date and skipping painful labor, because doctors tell women that their pelvis is too small or baby is too big, and various other reasons.
Many women have positive birth experiences, with and without interventions. But there are also a great deal of women who end up with interventions they didn't want and birth experiences leaving them feeling powerless and disappointed.
The intention of this article is to provide you with a knowledge base of options so you can make powerful choices no matter what circumstances you face in the birth of your child.
Why might interventions be needed?
Preterm/premature labor - when a baby decides to come before reaching full term
Preeclampsia - a condition that causes high blood pressure and risk of kidney failure and death to a mom or baby
Fetal arrhythmia - if the heart rate is too high or too low and doesn’t change when mom changes positions
Placenta previa - the placenta is partially or completely covering the cervix
Placental abruption - the placenta detaches from the uterus before baby is out
Baby position - shoulder dystocia, breech, pelvic abnormalities
How common are these causes for intervention?
(according to AmericanPregnancy.org)
These are really low percentages.
What does this show us?
Most women can have a healthy, vaginal birth without intervention.
*One common reason women end up with an unnecessary induction or cesarean section is for "failure to progress" meaning labor isn't moving forward at the rate doctors and nurses are trained to expect. However, as long as mama and baby are doing well, evidence shows there is no reason to intervene with labor. In fact, there is no such thing as a "normal" length of labor. Sometimes all that's needed is for a laboring woman to be undisturbed, feel safe in her environment, or simply use visualizations. (Find some great evidence here.)
Why can intervention disrupt birth?
There’s a cascade of hormones (oxytocin, beta endorphins, adrenaline, noradrenaline, prolactin, etc.) occurring in birth that optimize survival for mother and baby, promotes successful breastfeeding, and initiates secure bonding. Labor and birth are designed so that the mother (of any mammalian species) feels private, safe, and unobserved in labor. When we don’t provide conditions where the basic needs of the laboring woman are met, then we can end up with disruption to the hormonal physiology. In other words, if there are disruptions to the birth process, it can potentially cause complications requiring further intervention that wouldn’t have otherwise been needed. (Learn more about Nature's Hormonal Blueprint for Labor with Sarah Buckley)
When labor is induced, it impacts the flow of hormones that would be present during a natural onset of labor. This causes contractions to be more intense and close together. Feedback to the brain is blocked and doesn't give your body the signal to start producing natural pain relief called endorphins. It's also key to note that your cervix dilating is not the only factor in a baby being born. Your body needs to move and open while your ligaments and muscles stretch for your baby to rotate and descend.
Pitocin (synthetic oxytocin) - administered through an IV - can cause stronger contractions than the body would produce on its own
Cytotec (also known as Misoprostol) - a pill taken orally or inserted into the vagina - can cause stronger contractions than the body would produce on its own - high risk for VBAC
Foley Balloon - balloon insert into the cervix and pumped to expand and dilate - can be painful
Prostaglandin - synthetic gel to soften and ripen the cervix
Membrane sweep - manually separate amniotic sack from lower part of uterus
Rupture membranes - also known as breaking the bag of waters - puts you on a time limit for labor and risks infection or need for antibiotics
ENCOURAGING LABOR TO START NATURALLY
It is rare to go into labor exactly on your due date. For first time moms, it's very common to go a week or two beyond your due date. And there's nothing wrong with this! As long as your placenta and baby are still healthy, your baby can safely come Earth side up to 42 weeks (and even 43 weeks). Yes, babies are growing during that time. But it's very rare that your body would produce a baby too big for your pelvis. Mom's frequently birth 9, 10, and even 11 pound babies vaginally with no complications. If it's time for you to induce, consider some natural alternatives. (Check with your doctor or midwife before choosing any of these.)
Hypnotherapy - guided meditation with hypnotherapist
Chiropractic adjustment - makes space for baby to get into optimal position
Acupuncture/acupressure - trigger points to signal the body
Natural prostaglandin - semen or evening primrose oil
Orgasm or nipple stimulation - releases oxytocin
Rest and sleep - allows the body to feel safe
Herbs or castor oil - consult a midwife first!
Medical Pain Relief
Medical pain relief is routinely offered in hospitals but it doesn't come without risks during and after the birth such as: slow or stalled labor, disconnection from body during labor, drowsy or drugged feeling, difficulty establishing breastfeeding, horrible headaches, chronic back pain. Some of the drugs can pass to the baby via placenta, increasing the possibility that the baby has a hard time rotating and descending through the birth canal. Here are some drugs you may be offered at a hospital:
Natural Pain Relief
Not only do these practices help cope with labor sensations, they help you to open and allow baby to rotate and descend. None of these methods disrupt your hormones, so labor can flow as it's designed to. Keep in mind, it's natural for labor to slow down and speed up again. When you're coping well and feeling safe and secure, labor will generally move along in a healthy way. (Learn more about pain in childbirth here.)
Having a doula (trained birth support person)
The 3 R’s - relaxation, rhythm, ritual with slow breathing (Penny Simkin)
Movement - swaying, walking, changing positions
Hypnosis - hypnobirthing classes to master deep relaxation (Vivian Keeler)
Second pain - creating a discomfort such as squeezing a hard object or sticking your hand in cold water during surges forces the brain to move its attention (Julie Bonapace)
Sterile water injections - injecting sterile water just under the skin in the lower back significantly reduces pain for around an hour (Julie Bonapace)
Water - soaking in a bathtub or shower
Hip squeeze - being on hands and knees with someone behind you who pushes your hips together from the back, allowing the pelvis to open in the front (NaturalLifeMom.com)
Benefits of Intervention-free Birth
Natural onset of labor
Labor begins when you feel safe, secure, and comfortable
Labor begins when Baby is ready
Hormones are able to flow as they're designed to
Saline lock instead of continuous IV drip
A saline lock (sometimes called a “hep-lock” for historic reasons), is an intravenous (IV) catheter that is threaded into a peripheral vein, flushed with saline, and then capped off for later use.
This way you are not hooked up to an IV pole, but the nurses have easy access in case you need something injected into your vein later.
Learn more about the evidence behind this at evidencebasedbirth.com
Eating and drinking during labor
Some women feel hungry during labor and some don’t
It’s important to listen to what your body needs
Eating and drinking is not only safe but gives you energy for this strenuous event
Learn about the evidence behind this on evidencebasedbirth.com or by listening to the Birthful Podcast Episode 104: Evidence & Eating During Labor
Intermittent fetal monitoring
Your nurse or midwife can monitor your baby’s heart tones at different times through labor instead of constantly being attached to a machine
This allows you to move around freely
Baby’s heart rate naturally fluctuates in labor and they are built to handle it. Usually a change of mom’s position can regulate it again.
Less Vaginal Tearing
Tearing is common in childbirth but it doesn’t always happen
There are 4 degrees to a vaginal tear and most women don’t tear very badly in natural birth because they can feel when to slow down with pushing
The perineum naturally becomes more stretchy for birth due to hormones
You can prevent tearing by:
Massaging the perineum with coconut or jojoba oil during pregnancy
Eating healthy fats and oils high in Omega 3 during pregnancy
Doing pelvic floor exercises during pregnancy (SpinningBabies.com)
Soaking in water or giving birth in water
Perineum support during pushing
Pause pushing as baby’s head crowns
Birth on hands and knees, standing, kneeling, or on your side
Delayed Cord Clamping
Delayed cord clamping is actually physiological cord clamping
50% of baby’s blood that would normally go to lungs actually goes to the placenta
The placenta is like a fetal lung - delivering oxygen to the baby even up to a few minutes after birth
There is no benefit to cutting the cord immediately after birth
The cord will stop pulsating by itself after 2-3 minutes
Waiting for the cord to stop pulsing allows the blood (containing vital iron) to transfer into the baby, which boosts neurological development
Learn more about this with Dr. Mark Sloan
Babies born vaginally get seeded with good bacteria from the mother’s vagina and anus that strengthens their immune system and prevent asthma, diabetes, cancer, autism, food allergies, and more
Babies born via c-section can still get some of this beneficial bacteria using vaginal swabs
Learn more about this with Toni Harman or Dr. Rodney Dietert
Regulates baby’s body temperature, heart rate, breathing
Prevents a spike in cortisol (stress hormone)
Promotes bonding and attachment for both parents
Makes the establishment of breastfeeding easier
Learn more about this with Sylvia Houston