2 hospital labour procedures you might want to avoid!

[ 15 ] 24/02/2014 |

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IMPORTANT NOTE: The purpose of this article is just to INFORM about procedures and that there can be other options! The article is based on my experience, and what I’ve read on my own (all sources included). One can always question and express concerns, but each case is different, and you should ALWAYS consult your doctor(s), as they know what’s best for you and your case. 

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Although I had a low risk, uncomplicated pregnancy, I had a difficult, complicated and extremely painful birth experience. I was very close to an emergency cesarean, which I avoided thanks to a wide pelvic bone, and my baby was born with episiotomy and vacuum extraction. You can read my birth story here. I decided to look more into certain common practices, for the sake of others, and for a future pregnancy of my own.

This is what I found out. PLEASE READ IT, SHARE IT WITH YOUR PREGNANT FRIENDS, inform yourselves and others, and talk to your doctor in advance about the different standard hospital procedures and protocols, your options and what YOU want for YOUR baby and YOUR body.

1) Artificial rupture of membranes (ARM) – midwife breaking your water

It seems to be common practice to ask you to break your water if you are in labour and it hasn’t broken already. My labour started naturally and I went to the hospital to give birth. When I went there and into the delivery room, and at the very beginning of the whole process and 3 or 4 cm dilated, I was asked if I would like to have my water broken artificially as this would speed up the process. I didn’t know any better, so I agreed.

Well, IT DIDN’T SPEED UP THE PROCESS, and I had not sufficient liquids to ease the baby out when this was needed. Plus, I was not informed about the RISKS involved, which apparently are quite a few.

Please read this:

‘The forewaters usually break when the cervix is almost fully open and the membranes are bulging so far into the vagina that they burst. This ‘fluid burst’ lubricates the vaginal and perineum to facilitate movement of the baby and stretching of the tissues’. ‘Around 80-90% of women start labour with their membranes intact. This is probably because the amniotic sac plays an important role in the physiology of a natural birth.’ (Source: In defense of the amniotic sac).

Moreover,

‘Your midwife may suggest breaking your waters to speed up your labour. Breaking your waters near the beginning of labour isn’t recommended, as it doesn’t make any difference to the length of labour. ‘

‘However, if the active stage of labour slows right down, breaking the waters can help get labour going again. This does tend to shorten labour by about an hour. If you agree to the procedure, here is how your midwife will do it. Once you are on the bed, she will remove the last section of the bed so that your bottom is right at the end. She may ask you to put your legs up in stirrups, or to just hold them apart. ‘

‘Your contractions may become much stronger after your waters have been broken. Be prepared to work hard with breathing and relaxation exercises. Or you can ask your midwife for some pain relief if you need extra help.’
(Source: Speeding up labour)

Keep on reading:

‘In a spontaneous labour the rationale for an ARM is that once the forewaters have gone the hard baby’s head will apply direct pressure to the cervix and open it quicker. However, a cochrane review of the available research states that “the evidence showed no shortening of the length of first stage of labour and a possible increase in cesarean section. Routine amniotomy is not recommended for normally progressing labours or in labours which have become prolonged.” The Royal College of Midwives (UK) have evidenced based guidelines about ‘rupturing membranes’ that you can download from their site.

There are also risks associated with an ARM:

  1. It may increase contraction intensity and pain which can result in the woman feeling unable to cope and choosing an epidural… and the intervention rollercoaster begins.
  2. The baby may become distressed due to compression of the placenta, baby and/or cord (as described above).
  3. Fok et al (2005) found amniotomy altered fetal vascular blood flow, suggesting there is a fetal stress response following an ARM.
  4. The umbilical cord may be swept down by the waters and either past the baby’s head, or wedged next to the baby’s head. This is called a ‘cord prolapse’ and is an emergency situation. The compression of the cord interrupts or stops the supply of oxygen to the baby and the baby must be born asap by c-section. The only cord prolapse I have been involved with happened after an ARM (not done by me – honest!). The outcome for the woman was a live baby born by emergency c-section. Her previous 2 babies had been vaginal births.
  5. If there is a blood vessel running through the membranes (see picture below) and the amni-hook ruptures the vessel, the baby will lose blood volume fast – another emergency situation.
  6. There is a slight increase in the risk of infection but mostly for the mother (not baby). This risk is minimal if nothing is put into the vagina during labour (ie. hands, instruments etc.).’

(Source: In defense of the amniotic sac - worth reading the whole article and comments!).

2) Discontinuation of epidural at 10cm dilation, during active labor

These two articles are super interesting to read, and related to the discontinuation of the epidural. I had epidural, they stopped it at 10cm dilation and the pain, I felt it was unbearable.

The following text is from the article Turning off the epidural for pushing

“Epidural anesthesia is a powerful form of pain relief commonly used in labor and delivery. It is strong enough to be used even for cesarean births, allowing a mother to be awake and alert for her baby’s birth without experiencing the pain of surgery. However, as with anything, the epidural does carry risks. One of the risks frequently associated with epidural anesthesia is an inability to push effectively and/or an increase in the use of forceps or vacuum extraction, called an instrumental vaginal delivery (IVD).

A theory began to emerge that if an epidural was turned down or discontinued to allow a mother to have better sensation during the pushing stage of labor, that these risks would decrease. Many women were requesting this in an attempt to have better control. However, it was discovered that this theory does not appear to work in this manner.

One problem is that of pain relief. Once the body has been numbed with the epidural, it stops producing as many of the helpful hormones that allow natural pain relief, because the mother isn’t experiencing pain. So to turn off the epidural at this point requires the body to catch up, in effect, to help alleviate pain naturally. This causes the mother even more pain than if she had chosen not to have an epidural.

The other issue is that we don’t really seem to be able to prove that there is a decrease in the instrumental vaginal deliveries. There is a call out for more research to find a way to lower the risks of forceps and vacuum extraction births. One other way that is currently being used more effectively, without discontinuing the epidural, is laboring down. This is basically just allowing women who choose epidurals to labor a bit longer before beginning to push, allowing the fetal head to come down naturally. Many institutions are having a lot of luck with this technique, be sure to ask about it at your prenatal care appointments and in your childbirth class.

Sources:

Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. Torvaldsen S, Roberts CL, Bell JC, Raynes-Greenow CH. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004457. Review.

A retrospective case-controlled study of the association between request to discontinue second stage labor epidural analgesia and risk of instrumental vaginal delivery. Toledo P, McCarthy RJ, Ebarvia MJ, Wong CA. Int J Obstet Anesth. 2008 Jul 8.’

From another source, Doctors Urge Patience, And Longer Labor, To Reduce C-Sections

‘Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation’s obstetricians say.

The new guidelines on reducing cesarean deliveries are aimed at first-time mothers, according to the American College of Obstetricians and the Society for Maternal-Fetal Medicine, which released the guidelines Wednesday online and in Obstetrics and Gynecology.
About one-third of all births in the U.S. are done by C-section, and most of those are in first-time mothers. There’s been a 60 percent increase in these deliveries since the 1990s, but childbirth hasn’t become markedly safer for babies or mothers.

That discrepancy has led many to conclude that the operation is being overused. A C-section is major surgery. The procedure can increase complications for the mother and raise the risk during future pregnancies.

Women giving birth for the first time should be allowed to push for at least three hours, the guidelines say. And if epidural anesthesia is used, they can push even longer. Techniques such as forceps are also recommended to help with vaginal delivery.

Early labor should also be given more time, the doctors say, with the start of active labor redefined to cervical dilation of 6 centimeters, rather than 4.’

PLEASE LOOK MORE INTO THESE COMMON PROCEDURES ON YOUR OWN, EDUCATE YOURSELVES, DISCUSS ABOUT THEM OPENLY WITH YOUR DOCTOR, AND AVOID RISKS, COMPLICATIONS AND EXCRUCIATING PAIN, THAT IS, IF THEY CAN BE AVOIDED.
All the best with your future births and babies,

Liza
xxx

 

Category: Birth Stories, Resources for Malta Mums


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