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Routine Procedures During Labour

Parents usually think that no matter where you go to give birth, the care you get is basically the same.

That’s not true though, and not all midwives, birth centres or hospitals use the same standards and routines. These depend on the legal framework, insurance, number of people working (and birthing!) in a given shift but most of all, how they are used to working. Some common routine procedures are described below.


Shaving and enema used to be done because it was thought that shaving pubic hair would prevent infections and doing an enema (emptying your bowels by rinsing them with water) would make birth cleaner and faster.
What are the problems with it?
Both procedures are degrading and uncomfortable, do not reduce infection rates or reduce the length of labour. Finally, both procedures cause discomfort in the days after birth as pubic hairs grow in (causing itchiness and ingrown hairs) and your bowels have trouble getting to work again.
What are the alternatives?
Skipping both procedures outright. If you are used to shaving your pubic hair, you might also consider taking a break during pregnancy - pubic hair has an important purpose and dealing with ingrown hairs and itchy new hair growth in late pregnancy and postpartum can be annoying and painful.

Having an IV line inserted as soon as you come in is regular policy at many hospitals. This can be because you are not allowed to eat or drink during labour and birth (an out-dated practice not supported by more recent evidence) and that you are being given nutrients and fluids through the IV. At some hospitals they introduce an IV line just in case they need it later, another practice that is not supported by evidence.
What are the problems with it?
Having an IV line can be uncomfortable and can severely restrict your movement. It can also cause severe fluid retention (resulting in swelling), and all these things can interfere with the hormonal orchestra. In some hospitals, having an IV-line open means that midwives, nurses and doctors may be quicker to give you medications for speeding up labour or pain relief (which may or may not be a good thing).
Finally, getting IV fluids can cause problems with breastfeeding because baby has trouble latching on to breast tissue swollen by excess fluids. The excess fluids also cause the baby to weigh more at birth, and consequently when she urinates the excess fluids it may seem that she has lost much more weight than she actually has.
What are the alternatives?
Opening an IV line for low-risk women having a normal vaginal birth is not necessary - if you need a line later on, it doesn’t take long to open one.

Restricting food and drink is an old-fashioned routine that is still practiced in many places. In the past, there was a theory that eating before surgery under general anaesthesia could cause you to aspirate the food in your stomach (aspirate means vomit and then breathe in), which could be dangerous. Because there is the chance that you may need a caesarean section, women were not allowed to eat or drink during labour.
What are the problems with it?
The theory has not been proven, and the majority of caesarean sections are now done using local (regional) anaesthetic, meaning that there are no problems with food eaten before surgery. Finally, being without food and drink for hours (sometimes days, if you have a long labour) can cause you to lose energy and feel sick or weak.
What are the alternatives?
Eating light meals, especially in early labour, and drinking clear fluids whenever you feel thirsty.

Monitoring your progress in labour can be helpful to know how much your cervix has opened and where baby’s head is in relation to your pelvis. There are a number of different ways to do this, although not all of them are proven to be beneficial. Vaginal exams are usually done every four hours to measure dilation in early labour, and become more frequent as labour progresses.
What are the problems with it?
Doing exams more often can unnecessarily introduce bacteria into the cervix and may be uncomfortable. They can also disturb your concentration and interrupt her hormonal orchestra.
What are the alternatives?
Your midwife can monitor your progress by watching a red line that is formed on your behind as your baby descends, or by watching your behaviour and assessing your progress with that. It’s up to you to say yes or no to measuring progress during labour and to decide on what method you prefer.

Monitoring your labour waves and your baby’s heart rate seems like a rational and responsible thing to do, checking how your baby is tolerating labour waves and how strong your waves are becoming.
However, there are a number of problems with the technologies we are currently using.
Labour waves can be monitored using an electronic device known as a CTG. This machine has straps that go around your belly that communicate to a base unit over wires or wirelessly. It measures the intensity and frequency of your labour waves and your baby’s heart rate and prints them out on a strip.
What are the problems with it?
This monitoring means that your healthcare providers are often more concentrated on the strip printing out of the machine than on what is happening with you. The wires between the sensors on your belly and the machine also severely restrict your movement. Most importantly, this technology has not been proven to be helpful and it does not improve the health and outcomes for mothers and babies. The only thing it has been proven to do is to raise caesarean section rates.
What are the alternatives?
Your healthcare providers can monitor your progress by watching you closely and watching your behaviours and movements; baby’s heart rate can be monitored intermittently (occasionally) using a handheld pinard horn (wooden tool to listen to baby’s heart) or an electronic doppler device about every 15-30 minutes in early labour, and every five minutes during the pushing stage. This is an equally safe way to make sure that your baby is doing well.

Having your labour augmented (sped up) with synthetic oxytocin is sometimes helpful when it’s important to ensure that a baby will be born sooner rather than later, for example in cases of pre-eclampsia or if the mother is exhausted. In these cases the risk of the intervention is less than the risk of doing nothing. However, in many cases synthetic oxytocin is used to clear out labour and birth rooms more quickly, or are just used because that is the way it is done in that setting.
What are the problems with it?
The oxytocin your body produces is released as a pulse and your body regulates it, never allowing labour waves to get too intense and allowing you some time to rest between them. Artificial oxytocin is released continuously, which means that your labour waves are longer and more frequent with a shorter rest time between them. This can cause foetal distress and make labour very difficult for you and your baby.
Also, oxytocin produced by your body peaks just before birth making the pushing phase shorter and easier, which does not happen with the steady drip of artificial oxytocin. When releasing oxytocin your body also releases endorphins which help relieve pain. This does not happen with artificial oxytocin. Finally, artificial oxytocin does not cross into the brain and so you lose out on the hormonal peak after baby’s birth.
What are the alternatives?
Creating an environment where your hormonal orchestra can do its work best and being patient enough to wait for your body to do her work, all the while checking to make sure you are both well.

Lying down during labour and birth was normalised hundreds of years ago by the King of France (seriously). Now, healthcare providers are used to seeing the vulva from that position and continue to use it. If you are on a table, it’s also more comfortable for them to look directly at your vulva as the baby comes out if you are on your back.
What are the problems with it?
Lying on your back makes it more difficult for your baby to navigate and exit your pelvis. It also slows the flow of blood and oxygen to the baby, and when you are pushing, you are working against (instead of with) gravity. Finally, it is a very uncomfortable position to experience labour waves in.
What are the alternatives?
You can and should be mobile throughout labour and birth and should be able to choose the position(s) that are best for you at all times. Think about using equipment like a birthing stool, pool, rope or others to help you take different positions. You can write this in your birth plan.

Artificial rupture of membranes (AROM or ARM) is when a midwife, nurse or doctor break your bag of waters using their fingers or a special tool.
What are the problems with it?
Doing this can help bring on labour or make your labour waves more frequent (although not necessarily), but once it is done there is no going back. In many places it is done routinely when a woman comes in, but it can cause complications and should only be used if there is a good reason, and only if you consent.
What are the alternatives?
Waiting for the bag of waters to release by itself.

Having a routine episiotomy was the norm for a long time because in the past, it was believed that cutting a woman’s genitals would prevent severe vaginal tears and make the baby be born faster. We have since learned that vaginas are stretchy and are able to grow wide enough to let a baby out, but also to return to the way they were before.
What are the problems with it?
Episiotomies have not been proven to prevent severe tears, they are also more painful than tears and take longer to heal. They also tend to get infected more often and can be painful for women for weeks and even years after they are cut.
What are the alternatives?
Saying no to routine episiotomy.

 

 

http://www.roda.hr/en/projects/3p-plus-education-for-a-positive-pregnancy-birth-and-postpartum/pregnant-your-friendly-guide-to-the-next-twelve-months.html