Induction
What is it?
The induction of labor is one big intervention made up of smaller interventions. While it is vaginal birth and can be done without pain medication there is nothing natural about it. Do you remember the older cars that needed really needed to run in the cold for a while before you could pull off? Well your womb is like one of those cars and induction is like turning the engine over and pulling off. There's a good chance you'll break down. Induced labor is painful due to the nature of the "enhanced" contractions. Most doctors will offer you an epidural with your induction as the pain is usually unbearable. To start your induction you will be given an IV drip containing Pitocin. Other interventions may be needed including:
- Artificial Rupture of Membranes
-Epidural
-Episiotomy
-Cesarean
Why don't I want it?
-Pain
-More interventions are usually needed
-In first time mothers induction can actually double the chance of cesarean section.
-ACOG (The American Congress of Obstetricians and Gynecologists) recommends against induction without medical indication.
Why would I want it?
Here are where those "medical Indications" come into play. Some of these include but are not limited to:
-Extreme post term status (greater than 42 weeks) especially with ultrasound showing placental insufficiency and or fetal weight loss.
-Situations where the fetus must be removed as quickly as possible for the need to save the life of the mother or fetus but not being so grave as to call for cesarean.
Can I say no?
Absolutely. Always ask to be educated on your options by your health care provider or another health educator when faced with any medical decision you are unsure of. Remember you must be informed of your choices in order to give consent.
The induction of labor is one big intervention made up of smaller interventions. While it is vaginal birth and can be done without pain medication there is nothing natural about it. Do you remember the older cars that needed really needed to run in the cold for a while before you could pull off? Well your womb is like one of those cars and induction is like turning the engine over and pulling off. There's a good chance you'll break down. Induced labor is painful due to the nature of the "enhanced" contractions. Most doctors will offer you an epidural with your induction as the pain is usually unbearable. To start your induction you will be given an IV drip containing Pitocin. Other interventions may be needed including:
- Artificial Rupture of Membranes
-Epidural
-Episiotomy
-Cesarean
Why don't I want it?
-Pain
-More interventions are usually needed
-In first time mothers induction can actually double the chance of cesarean section.
-ACOG (The American Congress of Obstetricians and Gynecologists) recommends against induction without medical indication.
Why would I want it?
Here are where those "medical Indications" come into play. Some of these include but are not limited to:
-Extreme post term status (greater than 42 weeks) especially with ultrasound showing placental insufficiency and or fetal weight loss.
-Situations where the fetus must be removed as quickly as possible for the need to save the life of the mother or fetus but not being so grave as to call for cesarean.
Can I say no?
Absolutely. Always ask to be educated on your options by your health care provider or another health educator when faced with any medical decision you are unsure of. Remember you must be informed of your choices in order to give consent.
Pitocin
What is it?
- A synthetic version of oxytocin.
-Can be used to stop excessive bleed due to improper contracture if the uterus in the 3rd phase of labor.
-May be used to "enhance" contractions during labor already in progress
Why don't I want it?
- Aside from the pain caused by these "enhanced" and unnatural contractions pitocin can increase the chances of neonatal jaundice and low apgar scores. It is also known as a risk factor for NICU stays in full term infants.
Why would I want it?
-In the case of excessive bleeding due to improper contraction of the uterus pitocin can save your life.
Can I say no?
-Yes. In New York state you can say no to the usual intramuscular dose of pitocin given after the birth of the baby. Activities like the breast crawl, nipple stimulation (including breastfeeding) and abdominal massage can all help the uterus to contract quickly and naturally.
What is it?
- A synthetic version of oxytocin.
-Can be used to stop excessive bleed due to improper contracture if the uterus in the 3rd phase of labor.
-May be used to "enhance" contractions during labor already in progress
Why don't I want it?
- Aside from the pain caused by these "enhanced" and unnatural contractions pitocin can increase the chances of neonatal jaundice and low apgar scores. It is also known as a risk factor for NICU stays in full term infants.
Why would I want it?
-In the case of excessive bleeding due to improper contraction of the uterus pitocin can save your life.
Can I say no?
-Yes. In New York state you can say no to the usual intramuscular dose of pitocin given after the birth of the baby. Activities like the breast crawl, nipple stimulation (including breastfeeding) and abdominal massage can all help the uterus to contract quickly and naturally.
Cesearan
What is it? The cesarean or C- section is a surgical procedure used to deliver a baby through incisions in the mother's abdomen and uterus. rem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip.
Episiotomy
|
|
Episiotomy
What is it?
Also known as perineotomy is the cutting of the perineum and the posterior vaginal wall performed by the OB or midwife during second stage of labor to quickly enlarge the opening for the baby to pass through. It is performed under local anesthesia and sewn up after the delivery. It is done as a preventive measure against tearing which would involve the anal sphincter and rectum.
Why don't I want it?
-Episiotomy especially on the midline tends to lead to more severe tears than natural delivery. A severe tear to the midline could lead to lifelong problems such a fecal incontinence and sexual dysfunction.
There are many better ways to avoid a tear:
-Controlled delivery of the head that allows slow gradual stretching of the perineal tissue
-Perineal massage
-Use of a perineal dilator can be used to stretch the perineal tissue gradually and train it in preparation for first births.
Why would I want it?
-I have no idea.
Can I say no?
-Yes.
What is it?
Also known as perineotomy is the cutting of the perineum and the posterior vaginal wall performed by the OB or midwife during second stage of labor to quickly enlarge the opening for the baby to pass through. It is performed under local anesthesia and sewn up after the delivery. It is done as a preventive measure against tearing which would involve the anal sphincter and rectum.
Why don't I want it?
-Episiotomy especially on the midline tends to lead to more severe tears than natural delivery. A severe tear to the midline could lead to lifelong problems such a fecal incontinence and sexual dysfunction.
There are many better ways to avoid a tear:
-Controlled delivery of the head that allows slow gradual stretching of the perineal tissue
-Perineal massage
-Use of a perineal dilator can be used to stretch the perineal tissue gradually and train it in preparation for first births.
Why would I want it?
-I have no idea.
Can I say no?
-Yes.
Artificial Rupture of Membranes
|
|
|
|
What is it?
Also called amniotomy. The artificial rupture of membranes is a process by which the doctor or midwife uses a hook resembling a crochet needle or afghan hook that has a sharp edge on the tip to puncture and rip the amniotic sac. It can also be performed with a special "glove" that has a sharp projection on the front of the index finger also in the form of a hook.
Why don't I want it?
The reason most amniotomies are performed is to "speed up" labor. Not only does this usually not work when it does it usually is the contractions produced are
very strong and can be more painful.
Why would I want it?
When internal fetal or uterine monitoring is needed.
Honestly sometimes that bag is just a tough sucker. Babies will be halfway through the vaginal canal with a bulging, unruptured sac being the only thing holding them back. At that point it can make sense to break the water and finish the birth. We are not trying to prolong labor on principle. As with any other intervention think if it is justified in your situation.
Can I say no?
Yes. As with all interventions ask why it is being recommended and weigh your options.
Also called amniotomy. The artificial rupture of membranes is a process by which the doctor or midwife uses a hook resembling a crochet needle or afghan hook that has a sharp edge on the tip to puncture and rip the amniotic sac. It can also be performed with a special "glove" that has a sharp projection on the front of the index finger also in the form of a hook.
Why don't I want it?
The reason most amniotomies are performed is to "speed up" labor. Not only does this usually not work when it does it usually is the contractions produced are
very strong and can be more painful.
Why would I want it?
When internal fetal or uterine monitoring is needed.
Honestly sometimes that bag is just a tough sucker. Babies will be halfway through the vaginal canal with a bulging, unruptured sac being the only thing holding them back. At that point it can make sense to break the water and finish the birth. We are not trying to prolong labor on principle. As with any other intervention think if it is justified in your situation.
Can I say no?
Yes. As with all interventions ask why it is being recommended and weigh your options.
NPO or Food Restriction:
Not exactly an intervention, many hospitals will still ask that you do not eat while in labor. One of the reasons often given is that if an emergency C-section is needed it is better to have an empty stomach. While this may be loosely true (if intubation is necessary it is always preferable that the stomach not be full and vomiting while under anesthesia can lead to aspiration) it is more based on the fact that vomiting is extremely common during labor. Many women will vomit especially during the part of the active phase of labor known as transition. For this reason I personally don't recommend you eat large meals during active labor. This said you should eat. You're up, you're working, you're working hard and you should eat. There is no other time in a person's life where they would be expected to work that hard for that long and not eat something. It's insane. But watch what you eat. If there was ever a time to eat healthy, clean, and light in your life this is it. Eat small snacks and sip consistently on non-carbonated liquids. Eating and staying hydrated will help you avoid needing an IV later on. It will keep your energy up and help you avoid cramping . If for some reason an emergency C-section becomes truly necessary it will not make that much of a difference, Name one emergency surgery you are told not to eat before. The very definition of something being an emergency is that it could not be foreseen; you don't know when you'll get in a car accident or your appendix will burst. You'll be successfully intubated in both of these cases even if you just ate Thanksgiving dinner. This really is a holdback to the days of "twilight sleep" when aspiration would have been a common, serious, and often fatal complication. So don't overdo it but eat.
Not exactly an intervention, many hospitals will still ask that you do not eat while in labor. One of the reasons often given is that if an emergency C-section is needed it is better to have an empty stomach. While this may be loosely true (if intubation is necessary it is always preferable that the stomach not be full and vomiting while under anesthesia can lead to aspiration) it is more based on the fact that vomiting is extremely common during labor. Many women will vomit especially during the part of the active phase of labor known as transition. For this reason I personally don't recommend you eat large meals during active labor. This said you should eat. You're up, you're working, you're working hard and you should eat. There is no other time in a person's life where they would be expected to work that hard for that long and not eat something. It's insane. But watch what you eat. If there was ever a time to eat healthy, clean, and light in your life this is it. Eat small snacks and sip consistently on non-carbonated liquids. Eating and staying hydrated will help you avoid needing an IV later on. It will keep your energy up and help you avoid cramping . If for some reason an emergency C-section becomes truly necessary it will not make that much of a difference, Name one emergency surgery you are told not to eat before. The very definition of something being an emergency is that it could not be foreseen; you don't know when you'll get in a car accident or your appendix will burst. You'll be successfully intubated in both of these cases even if you just ate Thanksgiving dinner. This really is a holdback to the days of "twilight sleep" when aspiration would have been a common, serious, and often fatal complication. So don't overdo it but eat.