Lower Your Risk for Induction, Episiotomy and Other Labor Interventions

There is an old Filipino saying about a woman in childbirth: "Nakatapak ang isang paa nya sa hukay." While a baby is an incredible miracle, giving birth puts a woman in danger; it's why it so joyously celebrated when a woman and her baby are proclaimed safe and healthy.

Despite fears of all the things that can go wrong, more and more women are discovering and planning for a natural childbirth. In fact, the American Congress of Obstetrics and Gynecologists (ACOG) now recommends a  drug-free birth as much as possible.

Sometimes, however, your doctor or your chosen healthcare professional like a doula or midwife may support medical intervention during labor for health and safety reasons. You need to know what these are so you can make an informed decision because sometimes you don't need them. So prepare your birth plan by acquainting yourself with the following labor interventions and discuss with your doctor. 

Intravenous drip
An IV drip can be a routine procedure in hospitals, including lying-in centers and birthing homes. You receive it if there are fears you may be dehydrated. It can also be used to administer medicines such as those that could help speed up contractions or help with pain relief. 

Fetal monitoring
During labor, your doctor may ask to use an electronic fetal monitoring device. It serves to check your baby's heartbeat and also evaluate how strong, how often, and how long your contractions are. The device is usually strapped onto your belly so if foresee that it will be uncomfortable, ask for a fetal monitor that allows you to move around while in labor. Nurses can also occasionally check your baby's heart rate via a Doppler instead of the machine. 

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Induction of labor 
The longer the baby remains inside the womb, the greater the risks are. Labor is induced only when when you are already past the 41-week mark of your due date. Having twins or multiples, complications such as diabetes, kidney problems, and high blood pressure may be reasons your doctor will suggest induction. There are a few ways to jumpstart a pregnant woman's labor.  

Amniotomy or breaking your water bag. A health practitioner will use a sterile instrument called and amnio hook to pierce your water bag to induce labor. Once your water bag breaks, however, your baby is more exposed to infections, so your doctor will work fast to make it a swift delivery. 

Ripening the cervix. A nurse or doctor will insert prostaglandin gel or a balloon-like catheter into your cervix.

Membrane sweep. A nurse or doctor will insert a gloved finger to separate your cervix from the tissue around your baby’s head. It can cause discomfort, pain, and bleeding.

Artificial induction. Through your IV, a doctor or nurse will give you a synthetic version of the hormone oxytocin, which stimulates labor contractions.

A 2011 study found that women who had labor induced without a recognized indication for the need to do so were 67 percent more likely to have a C-section, and their babies were 64 percent more likely to wind up in a neonatal intensive care unit, compared with women allowed to go into labor on their own.

Shaving down there
Studies have found that shaving the area around your vagina, which many hospitals do routinely, could potentially increase the risk for infection. Discuss with your doctor if you can give birth with a full head of hair down there, and if possible, if and when you could do it at home before your due date.

Episiotomy
It is a procedure where the doctor makes a clean cut to the perineum and the muscles beneath it, between the vagina and the anus, to widen the opening and let the baby pass through quickly. Sometimes doctors do this to be able to perform instrument-assisted births (see below).

Unless the baby is already in distress and needs to be delivered ASAP, studies show that episiotomies are not necessary. "There's no evidence for what were believed to be benefits: less pain, faster healing, and sexual functioning," says Katherine Hartmann, M.D., assistant professor of obstetrics and gynecology at the University of North Carolina, lead author of a review of 986 related studies on episiotomies. Dr. Hartmann adds that it could even cause further tearing.

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Instrument-assisted births
It involves using a pair of forceps or a suction cup to gently guide and pull your baby out by the head during a contraction. Forceps may leave a mark on baby's cheeks, but it should disappear in a few days. Doctors now prefer the suction cup. The downside is the baby may experience a soft tissue swelling for a few days where the suction cup was attached.

Instrument-assisted delivery is performed when "the baby isn't descending, or having breathing difficulties and should be delivered quickly. Or the mother can no longer push because she's fatigued or contractions have slowed," says ACOG spokesperson Iffath Hoskins, M.D.

Epidural or other medical pain relief
Pain management during labor depends on the mother. There are many natural ways to relieve labor pain. If you opt for drug-assisted pain management, such as epidurals, general anesthesia, and the like, discuss with your doctor. Remember, while contractions can be painful, it’s necessary because it's your baby's way of telling you when to push and usher him into the world. 

C-section
It is a surgical procedure that involves the doctor making a cut on a pregnant woman's belly and uterus to deliver the baby. There are a few instances wherein an emergency C-section is necessary. Elective C-sections are also only recommended if the doctor sees that labor poses risks for mom and child. Likewise, having an automatic C-section because you’ve had one before is not routine. Ask your doctor if you qualify for a VBAC. 

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All the interventions above can be avoided, but it is dependent on your well-being, your baby's health, and your doctor's advice. But you can lower your risks for labor interventions. 

1. Have a healthy pregnancy.
Many pregnancy complications are due to health and lifestyle factors or genes. Eat good food (and not always for two), do light exercises regularly, and follow doctors’ orders to the letter. Err on the side of caution when a life depends on you.

2. Make a birth plan.
Discuss all the childbirth options with your doctor and write a birth plan. Your doctor is the best person to ask beforehand which ones you need and what happens if you say no. Check also what your birth hospital will allow.

3. Attend a birthing class.
Birth classes are helpful in learning about what really happens during childbirth. You can also learn natural ways to induce labor, to cope with labor, to practice labor positions, and to push properly.

4. Get a doula.
Aside from the specialized care that a doula offers, she can be of help to you if you’re giving birth in a hospital. Your doula can help your doctor ensure your birth plan is followed as much as the circumstances allow.

5. Do Kegel exercises.
It can help strengthen and elasticize your pelvic floor. Regularly do Kegels during pregnancy to help decrease the need for an episiotomy and lessen the chances of accidental tearing down there.

6. Practice perineal massages.
Similar with Kegel exercises, this could potentially shorten the labor process and accelerate your delivery. Amy Johnson-Grass of Health Foundations Birth Center advises to start massaging your perineal area at 34 weeks.

7. Prepare, prepare, prepare.
Do your research, be informed. Articulate your needs. Listen to your body and your baby; follow your body's cues during labor, pushing when you feel the urge. 

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