Many interventions for low risk births are becoming more standard procedures or matters of convenience, rather than necessary interventions for safe births. In fact, these procedures are found to provide minimal benefit for women in low risk labor situations. Evidence supports many best practices that can be used as alternatives to the most common labor interventions. Be sure to discuss these interventions with your service provider well before birth so you can evaluate options or even find a different care provider who’s practice is more in line with your wishes.
1. Early Admittance to Birth Facility
The sooner a woman checks into her birthing facility, the more likely it is that some procedure will follow, perhaps to speed labor or ease labor pain.
Alternatives: Stay home until “active” labor has begun, usually about 5-6 centimeters dilation. Since you probably won’t know how far you have dilated, it is recommended to use the 4-1-1 or 5-1-1 rule. This rule means that your contractions four or five minutes apart, each lasting at least one minute for a period of one hour. Other signs may be that you have lost your mucus plug and/or the contractions are more intense, requiring your complete attention to get through them.
2. Continuous Electronic Fetal Monitoring
Many studies show that continuous EFM in low-risk pregnancies does not lead to healthier babies. It does, however, double the likelihood of cesarean section, makes labor unnecessarily high-tech, confines a woman to bed, and distracts her labor support team.
Alternatives: Listen to the babies heart tones intermittently with a hand-held Doppler or fetal stethoscope allows for movement and is just as reliable as EFM.
3. IV Fluids
It has become typical for a laboring woman to be hooked up to IV fluids upon admittance into hospitals. Although hydration and electrolytes are important for a laboring body, IV lines restrict movement much as the electronic fetal monitoring.
Alternatives: Drinking clear fluids throughout labor. If acceptable to laboring mama, the hep-lock can be placed in case IV fluids become necessary later.
4. Labor Induction and Speeding Up Labor
There are several methods your service provider may suggest for starting or moving the labor process along. These include induction (using drugs to start contractions), augmentation (using drugs to increase contraction activity) and artificially breaking the membranes. Although there may be sound medical reasons for these procedures, they are not shown to improve outcomes such as fewer cesareans or shorter labors. In fact, over-riding the natural process often leads to further interventions such as epidurals (due to increased intensity of contractions) or cesareans (due to labor not progressing).
Alternatives: Allow labor to start and proceed on its natural timeline, unless it is medically necessary. Due dates are not exact and typically your body and baby know together when it is time to get things moving. Allowing membranes to rupture naturally during the labor process is healthier for baby and provides cushion of fluid for mom and baby’s comfort.
Although epidurals provide excellent pain relief during labor, it can have adverse effects on the woman, baby and labor progress. The restriction of movement does not allow the laboring mama to find the best positions and movements to keep labor moving naturally. Studies also show that using an epidural can slow mother/baby bonding, especially with breastfeeding.
Alternatives: Try various drug-free pain relief and relaxation methods such as movement, position changes, relaxation techniques, massage or a shower/bath. Having good labor support from your partner or a birth doula will increase your ability to manage labor pain and discomfort successfully. >> Learn more about my birth doula services.
A surgical cut to increase the vaginal opening can cause more postpartum pain than necessary and can lead to further complications down the road. Episiotomies can be medically necessary, but typically can be avoided.
Alternatives: If done correctly and safely, perineal massage (gently stretching the tissue between the vagina and anus) starting at around 34 weeks has been shown to help prepare the perineum for birth. Upright positioning and movement during labor will help baby work with gravity for more effective movement through the pelvis and reduce the need for surgical intervention. Another strategy for putting less stress on the perineum is to push naturally when the urge is strong, as opposed to directed pushing at 10 cm. By being patient and following the natural instinct, it allows for the baby to move down the canal and provides good, strong urges to push.