1. First-stage interventions
1. Induction
1. Reasons for doing
1. Past due--see "due dates," Outline Four
1. Placental aging
2. Size of baby
2. Gestational diabetes (same concerns as above)
3. Toxemia--almost unheard of in well-nourished mothers
4. PROM
1. Rare in well-nourished mothers
2. Not dangerous as long as precautions are followed
3. Can be caused by internal infections
5. Uterine infection--usually caused by vaginal exams and other intrusions
6. Convenience--mother's or doctor's
2. Methods of
1. "Stripping membranes"
1. Done during vaginal exam; doctor or midwife runs one finger around the inside of the cervix
2. Often painful
3. Little effectiveness in actually starting labor
2. Breaking of waters
1. Works less than 50% of the time
2. Immediate time limit set because of concern of iatrogenic infection (usually 12-24 hours)
3. Makes labor more painful for mother
4. Makes labor more stressful for baby
5. Carries risk of causing prolapsed cord if baby's head is not fully engaged
3. Synthetic oxytocin (Pitocin most common--"pit-drip")
1. Requires IV
2. When routine levels are used, labor often extremely painful
3. Contractions harder and longer than in spontaneous labor
1. Compromises baby's oxygen
2. More stress on baby's head
4. Carries risk of uterine rupture (even without previous scarring)
5. Constant fetal monitoring required (often internal if water is broken)
6. Makes postpartum hemorrhage more likely
4. Prostiglandin gel or bolus
1. Applied in and around cervix
2. Results unpredictable
3. Cannot be controlled by medical personnel
4. Will not work unless cervix is already "ripe" (soft)
5. "Home" methods
1. Castor oil
1. Stimulates the bowels, which in turn stimulates uterus
2. Will work only if labor is close to starting anyway
3. Tastes bad
4. Causes diarrhea
5. May cause nausea and vomiting
6. May leave mother weak and ill-prepared to cope with labor
2. Nipple stimulation
1. Produces natural oxytocin
2. Can be uncomfortable (tender nipples; long, hard contractions)
3. Can help to ripen the cervix, but will only start labor if close to time anyway
4. No outside danger if "at term"
3. Lovemaking
1. Semen contains prostiglandins; also direct stimulation of cervix
2. Safe as long as water is intact
3. May help ripen cervix (and relax mom?) if nothing else
4. Blue and black cohosh (or other herbal methods)
1. Taken as tea or other preparation in late pregnancy only
2. Some object to taste
3. May not be effective if not time (though also may help ripen cervix and tone uterus)
3. Alternatives to
1. Wait on the Lord's perfect timing (He may use a natural method or not)
2. Pray
2. Augmentation ("lets speeding things up a little")
1. With the following exceptions, things used to start labor can be (and are) also used to speed them up, with the same risks
1. Prostiglandin gel
2. Castor oil
3. Stripping of membranes
2. "Natural" methods
1. Walking
2. Changing positions
3. Being in upright position (sitting, rocking, standing, etc.)
4. Eliminating factors that stall labor
1. People present who upset mother
2. Procedures that upset mother or make her uncomfortable
1. Fetal monitor
2. Vaginal exams
3. Student observation
4. Excessive noise, light, cold/heat
3. Spiritual reckonings (ask the Lord to show you if there is anything in this category)
4. Fear of labor/birth (fear is opposite spiritual force of faith--see again Bible study #1)
5. Wait!! Again, God's timing is always perfect.
3. "Routine" interventions (things you must be assertive about to avoid in hospital)
1. Intravenous fluid (IV)
1. Restricts movement
2. Makes mother feel more like a "patient" (although pregnancy and labor are not illnesses or medical emergencies)
3. Introduces pathway for infection
4. Makes it easier for medical personnel to administer drugs without consulting you (happens frequently!)
5. Introduces risk of water intoxication
1. Can be dangerous to baby as well
1. Glucose in IV fluids can cause baby's sugar level to drop after birth
2. Baby can actually take on "water weight" during labor
1. Can add to difficulty of labor
2. Can cause concern for baby's welfare when significant weight loss occurs after birth (baby passes extra water in urine)
2. Gives false impression that other fluids or food are not necessary
6. We are designed to take in nourishment through our mouth, not directly into our veins
2. Heparin lock
1. Commonly seen as "acceptable alternative" (compromise with hospital system) to IV
2. Carries own risks
1. Introduces pathway for infection
2. Makes it easier to administer drugs
3. Can be uncomfortable
4. May contribute to hemorrhage
1. Heparin is an anticoagulant
2. It is introduced locally (to keep blood from clotting around tubing) but into the bloodstream
3. Common sense tells us that, theoretical or not, anything introduced in this way can affect the entire body (including the baby)
3. Fetal monitoring
1. Use of electronic fetal monitoring (EFM) alone increases risk of C-section by 1/3
2. External monitor uses ultrasound to chart baby's heart rate
1. Long term effects unknown
2. Baby exposed to very large doses over time
3. Belts holding monitor in place need to be adjusted every time mother changes position, often to annoyance of nurses
4. Obviously precludes walking around
5. High rates of inaccuracy
6. Belts uncomfortable after short period of time
3. Internal monitor operates by screwing electrode into top of baby's head and placing probe into uterus
1. High rate of infection at point of entry (baby's head)
2. Introduces risk of infection in uterus
3. Requires amniotomy
4. Severely restricts mobility
5. Damages baby elsewhere if top of head is not presenting part
4. EFM presents the temptation to "watch the machine instead of the mother"--labor and birth are human events, not mechanical
5. Infant outcomes for auscultation (nurse using fetoscope) are at least equal, if not superior, to that of EFM, with none of the dangers
4. NPO (non per os)--nothing by mouth
1. Instituted because of concern of aspiration of stomach fluids while under general anesthesia
1. Actual need for general anesthesia rare
2. NPO does not guarantee lesser likelihood of aspiration, which is caused by a fault in the technique of the anesthesiologist, rather than a natural consequence of anesthesia
2. Causes more problems in labor than those it hypothetically solves
1. If labor is very long, mother is often weak by end (when she needs most strength)
2. When glucose or electrolyte IV used to provide energy instead:
1. Does not provide complete nourishment
2. Carries its own risks (see IV's, above)
3. Feelings of thirst or hunger can be intense and may interfere with labor
5. Rarely used interventions
1. Enema
1. Once used routinely everywhere to empty bowels for labor/delivery
2. Can cause much discomfort or trapped fluid in bowel if done at wrong time of labor
3. Natural cleansing usually occurs before/with spontaneous labor
2. Perineal shaving
1. Rarely done now
2. Once believed to prevent infection; now known to actually contribute to it
4. Drugs
1. NO DRUG HAS EVER BEEN SHOWN TO BE SAFE FOR THE BABY
2. All drugs cross the placenta and affect the baby, both before and after birth (EPIDURALS INCLUDED)
1. Often direct cause of fetal distress
2. Baby may need resuscitation after birth
3. Baby may be sluggish and sleepy for WEEKS
4. Baby may not nurse well
5. Baby may suffer brain damage
3. All drugs interfere with labor in some way
4. All drugs increase the need for additional interventions
1. IV
2. Fetal monitors (necessary to check the baby's reaction)
3. Pitocin (increase contractions made irregular or weak by pain medications)
4. Confined to bed (disorientation or loss of coordination in legs in addition to restriction of other interventions)
5. May need additional drugs to alleviate side effects of original
1. Phenergen to prevent vomiting in addition to Demerol
2. Pitocin (above), especially with epidural
3. Pain relievers or anesthesia in addition to Pitocin
4. Local anesthetic for episiotomy repair (or tear)
6. Episiotomy (drugs may prevent mother from being in a position most favorable for birth)
7. Forceps or vacuum extractor to deliver baby, if epidural is used (loss of sensation often leads to inability to push effectively)
5. There are side effects connected with all drugs
1. Disorientation with anesthetics and analgesics
2. Backaches and lingering headaches with spinal and epidural anesthesia
3. Loss of sensation and/or ability to move with regional anesthetic
5. Every single intervention increases the chances of ending up with a cesarean
2. Cesarean section
1. Vast majority unnecessary
1. "Experts" agree that the incidence of medically unavoidable cesareans is only 3-6% of all births (national average is higher than 25%)--for the following reasons:
1. Transverse lie (baby sideways in uterus)
2. Placental abruption (placenta prematurely separates from uterus, compromising baby's oxygen supply)
3. Complete placenta previa (placenta entirely covers cervical opening during labor)
1. Vaginal delivery is often possible if placenta is only partially covering cervix
2. Placenta previa early in pregnancy will often resolve itself
3. Characterized by significant bleeding (may be in late pregnancy or during labor--also can be signal of abruption)
4. Prolapsed cord (cord comes down into birth canal during labor--cuts off baby's oxygen)
2. All of the above can be iatrogenic (caused by procedures or drugs used by medical personnel)
1. Babies that are not induced are almost always head down (estimated 3% of babies are breech at time of delivery)
2. Abruptia can be caused by
1. Pitocin to induce or augment labor
2. Previous uterine scarring (as in cesarean--more likely with classical incision)
3. Poor nutrition during pregnancy
3. Previa will often resolve itself (placenta migrates upward) by the time natural labor starts (obviously may not have time if labor is induced)
4. Pitocin augmentation during a labor with partial previa can cause serious hemorrhage
5. Prolapsed cord is most common when amniotomy is done
1. Naturally breaking water usually occurs after head is well engaged
2. Cord will not prolapse when water is left intact
2. Common reasons for cesareans
1. Dystocia (failure to progress)
1. Usually caused by
1. Mother lying in bed, instead of upright and/or walking
2. Medication (any type of meds given for pain has the potential to slow or stop labor--vicious cycle: slow labor-->pitocin-->more medication-->more pitocin-->fetal distress-->cesarean)
3. Stress
1. Change of environment (home to hospital, labor room to delivery room)
2. People present at the birth (obnoxious nurse, the one doctor in the practice you didn't like, medical students, your mother, etc.)
3. Fear
4. Exhaustion/starvation
1. Long labor is not necessarily more difficult than short one; difference depends on how conducive the environment is to resting between contractions
2. Starvation in labor is a major factor in progress and ability to cope when labor stretches out
5. Spiritual issues
1. Must not be ignored--we are spiritual beings as well as physical
2. There may be a spiritual battle going on which needs to be resolved through prayer, forgiveness, etc.
3. God may have a "dealing" for someone else present at the labor
2. Cephalopelvic disproportion (CPD)--baby's head too big for pelvic opening
1. Cop-out reason--usually "diagnosed" after delivery
2. Fear of this is common reason for induced labors
3. Many cesareans done for CPD result in 6-7 lb. babies
4. Many women diagnosed with CPD give vaginal birth later to babies 1-2 lbs. (or more) larger than their "CPD" babies
5. Pregnancy hormones and the process of labor itself make your body flexible so that the pelvis will allow the baby to come through
6. Trust that God knows your body and will not give you a baby too large to birth - Isaiah 66:
3. Fetal distress
1. Electronic fetal monitor increases risk of cesarean by 1/3
1. Results are often difficult to interpret
2. Restricts mother's mobility, increasing chance that baby will go into distress from improper labor positioning
3. Simple mechanical malfunction
2. Medication--from narcotics to anesthetic to pitocin--all affects baby
3. Often a "scare tactic" used to bully couple into cesarean ("Your baby could die!" is oft used)
4. May be remedied by
1. Getting rid of EFM (use auscultation instead)
2. Changing position
3. Avoiding all intervention in the first place
4. Breech presentation
1. Breech babies more likely to have breathing problems whether delivered vaginally or by cesarean
2. No reason baby can't be delivered vaginally
3. Many doctors simply don't have the training to do it any more; all they know is c-section
4. Breech may be able to be turned
1. Special exercises (by mother)
2. External version
1. Carries some risks (less than cesarean)
2. Ultrasound is used during procedure
3. Baby may be turned, but then switch back
3. Prayer--there is speculation that confusion in the home (proper order is Christ-->husband-->wife-->children) may be reflected by baby's position
3. Other things to consider
1. Not one of these things is beyond the capability of God to handle
1. Prepare spiritually as well as physically before the birth
2. Pray for guidance and help when faced with any decision that needs to be made
2. Prayer--your own and others--is the most powerful weapon we have in the earthly realm--use it
3. Some of these are the result of indirect attacks by Satan, through the "wisdom" of man which fails to take God (His design, His plan) into account - Proverbs 16:25, 14:26-27
4. The procedure itself (since the average rate is so high, we feel a need to cover this information)
1. Once decision is made, anesthesia is given--usually epidural, rarely general
2. Mother is prepped and shaved for surgery
3. Mother's arms are restrained on surgical table
4. Incision is made in lower abdomen, through tissue until organs can be moved out of the way
5. Incision made in lower portion of uterus
6. Amniotic sac is ruptured (if still intact) and baby lifted out
7. Placenta is removed
8. Uterus is sutured
9. Organs are replaced in proper positions (hopefully!!)
10. All tissues are sutured, one layer at a time
11. Abdominal incision is closed with sutures or staples
5. Afterwards
1. Mother should ask to hold and nurse baby right away
2. Father should try to stay with the baby (this is where an additional support person can be most essential, to stay with mother)
3. Use pain medication sparingly
4. Try to walk as soon as possible to minimize gas in intestinal tract
5. Have father or someone else sneak truly nutritious food into hospital
1. Mom will recover faster
2. There will be fewer postoperative discomforts like constipation
6. Go home as soon as possible, if rooming-in is not workable
1. Baby needs mother more than anything else
2. Mother needs baby as much
3. Mother needs to have extra help at home for a few weeks at least
3. Second-stage interventions
1. Episiotomy (rate is 90+% in most hospitals)
1. Reasons (excuses!!) for doing
1. To prevent trauma to baby's head (after labor???)
2. To prevent perineal tears
1. Actually causes them (n% chance of tearing without episiotomy; 100% with!)--further tearing extremely common when tissues are already cut
2. Also unnecessary when mother is in proper position for delivery (see Outline Four)
3. Speeds up delivery
1. Baby may or may not really be in distress
1. True distress may be an indication for episiotomy (try for pressure episiotomy--see Bradley books for more info)
2. Distress may be from controllable factors (consider this first)
2. Most often, doctor or midwife is just impatient
4. Easier to repair than "jagged tear"--again, this is for doctor/midwife's convenience rather than mother's well-being
2. Reasons to avoid
1. Vaginal opening designed to unfold gradually without outside help (when birth is not hurried)
2. PC muscle and surrounding tissue remains more elastic even after stretching than if cut
3. The cut is more painful for the mother than a tear (scissors used actually crush tissue while cutting)
4. The pain from episiotomy repair may last for months (improper repair, stitching too tightly)
2. Forceps or vacuum extraction
1. Most often done when mother is exhausted or in wrong position for birth, has been drugged, or has regional anesthesia
2. Forceps can damage baby (bruising, brain damage) and mother (pelvic floor or other internal damage)
3. Carries attendant risks of pulling on baby's head (next point)
3. Pulling on baby's head/forcibly turning baby
1. Can cause brain/spinal cord damage
2. Baby will turn on its own in normal, undrugged labor
4. Immediate cutting of cord--should not be cut until pulsing stops
1. Prevents hemorrhaging
2. Baby receives all needed blood

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