When is intervention Ok?

[bri276]

In what situations are the following ever necessary or appropriate?

-pitocin
-epidural
-c section
-forced breakage of waters

just wondering because I'd like to avoid all of them at all costs, but would also like to know where to draw the line and say "everything else has been tried-now it's okay". thanks!

[pamamidwife]

Just like what you said - as long as you're fine and baby's fine, and you're fully informed of all the risks/benefits, there is a time and a place for interventions. It's when you're being pushed into them with threats and fear tactics based on someone else's idea of how birth should be that gets unpleasant.

[thepeach80]

I think she pretty much covered it. Obviously some women do need c/s etc, but definitely not to the degree that they are given. By the time I had mine w/ my first, I needed it. The problem is I didn't need all the things that led up to my c/s. I had a wonderful vaginal birth this last time. I did end w/ a forcep delivery, but I had abrupted in labor and my ds was being deprived of O2 so they helped him out. Not ideal, but better than another c/s! Good luck and have a wonderful pgcy and delivery!

[JanetF]

To my way of thinking, the only time for most of those interventions is when the baby will be better out of your body than in. This is pretty rare! Some of the signs that hospitals think are indications of this are a.caused by earlier unnecessary interventions and b.blatantly not true. I strongly recommend you get copies of Henci Goer's books "Thinking woman's guide to a better birth" and "Obstetric myths versus research realities" so you can see in very concrete form the indications, risks and realities of performing those interventions. You can also read articles like the ones that Marden Wagner has written on the active management of labour. A quick look on google will find that for you. He clearly spells out the rationale of hospitals in performing those interventions.
I think a really good question to ask is "Who will benefit from this?" If you and your baby aren't going to benefit, you can bet that the OB on duty *is* going to, and since they're there to support you (you employ them, they're not doing you a favour, remember!) it doesn't matter what's good for them. Your emotional, physical and spiritual wellbeing, and that of your baby, are the most important thing in labour and birth.
Sending you beautiful birthing vibes

[cottonwood]

If the mother is very ill and the pregnancy is becoming dangerous for her, and gentler methods of induction have failed, I can see trying pitocin before resorting to a c-section.

If the mother is very stressed out or so exhausted she is becoming ill, I can see an epidural helping the labor progress by helping her relax.

There are many reasons for a c-section (although rare when not iatrogenic,) basically the mother or baby's health depends on getting the baby out very quickly, or the mother's pelvis is deformed and cannot admit the baby.

I can't think off-hand of any good reason for AROM.

[Full Heart]

There are some clear cut reasons and there are the more grey areas. Sometimes it can be something about a personal situation that leads up to an intervention. So ditto what Pam said. Just make sure you are fully informed and not being forced into something out of fear (usually someone elses fear).

Michelle

[Greaseball]

-pitocin
Can't think of one. I might prefer a c-section over a pit-induced birth. Wait, I've got one: if there is postpartum hemmorhage, or if the placenta is very stubborn, pitocin can help stop bleeding and expel the placenta.

-epidural
During a c-section.

-c section
Fetal distress, unmovable transverse position, placenta previa, extremely early delivery due to mother's deteriorating health.

-forced breakage of waters
I don't know. Perhaps during a c-section?

I did have some interventions at my homebirth. I don't think they were absolutely necessary, but I don't regret them. I had oxygen; I don't know if that helped or not. I also asked the midwife to reach in and yank the placenta out because an hour after the birth, I was still having contractions that were just as painful and frequent as the labor contractions and the baby didn't want to nurse so the placenta was not coming out. She reached in and pulled, and it all came out in one piece and the pain stopped.

[doctorjen]

I think Pam's reply is right on. There are some clear cut cases where intervention is best for everybody (cesarean birth for complete placenta previa for example) and some clear cut cases where no one is helped by an intervention (episiotomy for all first time moms for example.) Much, much more common, though, are the grey areas where decisions need to be made. Then, it is important to know that the risks and benefits to YOU are being accurately described, and that any decision is left in YOUR hands. It is important that the birth attendant you've chosen can be trusted to be truthful, and is known to trust birth.
I've seen lovely births with any of the above interventions used appropriately, and I've seen traumatic, unnecessarily medicalized births were no intervention was needed, but many happened anyway.

[Moon Faerie]

I had AROM. I'm curious now what others opinions would be, since no one could think of a reason for AROM. I'm 100% comfortable with the decision, so don't worry about hurting my feelings.
Once I hit active labor, things went super fast. I got to the birth center, and was only 2 cm, and Lauren was born 1.5 hours later. Things got intense really fast, and I was laying down because I was feeling so queasy. All of the sudden, I felt something coming out. (This was pretty funny because I was fully dressed still, so she was pulling my pants off. The panties I had on we never did figure out where they ended up.) The bag of water was bulging out ahead of her. I was pushing but not making much progress. Lauren's heartrate dropped into the 40s and wasn't recovering. My midwife broke my water, and Lauren crowned with the next contraction and was born with the following one. The cord was wrapped super tight around her neck 3 times and she did need oxygen. She was only away from me for about 10 minutes.

[AnnMarie]

It depends on each person's situation. Sometimes they are all necessary. As long as the woman is informed and makes the choice she feels comfortable with then I think it's the right choice. I do have to say though that there are far too many unnecessary c-sections, usually do to too many doctor interventions. Why more women don't educate themselves and stand up and say no I'll never understand though.

[AnnMarie]

Originally Posted by Greaseball

-pitocin
Can't think of one. I might prefer a c-section over a pit-induced birth. Wait, I've got one: if there is postpartum hemmorhage, or if the placenta is very stubborn, pitocin can help stop bleeding and expel the placenta.

When the baby is in distress and your fluid is low and you are "overdue" and the baby is better off coming now than later, I can see it. That's what happened with my second birth. I was pressured to do the same with my next two births and declined.

-epidural
During a c-section.

During a mismanaged pit induced birth. When you are so afraid of the hospital because of past births that the fear is making your labor unproductive. (Baby #3 from fear after baby #2.) I wasn't getting anywhere, had the epidural and just a short time later I was pushing.

[pamamidwife]

I would be really leery of making absolute comments about one intervention vs another (well, except for routine episiotomy!!). Really, that places judgement on a person.

What was asked was when an intervention is ok. There are LOTS of times when it is ok - not by the AP/NFL jury, but when it is chosen by the woman and her care provider together as the next best option to take.

I've been at really, really long births where women are tired and exhausted to the point of their body and uterus not "working" properly. With some of these women, we've stayed home, inserted an IV, gave some herbs to sleep and viola! They woke up an hour later, refreshed, their uterus contracting differently and then they have a baby. Other women in the same scenario choose to go to the hospital, get pitocin to see if that helps (as well as breaking water or getting an epidural sometimes).

We can never really say that one intervention isn't completely necessary. While we may think that we'd never choose it, that's fine. But to say across the board that it isn't necessary is really coming from a place of judgement without being in those shoes.

I think any choice a woman makes in labor needs to be accompanied by as much information as possible - and it needs to be her decision alone.

Like docjen said, it's the interventions that are done because they are "routine" and women are not told why they're done or what the risks/benefits are that are NOT ok. What we're talking about here is empowerment of a woman to make choices - informed choices - not really about the intervention themselves.

[stafl]

What Pam and DocJen said! It was my personal opinion that interventions were always wrong and bad that made my intervention-laden first birth experience even more traumatic for me. I spent a very long time blaming myself because I had bought into the idea that I could avoid all that just by being educated and saying no to interventions. It's not that easy, and doesn't work that way when you are in the hospital, scared to death already, and they play on your worst fears to scare you into agreeing to things you had already decided against.

Interventions aren't always such a horrible thing. It's when "informed consent" involves neither information nor a choice in the matter that medical interventions are wrong.

[faythe]

There are no absolute right or wrong decisions with the interventions you've listed. Things can change quickly at the end of a healthy pregnancy, even during labor, and your best preparation is to educate yourself and have an educated, strong advocate who can discuss things with you and your caregiver as they're happening.

It's nice to have an idealized birth experience, but don't forget the whole purpose of it - the baby. You didn't get pg to give birth, you got pg to have a baby. Don't lose sight of that, either now or after the baby is born, perhaps not exactly the way you had planned. If you decide that you won't have an epidural or a c-section and you end up with both then you'll spend months (or longer) regretting your birth experience when it's really not necessary.

Having had all my babies in different ways (c-sec, medicated vbac and unmedicated vbac) I have the luxury of looking back at all my options and seeing that in the end, 4+ years later, the way my girls were born doesn't really matter.

[stafl]

OT

Originally Posted by faythe

Having had all my babies in different ways (c-sec, medicated vbac and unmedicated vbac) I have the luxury of looking back at all my options and seeing that in the end, 4+ years later, the way my girls were born doesn't really matter.

FYI - this is a very hurtful statement to make to someone who may have had a very traumatic birth experience. It DOES matter how my daughters were born! I will suffer PTSD probably the rest of my life because of what happened when my oldest was born. Four years is no amount of time, and doesn't lessen the trauma I still feel every time I think about it. Good for you that you weren't that effected by your cesarean, but many women are. The very worst thing you can tell them is that all that matters is a healthy baby. Statements like that invalidate our feelings. The sort of grief I feel about the loss of the birth I wanted does not go away with time, it just gets easier to deal with those memories.

[Greaseball]

It does matter how my children were born. I wanted a birth as well as a baby. I wanted a birth experience I could look fondly upon. If I didn't get it the second time around, I would have had another baby. I don't care if that makes me shallow. If all I wanted was a baby, I could adopt or foster. But I wanted to experience a pregnancy and an ideal birth.

How many of us walked on the stage during our high school or college graduations, even though really it was the piece of paper that mattered? Or had a nice ceremony during our weddings instead of just going to city hall? Some rites of passage are so vitally important to us.

[waxwoman]

Originally Posted by AnnMarie

When the baby is in distress and your fluid is low and you are "overdue" and the baby is better off coming now than later, I can see it {Pitocin}. That's what happened with my second birth. I was pressured to do the same with my next two births and declined..

But how low is "low" fluid? How "overdue" is "overdue?" I have information about a study out of Harvard that showed that low fluid, absent signs of fetal distress, is NOT a good medical cause for induction, and they consider "low fluid" anything less than 5 cm. Many care providers use 10 cms as a cut off. And what is "overdue?" Again out of Harvard...average first pregnancy is 41 weeks 1 day, average subsequent pregnancy is 40 weeks 3 days. Research showing the dangers of going past 42 weeks is from 1958 and has LOTS of problems with it. More recent research does not reproduce its results.

Other than post-partum Pit for hemmorhage, I've got a problem with Pitocin--if a baby is already in distress, why add to the distress with Pitocin? If the baby isn't in distress, why do you need to speed things up?

Jenn

[faythe]

Originally Posted by stafl

OT
FYI - this is a very hurtful statement to make to someone who may have had a very traumatic birth experience. It DOES matter how my daughters were born! I will suffer PTSD probably the rest of my life because of what happened when my oldest was born. Four years is no amount of time, and doesn't lessen the trauma I still feel every time I think about it. Good for you that you weren't that effected by your cesarean, but many women are. The very worst thing you can tell them is that all that matters is a healthy baby. Statements like that invalidate our feelings. The sort of grief I feel about the loss of the birth I wanted does not go away with time, it just gets easier to deal with those memories.

I'm sorry your experience was so traumatic to you. I certainly didn't intend for my statement to be hurtful. You shouldn't have to suffer PTSD, though, there are treatments available.

Perhaps we are just moving through the stages of grief at a different pace. I'm at the point where they could have pulled my girls out through my nostrils and I wouldn't care, just so long as we are all healthy. I also got advance warning that things were not going to go as expected or hoped for, more than 2 weeks in advance. I'm sure it's more traumatic to have everything turned upside down at the last minute.

[bri276]

Originally Posted by faythe

There are no absolute right or wrong decisions with the interventions you've listed. Things can change quickly at the end of a healthy pregnancy, even during labor, and your best preparation is to educate yourself and have an educated, strong advocate who can discuss things with you and your caregiver as they're happening.

It's nice to have an idealized birth experience, but don't forget the whole purpose of it - the baby. You didn't get pg to give birth, you got pg to have a baby. Don't lose sight of that, either now or after the baby is born, perhaps not exactly the way you had planned. If you decide that you won't have an epidural or a c-section and you end up with both then you'll spend months (or longer) regretting your birth experience when it's really not necessary.

Having had all my babies in different ways (c-sec, medicated vbac and unmedicated vbac) I have the luxury of looking back at all my options and seeing that in the end, 4+ years later, the way my girls were born doesn't really matter.

I really don't have some perfected idealized picture of what I want birth to be like (of course, we all envision things going wonderfully). I'm not going to be laying there saying "No c-section!" if the baby isn't doing well. In fact, the one piece of advice about labor that I've held on to the most is, it's only a few hours in the scheme of things.
I still have another 2.5 months, so I'm just trying to become as informed as I can so that I know what's going on with my body and my baby.
At the same time, a horrible birth experience IS traumatic, obviously I've never given birth before but I've had a really horrible experience that only lasted a few hours but gave me some mild post-traumatic stuff to deal with for months, maybe even years afterwards.
I've had two miscarraiges before this (so far) successful pregnancy and believe me, the birth is NOT about me. I would do whatever, suffer whatever, to bring a healthy baby home. But it doesn't mean I shouldn't learn about what's going to happen beforehand!

[faythe]

Originally Posted by Greaseball

It does matter how my children were born. I wanted a birth as well as a baby. I wanted a birth experience I could look fondly upon. If I didn't get it the second time around, I would have had another baby. I don't care if that makes me shallow. If all I wanted was a baby, I could adopt or foster. But I wanted to experience a pregnancy and an ideal birth.

How many of us walked on the stage during our high school or college graduations, even though really it was the piece of paper that mattered? Or had a nice ceremony during our weddings instead of just going to city hall? Some rites of passage are so vitally important to us.

I find this slightly amusing. The only reason I attended my hs and college graduations was because my family wanted me to do. Ditto on the wedding, I would have been happy to go to city hall.

I've never thought of birth as a rite of passage. Pregnancy, yes, becoming a parent, yes, but not child birth.

It sounds like you got your ideal, and I'm happy for you. I never did, there was always something unexpected that came up and changed the playing field.