Medical Interventions

This will describe some of the different medical procedures that can occur in labor and delivery.

Induction:

1. Oxytocin Also knows and Pitocin and Syntocinon which are given via an I.V. Pros: Having your baby on a schedule, probably a faster delivery Cons: A "cascade of intervention." Basically, once you start a labor with intervention, it's more likely that more intervention will be used as your labor progresses. Sometimes, this leads to an unnecessary C-section. Many studies have shown that there is an increased risk of C-section when labor is induced medically. The likelihood of needing a C-section after induction depends on many factors. You are most likely to have a successful induction if you have given birth vaginally before, your cervix is ready for labor and you have begun to dilate. Keep in mind that this means you'll probably go into labor soon anyway! The chance that an induced labor will end in Cesarean is greater for a first time mom with an unripe cervix, meaning it is firm and long and has not dilated at all. Fetal distress, Abnormal labor, Painful labor fetal heart abnormalities (slow heart beat, PVCs and arrhythmias)low APGAR scores, neonatal jaundice, neonatal retinal hemorrhage, permanent central nervous system, or brain damage, fetal death

2. Prostaglandin: Also known as Cervadil or Prepidil Suppository given by inserting into the vagina. This medication is used to help prepare your cervix (the lower opening of the womb) for labor and delivery. It is used in women who are having a normal pregnancy and who are at or near their delivery due date. Dinoprostone is a natural substance that your body makes in preparation for labor. It relaxes and softens your cervix (cervical ripening) to allow the baby to pass through the birth canal during delivery. Cons: All medicines may cause side effects, but many people have no, or minor, side effects. No COMMON side effects have been reported with Cervidil inserts. Seek medical attention right away if any of these SEVERE side effects occur: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); severe stomach or pelvic pain.

1. Artificial rupture of the membranes or Amniotomy breaking your bag of water (amniotic sac) by inserting what looks like a crochet hook via the vagina to break the amniotic sac. Pros: Enables care practitioner to insert an IFM (Internal Fetal Monitor) if he or she does not feel that the External Fetal Monitor is giving an accurate reading,If there is concern about fetal distress, this allows care provider to view the amniotic fluid to see if there is maconium, Progress dilation, May help move labor along Cons: Increased chance of cord prolapsed, The baby no long has a cushion of fluid which helps him or her shift and move easily to adjust in the pelvis to find the best fit for the head to apply pressure to the cervix, Increased chance of cord compression, Increase chance of introducing infection with the protective barrier gone, Labor contractions are often perceived as much more painful once the water has broken, The “time clock” starts, Increased risk of Caesarean section

2. Stripping the Membranes: A doctor or midwife can strip the membranes to possibly induce labor. This is also called a stretch and sweep. The cervix is gently stretched with a finger. Then the finger is swept between the cervix and the bag of water. Pros: May stimulate labor. Stimulates the release of prostaglandin hormones which may soften the cervix to prepare it for labor. Pros: May induce labor naturally Cons: Membrane stripping comes with the risk of rupturing the amniotic sac. If the amniotic sac ruptures, the woman, if planning on having a hospital birth, will more than likely have to go to the hospital immediately, A woman who has an infection called Group B Strep. Although some research suggests otherwise, women who have GBS infection are cautioned not to have their membranes stripped as the possibility for spreading the infection, A woman who is cautioned not to deliver vaginally, A woman who has placenta abnormalities, It requires a vaginal exam in order to perform this procedure – along with all of the physical and emotional risks associated with vaginal exams, It is uncomfortable – with many women complaining that it is even painful, Women are more likely to report negative effects after having membranes stripped – bleeding and cramping are common side effects

Pain Medication:

1. Epidural The area will be injected with pain relief and a needle will be inserted into the lower back, then a catheter is inserted and the needle is withdrawn. Pain medication is administered through this catheter. Pros: Allows you to rest if your labor is prolonged,by reducing the discomfort of childbirth, some women have a more positive birth experience,Normally,an epidural will allow you to stay alerted and remain an active participant in your birth, When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue, an epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience, the use of epidural anesthesia during childbirth is continually being refined, and much of its success depends on the skill with which it is administered,If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery. Cons: Epidurals may cause your blood pressure to suddenly drop. For this reason, your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen, you may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect. If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space can be performed to relieve a headache, after your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop, you might experience the following side effects: shivering, a ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating, You might find that your epidural makes pushing more difficult and additional medications or interventions may be needed such forceps or cesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases, for a few hours after the birth, the lower half of your body may feel numb. Numbness will require you to walk with assistance, in rare instances, permanent nerve damage may result in the area where the catheter was inserted, though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries, and episiotomies.

2. Narcotics Also known as Opiates can be administered as a shot into a muscle or through an I.V.

Pros: Getting the pain medication during labor intravenously gives you relief more quickly than an intramuscular injection. Intravenous pain medication during labor also wears off faster. After an intravenous injection a mother usually feels some relief within 5-10 minutes; this relief may last around an hour. Intramuscular injections, on the other hand, typically take half an hour to an hour to reach full effect, but the relief may last 3-4 hours. Systemic medication can cause a variety of unpleasant side effects, such as drowsiness, dizziness, and disorientation. Because of this, you'll have to stay in bed. Some of these drugs may also cause nausea and itchiness, Women using systemic medication are less likely to end up needing Pitocin or a delivery assisted with forceps or a vacuum than those who get an epidural. It's easier and less invasive to be given an IV or an injection than it is to have an epidural or a spinal block, and it doesn't require an anesthesiologist. Cons: Electronic fetal monitor tracings of babies whose mothers received narcotic pain medication during labor show heart rate patterns that differ from normal. Babies’ brain wave tracings (electroencephalograms – EEG) change, as do their respiratory movements. Depending on the type, dose, and timing of the pain medication during labor, babies born under the influence of narcotics sometimes show respiratory depression and require temporary assistance to stimulate their breathing. They may also be a bit groggy as they first enter the world. Bonding may be affected; a drugged mother and a drugged baby don’t make a good first impression on each other. These newborns are also slower at learning how to breastfeed. Narcotics given during labor have been detected in babies’ bloodstreams up to eight weeks after birth.

3. Spinal Block The medication is injected into the sac of fluid below the spinal cord in the lower back and typically takes effect within minutes. A spinal block is commonly combined with an epidural block during labor. Pros: Complete pain relief kicks in after only a few minutes, In contrast to systemic narcotics, only a tiny amount of medication reaches your baby.

Cons: You have to stay in an awkward position for five to ten minutes during the procedure.

You need an IV and continuous fetal monitoring. Depending on the medication, you may or may not maintain muscle strength, which means you may or may not be able to get around, even with assistance. At any rate, many obstetric caregivers will want you to stay in bed once you've had a spinal block.The reduced sensation may make it harder for you to push your baby out, which can make the pushing stage longer and increase your odds of needing a vacuum extraction or forceps delivery (which, in turn, raises your risk of serious lacerations). The appropriate dosing of drugs can minimize this effect, however.The drugs may temporarily lower your blood pressure, reducing blood flow to your baby, which in turn slows his heart rate. (This is treated by giving you IV fluids and sometimes medication while you're in labor.)If a narcotic is used it can cause itchiness, particularly in your face. It may also bring on nausea – though this is less likely with a spinal than with systemic medication, and some women feel nauseated and throw up during labor even without pain medication.In rare cases, a spinal causes an uncomfortable tingling sensation in your legs or buttocks that lasts a couple of days.The spinal can cause some soreness for a few days at the injection spot.In 1 in 100 women, a spinal causes a bad headache that may last for days. In very rare cases, a spinal affects your breathing, and in extremely rare cases it causes nerve injury or infection.

1. Episiotomy: An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening. Pros: When used properly, episiotomy can prevent more extensive childbirth injury. A single cut edge is easier to surgically repair than an extensive jagged edge, or multiple jagged edges. Episiotomy can shorten pushing by 15-30 minutes, critical in the case of fetal distress and helpful with maternal exhaustion. The use of episiotomy in difficult births, such as shoulder dystocia (trapped shoulders), can prevent permanent and disfiguring injury to the baby. Proponents of routine episiotomy believe it can lessen stretching of vaginal muscles, which can result in long term laxity. Cons: Episiotomy used routinely can result in unnecessary trauma. Specifically, the incision may be more extensive than a small tear and certainly more extensive than no tear. This results in more bleeding, especially with mediolateral episiotomy. Healing after episiotomy is painful and can result in painful intercourse. Opponents to routine episiotomy believe that the stretching of the vaginal muscles have already occurred prior to the time of potential episiotomy, and that the performance of an episiotomy is of no help to prevent vaginal muscle laxity. Kegel exercises before and after childbirth best protect vaginal muscle integrity.

2. Cesarean Section (c-section) A c-section, or cesarean section, is the delivery of a baby through a surgical incision in the mother's abdomen and uterus. Pros: A mom will know in advance, if it's a planned C-section, when she will have the baby, knowing that you may have important resources available, like neonatologists who can help if there are issues with the baby. The procedure also helps is the preservation of the vagina. Having a vaginal birth is thought to change everything. With vaginal birth, a woman will tend to feel “looser”, experience urine leakage and even the incapacity to manage bowel Another advantage to acquire from cesarean section is the prevention of pain from labor. Contractions during delivery and labor are recognized to cause severe pain, which most people will choose to avoid as much as possible. Having a C-section scheduled may avert the requirement of labor unless some women will undergo the labor before the date of schedule Cons "While the process usually works very well, we are cutting into abdomen, adjusting the organs, and making incisions near the bladder and bowel."As a result, there could be damage to the surrounding organs, excessive bleeding, or an infection. The placenta could be deeply attached to the uterus because of scarring from previous C-sections, and it could be difficult to get out, which means heavy bleeding, therefore a higher chance of needing a blood transfusion, or needing hysterectomy just to save the mother's life," Hoskins says. You may not have a vaginal birth after the first c-section. He says that 40% or more of women having three or more C-sections will experience these complications, so keeping the procedure limited to those that are medically necessary could be life-saving. As the number of primary C-sections rises, so does the number of subsequent C-sections. Typical hospitalization time is 4 days and harder to recover from than a natural birth. Women who have C-section may also draw an increased risk of breathing issues for their babies. It has been recognized that vaginal delivery and the labor process helps in the development of babies’ lungs allowing them to breathe on their own once they are out of the womb. Without undergoing a labor, babies born through planned C-sections are likely to experience respiratory distress syndrome or some other breathing issues. Those premature infants also tend to develop breathing complications because of having incompletely developed respiratory organs, especially lungs.

Resources: Mayo Clinic Guide To A Healthy Pregnancy. Labor and delivery, postpartum care Harms, Roger W., M.D., et al, Part 4. Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 8. Lamaze International, http://www.lamaze.org/ American Pregnancy Association Inducing Labor https://www.babycenter.com/0_inducing-labor_173.bc Baby center Epidural pain relief for labor https://www.babycenter.com/0_epidural-pain-relief-for-labor_1489911.bc All about Episiotomy, c-sections: Giving birth by cesarean section nurturing Hearts Birth Services Stop Stripping Membranes Natural childbirth VI:Pictocin side effects and risks by Chris Kresser Cervidil vaginal Web MD Prenatal Yoga Center Truth about C-sections webmd healthresearchfunding.org Pros and cons of cesarean section