Unmedicated Hospital Birth Series: Common Interventions at the Hospital
If you are wanting an unmedicated birth, you are likely wanting to avoid unnecessary interventions. By avoiding unnecessary interventions we can also avoid what is called the “cascade of interventions”. A very real phenomenon where one (seemingly harmless) intervention leads to another, which leads to another, and so on.
There is, of course, a time and a place for interventions. A big one: epidurals! Epidurals are a wonderful resource for those who are not interested in an unmedicated birth experience. Another example might be Pitocin if bleeding is looking heavy after your baby is born.
Medical interventions are morally neutral. They are not evil and to be avoided at all costs. What’s important is having an understanding of what these interventions are, and then making the decision that feels right for you and your baby.
Upon arrival at the hospital, you may be offered:
Continuous Fetal Monitoring
Besides intake paperwork and being offered a hospital gown to wear (which you can totally decline, by the way, and wear your own clothes instead), one of the first interventions is fetal monitoring.
Some hospitals will want to monitor your baby continuously (especially for certain births, such as VBAC or births with an epidural) throughout your labor. Other hospitals will only want to monitor continuously for 20 minutes or so when you first arrive, to get a good baseline of babies normal heart rate and your contraction pattern.
I have more often seen the second scenario - a 20 minute continuous monitoring upon arrival. Ask your provider what is standard where you will be giving birth ahead of time, so you can go in prepared with a plan.
Continuous fetal monitoring involves wrapping straps around your belly to hold a monitor in place to trace your baby's heart rate and your contractions. While it can provide valuable information about your baby's well-being during labor, it can also limit your mobility and increase the likelihood of medical interventions due to false alarms.
Benefits:
Constant (continuous) information about your babies heart rate
Early detection of fetal distress, allowing for prompt intervention if necessary.
Risks:
Limits mobility during labor, potentially restricting your ability to move around and find comfortable positions
May lead to false alarms, prompting unnecessary medical interventions or anxiety for the birthing person
The false alarm piece is really something to consider. There was a study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464257/) done comparing Continuous Fetal Monitoring to Intermittent Fetal Monitoring (checking on baby every so often using a doppler) and birth outcomes. The *only* major difference in outcomes between the two groups were higher c-section, vacuum and forceps birth occurrence in the Continuous Fetal Monitoring group.
All of that to say – there is no right or wrong answer here. Everyone’s situation will be unique. It’s all very gray, and what feels right for someone else may not be what feels right for you.
There are also specific scenarios where continuous monitoring is a helpful intervention - VBAC, births with any medications on board, etc.
A cervical check
After monitoring, a cervical check is likely to be offered. The reason for this is that providers like to “make sure that you’re in active labor” before admitting you to the hospital.
However, this is *optional*, and there are other ways to check labors progression.
Contraction pattern
Birthers behavior & demeanor
Sensations being reported by birther
Benefits:
See what your cervix is doing in *that moment*
Risks:
Cervical status alone does not tell us a lot
Increased risk of infection with each check
Feeling defeated if cervix is not where you thought it would be
Being brought out of your “labor land” during check
Being put “on a clock” - Now that your cervical status is known, the expectation may be for it to be dilated to x cm by a certain time
If you are wanting a cervical check (totally valid!) that’s a good reason to get a check. If you are not, you do not have to have one.
As mentioned above, cervical status alone does not tell us a lot. This is because you can go from 5cm to complete in an hour, or you can be 5cm for several hours. It can be hard to keep this in mind, however, while you’re in labor. Often, when someone hears 5cm, their thought is “oh no, I’m only halfway” - *which couldn’t be farther from the truth, but that’s a story for another day* . You can avoid this mental turmoil by either:
Declining checks, or
Having the provider performing the check tell your birth partner/doula what they found and NOT tell you so that you stay encouraged and keep your thinking brain turned off (more on this later)
After the initial cervical check, you might be encouraged to have an IV/Saline Lock placed.
IV/Saline Lock
At this point, the next intervention suggested is likely to be an IV port - also commonly called a saline lock or hep lock. The IV/Saline Lock allows for quick access to your veins if medications or fluids are needed during labor.
While it can be a precautionary measure, it's important to discuss the necessity of this intervention with your care team, especially if you prefer to avoid unnecessary medical procedures.
Benefits:
Allows for quick access to your veins in case of emergencies or the need for medical interventions during labor
Can provide a sense of security, knowing that intravenous access is available if needed
Risks:
Being taken out of “labor land” while it’s being placed
Can restrict movement and be uncomfortable
Carries a risk of infection or discomfort at the insertion site
May require additional monitoring or maintenance throughout labor
As far as admission into the hospital, a cervical check, continuous fetal monitoring and IV/saline lock are the three you are likely to encounter. As you’re laboring, there are other interventions that may come up. One we have already talked about briefly: cervical checks.
Routine Cervical Checks
We have already talked about cervical checks upon admission to the hospital. But what about checks during labor?
Cervical checks in years passed were performed with a higher frequency than what is often seen today. It will vary from hospital to hospital, but I often see providers wanting to check every few hours.
The more cervical checks that are performed, the higher the likelihood of infection. This is one good reason to be leery about too many checks.
Another reason we’ve already talked about which is… the cervix is not a crystal ball. Cervical progress is not always linear.
The cervix can stay at one point for quite a while (which is completely normal), but if you’re having cervical checks every few hours and it’s noted that there has not been cervical change, interventions may be suggested.
These routine checks every few hours can also feel discouraging. If you are not as far as you thought you may be, or if “nothing is happening”, it can feel hard to keep following through with your goal of an unmedicated birth.
If you are wanting a check, as mentioned before, it may be a good idea to have the provider not tell you the number. They can tell your birth partner or your doula instead.
If you would like your birth partner to be the one they tell, explain this to your birth partner ahead of time. They will also need to explain it to the staff - this is not likely something they see very often! Have your birth partner use vague language, if they tell you anything at all. Make sure they know to keep a poker face and just encourage you of how wonderful you are doing.
AROM (Artificial Rupture of Membranes) or “Breaking Your Water”
“Let’s go ahead and break your water!” … wait, what? Healthcare providers may suggest breaking your water to speed up labor, and occasionally even suggest it as a “why not?”.
While this intervention can sometimes be helpful, it is definitely not without risks.
Benefits:
In certain scenarios, can expedite the birth of your baby
Risks:
Increases the risk of infection due to the introduction of bacteria into the uterus
Can lead to more intense contractions
Puts you “on a clock” - the risk of infection starts to go up after about 24 hours of waters being released
There is also one benefit of keeping your waters intact (not breaking your water), that is not commonly talked about. That is: a more gradual descent of your baby through the birth canal. When your waters are still intact, you have basically a water balloon making its way through the cervix and into the birth canal first. This allows for a much more gradual stretching of tissues than just the bony skull of your baby. This can be much less impactful on your tissues, and reduce your chances of tearing.
Pitocin
Pitocin, a synthetic form of oxytocin, is commonly used to augment (speed up) labor. Pitocin is also routinely used as a preventative for postpartum hemorrhage.
Benefits:
Can effectively augment labor, in cases of prolonged or stalled labor
Helps prevent postpartum hemorrhage by promoting uterine contractions after birth
Risks:
May cause stronger and more frequent contractions, increasing the need for pain management interventions like epidurals
Carries a risk of overstimulating the uterus, leading to fetal distress or complications during labor
Has been associated with increased risk of postpartum depression (source) https://pubmed.ncbi.nlm.nih.gov/26554749/
Pitocin is also commonly called oxytocin, but they are not the same. Moleculary, they are identical BUT - Pitocin is synthetic, and oxytocin is produced by your body. Pitocin does not cross the blood-brain barrier, while oxytocin does.
Purple Pushing
“Purple pushing” refers to coached pushing that includes pushing forcefully for a number of seconds, while also holding your breath. This is almost never necessary in an unmedicated birth.
While this pushing technique can create more forceful pushes that can bring a baby into the world more quickly, there can also be unintended consequences.
By holding your breath your baby may also not be receiving adequate oxygen levels. You may also tire more quickly, as your muscles need oxygen! Pushing forcefully and ignoring your body's cues can also make it harder for your baby to descend in an optimal position - if you are pushing before they’re ready.
If it is found that you’re 10cm and your provider starts to encourage you to push, but you are not yet feeling the urge, simply tell them you are not ready yet and you want to wait for your body to tell you it’s time.
Pro tip- tell them you wish to “labor down” before you start pushing. This refers to your uterus and baby working together to start the descent, without you consciously doing any pushing.
Fundal Massage
Fundal massage (which is not aptly named - it can actually be quite uncomfortable) is an intervention to stop excessive bleeding that is approached as a preventative measure. When there is excessive bleeding, it is a wonderful intervention, as it’s usually fast-acting and there are no medications involved. However, if your bleeding is normal, and your provider is wanting to perform a fundal massage - you have the right to decline.
If shortly after birth you hear a nurse say “I’m going to just rub your belly for a second” - ask them if they are planning to perform a fundal massage. If they say yes, you can ask if your bleeding is concerning. This can open a conversation, so that you can decide if you want to consent to the fundal massage or not.
You can also ask your provider to show you how to perform a fundal assessment on yourself.
Advocating for yourself
One question I often get is, “But will they look at me like I’m crazy for declining this?” or “Do you see clients declining this intervention often?” My response? WHO CARES. We cannot make our decisions based on what others think, or what the cultural norms are. It is vitally important that you make decisions that you understand, and feel good about.
But to encourage you a bit, here are a few things that I’ve seen clients achieve in a hospital birth…
A birth with ZERO cervical checks. Declined at admission, and baby was born a few hours later
A client who declined Pitocin for over 24 hours after their water broke and contractions hadn’t started
Multiple clients refusing the IV/hep lock
So no, you are not crazy. But let’s get past the worry that we’re “crazy”, and instead understand that we are well-informed and making decisions that feel right for us and our baby. Do your research, and trust your gut. And know that you have the right to refuse ANY intervention.
