Medical issues to think about
There's more detailed information on the following subjects in other parts of the website, but this might be a good time to start thinking about certain issues. If you're aware of the arguments against some of these medical practices, you'll be more confident about questioning them, if you need to, with your medical and midwifery attendants.
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Generally they should be happy to go along with your wishes, but occasionally you may be told that to continue with a particular option will put your baby and you at serious risk - for instance, if your baby is showing signs of distress and you're still determined to continue with a totally natural childbirth. In this situation it's good to have an alternative birth plan ready (see It's your choice) and to be prepared to change it if need be.
This doesn't happen very often, though, so don't give in to medical intervention you're not happy about until you feel you've had proper answers to your questions. There can sometimes be intervention because midwives and doctors want to get a baby out quickly. An episiotomy, for instance, may be made necessary when you're encouraged to deliver your baby's head before the skin and muscles in your perineum have been given a chance to stretch. Given time, very few women need an episiotomy - as Michel Odent has proved.
Nothing by mouth
There's no medical or scientific rationale for starving a woman during labour. In fact, quite the opposite. Sometimes a labouring woman has a sudden need for energy and wants sugar. Other women don't feel like eating anything but they certainly need fluids; labour is hard work and uses up lots of energy, which causes sweating, and a woman must replace the fluids that she's lost through her skin. That said, if there's a high risk of a woman having an emergency Caesarean section, it's safer to give an anaesthetic on an empty stomach.
Issues about moving rooms
In most hospitals you should be able to labour and deliver your baby in the same room, without having to move. Depending on the unit, you may need to be moved to an operating theatre if you have to have an emergency Caesarean section. Otherwise, you should have peaceful surroundings, in a room equipped with good lighting, oxygen, and a suction apparatus to clear out the baby's air passages.
Induction
Starting labour artificially is not a new idea, but it only became an easy procedure in the second half of the 20th century. However, labour should only be induced for medical reasons such as pre-eclampsia, high blood pressure, or post-maturity, when induction can save the lives of mothers and babies.
Amniotomy
This means that the membranes (the bag of waters) surrounding the baby are artificially ruptured. This procedure is often referred to as artificial rupture of the membranes (ARM). It's not routine and is generally only done early in labour if the baby's heart rate is abnormal. Amniotomy is done for three reasons. The first is so that electronic fetal monitoring equipment can be set in place; the second is to check if the amniotic fluid contains meconium (this is the baby's first bowel movement and its presence may indicate fetal distress); the third reason is that once the bag of waters has been removed, the baby's head can then press hard on the mother's cervix, so helping along the dilatation of the cervix and completion of the first stage of labour.
Fetal monitoring issues
For this, a heart-rate sensor is strapped to the mother's abdomen. A low-risk mother is monitored only intermittently through her labour, although some units prefer to monitor for about 20 minutes on admission so there's a permanent record of the baby's heart rate in case of problems later on. A mother with a high risk of problems is generally advised to have continuous monitoring. Fetal monitoring should not mean a woman has to keep still. Although movement is limited, you can sit on the bed and may be able to stand. Obviously having a “window” into the uterus during labour is of great value, but machines can go wrong, and they need trained staff to use them correctly. If machines are not working properly, or interpreted incorrectly, this can lead to unnecessary intervention. Also, using a machine to monitor the baby may switch attention from the mother to the machine, which can be very upsetting for a labouring woman.
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Posted 16.11.2010
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