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Natural Birth
savish
member
When do I know when intervention is needed
savish
member
It's very important to me to have a natural birth, I would like to do everything in my power to have one! The laws in my province are crappy.. home birth is illegal and midwives cannot practice here. I did find myself a doula who has actually worked with my OB before, he even delivered her two girls! (very small town haha) He is also my MIL and SILs doctor as well, so I know from them that he is very pro induction and seems to give out a lot of c-sections.. Just wondering what a situation would be where I would need surgery? I of course want what is best for my baby but I want to know when it's okay to refuse procedures. I was thinking staying home as long as possible before delivering may help with pressure for intervention.
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Re: When do I know when intervention is needed
This is the advice that my doula gave me before my son's birth. Before agreeing to any intervention, ask three questions. 1. What happens if we do this? (what are both the benefits and risks?) 2. What happens if we do not do this? 3. What happens if we wait? The doctor's answers to these questions will give you a lot of insight as to how urgent the situation is. Something that would require an emergency C-section would be something like a prolapsed cord. That would absolutely require immediate and emergency intervention. Another option would be if your baby went into distress. If your membranes have ruptured and you begin to show signs of infection, that is another reason to perform a C-section. Obviously in a true emergency I would hope that my doctor would use the words, "If we do not do this you or your baby are likely to die." That gives you all the information you need.
My goal for my births is to have the RIGHT birth for US. Ideally this would be a non-medicated delivery. In my son's birth, interventions were needed and I have no regrets. We used the interventions thoughtfully, and for medically necessary reasons. The interventions that are available are wonderful tools that allow us to have our babies more safely when they are used correctly. It's when they are abused that you find skyrocketing complications and c-sections. Good luck!
The pp has some good info. Our Bradley instructor told us to ask basically the same questions if there was an intervention.
That being said, birth is emotional and deciding in 4-5 min seems so very fast sometimes. I think being very prepared (and DH being prepared) through an extensive natural birth class will help you more than anything to feel confident in your decisions.
...baby #3 is here...
a lot of women end up with c-sections due to the baby being "in distress" this is usually shown by dips in the baby's heart rate. this happened with my DS. As soon as I noticed the dip I changed positions until I found one baby was more comfortable in and continued laboring there. you need to be informed on situations that warrant c sections. many doctors will claim "failure to progress" if you aren't progressing at least 1cm/hr, unless the baby is distressed, your membranes have ruptured AND there is a sign of infection, be prepared to ask to continue laboring. many doctors give pitocin or attempt to offer c sections to "speed things up", be prepared to take as much time as you like, and realize that there are definitely certain situations where a C section is necessary, and situations where the doctor just doesn't want to sit there all night while you labor.
I think laboring at home for a while is a great idea.
I know I am just going to try and be as knowledgeable as possible about the different situations in which they will try to intervene and know which ones are actual emergencies.
I would really like to hear some first-hand experiences from people that have refused certain interventions and how that went over with the doctors and how it turned out.
This isn't exactly what you are asking, but along the same idea of asking questions. I was fully dilated and ready to push when my MW asked me if I wanted her to break my bag of water before I got out of the tub. I asked her what the advantage to this was and she said, "So we don't get sprayed in the face!" Then she went on to say it was fine if I refused, they would just hold up towels when I started pushing. Even though I felt kind of bad (I certainly didn't want them to get sprayed) I refused and she was fine with that. I think my L & D nurse was excited that I declined because she said, "I've never seen a baby born in it's sack before!"
First, I would recommend finding a new OB if you know that yours is big on interventions. You want to be able to trust your care provider and not have to be on the defensive during labor. I changed providers at 24 wks. It's not impossible to find an OB that is supportive of natural birth. Also, avoid continuous fetal monitoring if possible, since there is a strong correlation between continuous monitoring and csections. Also, keep moving!
That being said, despite all our preparation through Bradley courses, I did not end up with a natural birth. My water broke 2 weeks early, and I was not able to get to active labor on my own. I refused frequent cervical checks ( to prevent infection), fluids when my temperature went up slightly, and continuous monitoring (until pitocin). We ended up refusing pitocin at first despite it being 24 hrs after my water broke. Then we made the decision to start it. I also ended up asking for an epidural, because of how insane pitocin made my contractions. I requested that the epi be turned off before I started pushing. Despite labor not going according to plan, I still ended up with a vaginal delivery 38 hours after my water broke. Most OBs would be talking Csection after 12 hours when your water is broken. Part of the reason I didn't end up with a cs is because our OB was incredibly supportive of our wishes. Another reason is that we were extremely knowledgeable about interventions and were able to make confident decisions along the way. Just go into it as knowledgeable as you can, and like others said make sure you ask all the right questions...especially what happens if I do nothing? Good luck!
That said, you should try to discuss your reasons for refusing something with your OB and let it spark a conversation. If you feel pushed around by a nurse or resident, ask to speak with your own doctor. You always have the right as a patient to say no.
After pushing for 3.5 hours I was getting tired, LO was starting to show signs of destress (accelerated heart rate) and I couldn't seem to progress any further. My dr was concerned about LO's heart rate and said that if I didn't deliver soon we'd have to discuss a vaccum delivery or other intervention. I immediately thought of my Bradley classes and asked what I could do first to try to deliver before resorting to the vaccum such as using a cath to empty my bladder (all attempts to empty it on my own failed due to the position LO was in). My dr agreed and used a cath to empty my bladder (200cc's!). After cathing I was allowed to push and LO was out in 30 minutes.
Laboring at home as long as possible is a great plan. We waited until I hit all of the "right" signs and had our doula and nurse's line saying to come in. Alas, I was nowhere near delivery (it turns out baby was OP which leads to long, wacky labors), but I...
-refused any sort of meds to speed up my labor (to the point of leaving the hospital after 20 hours there at my OB's suggestion)
-minimized internal exams to the point that I asked for a bedside sonogram to check if baby was OP versus an internal (different OBs approached my refusal of most internals differently. During labor, 1 was fine with it,1 expressed concern, and 1 was high-pressure/nasty about it)
-did most of my hourly intermittent monitoring but delayed some of it to stay in relaxation mode (that tended to make the hospital staff unhappy).
-initially refused Pitocin after baby was delivered. The Dr was not happy with that choice and wouldn't you know it but a minute later she got "very concerned about hemmorage" and said I really should have it. I agreed to it. Wouldn't you know it, but there is no evidence of abnormal blood loss in my hospital records.
-refused to have baby bathed so the vernix could stay on him. One post-partum nurse wwas VERY high pressure about this. She went to far as to try to trick us into letting him go for a bath, appeal to DH, etc.. It was wacky. We had to get extremely firm with her and tell her not to bring it up again.
There is a lot more to weighing interventions than just c-sections. Ultimatley, at 55 hours into labor I did elect an epidural to faciliate some things to try to turn baby so he would descend rather than face maternal exhaustion and the c-section that the Dr was starting to push. I agree with asking yourselves the questions that PP mentioned. For me, it wasn't a decision out of urgency but out of weighing the costs and benefits privately with DH and our doulas on our own timeline. I was bummed to elect an intervention, but in retrospect everyone agrees with what we felt at that time--that it was an educated, medically beneficial decision. My labor ended up being 63 hours and DS turned OT and had a nuschal hand, so between all of that and the OB on-call's track record of being c-section happy, that was a "win". This OB was telling me I would need a c-section and couldn't do it vaginally during my 3 hours of pushing. When his head showed, she was shocked and unprepared, LOL!
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