The Business of Being Born has spawned many-a-passionate birth advocate. Most of us remember the moment we watched a very pregnant Ricky Lake pushing in a bathtub, feeling a future doula/midwife rising up within us, letting out a primal cry on behalf of all mothers, fathers and babies. “We must bring an end to all medical interventions – [insert Tarzan yell]”.
In that moment, something powerful happened in many of our minds:
Doctors became the bad guys.
Midwives, with their rebozo capes and linen tights swoop in to save the day, rescuing the innocent mother from the terrorizing doctor, most certainly about to subject the mother to all sorts of unwanted and unnecessary medical interventions. This is how you felt, right?
Or maybe it was just me.
Though I am a thumbs-up supporter of The Business of Being Born [see it, if you haven’t], I feel it’s important that our readers don’t misinterpret our love of spontaneous, natural birth as a statement against all other types of births.
We are not against interventions, but rather for the education of women and their partners. When we are educated, we are truly free to make the decisions that are best for our bodies and souls, and those of our babies.
On more than one occasion, I’ve had moms reach out to me and say something to the extent of “I’d love my birth story to be featured on cord, but it’s not an intervention-free birth. Does it still qualify?”
In a word (four words, actually) – Oh my goodness, yes!
Somewhere along the way, cord got a reputation that we believe the pinnacle of birth is a natural, medicine-free birth, and that all other births are “secondary” to this goal.
This is, unequivocally, not our stance.
Let’s Get a Few Things Straight
- Do we believe that many birthing professions over-use and under-educate on interventions? You bet.
- Do we believe every use of an intervention is bad? Nope.
- Do we believe an unmedicated birth is the right fit for every mom? Nope.
Here are a few more things we believe:
- Cesareans save lives.
- Epidurals are powerful tools.
- Labor is a marathon, and over-exhaustion is a real and dangerous risk to both mom and baby.
- Some moms need help getting labor started (i.e. induction).
Inductions – Elective vs. Medically Necessary
Though a spontaneous (when labor begins on its own) labor is preferable for many reasons (less painful, progressive contractions; baby and mom are both “ready,” etc.), there are plenty of situations where moms require additional assistance in beginning labor.
Methods for Induction
- Peppermint oil
- Stripping/sweeping the membrane
- Breaking the bag of waters
- Prostaglandins (cervical ripening application) (e.g. Cytoec, Cervidil, etc.)
Possible Reasons for Inductions
- Mom is at 42 weeks with no impending labor
- Mom’s water has broken, and labor has not started spontaneously within 24 hours
- Uterine infection
- Growth issues with baby
- Inadequate amniotic fluid
- Deterioration of the placenta
- Placental abruption (placenta peeling away from uterine wall)
- Some chronic illnesses (high blood pressure, diabetes, kidney disease, etc.)
- Stalled labor and possible fetal/maternal distress
Invalid Reasons for Elective Inductions
- Mom is uncomfortable and “just ready for this baby to be born”
- Schedule convenience – either for mom or doctor
- Wanting to ensure preferred doctor is on call during labor
Reasons to Avoid Elective (i.e. non-medically necessary) Inductions
- Induced contractions (i.e. Pitocin) are more painful than natural ones.
- Increased risk of cesarean.[i] [ii]
- Increased risk of greater blood loss during labor[iii].
- Longer recovery time.
- It can lead to the dreaded “waterfall of interventions” (summary: induced labor is more painful à bring on the epidural à increased Pitocin due to slow labor from epidural use à fetal and/or maternal distress due to increase Pitocin/abnormally strong contractions often without cervical ripening à emergency cesarean).
When an Epidural is a Great Idea
Sure, we love natural birth just as much as the next crunchy blog – bring on the peppermint oil and doula pools. However, there is most definitely a time and place for the use of epidurals. Here are a few of the situations in which we are so grateful epidural exist:
- One word: cesarean. Enough said.
- Due to maternal exhaustion – mama’s body needs a break to rest and recover strength to safely push baby out.
- The pain of labor is causing severe anxiety, extreme stress or panic.
- The pain of labor may result in emotional trauma to mom (i.e. those who have suffered abuse, have anxiety/mood disorders, etc.).
Why Not Get an Epidural?
Epidurals are often touted as “side-effect-free pain relief” - unfortunately, it’s not that simple. Like any medical intervention, epidurals come with their own benefits, risks and side-effects. Here are a few reasons to consider not getting an epidural:
1. Epidurals restrict movement (hello, your legs are numb). Movement and positioning are two of mom’s most powerful allies in natural pain management and labor progression.
2. Epidurals can slow labor, specifically the pushing stage (but who wouldn't want to extend that fun stage?). Because most moms are completely numb from the waist down, pushing becomes more difficult and less effective (not to mention you’re bed-bound, decreasing your pelvic space by 33% [as opposed to squatting or all-fours positions]). In addition, moms can’t move around to help baby get in the optimal position to descend the birth canal.
3. Epidurals increase the risk of an assisted birth (i.e. requiring instruments to aid in delivery). According to the Cochrane Review (heavy-hitting medical journal), epidural babies were more likely to require the assistance of forceps, vacuum or other tools during delivery[iv]. These tools can increase the risk of tearing or requiring an episiotomy, not to mention cause trauma to baby’s head.
4. Epidurals increase the risk of maternal fever. Just over 19% of moms who received an epidural developed a fever of 100.4 or greater[v]. Maternal fever can increase both mom’s and baby’s heart rate. Because an increase in baby’s heart rate can be a sign of fetal distress, if labor does not progress quickly (see #2), additional interventions may be encouraged or required (i.e. cesarean).
5. Epidurals increase the risk of 3rd and 4th degree tearing.[vi] Because of numbness, many moms who receive epidurals are unable to engage in the act of instinctive pushing, following the body’s natural urges to push and relax. Directed pushing can increase mom’s risk of severe tearing.
Again, we are NOT against epidurals, but rather FOR informed decision-making. The decision to receive an epidural is not one that should be made lightly.
One of the best gifts you give yourself and your baby is to be informed. Educate yourself on your choices. Recognize that every decision has risks and rewards, and that if it seems too good to be true (i.e. risk-free pain relief), it likely is.
Each birth story is beautiful and unique – it forever shapes the lives of all those involved. Have a birth story you want to share – induced, epidural, cesarean, unassisted, natural, etc.? Email me atKelsey@CordMama.com. We’d love to feature you!
DISCLAIMER: WE ARE NOT MEDICAL PROFESSIONALS. EACH WOMAN AND PREGNANCY ARE UNIQUE, AND WOMEN SHOULD ALWAYS DISCUSS ALL MEDICAL OR HERBAL INTERVENTIONS WITH HER DOCTOR OR MIDWIFE.
[iv] (Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD000331. DOI: 10.1002/14651858.CD000331.pub3