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Intervention Intelligence
Common Medical interventions you should know about, just in case.
By Teri Shilling, MS, CD(DONA), IBCLC, LCCE, FACCE
You may be planning a natural birth, but there are times when your health-care provider must intervene for health and safety reasons. Or you may find that standard hospital practices often include medical interventions. In either situation, it’s important that you be involved in the decisions related to your care. You can do that by asking questions and openly com-municating your desires to everyone in attendance. When a medical intervention is sug-gested or presented as routine pro-cedure, ask about the benefits, risks, alternatives and whether you can do the procedure later – or not at all. Most important, trust your intuition. Everyone, including you, should stop and think before an intervention is suggested. Research shows that many times interventions are done more for convenience sake than for medical reasons. Being well-informed about the common interventions that might arise will enhance your ability to make crucial decisions. Educate yourself, communicate your preferences well in advance and stay involved in all decisions related to labor and birth. Your choices will be critical to the health and safety of you and your baby.
ELECTRONIC FETAL MONITORING
What: Electronic Fetal Monitoring (EFM) is used to evaluate uterine contractions and the baby’s response to them. There are three types of monitors. External monitors have two belts that use ultrasound and a pressure transducer. Telemetry units allow the woman more movement, so she’s not “tethered” close to the machine. If there is some reason that the above are not taking accurate measurements, internal monitors can also be used.
Why: For a long time, listening to a baby’s heartbeat has been used to assess how the baby is tolerating labor. Low-risk women can be monitored intermittently, while high- risk women may be monitored nonstop. Continuous monitoring has not improved outcomes for healthy women having normal labors; instead, it has proven to increase the rate of cesarean. And it has affected women’s ability to move and change positions as needed. There are times when continuous monitoring is necessary in low-risk women, for example, if your labor is induced or augmented with Pitocin, or if you have an epidural. If your baby’s heart rate changes, or you or your baby have a health problem, you also may be monitored continuously.
Lower your risk: The American College of Obstetricians and Gynecologists (ACOG) supports periodic monitoring (once every 30 minutes in active labor) via EFM or auscultation, which is “listening” to what’s going on with the baby and the contractions using ultrasound. If that’s not an option in your hospital or birth center, talk with your nurse about being upright (such as in a rocking chair or on a birth ball) when being monitored, as opposed to laboring in bed. Or, ask for a mobile monitoring unit so that you may continue to walk, go to the bathroom, stretch or slow dance. Try not to labor in bed for long periods. Don’t be distracted by the monitor – turn it away and lower the sound. Remind your support team to focus on you, not on the machine.
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