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Quick reference guide for labor interventions


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  • 1 Post By Kelllilee

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  #1  
September 22nd, 2009, 08:24 PM
Kelllilee's Avatar Platinum Supermommy
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INTERVENTIONS: RISK/BENEFITS

"WHO" stands for World Health Organization

Continuous fetal monitoring (internal and external):
Risks:
  • increased likelihood of further interventions for detected fetal distress
  • Internal monitoring is more accurate, but will restrict movement more and will require water be broken, increasing risk of infection
  • Internal monitoring involves screwing a small wire in baby's head usually leaving a small scab/scar on their scalp.
Benefits:
  • Can help in indicating a problem. Generally required with certain interventions such as pitocin.
Alternatives:
  • Intermittent monitoring via hand held Doppler or small increments of time on the monitor.
Misc:
  • not recommended by the WHO and is not proven to improve outcomes of normal birth. May be a factor in rising cesarean rates.
IV:
Risks:
  • Limits freedom of movement. When combined with "no food or drink" policies, can lead to maternal lack of energy and drowsiness which can contribute to a longer labor/pushing phase
Benefits:
  • Easier to introduce medications, required with an epidural, induction, or cesarean delivery
Alternatives:
  • Hep-lock that can be hooked up to medications if necessary, but will allow freedom of movement
  • Drinking and eating during labor to stay hydrated and energized.
Induction - General:
Risks:
  • failure to progress" due to baby/body not being ready; breathing problems if dates are wrong or baby needed longer to mature; often longer/more painful labors; 2-3 times the risk of a cesarean in first time moms; not recommended to induce prior to 39 weeks for a normal pregnancy. Significantly increases uterine rupture risk with VBAC.
Benefits:
  • Beneficial if baby or mother has medical problems where the risk of an early delivery outweighs the risk of baby staying put.
Alternatives:
  • If you feel pushed into an induction, get a second opinion
  • try "natural" induction methods first such as sex, walking, acupuncture, etc...
Induction - Cervidil:
Risks:
  • nausea/vomiting; infection; small risk of uterine hyper stimulation; requires continuous fetal monitoring; abnormal fetal heart rate
Benefits:
  • ripens the cervix when not favorable for induction.
Induction - Cytotec (Misoprostol):
Risks:
  • not FDA approved for induction. Not fully studied /researched. Many cases of uterine rupture resulting in permanent harm or death to mother and/or baby including cases with no prior uterine scarring; no standard usage method exists; cannot be stopped/reversed in cases of overdose.
Benefits:
  • can help with postpartum hemorrhage
Misc:
  • used in chemical abortions and induced miscarriages
  • all providers were informed in writing not to use this drug for induction.
Alternatives:
  • Cervidil carries less risks if you need a cervical ripening medication
Induction/Augmentation - Pitocin/Oxytocin:
Risks:
  • Fetal distress; uterine hyperstimultation (which can result in rupture if not treated); increased pain reported in over 80% of surveyed mothers given the medication; increased likelihood of getting an epidural; recent study indicates a possible connection with autism (study showed among autistic children studied, there was a 3 times greater likelihood of the mother having been given pitocin in labor); disrupts the body's own Oxytocin production.
Benefits:
  • shortens labor; generally preferred method of labor induction or augmentation; can jump start a stalled labor; easy to decrease or stop dosage
Alternatives:
  • If labor is stalled, try changing positions, nipple stimulation, walking, rocking, and other natural methods for getting it going again.
Induction/augmentation - Foley Catheter:
Risks:
  • can only be used if cervix is already slightly dilated; can cause water to break prematurely (see below)
Benefits:
  • Non-chemical induction method
Induction/augmentation - Rupture of membranes (breaking your water):
Risks:
  • risk of cord prolapse (cord coming out before baby - life threatening) if done too early; increases pain of contractions; baby can become stuck in an unfavorable position, leading to further interventions or c/s; increased risk of infection; generally puts you "on the clock" for delivery within a set time frame.
Benefits:
  • can jump start stalled labor; can give warning of potential problems if meconium is present
Misc:
  • Not necessary in most births
Epidural:
Risks:
  • can slow labor; limits mobility; drop in blood pressure; bladder problems; shaking; itching; nausea/vomiting; backache and severe headaches postpartum; fever; infection; increased need for labor augmentation; prolonged pushing/ineffective pushing; increases likelihood for forceps/vacuum assisted delivery; fetal distress; drowsiness at birth; RARELY: nerve injury; death; allergic reaction; cardiac arrest; paralysis
Benefits:
  • provides pain relief for most; allows the mother to rest/sleep
Misc:
Alternatives:
  • Natural pain relief methods include: water therapy (shower/bath); changing positions/movement; hypnotherapy; massage; TENS machine; breathing/visualization techniques
IV Pain medications (Demorol, Nubain, Stadol):
Risks:
  • nausea/vomiting; allergic reaction; can slow labor; generally can only be used once (each kind); used late in labor can cause breathing problems or drowsiness at birth for newborn; many women report it makes them feel "drunk" or "out of it"
Benefits:
  • Temporary pain relief
Episiotomy:
Risks:
  • risk of tearing past episiotomy; damage to pelvic muscles; incontinence; scarring; can take longer to heal than a tear
Benefits:
  • beneficial if baby needs to be extracted quickly in cases of severe distress; used with forceps delivery; medically indicated very rarely
Alternatives:
  • Tearing naturally generally heals faster and causes less damage to the perineum.
Forceps/Vacuum:
Risks:
  • bruising to baby; usually requires episiotomy and associated risks
Benefits:
  • helps deliver a baby faster when in severe distress; can help dislodge a "stuck" baby
Alternatives:
  • Changing positions (all fours or squatting) opens the pelvis and can help a baby move through the birth canal easier.
Cesarean Delivery:
Risks:
  • infection; hemorrhage; injury to organs; adhesions; extended hospital stay/postpartum recovery; reactions to medications; possible additional surgeries if there are problems; 3-4 times greater maternal mortality rate; risks to future pregnancies including mild to severe placenta problems; premature birth if dates are wrong; increased breathing problems in newborns; lower apgar scores; fetal injury.
Benefits:
  • Life saving for mother/baby in emergencies or potentially dangerous birth situations
Misc:
Immediate cord clamping:
Risks:
  • deprives newborn of up to 50% of their blood supply; increased chance of anemia in the first 6 months

Benefits:

  • allows cord blood banking; necessary in the case of very short or tightly wrapped cords; may decrease jaundice
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Kellisa, Mama to:
Courtney, Nola, Kya, and Whitney

Breastfeeding Peer Counselor, training to be an IBCLC!




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  #2  
September 23rd, 2009, 07:15 AM
moon~maiden's Avatar Cheryl~ birth truster
Join Date: Jul 2007
Location: south eastern Mass
Posts: 13,088
Thanks so much for doing this Kelli!
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  #3  
January 4th, 2010, 06:30 PM
moon~maiden's Avatar Cheryl~ birth truster
Join Date: Jul 2007
Location: south eastern Mass
Posts: 13,088
Here is a resource of the appropriate use of interventions

Lamaze International: Appropriate Use of Interventions
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  #4  
March 22nd, 2010, 08:26 PM
moon~maiden's Avatar Cheryl~ birth truster
Join Date: Jul 2007
Location: south eastern Mass
Posts: 13,088
more info on Fetal Monitoring-

Monitoring Resources - Childbirth.org

Understanding Fetal Monitoring
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Last edited by moon~maiden; March 22nd, 2010 at 08:39 PM.
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