Tuesday, November 22, 2016

The Risks and Benefits of Birth Interventions

Birth is normal. It is a healthy physiological process that most every woman goes through in her lifetime at some point. For thousands of years, women have birthed their babies just fine without much hazard. It was simply a part of life. Today however, birthing has become largely a technological and pharmaceutical event. Now, more than ever in history, women have abundantly more options available to them during labor and birth. What many fail to realize is that with all that technology comes a greater responsibility for understanding the risks and benefits of the available options.

Birth interventions have a time and a place where they are useful tools in the delivery room. At some point, all of them have the ability to save a life. However, they are not risk free for every woman just because they are lifesaving in a handful of rare situations. Furthermore, unwarranted use of them can cause serious harm, which is why they should only be used with serious medical justification.

Interventions all carry risks and benefits. They are not always bad - they are simply tools, and nobody should ever feel judged because they chose or consented to one or many.  However, when discussing risks and benefits, it’s important to note that the evidence shows there are more risks than benefits most of the time. Women have a right to know and understand the risks, benefits, and alternatives of proposed treatments in labor. Without this information, she simply cannot make an informed decision.

There is so much to know about basic physiological birth. In addition, all of the available birthing options women have make comprehensive childbirth education quite an undertaking. The risks and benefits of birthing interventions change as labor progresses, so it’s not enough to simply study a chart explaining the risks and benefits of each procedure.

For instance, AROM (artificial rupture of the membranes) carries ricks to the mother and baby. The primary concern is the risk of infection because breaking the water opens the womb to bacteria. However, those associated risks change as labor progresses. When a woman is just starting to labor, breaking her water carries a lot more risk because she is likely going to be in labor a much longer time, providing more opportunity for bacteria to cause infection. If a provider wishes to break the water as a woman is pushing, the associated risks go down because the birth is imminent. In a clinical sense, the list of risks is the same, but the actual risk is much different. To further complicate things, a woman’s GBS status adds an increased level of risk when discussing artificially breaking the waters, regardless of when it’s being done.

Another example of how intervention risk is always in flux is with the use of epidural anesthesia. Epidural risks are well known. They include immobility in bed, catheter placement, increased use of of pitocin, increased risk of cesarean, drop in blood pressure, lower APGAR scores in baby, and so on. The evidence shows that having an epidural placed early in labor greatly increases a mother’s risk of  needing a cesarean. As labor progresses, that risk goes down. At 7-8 cm, a mother is less likely to need pitocin, less likely to become infected from the catheter placement (because it’s not in as long), the baby is likely to be in a better position in the pelvis (because they’ve been navigating the pelvis throughout labor), and so on.

However, epidurals may have tremendous benefits when, for instance, mothers have out of control high blood pressure. Epidurals are well known to drastically drop blood pressure. It can also be useful in some cases of sexual abuse survivors. Birth can cause a woman’s body to tense up and resist any activity involving the same organs where her abuse took place.  In some cases,  using an epidural allows a mother to have a vaginal birth because the associated organs cannot feel what is happening however the risks still apply, but in some cases such as these, the choice is between a cesarean or epidural. So it’s well worth it to consider whether the benefits outweigh the risks.

Simply memorizing a bulleted list of benefits and risks associated with each intervention cannot possibly give you the whole picture. The best thing you can do when preparing for birth in a medical facility is to take a quality independent childbirth class. A hospital class does not cover everything. Consider hiring a birth doula who can support your labor, help you focus on your desired plan, and help you navigate the fluctuating risks and benefits of available labor interventions.

Birth interventions are not bad - they are simply tools. And it’s your responsibility to be informed to the best of your ability before birth about all your available options.

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