Aim to Limit Interventions

May 05, 2017

Aim to Limit Interventions

I know its been awhile but I have been busy anticipating the birth of my client's baby. By the way, it was an amazing experience! I will post a separate blog about it :)

In my downtime, I love to read! Learning and teaching is a passion of mine. Due to my passion of teaching. I want to share an article I came across. It's from a trusted organization called ACOG (American Congress of Obstetricians and Gynecologists).  In February, ACOG released a list of new childbirth recommendations to aim to limit interventions. Over the years I have learned, all interventions aren't good interventions depending on the circumstances. The list of recommendations include: allow women to move/change positions, use intermittent fetal monitoring, support natural methods of pain relief and coping, let women push on their own accord, allow hydration and oral intake during labor, allow first time mothers a 1-2 hour rest period after dilation (before pushing), women do not need to be admitted to the hospital before active labor, continuous support during labor, and routine amniotomy. 

Of course, I have some input about some of the recommendations because they can seem a bit broad. Because I am a NICU nurse, I have witnessed some pretty scary situations due to lack of education/knowledge regarding childbirth. In order to have safe labors/deliveries education is key.I truly believe these recommendations are amazing but all women do not fall into the category to follow these recommendations. 

Use Intermittent Fetal Monitoring

Using intermittent fetal monitoring is great! Love the idea especially with women who want to take advantage of moving around/changing positions. Moving/changing positions allows the baby to move into optimal position for labor, helps with coping with pain, etc. With intermittent fetal monitoring their should be a protocol for how often the baby's heart tones should be checked especially with contractions/during pushing to see how the baby is responding to such stress. High risk pregnancies are of major concern for me as unforeseen circumstances that place quickly. In my opinion, using intermittent fetal monitoring can be done safely but there would need to stricter protocols in place ie. how often heart tones should be checked, what diagnoses qualify (mom/baby), etc. Can someone invent an effective wireless fetal monitor so women can be mobile! I honestly believe this can be done safely for all women and their babies. 

Do Not Admit Women to the Hospital Before Active Labor

Being admitted to the hospital before active labor can lead to unwanted interventions ie cesarean section, forceps/vacuum use, pitocin, and epidural. It is best to wait until you are in active labor to be admitted to the hospital unless there are other medical issues such as pre-ecclampsia, concerns with the baby, known medical conditions with mom and/or baby that may need to be monitored before active labor. These would be some exceptions to the recommendation. If you are healthy mom/baby with no complications it is best to stay home in your environment to help labor progress naturally on its own. Once you are in active labor call your doctor and/or midwife and head to the hospital or birth center. If you know beforehand you want an epidural, this is still an option even in active labor. If you want limited interventions stay home relax, eat, stay hydrated, take a shower/bath, and sleep. 

Routine Amniotomy

Routine amniotomy (breaking the water) is questionable. In my opinion it puts both the mom and baby at risk for infection especially if there is a prolonged rupture of membranes. In this case, both the mom and baby are being watched for signs of infection and may need to be started on antibiotics depending on the protocol. Breaking the water should happen naturally or in a case of emergency. If the bag of water should be done there should also be protocols in place such as making sure the baby is engaged enough where there won't be a prolapsed cord (emergency situation) and vaginal checks should be limited to the bare minimal. 

Continuous Support During Labor

Having continuous support during labor whether its your spouse, family, doula, or a combination of all is great to have. Just having someone supportive there for you during such an emotional yet exciting time is needed. There are great benefits of having continuous support. Having a doula present can reduce the need of interventions, respite for your loved ones, and someone who has unlimited amount of tools, education, and love to get you through whether its natural birth, medicated birth, home birth w/ a midwife, birth center, or planned cesarean. If you have never thought about having a doula, today is the day to contact me to learn more about how I can assist you and your family to have a satisfying birth experience. 

If you're interested in reading the research article regarding continuous support for women during childbirth click the link below: 

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth

As always, I welcome your thoughts and opinions :) 

Infused with Love, 

Tunisha 

 




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