What do you think of when you hear the word “intervention”? You may think interventions are unnecessary, and that they’ll lead to more interventions. Or maybe you feel like they’re necessary, or that your provider needs to be the person deciding when to use an intervention. A good way to view interventions is to think about them as tools. Each of these tools has a purpose, and sometimes they’re misused or overused. Let’s look at two of the more common interventions.
You can expect that as soon as you’re admitted to labor and delivery, they’ll be wanting to start an IV. A lot of people don’t view IV fluids as an intervention but it is!
- You’ll be on continuous fluids which could inflate baby’s birth weight and cause an “artificial” drop in baby’s weight in the first few days postpartum
- You’ll be hooked up to the IV drip which means needing to maneuver around the IV line and IV pole while in labor
- The IV catheter placement could be uncomfortable, making it difficult to relax and stay relaxed
- If the IV tubing gets a bubble or is kinked, the IV pump machine will yell at everyone within earshot 😉
- Easy access to the veins via IV catheter means it is easier to give medications, allowing your provider to react quickly in the event of an emergency
- Continuous fluids do a great job keeping you hydrated, especially if you’re vomiting
- Some research suggests people receiving IV fluids in labor, and as a result are adequately hydrated, have shorter labors (by about 30 mins)
- You can request the hep lock/IV port be placed, but to not be hooked up to continuous fluids unless you ask to be, ie you’re having a difficult time hydrating by mouth, or vomiting often.
Continuous Electronic Fetal Monitoring
Many people do not view continuous EFM as an intervention. But remember, we’re reframing our thought process to see interventions as tools. Fetal monitoring is a tool. It tells providers how your baby is handling the labor process. Based on evidence, intermittent auscultation (the act of listening to the sounds of the heart) is safer to use in healthy laboring people with uncomplicated pregnancies.
Typically in the hospital setting, you’d have two straps placed around your abdomen. One strap holds in place a pressure transducer that will monitor your contractions, and the other strap holds in place a doppler ultrasound transducer to monitor your baby’s heart rate. Being “hooked up” to these monitors can limit your mobility while in labor. It’s important to note that continuous monitoring is associated with a significant increase in c-sections. You can ask for intermittent monitoring but because of the way our hospitals are staffed, it may be a bit of a challenge to advocate for this. Depending on which professional organization you’re consulting, intermittent monitoring requires assessment every 15-30 mins in active labor, and every 5-15 mins during the pushing stage. Nurses are usually not available to do intermittent monitoring at the required intervals, so it is easier to have the continuous monitoring.
In a home birth or birth center setting, intermittent fetal monitoring is standard (they also only take low-risk, healthy individuals) but keep in mind, the care team is responsible for 1-2 laboring people at a time. It’s a different atmosphere than a busy hospital L&D floor. Some local hospitals do have wireless monitors available, but they seem to always be “in use” or “broken” when clients request them.
Remember, interventions are tools and YOU should have final say when it comes to when and how any intervention is used.
You should always be informed of all the risks and benefits associated with any intervention. Whole books have been written about interventions in birth—we’ve merely scratched the surface here. We encourage research and asking questions. Have the discussions with your provider.
Stay tuned for Part 2 where we’ll discuss AROM and IV pain meds. Want a Part 3? Let us know which interventions you are curious about!