Healthy Birth Blog Carnival: Avoiding interventions that are not medically necessary.

Science & Sensibilty has been hosting an incredibly interesting Healthy Birth Blog Carnival, and I have decided to participate in this week’s topic. Over the course of this carnival, they have been accepting blog entries pertaining to the Lamaze Healthy Birth Practices, which is a paper outlining “…’evidence-based care,’ which is the gold-standard for maternity care worldwide.”

The topic I chose to jump in on is based on Healthy Birth Practice #4: Avoiding interventions that are not medically necessary. Those interventions include:

  • Restrictions on eating and drinking.
  • Use of intravenous fluids.
  • Continuous electronic fetal monitoring
  • Speeding up labor via artificial rupture of membranes and/or augmentation of labor.
  • Epidural analgesia.
  • Episiotomy

Rather than focus on avoiding each one of these interventions, I decided to talk exclusively about the most important action you can take, if your desire is to avoid all of these in the absence of any medical indication.

“…Lamaze International … encourages you to choose a health-care provider and place of birth that provide you with the full range of choices for your care and use interventions only when medically necessary.

~Lamaze Healthy Birth Practice #4

The number one way to avoid any medically unnecessary interventions is to choose your care provider wisely.

“A growing body of research shows that among the most important factors influencing a woman’s risk of obstetric interventions, especially cesarean surgery and episiotomy, are where and with whom she gives birth.”

~Amy Romano, Science & Sensibility

A good place to start is to learn about the different types of care providers there are, and to get a good idea of the general birth philosophy typical of each of these types.

As a general rule, the main difference between these two types of care providers lies in their “model of care.” Physicians tend to operate under a medical model of care, while midwives use a midwifery model of care.

Midwifery Model of Care vs. Medical Model of Care:

  • The focus is on nutrition, wellness, and prevention vs. Focus is on managing possible complications .
  • Labor & birth are seen as normal, physiological processes vs. Seen as a medical event needing technology.
  • Rates of intervention tend to be lower vs. Rates being higher.
  • Mother is giving birth vs. The doctor “delivering” the baby.
  • Care is usually individualized vs. Care is more standardized and based on routine.

Once you have a general idea of who you may want to turn to for care, start with recommendations from the birth professional community – not your mother’s aunt’s sister’s girlfriends “good experience” with Dr. So-and-So.

Visit the Birth Survey, and look up the names of doctors and midwives in your area to get a sketch of what you might expect from them. You can also take a look at various places of birth on this site.

You may also want to look up your local chapter of Birth Network National, and get in touch with some of the members to get recommendations for local care providers and places of birth that support and encourage natural birth.

When beginning to interview prospective providers, remember: Individual statistics matter more than words. If you ask a care provider under what circumstances he or she would use any of the above interventions, watch for specifics in their answers. A vague “only when necessary” doesn’t really cover it. It helps if your questions are specific too: “What are some medical reasons you would wish to perform a scheduled cesarean and why?” vs. “When do you do a cesarean?”

On a side-note, sort of, some physicians do not grant interviews, and will just schedule a “first prenatal,” at which they may want to do a pelvic exam. This is not necessary, and if you do not feel comfortable with this – don’t take your pants off, and pay attention to the response of the care provider. You are not obligated allow a total stranger access to your most private body parts. Period. (I’m amazed at how many women forget this…anyway…off the rabbit trail, and back on course we go!)

Remember that you are hiring someone to help you bring a new life into the world – they answer to you. It’s your vagina, and your baby. You are the one who will have to take care of your child, and live with any long-term consequences. The care provider does not.

Therefore, you should be careful in your choice. A wise woman once told me that women spend more time researching the best cell phone plan than they do researching who will help them usher a new life into the world! Don’t let that be you! Be sure you find someone whose philosophy of birth is as close as possible to your own, and make sure the place where you will have your baby is one whose policies are evidence-based.

Good Reasons to Choose a Particular Provider:

  • The caregiver’s practices are in line with the best and most current research regarding normal pregnancy and birth.
  • The caregiver practices true informed consent for any procedures that become necessary.
  • The caregiver sees their job as one similar to a lifeguard at a pool: Most of the time, they are simply eyes and ears watching carefully. Once in awhile, they have to recognize true distress, and act quickly.
  • You are able to establish a good relationship based on mutual trust and respect with the caregiver, and are treated as a participant, not a patient.
  • The caregiver’s birth philosophy is as similar as possible to your own.

Lousy Reasons to Choose a Particular Care Provider:

  • They are in close proximity to where you work or live. Convenience is not worth seeing someone who will not be on the same page you are.
  • Your aunt/cousin/sister/friend loved them. It is all too common for women’s birth philosophies to differ widely – choose who is right for YOU.
  • They are the gender you feel most comfortable with. This does not necessarily mean they will practice evidence-based care, or that you will be compatible. If you have a strong preference (which I do), make absolutely sure their philosophy and practices are in line with your needs and the latest research.
  • They are already the person you see for well-woman needs. To reiterate: find out what their practices and preferences are regarding pregnancy and birth before you automatically default to them.

If you are now wondering what good, evidence-based care looks like, you can start with the Lamaze Healthy Birth Practices, already mentioned in this article. Another excellent resource is ChildbirthConnection.org.

One last thing to consider is your place of birth. Have you considered birthing outside of the hospital environment? Perhaps a free-standing birth center, or even at home? Do yourself a huge favor, and do not rule anything out until you know for sure that it isn’t for you. To get you started, I have several links to good information in my sidebar, or at the top of my site under the heading “Homebirth & Midwifery.” I encourage you to click through and read up a little. You might be surprised at what you learn!

Now that you’ve made it through this post, how did I do? Do you still have any questions? Feel free to leave a comment, or email me: birthinjoy [at] yahoo [dot] com.

Click HERE for more great posts on Avoiding Unnecessary Medical Interventions.

Thanks to Science & Sensibility for hosting!

***NOTE: All links provided are meant to credit the sources of my information. Links are either in green or red text.***

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2 Comments

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2 responses to “Healthy Birth Blog Carnival: Avoiding interventions that are not medically necessary.

  1. Choosing a care provider is SO important!! We lucked out finding a midwife at a birthing center that really trusted me. Next time we’re going to try a homebirth – I am excited, and have already started to think about what midwife we’ll choose 🙂

    • faerylandmom

      I’m so glad to hear that you were able to find a care provider like that – too many women forget the vital importance of this. Kudos to you!