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Utah Doula



Last Updated: 3/22/2009

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Gender: Female
Status: Married
Age: 101
Sign: Virgo

City: Santaquin
State: Utah
Country: US
Signup Date: 9/24/2007
Thursday, October 18, 2007 
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Appropriate Use of Interventions
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From The Official Lamaze Guide: Giving Birth with Confidence.

Many common medical interventions can hinder the process of birth by prolonging labor, discouraging you, and interfering with your ability to find comfort. These interventions can certainly be beneficial if they're used appropriately, when complications develop or the risk for complications is high. But they're often used inappropriately on healthy women whose labors are progressing normally.

To avoid interventions that will make labor more difficult, you'll need some basic knowledge about the appropriate use of interventions and strategies for preventing inappropriate use. You'll also need to know how you can minimize the negative effects of truly necessary interventions and keep your labor as normal as possible.

Continuous Electronic Fetal Monitoring --> --> --> --> --> Start_Module_810 -->

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know:
  • Routine continuous EFM provides no benefit for babies and increases the risk of cesarean for mothers.
  • The American College of Obstetricians and Gynecologists (ACOG) recommends that for healthy, low-risk women (almost all women), fetal heart rate be monitored with a fetoscope or Doppler every 30 minutes in active labor and every 15 minutes during pushing.
  • The World Heath Organization (WHO) encourages intermittent manual listening and warns that EFM is often used inappropriately.

You'll Need Continuous EFM if:

  • Your labor is induced or speeded up with Pitocin.
  • You have an epidural.
  • Your baby's heart rate changes.
  • You or your baby has a health problem.

How to Avoid Unnecessary Use:

  • Remember that routine use of continuous EFM doesn't make labor safer for your baby.
  • Find a caregiver who doesn't use continuous EFM routinely.
  • Talk to your caregiver about intermittent fetal monitoring.
  • Stay at home as long as possible in labor.

How to Keep Labor as Normal as Possible if You Need EFM:

  • Remember that your body knows how to protect your baby during labor.
  • Continue to move as much as possible, both in and out of bed.
  • Ask staff to turn off the monitor's sound.
  • Ask staff to turn the monitor away from you and your helpers so it doesn't distract you.
  • Ask to be disconnected from the monitor for regular trips to the toilet.
  • Remind your helpers that you are the one in labor, not the machine.
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Intravenous Fluids
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From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know:

  • Routine IV use restricts movement, decreases confidence, may over-hydrate mothers and may contribute to low blood sugar in newborns.
  • Restricting eating and drinking in labor depletes a woman's energy when she needs it most.
  • The WHO recommends offering women fluids by mouth and eliminating routine IV use during labor.
  • The American Society of Anesthesiologists (ASA) recommends that low-risk laboring women be allowed to drink clear liquids (such as water, juice, carbonated drinks, clear tea, and black coffee).

You'll need an IV if:

  • You develop health problems or complications before or during labor.
  • You're at high risk for complications.
  • Your labor is induced or speeded up with Pitocin.
  • You have an epidural.

How to Avoid Unnecessary Use:

  • Choose your caregiver and birth site carefully.
  • Talk to your caregiver about your desire to eat, drink, and avoid unnecessary IV use.
  • Confidently eat and drink while you labor at home.
  • Labor at home as long as possible.

How to Keep Labor as Normal as Possible if You Will Need an IV:

  • Labor at home as long as possible
  • Eat and drink as your body commands while you're at home.
  • Suck on ice chips, Popsicles, or lollipops during labor.
  • Walk around with your IV pole.
  • Stay as active as possible.
  • Remember that you don't need the IV to have a safe birth and a healthy baby.
Restricting Movement --> --> --> --> --> Start_Module_812 -->

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know:
  • Research shows that restricting movement reduces the effectiveness of contractions, prolongs labor, and increases Pitocin use.
  • The WHO encourages freedom of position and movement and discourages the supine (back-lying) position during labor.
  • The ACOG encourages women to change position often.

You'll need to stay in bed or have help moving if:

  • You're having preterm labor.
  • You have severe pregnancy-induced hypertension.
  • You have epidural or spinal medication.
  • You have narcotic medication through an IV.

How to Avoid Unnecessary Use:

  • Discuss movement with your caregiver.
  • Find out if your birth site restricts walking and movement during labor.
  • Consider changing your birth site if it will restrict your movement.
  • Labor at home as long as possible, walking and moving freely.
  • Remember that walking, moving, and changing positions help your labor progress.

How to Keep Labor as Normal as Possible if Your Movement is Restricted:

  • Labor at home as long as possible, walking, moving, and changing positions freely.
  • Change positions often in bed:
    • Move from side to side.
    • Sit on the side of the bed.
    • Kneel while leaning your head and shoulders against the raised head of the bed.
    • Lie in different directions; for example, move your head to the foot of the bed.
    • Squat while supported.
    • Remember that the more you move, the more efficient your contractions will be.
Artificial Rupture of the Membranes --> --> --> --> --> Start_Module_813 -->

From The Official Lamaze Guide: Giving Birth with Confidence. 

What to Know:

  • An intact amniotic sac protects your baby's head and your vagina during labor.
  • Artificially rupturing the sac increases your risk of infection and interventions (Pitocin, EFM, IV, restricted movement, and cesarean).
  • Research shows that movement and hydration are often all that's needed to get a slow labor moving and that membranes shouldn't be ruptured routinely.
  • You may benefit from having your water broken if your labor is very difficult or slow to progress.

How to Avoid Unnecessary Use:

  • Discuss this intervention with your caregiver.
  • Tell your caregiver that a longer labor is okay with you.
  • Labor at home as long as possible.

How to Keep Labor as Normal as Possible if Your Membranes are Ruptured Artificially:

  • Be prepared for stronger contractions.
  • Continue to use all the support and comfort resources you have.
  • Keep moving and changing position often.
  • Remember that your body knows how to birth your baby.
Directed Pushing --> --> --> --> --> Start_Module_814 -->

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know:

  • Research shows that routine directed pushing, breath holding, and limiting pushing during labor is not beneficial, and that prolonged breath holding may reduce fetal oxygenation.
  • The WHO recommends not directing laboring women to hold their breath or consciously sustain pushing.
  • The American College of Nurse Midwives (ACNM) recommends that a laboring woman's body direct any pushing.
  • Directed pushing may help you if you've had an epidural and don't feel the urge to push.

How to Avoid Unnecessary Use:

  • Remember that your body knows how to push your baby out.
  • Listen to and follow your body's signals.
  • Change position often while you're pushing.
  • Ask your helpers to support your efforts to push naturally.
  • Be patient with your body.
  • Visualize your baby rotating and descending through your birth canal.
  • Ask your helpers to keep comforting you while you push your baby out.
  • If you have an epidural, "labor down"—wait until the epidural wears off, and then let spontaneous pushing kick in.

How to Keep Labor as Normal as Possible If You Use Directed Pushing:

  • Remember that your body knows how to birth your baby.
  • Don't hold your breath for more than six seconds at a time.
  • Push in an upright position.
  • Rest between contractions.
  • Be patient.
  • Visualize your baby rotating and descending.
  • Ask your helpers to keep supporting and comforting you.
Induction or Augmentation with Pitocin --> --> --> --> --> Start_Module_809 -->

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know:

  • Pitocin increases stress on your baby and your uterus and makes contractions more difficult to manage.
  • Pitocin use necessitates an IV and continuous EFM, restricts your mobility, and raises your risk of epidural and cesarean.
  • The WHO believes that Pitocin induction and augmentation are often used inappropriately.
  • The ACOG notes the risks of Pitocin use and recommends cautious decision making.

You'll need induction if:

  • Your labor is slow and doesn't respond to movement, position change, and hydration.
  • You don't go into labor spontaneously by forty-two weeks gestation.
  • You have a uterine infection.
  • You have severe pregnancy-induced hypertension.

How to Avoid Unnecessary Use:

  • Be patient waiting for labor to begin and to progress.
  • Remember that your body knows how to give birth.
  • Surround yourself with helpers who trust birth.
  • Stay confident.
  • Use all the comfort measures you've learned.
  • Don't agree to be induced because your caregiver says your baby is getting too big.
  • If your water breaks before contractions start, or if you go past your due date, discuss with your caregiver natural ways to stimulate contractions, such as drinking a bit of castor oil in juice, stimulating your nipples, and being active.
  • Ask, "What if I wait?" if your caregiver is insistent about inducing labor.

How to Keep Labor as Normal as Possible if You are Induced:

  • Make sure your helpers give you continuous emotional and physical support.
  • Actively seek comfort in response to the pain of contractions.
  • Remember that your body knows how to give birth.
  • Visualize your baby rotating and descending through your birth canal.
  • Keep moving and changing positions as much as possible.
Epidural Analgesia and Anesthesia --> --> --> --> --> Start_Module_815 -->

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know
  • Seeking relief from labor pain without drugs protects your baby and your body from injury, helps labor progress, and facilitates breastfeeding, bonding, and other postpartum adjustments.
  • Epidural use necessitates an IV, continuous EFM, and restricted mobility, and it relaxes vaginal muscles. All of these factors can prolong labor.
  • Epidural use increases the risk of instrument delivery and may increase the risk of cesarean.
  • Epidural use raises the risk of fever and postpartum separation to rule out infection.
  • Epidural drugs do reach your baby. Both of these factors can make breastfeeding initiation harder.

You May Need an Epidural if:

  • Your labor is very long and difficult and you need to rest.
  • You have a cesarean.
  • Your blood pressure is very high.
  • You don't have good labor support.
  • Your birth site restricts your ability to find comfort in other ways.
  • You can't move beyond your fear of labor pain.

How to Avoid Unnecessary Use:

  • Labor at home as long as possible.
  • Choose your caregiver and birth site carefully.
  • Discuss your desires with your caregiver.
  • Make sure you have excellent labor support.
  • Use all the non-drug comfort measures you can.
  • Be patient and remember that your body knows how to give birth.

How to Keep Labor as Normal as Possible if You Have an Epidural:

  • Use a wide variety of other comfort measures for as long as possible, so you don't need an epidural for your entire labor.
  • Let your epidural wear off before pushing ("labor down").
  • Ask your helpers to massage your hands and feet and help you stay as active as possible.
  • Be patient with your breastfeeding baby and spend as much skin-to-skin time together as possible.
  • If your baby doesn't latch well at first or you have other breastfeeding problems because of your epidural, ask hospital staff (preferably a lactation consultant) to help you express colostrum and feed it with a small cup or eyedropper.
  • To avoid aggravating breastfeeding problems, tell the hospital staff not to feed your baby formula or use bottles or pacifiers.
Episiotomy --> --> --> --> --> Start_Module_816 -->

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know
  • Research provides no evidence that an episiotomy reduces the risk of perineal injury, improves perineal healing, prevents birth injury to babies, or reduces the risk of future incontinence. Rather, the evidence shows that routine or liberal use of episiotomy is likely to be ineffective or harmful.
  • The WHO recommends eliminating routine or liberal episiotomy.

You may need an episiotomy if:

  • You or your baby is in distress.
  • Your baby is very large or in an unusual position.  

How to Avoid Unnecessary Use:

  • Ask potential caregivers their thoughts about episiotomy and choose your caregiver carefully.
  • Push in upright positions that let your perineum stretch gently as your baby descends.
  • Change positions often while you're pushing.
  • Push spontaneously, according to your body's signals, not in a directed way.
  • Remember that your body knows how to give birth.
  • Be patient with your body.

What you can do if you have an episiotomy:

  • After birth, start doing Kegel exercises as soon as possible to help heal and strengthen your perineal muscles.
  • After birth, take warm baths to increase circulation and decrease pain and apply ice to reduce swelling.
Cesarean Surgery --> --> --> --> --> Start_Module_817 -->

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know:

  • Though some obstetricians tout the safety of cesareans and their value in preventing perineal damage, a systematic review of current research shows that vaginal birth is safer for mother and baby than a cesarean—unless there's a clear, compelling health reason for having a cesarean.
  • The risk of perineal damage in vaginal birth is extremely small if forceps, vacuum extractor, and episiotomy aren't used.
  • Cesarean surgery increases your risk of blood clots, stroke, surgical injury, infection, pain, separation from your baby, psychological trauma, longer hospital stay, emergency hysterectomy, and death in the short term. In the long term, it increases your risk of pelvic pain, bowel obstruction, infertility, and future pregnancy problems like ectopic pregnancy (pregnancy outside the uterus), placenta previa (placenta over the cervix), and uterine rupture.
  • A cesarean raises your baby's risk of surgical injury, respiratory problems, and breastfeeding difficulties. It increases you future babies' risk of stillbirth, low birth weight, preterm birth, and central nervous system injury.
  • If you've had a previous cesarean, there's a small chance your uterine scar could separate during labor and a small chance that the separation could endanger you or your baby. This is more likely if your labor is induced or if your scar is high and vertical.

You'll Need a Cesarean if:

  • You are hemorrhaging.
  • Your baby's oxygen supply is blocked.
  • You have placenta previa.
  • Your baby is in a transverse position (lying horizontally across your pelvis).
  • You have poorly controlled diabetes or severe pregnancy-induced hypertension.
  • You've had a previous cesarean and your caregiver is unwilling to attend a vaginal birth after cesarean (VBAC) or your hospital doesn't have round-the-clock anesthesia services.
  • Your labor is not progressing at all, and either you or your baby is not doing well.
  • Your baby is in a breech position (head up, feet or buttocks down) and your caregiver isn't skilled at assisting vaginal breech birth.
  • Your baby's heart rate slows and doesn't improve when you change position, drink more fluids, breathe some oxygen, or turn your Pitocin down or off.
  • You're carrying more than one baby, and one of your babies is in a transverse position or your caregiver isn't skilled at assisting vaginal multiple births.

How to Avoid Unnecessary Use:

  • Let your labor start and progress on its own unless there are clear, compelling health reasons to induce or speed up labor.
  • Visit the Childbirth Connection Web site, download the free booklet "What Every Pregnant Woman Needs to Know about Cesarean Section" and read it.
  • Discuss intermittent fetal monitoring with your caregiver.
  • Remember that your body knows how to give birth.
  • Plan for excellent labor support.
  • Move and change positions often during labor.
  • Labor at home for as long as possible.
  • Work actively with your contractions.
  • Keep up your energy by eating and drinking.
  • Try lots of non-drug comfort measures before considering an epidural.
  • If you have an epidural, let it wear off before pushing ("labor down").
  • If you've had a previous cesarean, visit the Childbirth Connection Web site and read "Should I Choose VBAC or Repeat C-Section?" Choose a caregiver who supports your decision to have a VBAC.
  • If your baby is breech, discuss external version (manually turning your baby head-down) with your caregiver.

How to Keep Birth as Normal as Possible if You Have a Cesarean:

  • Have your partner and doula (or other helper) in the operating room.
  • Hold your baby skin-to-skin as soon as possible after birth.
  • Nurse your baby in the first hour after birth.
  • Room in with your baby at the hospital.
  • Have support from family and friends while you're in the hospital.
  • Be patient with your baby as he or she learns to breastfeed.
  • If your baby doesn't latch well at first or you have other breastfeeding problems, ask hospital staff to help you express colostrum and feed it with a small cup or eyedropper.
  • To avoid aggravating breastfeeding problems, tell staff not to feed your baby formula or use bottles or pacifiers.
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