These common practices are an important part of a healthy delivery in some situations.
Four of the Most Common Labor & Delivery Practices and What You Should Know About Them.
by Christine Myers, AAHCC, CD (DONA)
These common practices are an important part of a healthy delivery in some situations. Is yours one of them? Use the following information as a starting point for further investigation and communication with your caregiver.
1. Electronic Fetal Monitoring. While you are in labor, your caregiver will want to monitor your baby’s well-being. Most hospitals monitor with Electronic Fetal Monitoring (EFM). In External EFM, two belts are strapped to your abdomen with monitoring devices. One is a device that uses ultrasound technology to monitor the baby’s heart rate, the other records when you have contractions. Alternatively, an electrode can be inserted through the birth canal into the baby’s scalp (Internal EFM).
You should know: The American College of Obstetrics and Gynecology recommends continuous EFM in certain high-risk situations.1 Otherwise, periodic monitoring with a stethoscope or doppler device is as equally effective as EFM in assessing fetal well-being.2 When connected to an EFM device, you will have to be sitting or lying in bed and the resulting lack of movement can make labor longer and more painful. EFM is also frequently associated with false indications of fetal distress, thereby increasing your risk of unnecessary interventions.1 Internal EFM is usually used when external monitoring has provided questionable results. It is continuous and your water will need to be broken (see “Amniotomy” below).
Ask your caregiver: What type of monitoring do you feel is right for my labor and why? If I am low risk, can I choose intermittent monitoring?
2. Amniotomy – Artificial rupture of membranes (AROM). The sac of fluid that is the baby’s home in the womb will usually break spontaneously during late labor. However, at some point, your caregiver may want to break the “bag of waters” artificially.
You should know: AROM is occasionally necessary for more detailed assessments of fetal well-being and may shorten labor by an average of 40 minutes.3 However, if done too early, rupturing the membranes can lead to cord compression and fetal distress.4 It can also decrease the baby’s ability to position itself properly in the pelvis, which can stall labor and increase your risk of cesarean. Although the procedure itself is usually painless, contractions will become more intense afterward. Your risk of uterine infection increases the longer the bag of waters has been broken - a risk that can be minimized by limiting the number of vaginal exams. Still, most caregivers will want you to deliver within a certain amount of time once your membranes are ruptured.
Ask your caregiver: Do you routinely do amniotomies? Will you leave my membranes intact if everything is progressing well? How much time do I have to deliver once my water has broken?
3. Episiotomy: A cut made in the perineum to widen the outlet of the birth canal (perineum).
You should know: An episiotomy can shorten the pushing stage by 5 to 15 minutes5 which could be important if your baby is in distress. However, according to recent research, routine episiotomy does not actually have the women’s health benefits once thought. And when it is not done women are more likely to give birth without injury to the perineum.6 Do some research on ways to minimize your risk of injury to the perineum during birth, which include: getting proper nutrition during pregnancy and delivering in an upright position. If you do not want an episiotomy, be sure to let your caregiver know.
Ask your caregiver: How often do you do episiotomies and for what reasons? Can I choose not to have one?
4. Immediately Cutting the Umbilical Cord. Sometime after your baby is born, the umbilical cord will need to be clamped and cut. Often, this is done immediately.
You should know: There are reasons your baby’s cord may need to be cut immediately, such as: if it is wrapped around the baby’s neck or the baby needs to be taken directly for special medical treatment. However, The American Academy of Pediatrics states, “If cord clamping is done too soon after birth, the infant may be deprived of a placental blood transfusion, resulting in lower blood volume and increased risk for anemia in later life.”7 Optimal blood volume is achieved when baby is placed on the mother’s abdomen at the level of the placenta and the cord is not clamped or cut until it stops pulsating.8 Choosing to bank your baby’s cord blood may affect the timing of cord cutting.
Ask your caregiver: When do you normally clamp and cut the umbilical cord? When does it need to be cut if I want to bank the cord blood? If the baby is fine, can we wait until the cord stops pulsating before cutting it?
1. Simpkin P, Whalley J, Keppler A. Pregnancy, Childbirth, and the Newborn: The Complete Guide.
2. Coughlin L, Huntzinger A. ACOG Recommendations for Fetal Heart Rate Monitoring. American FamilyPhysician. 2005; Vol. 72/No. 3. Available at: http://www.aafp.org/afp/20050801/practice.html#p2. Accessed March 15, 2006.
3. Simpkin, Penny. The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth, 2nd Edition.
4. Simpkin P, Whalley J, Keppler A. Pregnancy, Childbirth, and the Newborn: The Complete Guide.
5. Simpkin P, Whalley J, Keppler A. Pregnancy, Childbirth, and the Newborn: The Complete Guide.
6. Routine Use of Episitomoy in Uncomplicated Births Offers No Benefits to Women. Press Release May 3, 2005. Agency for Healthcare Research and Quality,
7. Cord Blood Banking For Potential Future Transplantation: Subject Review Pediatrics. 1999; Vol. 104/No.1, pp 116-118. Available at: http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ ZZZ4DJ3RE8C.html&soc=AAP&srch_typ=NAV_. Accessed March 15, 2006.
8. Simpkin P, Whalley J, Keppler A. Pregnancy, Childbirth, and the Newborn: The Complete Guide.
