Birth: is interference such a bad thing?
Having a natural birth is the aim of many
pregnant women but in fact, says
Sarah Kilby, medical intervention can save lives, dramatically reduce pain and increase the chances of having a healthy baby...
- Increasing interference
- When intervention helps
- Is intervention always necessary?
- Striking a balance
What makes a birth a 'good' experience? The answer depends on your
expectations; for some women it will be a natural, active delivery with
minimum pain relief; others will judge the whole thing a success if they
emerge safely from an elective Caesarean.
Despite high ideals and the best laid birth plans, what all mothers
(and their midwives and obstetricians) want is a healthy baby at the end of
labour. However, sometimes babies get stuck, they get tired and short of oxygen, and
exhausted mothers can't push them out 'as nature intended'.
Birth is safer now than ever, but it will never be risk-free. Out of 600,000
babies born each year, sadly around 5,000 will die during labour or shortly
afterwards. It is estimated that around 10 per cent of all babies with cerebral
palsy were damaged during birth. Medical intervention has its critics but
despite its negative associations, it has saved countless lives.
Increasing interference
- The latest Department of Health figures show that 21 per cent of all labours and 20 per cent of all deliveries are induced, an increase from around 17 per cent in previous years.
- About 10 per cent of births are instrumental deliveries (babies delivered with the help of forceps or ventouse), and are more likely to follow an induced rather than a spontaneous labour.
- About 20 per cent of all deliveries are Caesarean section: over half of these are emergency C-section, which has risen sharply in recent years.
If your baby is having trouble coming into the world, the medical
profession may want to intervene for the following reasons:
1) Your baby is overdue
Over 20 per cent of all labours are induced - the usual reason being that babies are more than 10 days overdue, although hospital policy varies. After 40 weeks the placenta begins to weaken and your baby may be deprived of
oxygen and food. Certain medical conditions, such as
pre-eclampsia (high blood pressure) or diabetes may mean you are offered an
early induction.
2) Your labour is slow or contractions have stopped
The hormone oxytocin, administered via a drip, can be used to speed up or restart
labour,
bringing about strong, intense contractions. This is known as 'active
management' of labour.
3) You can't cope with the pain
Many women in labour and particularly, induced labour, find the contractions
very painful and so opt for an epidural or spinal
anaesthetic. This can be very effective at blocking all feeling but usually
makes further intervention more likely.
4) Your baby gets stuck
If a mother cannot push the baby out because of an
epidural, she is exhausted or has lost her contractions, forceps can be
used to deliver a baby 'stuck' in the birth canal. An episiotomy, or cut in
the skin of the perineum, is usually done to allow more room for the
doctor to manoeuvre.
5) Your baby becomes distressed
If your baby is distressed before the cervix is fully dilated, a ventouse extractor can be used as an alternative to forceps, which would damage the rim of the cervix. This soft rubber cap is suctioned onto the
baby's head to assist the
baby's progress through the cervix and down the birth canal.
6) Your baby cannot be born vaginally
Sometimes, despite all efforts of
mothers and midwives, an emergency Caesarean will be needed to rescue a baby who is lying in the wrong position, or where the placenta is found to be
blocking the cervix.
"The doctor had to use forceps to get Daniel out"
One woman who has reason to be grateful for medical intervention is Sarah
Crampsie, 40. She is mum to five boys, Christopher 14, Daniel 12, James, nine,
Nicholas, seven, and Ben, five. Only Daniel had a natural delivery - with all the
other births Sarah needed high-tech help.
"With my first baby I imagined that I was going to give birth naturally, as all my ante-natal classes had suggested. But Christopher was 14 days late, so I had to be induced. Everything just got more and more complicated, he got stuck, and the cord was round his neck, so the doctor had to quickly cut me and use forceps to
get him out. I was so happy to this lovely baby in my arms that I didn't care.
It was only when the local anaesthetic wore off that I regretted having stitches!"
Is intervention always necessary?
Critics of medical interference argue that staffing levels, overburdened
hospitals and sometimes pure convenience or fear of litigation have led to
over-use of medical intervention.
"Most obstetricians regard birth as a disaster waiting to happen," says
Beverley Lawrence Beech, founder of the Association for Improvements of
Maternity Care, who argues that midwives are losing their traditional
birthing skills and becoming obstetric nurses, assisting doctors who expect
every birth to be problematic.
Not true, says Peter Bowen-Simpkins, consultant obstetrician at Singleton
Hospital in Swansea. "Obstetricians don't want to be seen as fire
fighters, rather we err on the side of caution. I admit that in the past,
obstetricians have been guilty of too much intervention, particularly
induction to fit in with hospital timetables, but ideas are changing. It's
our job to make a birth as smooth and safe as possible. "
Striking a balance
Despite concerns about the increase in medical intervention, focus group
research undertaken for the Sunday Times Good Birth Guide suggests that women find this trend reassuring. "They expect a complete range of readily
available pain relief and support in the event of an emergency - even women who felt strongly about wanting to give birth naturally expressed comfort at the though of high-tech medical wizardry and doctors on standby."
It's a wise mum-to-be who keeps an open mind. Write a courteous birth plan
requesting minimum intervention if you feel strongly, and as you approach
your due date, have faith in your own body and your ability to give birth. It
just might be that your baby has different ideas on the day!
Where to next?
- Find out more about assisted deliveries
- What happens if you have an unplanned home birth? Check our information
- Visit our main Labour and birth section
- Talk to other pregnant women on our Labour and birth discussion board
- Birth abroad: an
English midwife gives her account of birth in a German ‘birth house’
- Thinking of having a homebirth? Talk to other mums-to-be about giving birth at home in our Homebirth discussion forum
