One of the things I work on the most in my prenatal classes is educating students about the “cascade of interventions” that can happen in many hospital births. I strive to be neutral in class, especially recognizing that all sorts of moms come to prenatal class. I try not to assume everyone wants a vaginal birth with few interventions. Every year I am getting better at this, but still, I think it’s obvious if you talk to me that, in general, I favor as few tests and interventions as possible (hence, the title of this post).
Last week, an important evidence-based report was published by Childbirth Connections, an amazing advocacy group for women and families. It’s long and somewhat dense, but USA Today and Consumer Reports have written articles in summary. I’m reading the report in bits and pieces this week.
Here is an excerpt from the Consumer Reports article, talking about the overuse of high-tech measures:
The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:
- Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
- Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
- Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization’s recommended national rate of 5 to 10 percent
- Electronic fetal monitoring, unnecessarily adding to delivery costs
- Rupturing membranes (“breaking the waters”), intending to hasten onset of labor
- Episiotomy, which is often unnecessary
Though women and their partners shouldn’t have to become “experts” on maternal and fetal care when they’re pregnant, it’s very helpful to remember that you are a paying consumer. I recommend finding a doctor or midwife who will take the time to answer the questions you have, and who will talk to you about your choices, options and alternatives. Too often, women come to my class and say something like, “My doctor won’t let me go past my due date. She’ll induce me if I do.” We have to remember that we have a responsibility in all of this to ask questions, and know that it’s *our* decision whether we have that test or procedure. We cannot abdicate responsibility for our bodies and our babies, even if a doctor/midwife presents a procedure as non-optional. The time to set up this dynamic is before you’re in labor – it’s difficult to have rational conversation and decision-making in the midst of active labor!
If you’re pregnant, remember that you need to have confidence in your provider. It’s never too late to switch providers if you’re unhappy. I’ve had students switch providers mere days before giving birth! But also remember, the most important person to trust is yourself, and your baby. That’s how we use yoga – to empty out everything else so that we can hear the voice inside letting us know what we need to do.