Medical Interventions during Labour We have listed a range of the most common medical Interventions
that you might be offered during or just prior to labour. Some
of these interventions remain controversial but the aim of this
site is to inform you only. We have certain view points about
some of these interventions and our opinions are based upon our
own experiences, from discussions with independent midwives and
from evidence based reviews of the clinical literature from many
authors and resources including the excellent organisation The
MIDIRS (The Midwives Information and Resource Service), in the
UK. They also produce a series of leaflets called ‘Informed
Choice’, which assess the evidence for many interventions
and we thoroughly recommend them. Their website is http://www.infochoice.org and
you can download copies of the Informed choice leaflets. Medical Interventions Artificial ROM (Rupture of Membranes) This is often recommended by Midwives and Obstetricians when a
woman goes over two weeks (although times vary from practice to
practice)
beyond her due date. It involves placing a small instrument
into the vagina and through the cervix to break the waters (the
sack
of amniotic fluid which the baby floats in). This often has
the effect of initiating labour because of the increased pressure
of the babies head on your cervix. The key aspects to think about here is whether you dates are accurate
in the first place. The length of gestation in France is assessed
as one week longer than in most other countries, so there is room
for flexibility. You may wish to try you own methods of stimulating
labour as outlined on the Progressing Labour
page. Prostaglandin Pessaries Theses are small pessaries (oval shaped tablets) which are inserted
into the vagina to help initiate contractions of your uterus and
to get labour established or to re-establish labour of it has slowed.
They contain the hormone prostaglandin (present in male seminal
fluid) which helps to dilate the cervix and to stimulate your contractions.
With a hospital birth remember that it is very common for labour
to slow up once you arrive at the hospital. There will be a sense
of anticipation and you may feel nervous. This can cause labour
to slow up for entirely natural reasons. If you use the Second Nature
Birth Programme® you will want to get settled
in and commence your breathing and relaxation exercises in order
to calm everything down to help with labour progressing normally.
Your partner or companion will want to give your care team a copy
of your birth plan if you have not yet done so. Constant Electronic Fetal Monitoring (EFM) This is where sensors are attached
to your tummy in order to monitor your babies heart during labour.
It is contentious as most monitors will restrict your ability to
move around because you will be required to stay on the bed. We
believe that you should be free to adopt different positions during
labour and birth and constant fetal monitoring can prevent this
without conferring any proven advantage. In fact many studies showed
an increase in the use of surgical intervention due to the misinterpretation
that that the baby was in distress when it was not. There is still a 30% increase
in Caesarean section rates and a 30% increase in the rate Surgical
Vaginal intervention when EFM is used. It has been stated that EFM
reduces the rate of occurrence of Cerebral Palsy in babies, but
there is no evidence for this, and in fact there is some evidence
that it may increase it. The only thing that can be said about EFM
is that when Syntocin is used to induce labour, it may reduce the
occurrence of neonatal seizures. However, there is no evidence that
there are any short or long term problems associated with neonatal
seizures*. We would recommend that
unless there is a medical need during a high risk labour where there
is a high chance of foetal hypoxia (reduced oxygen) that there is
no need for constant foetal monitoring and that intermittent auscultation
(listening with a stethoscope to the babies heart) is adequate.
Ref. MIDIRS leaflet on EFM and Fetal Blood Sampling.
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