I want start by being very clear that I understand that many interventions are far more common than they need to be, sometimes to the detriment of the health of women giving birth. I don’t buy the ‘if the baby is ok that’s all that matters’ story. When women are traumatized by practitioners carrying out interventions without consent (including failing to be honest about the options available and the risks of the interventions) new mamas may struggle to take care of themselves, let alone their new babies.
However, I really want to take some time to focus on another side of the issue. Over the past five months it feels like I have seen more stories, read more comments, and heard more remarks about the evils of interventions in the birth process. I know it is, at least in part, due to selection bias – I see it because of the experience I had with my own birth. Sometimes there will be a minimal disclaimer at some point starting ‘except of course, when they’re needed,’ but rarely is ‘when they’re needed’ discussed. It can come across as blaming women for making poor choices for their babies. At the very least women are framed as naively ignorant of the risks and alternatives to interventions. I’m going to talk a little bit about my experience and the (many) interventions I had, what brought me to choose them, and how I feel about each one today. My hope is that my story will be a reminder of the reasons interventions are so very important to have as tool.
To start with a little context, I planned a home birth well before I ever considered getting pregnant myself (the plan had always been for MamaLee to carry first), in part due to the fact that home births have far fewer interventions than hospital births of the same risk category. This is without a significant increase in risk to mama or baby in terms of health. (For my personal favorite, see Cheyney et al. 2014 for more details on that here). When it comes down to it I’m a numbers person. I chose to attempt a home birth because it made sense by the numbers for the kind of birth I wanted.
When my midwives asked about what kind of birth I wanted it was simple: I wanted the baby to come out, with preferences for a vaginal birth without interventions. Birthing at home meant a much lower chance of a cesarean, pitocin, an episiotomy, an epidural, antibiotics, my water being broken and so on.
When I went into labor the Bug was firmly wedged onto my right side (as she had been since 32 weeks) and was unable to turn. I had intense back labor starting almost immediately, that was so painful I did what I always do when I’m in pain: I vomited. A lot. I was having contractions 3 minutes apart start-to-start and 60 to 70 seconds long within about an hour of my first crampy contraction and they didn’t let up until the very end of my 27.5 hours of labor. At around 13 hours into labor I had my first intervention: a vaginal exam to see how I was progressing. I was 7 cm dialated. I felt encouraged but tired, and I was getting dehydrated (remember no saline IVs at home). However, four hours later, after trying everything from belly lifts to high stepping down the driveway, I was not progressing in anything but my dehydration and exhaustion. My midwives conferred with each other, then let me and MamaLee know that there were a few more things we could try to turn the baby, but they were aware how tired I was. They asked me how I felt. Transferring was up to me. There was no emergency. The baby was doing great. I asked for another check of my cervix and the moment they told me I had not progressed at all in those four hours I consented, with full knowledge of what my condition was and what transferring meant, to my next interventions: an epidural and saline so I could sleep and rehydrate. I knew then, as I know now, that those interventions were very good things for my situation. If I ran out of steam before it was time to push I could end up with the c-section I wanted to avoid. An epidural would let me rest and IV fluids would help me and the baby stay healthy.
There are downsides to every intervention, of course. The epidural meant I couldn’t walk (although at that point I was basically only able to crawl anyway), and of course some amount of the drug would cross the placenta. As a person trained in economics though, everything is about not simply cost, but opportunity cost. What was the cost of not getting the epidural? In my case, continuing without sleep or rest (back labor contractions 1 minute long with 3 minutes from start to start are not conducive to rest). I knew that without rest at that point, I would have nothing left in me to push, so essentially the opportunity cost of not getting an epidural was a guaranteed c-section.
I continued to labor when the doctor suggested the next intervention I was pretty sure I didn’t want: breaking my water. RIGHT HERE is why it is so very important to have a caregiver you trust implicitly. Making the decision to have an intervention that you were quite sure you wouldn’t need after laboring for over 20 hours can be confusing and scary. For me it was neither. I was able to state why I was concerned about it and when the OB pushed it without giving me any good reason for it, I said I wanted to get my midwife’s opinion. She very clearly explained why it made sense at that point to break my water, and addressed all of my concerns. It took her probably less than three minutes to put my mind at ease that it was the right decision. I still don’t understand why that was so hard for the OB to take the time to do. I accept that I may not have been open to hearing her because of my general understanding that this intervention was bad.
My final major intervention was the one I really never expected. After being in active labor for over 24 hours and pushing for a significant portion of time as well, my contractions began to slow. My uterus was getting tired (seriously, what muscle wouldn’t give it after that!? My uterus is hard core). Contractions began to space out. The baby had late decels (heart rate decelerating after a contraction had passed) once or twice – I don’t remember, I was at over 30 hours awake on about three hours of sleep per night over the last few days. A very small amount of pitocin was suggested. I don’t remember at that point saying yes, but I remember my midwife saying it was the right call. I trusted her for a reason. She knew I wanted to push this baby out and she knew what it was going to take to get there. It was just a whiff of pitocin, but it did the trick to help me push that baby out.
I avoided two unnecessary interventions that were mentioned by the OB: a vacuum extraction and an episiotomy. However, I can say there are times and places for each of those, and I’ve been told stories where they were used as tools to support a woman in her quest to birth her child the way she chose to, given the circumstances in which she found herself.
It took a few months for me to be really comfortable with my intervention-heavy birth, and to be honest, there are still moments where I become tearful at the thought of the things that I didn’t have due to the transfer. But what I did have was the best birth possible given the cards I was handed. The interventions I had made it possible to have a vaginal birth, one of the most rewarding and powerful experiences of my life.
After processing all of this, the basic gist is this: interventions are tools, and like any tool they can be used appropriately, or abused and used in ways that do not have a laboring woman’s best interest at heart. My question to anyone who was interested enough in this topic to read this far is this: How do we, as a community, support appropriate use of interventions without creating an atmosphere of fear and shame around them?