Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary

Abstract

Maternity care in the United States is intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. Seventeen percent of women had an episiotomy, and 31% had a cesarean. The high use of these interventions reflects a system-wide maternity care philosophy of expecting trouble. There is an increasing body of research that suggests that the routine use of each of these interventions, rather than decreasing the risk of trouble in labor and birth, actually increases complications for both women and their babies.The purpose of this article is to review the literature related to the evidence base and the outcomes associated with the interventions routinely used in labor and birth in the United States. The findings make the case for the value of maternity care that avoids the use of routine interventions.Maternity care in the United States is intervention intensive. Listening to Mothers III (Declercq, Sakala, Corry, Applebaum, & Herrlich, 2013), the most recent national survey of women's pregnancy, birth, and postpartum experiences, reports that for women who gave birth from June 2011 to June 2012, 89% of women experienced electronic fetal monitoring (66% continuously), 62% received intravenous fluids, 79% experienced restrictions on eating, and 60% experienced restrictions on drinking in labor. Sixty-seven percent of women who gave birth vaginally had an epidural in labor, and 31% were given Pitocin to speed up their labors. Twenty percent of women had their membranes artificially ruptured.

Perception of be Cared in Childbirth at the Light of the WHO Model

“…The results agree with that, but are higher than those found in other researches [27]. This may mean relegation of clinical knowledge, in favour of data provided by electronic equipment, or a care model with less physical presence of the EESMO.…”

“…Women should be encouraged to act according to their preferences and the singularity of each clinical situation will guide decisions as to the type of pushing [29]. In this study, the majority of women carried out epidural, which may have contributed to high representation of directed pushing [27].…”

“…Administration of intravenous fluids is justified for clinical reasons or due to maternal ketosis. Nevertheless, care should be taken, as this can cause breast edema and affects breastfeeding, overload liquids diminishing uterine contractility, or facilitate hyperglycemic crisis in the mother and fetus and hypoglycemia in the new-born child [27]. Most of participants (83%) referred to lithotomy or recumbent dorsal position with stirrups in their experience during labor.…”

“…CTG is frequently performed 20 minutes after the admission, but there is no evidence of benefits for low-risk women [32]. Carrying this out on entry to maternity represents a defensive style of care, but adds 20% to the probability of a Caesarean or instrumental birth [27,32].…”

“…Epidural was suggested by EESMO in 20.8% of cases and was used by 61.5% (n=110) of the women, representation being therefore close to American studies [27]. As a means to alleviate pain, it is widely used and can be incorrectly included in the concept of a normal birth [9].…”