Hormones & Healthy Birth: Avoid Interventions that Are Not Medically Necessary

In this week's edition of our Hormones and Healthy Birth series, we address " Healthy Birth Practice 4: Avoid Interventions that Are Not Medically Necessary" and the implications the practice has with how hormones are affected by interventions during labor, birth, and postpartum. The Hormonal Physiology of Childbearing report from Childbirth Connection offers several guidelines when it comes to avoiding interventions (when not needed for medical reasons), as this is one of the most potent sources of harm when it comes to interrupting the hormonal process.

So what is meant by a "medical intervention" in labor and birth? Labor and birth is a physiological (naturally occuring in the body) process; a medical intervention is any medical practice that interferes with that process. For example:

• Induction by artificial r upture of membranes (breaking your water)
• Induction with Pitocin
• Labor augmentation (speeding up) with Pitocin
• IV fluids
• Cervical checks
• Epidural and anesthesia
• Restrictions on movement
• Restrictions on eating and drinking
• Continuous electronic fetal monitoring (EFM)
• Directed pushing (rather than allowing you to follow your body's urges for pushing)
• Episiotomy
• Cesarean surgery

While medical interventions are sometimes helpful, life-saving, and absolutely necessary for the health of you and your baby, it is often the case that medical interventions are used routinely -- not according to evidence -- when the potential for harms outweigh the benefits. How often do some of these interventions occur? In the Listening to Mothers III survey (2013), 67% of women had an epidural (for vaginal birth), 55% had an IV, 36% experienced Pitocin for augmentation, 31% had their w ater artificially broken by care provider after labor had started, 17% had an e pisiotomy, and only 21% of women reported eating during labor (restricting eating during labor is an outdated practice still in use in many hospitals). Each medical intervention used during labor and birth carries with it risks to mother and baby, including interfering with the important work of birth hormones.

Let's look at some of the most common interventions and see how they interfere with the flow of hormones and can impact birth.

Induction and augmentation with Pitoci n

The use of synthetic oxytocin (known in the U.S. as "Pitocin") has been associated with:

• Lowered release of natural oxytocin released from a woman's brain
• Lowered calming and pain relieving effects
• Increased risk of postpartum hemorrhage (excessive bleeding)
• Need for more/increased Pitocin to progress labor
• Prolonged pushing stage
• Increased use of vacuum or forceps at birth
• Disruption/difficulty with newborn breastfeeding and bonding/attachment (oxytocin & prolactin hormones interference)
• Potential long-term effects on infants

Analgesics (narcotic pain medication) and epidural

• Reduces natural oxytocin, which can slow labor, lengthen pushing stage and possibly require need for vacuum or forceps, and negatively affect mother-baby bonding
• Reduced beta-endorphines (natural pain-relieving hormones), which can interfere with mother-baby bonding after birth
• Rapid drop in epinephrine which may contribute to low blood pressure and overstimulation of the uterus
• Reduced epinephrine and norepinephrine, which can contribute to prolonged pushing and forceps or vacuum-assisted birth

Cesarean (scheduled, without experiencing labor)

• Prelabor oxytocin and prolactin is reduced, which can interfere with mother-baby bonding and breastfeeding success
• With no exposure to the catecholamine surge before birth, infants are more at risk for postpartum breathing difficulties, low blood sugar, and low body temperature
• Infant's reduced maturity (brain, hormones, organs)
• Reduced oxytocin, which can icrease risk of postpartum hemorrhage
• No exposure to epinephrine-norepinephrine spike in late labor, causing mom and baby to be less alert after birth (which can cause problems with breastfeeding initiation)

Avoid Interventions that Are Not Medically Necessary: Here's How

• Ask your care provider (the earlier, the better) about the kinds of interventions they use and when they use them. You can ask about their rates of interventions, but you'll most likely get more accurate and telling answers with more open-ended questions, like, "For what reasons would you recommend an induction?" and "Why would I need a cesarean?"
• Take a quality childbirth education class to really get to know different interventions and how they interplay with one another. For example, you cannot be induced without having continuous external fetal monitoring and IV fluids.
• Learn about the interventions used regularly at your chosen place of birth. Sometimes, those rates are available publicly and sometimes (more often), they are not. You can ask during your hospital tour or at a prenatal visit with your care provider. Your best bet may be to ask local doulas and childbirth educators, who will have insider knowledge.
• Research and practice a variety of coping and comfort measures , as well as position changes , to use during your labor and birth.
• Consider hiring a doula , who is trained on the use of interventions and can offer additional resources for you to make the best informed decision about your care. A doula will not advocate on your behalf, but can help you be a better advocate for yourself.
• When you hit 40 weeks and there is no sign of labor, remind yourself that 40 weeks is not a deadline but a vague estimate and that a healthy pregnancy can go to 42 weeks and beyond. The healthiest choice in most cases is to let labor begin on its own .
• If faced with the decision to induce your labor, find out why and ask about your Bishop's Score .
• Make sure your partner or birth support person (spouse, partner, friend, family member) knows about your birth preferences and understands how best to support you during birth . Your birth support person (spouse, partner, friend, family member, doula) is an invaluable asset to your birth experience.
• If interventions become necessary, find out how you can keep your labor as healthy as possible .

Additional Resources

• " Intervention Intelligence " from Lamaze - a list of common interventions and what you should know
• Learn about the evidence behind common interventions (when they are recommended and when they are not) at Evidence Based Birth
• Find out why your choice of birth place matters at Childbirth Connection
• Learn more about the measures taken by the American Congress of Obstetricians and Gynecologists (ACOG) to prevent the first cesarean

References

Buckley S. 2015. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care. Childbirth Connection, Washington, DC.

Childbirth Connection. 2015. Pathway to a Healthy Birth: How to Help Your Hormones Do Their Wonderful Work. National Partnership for Women & Families, Washington, DC.

Childbirth Connection, 2013. Listening to Mothers III: Pregnancy and Birth. Childbirth Connection, Washington, DC.

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