Interventions During Pregnancy & Childbirth

Interventions During Pregnancy & Childbirth A Deliberate entry into a situation to prevent an undesirable outcome!

Pros and Cons • As with any intervention, those used in pregnancy and childbirth the benefits and risks must be considered on an individual basis. • Expectant parents must confer with their medical care provider and be personally informed about any medications and interventions used during pregnancy and childbirth.

Interventions • Some interventions are medically necessary and some are done for convenience. • Would an Induction ever be scheduled so that a particular Dr. would be available to deliver a baby? • What if the Grandparent’s to be are visiting but just for a few days during the time of the unborn baby’s due date? Would a woman ever have her labor induced in this situation?

Induction • A woman’s body is subjected to a torrent of synthetic hormones. • Induction maybe necessary when there is a danger to mother or child if the baby is not delivered at that point. • A woman with a baby that is considerably over due may need to be induced. • A problem with the placenta or not enough amniotic fluid.

Types of Interventions Induction is a type of Intervention that cause labor to begin.

Dangers of Induction • Contractions maybe stronger become intense more quickly than with natural labor. • Use of medications, such Poticin • Increases the risk of abnormal fetal heartbeat, risk of baby being admitted to the NICU, need for forceps or vacuum extraction of baby, C-Section, prematurity or jaundice.

Methods to Induce Labor: • Stripping the membranes. The doctor puts on a glove and inserts a finger into the vagina and through the cervix (the opening that connects the vagina to the uterus). He or she moves the finger back and forth to separate the thin membrane connecting the amniotic sac (which houses the baby and amniotic fluid) to the wall of the uterus. • When the membranes are stripped, the body releases hormones called prostaglandins, which help prepare the cervix for delivery and may bring on contractions. • This method works for some women, but not all.

Stripping the membranes can be a little painful or uncomfortable, although it usually only takes a minute or so. • The woman may also have some intense cramps and spotting for the next day or two.

Breaking your water (also called an amniotomy).The doctor ruptures the amniotic sac during a vaginal exam using a little plastic hook to break the membranes. • This usually brings on labor in a matter of hours.

There is usually a degree of discomfort when the water is broken. • A tug followed by a warm trickle or gush of fluid is felt.

The hormone prostaglandin to help ripen the cervix.A gel or vaginal insert of prostaglandin is inserted into the vagina or a tablet is given by mouth. • This is typically done overnight in the hospital to make the cervix "ripe" (soft, thinned out) for delivery. • Administered alone, prostaglandin may induce labor or may be used before giving Oxytocin.

With prostaglandin, there might be some strong cramping as well. • With Oxytocin, contractions usually start stronger and more abruptally than if labor begins naturally.

The hormone oxytocin to stimulate contractions.Given continuously through an IV, the drug (often Pitocin) is started in a small dose and then increased until labor is progressing well. • After it's administered, the fetus and uterus need to be closely monitored. • Pitocin is also used to speed up labor that's going slowly or has stalled.

Epidural during Childbirth • An epidural is an injection of an anesthetic narcotic to block pain from reaching a specific area. • Currently considered the most popular choice in pain relief during childbirth.

Benefits of an Epidural: • Provides pain relief for laboring mother • Can reduce anxiety and allow a mother to rest during labor • Used during a cesarean section, a mother can remain alert and ready to meet her new baby the minute he/she is delivered.

Dangers of an Epidural: • Pain relief may be inadequate • Mother may experience a drop in blood pressure • Possible spinal headache (may make it necessary to do a blood patch) • Mother may retain urine requiring a catheter • May slow labor, requiring Pitocin; and has been found to increase the chances of a cesarean delivery by two or three times.

Dangers of an Epidural cont’d: • Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone and decreasing the mother’s urge to push. • In addition, forceps or vacuum extractor are required more often (20-75%). • Mom may also experience shivering, ringing in the ears, backache, and swelling at the site. • Numbness in the lower portion of the body for a few hours after delivery.

Epidural and the baby: • Dangers to the baby include: increased possibility of c-section, IV antibiotics and isolation in the nursery if mom develops and Epidural Headache and the effects are passed to baby, greater amount of medications in the baby’s system at birth. `

Prenatal Testing • Of the multitudes of options to expectant parents are the option of having prenatal tests. • Some of these are medically necessary and others are not. • Some of these are invasive and carry a risk to the pregnancy.

Amniocentesis • In the 1960s the ability to culture cells from amniotic fluid was developed. • Beginning in 1968, cells from amniotic fluid could be analyzed for chromosome disorders like Down's syndrome. • Today, amniocentesis permits the diagnosis of a wide range of disorders. • Amniocentesis is normally recommended at fourteen to sixteen weeks of pregnancy if there are risk factors. • Test results are usually available to the patient in two to three weeks.

During the amniocentesis a needle is inserted and an amount of amniotic fluid is withdrawn for testing. • The physician watches the needle on an ultrasound.

Risks of amniocentesis • Miscarriage • Cramping/Vaginal bleeding • Needle Injury • Leaking amniotic fluid • Infection

Chorionic Villus Sampling (CVS) • Chorionic villus sampling (CVS) is a prenatal test in which a sample of chorionic villi is removed from the placenta for testing. • During pregnancy, the placenta provides oxygen and nutrients to the growing baby and removes waste products from the baby's blood. • Chorionic villus sampling can reveal whether a baby has a chromosomal abnormality, such as Down syndrome. • Chorionic villus sampling can also be used to test for other genetic disorders, such as Tay-Sachs disease and cystic fibrosis

Risk of CVS • CVS carries the same risks as amniocentesis

Prenatal Testing • These types of tests raise complicated questions for a family if the results are not favorable for a normal outcome.

Parents-to-be must be their own health advocate and that of their baby. • They should be as informed as possible • When necessary get a second opinion.

Sources • http://www.naturalbirthandbabycare.com/birth-interventions.html • http://pregnancy.about.com/od/induction/a/risksinduction.htm • http://childbirthsolutions.com/articles/weighing-the-pros-and-cons-of-the-epidural/ • http://kidshealth.org/parent/pregnancy_center/childbirth/inductions.html# • http://www.discoveriesinmedicine.com/Ni-Ra/Prenatal-Diagnostic-Techniques.html • http://www.mayoclinic.com/health/amniocentesis/MY00155/DSECTION=risks • http://www.mayoclinic.com/health/chorionic-villus-sampling/MY00154/DSECTION=risks

Interventions During Pregnancy & Childbirth