Posts Tagged ‘electronic fetal monitoring’

Why I Chose Natural Birth

Why have a natural birth? If I told people during my pregnancy that I wasn’t planning on an epidural, I was asked, “Why put yourself through that if you don’t have to?” Why, indeed? Is it so I could pat myself on the back afterwards? It is so I could feel like a martyr? Is it to prove something to other women, or to feel more like an “earth mother?”

Well, no. I did not choose a natural birth for any of these reasons. Here are three important reasons why I chose to birth naturally:

1) For my body.

The term “Natural Childbirth”, or “NCB,” as some like to call it, loosely means that the mother gives birth without any drugs or interventions. It seemed to me that it was best for my body to avoid the risks and possible complications caused by commonly used medication and interventions if at all possible.

For example, the hailed epidural, while often providing excellent pain relief, can also bring about a fall in maternal blood pressure, nausea, and vomiting. It can slow labor down considerably. Epidurals are also associated with a higher cesarean rate, which can certainly be considered harder on the mother’s body than a vaginal delivery. They sometimes create long term side effects for mothers, such as spinal headaches,  and its possible to have rare but life threatening reactions to an epidural.

However, it’s not only the epidural that carries risks and adverse effects on mom’s body. Pitocin, the commonly used tool to augment labor, creates harder and much more painful contractions for mom. This often leaves the mother asking for more meds to ease the pain. Narcotics can depress mom’s breathing. IVs can lead to fluid in the mother’s lungs and diluting of red blood cell concentration (this anemia in labor predisposes mom to bleeding). Artificial rupture of membranes makes contractions harder on mom before they need to be, as well as increase the risk of infection.

These interventions all create secondary effects. Once mom takes medication, she needs electronic fetal monitoring (EFM) to watch the baby. If it’s internal monitoring, this means she is now attached to the machine. If she has an epidural, she’ll most likely need a urinary catheter since she cannot feel to go herself. And an epidural itself significantly decreases or completely cuts off mom’s mobility. Lack of mobility makes for slower labor, makes for a less physiologic birth because it doesn’t help the baby make her way down the birth canal , and often restricts the mother to the lithotomy position for pushing (this creates even more complications for mom’s body).

Phew! Maybe my body could handle labor a whole lot better if I just let it do it’s thing!

2) For my mind.

I’ve heard several mothers say that the narcotics given in labor made them feel drunk or drowsy, but didn’t take the edge off the pain too much. Some moms might prefer this sleepy, “out-of-it” state of mind, and it might help some mothers relax enough so that labor can progress smoothly when tension otherwise might have taken over. I personally, however, felt it was important to be “all there” for labor and delivery. I wanted to be alert and aware for my first meeting with baby- not half-asleep.

I’ve heard the argument that all the interventions in labor can create adverse psychological effects. How so? Well, they say that being hooked up to an IV, EFM, urinary catheter, and having an epidural in the back, along with being on my back, legs up high in stirrups, and constantly being poked at “down there” (frequent internal examinations) can make a woman feel helpless, non-participant, exposed, and more like a sick patient than a mother working on meeting her child. I cannot attest to this personally because I have not had this experience. I’m sure that some women might not mind this process so much, but to me, it sounded terrible. I wanted to remain active and feel in control of my labor.

This part might sound weird to some mothers, but for me, it was emotionally important to feel everything. I wanted desparately to experience the process as fully as possible. I wanted to be in touch with my body and my baby, to listen to his cues to move this way or that way, sit, dance, moan, or bellow. I felt that I wouldn’t appreciate the process of labor as much if I didn’t feel it. I felt like meeting the baby would be all the more enthralling if I had to work to get there. It seemed that the absolute bliss of delivering my child would be even more magnified if I fully understood and lived and smelled and tasted and breathed every second of labor and delivery.

3) For my baby.

Most importantly, I chose to birth naturally for the sake of my little one. We are so careful during our entire pregnancies to do the best for our babies. We (hopefully) give up smoking and alcohol (if you partook in your non-pregnant state), we limit our caffeine, and we make sure we don’t eat anything undercooked. We take prenatal vitamins religiously, avoid anything with the label, “If pregnant or breastfeeding, ask a doctor,” and are extra careful of our growing bellies. Yet, at birth, so many women quickly and sometimes carelessly sign up for medication that can and often does have adverse effects on the baby (in their defense, often without knowing the possible effects).

What are some of these risks I avoided by choosing to birth naturally?

An epidural can cause serious drops in baby’s heart rate, makes for longer labors (sometimes less tolerable for baby), and makes for an increased rate of vacuum extractions, forceps deliveries, and cesarean sections (which can create additional risks for baby). Are narcotics safer? Remember that they can depress mom’s breathing, leading to less oxygenation for the baby. Narcotics can also adversely affect fetal heart rate. Pitocin, often used to augment labor after an epidural (or for other reasons, some of which are not medically indicated) makes for longer, harder, stronger contractions, making the baby much more likely to experience fetal distress. Artificial rupture of membranes makes for higher risk of infection for mom and baby. IVs dilute mom’s red blood cell count, therefore also reducing oxygenation to the baby. Glucose containing IVs can have adverse effects on baby’s sugar levels and lack electrolytes. These IVs lead to low blood sodium in the newborn (putting the baby at risk for seizures and apnea). They also cause fluid overload. This excess fluid can get into the baby’s tissues and lungs (making for breathing diffuclties). Excess fluid can increase the likelihood and severity of newborn jaundice, and can also cause a type of transient pneumonia. Internal EFM requires a prick in the baby’s scalp, which isn’t at all a major injury, but I didn’t like the idea of it unless I really needed it to check for suspected fetal distress.

Keep in mind that many interventions decrease mom’s mobility. When this happens, mom can’t help baby move down, open up the cervix, and travel through the birth canal nearly as easily. However, if mom can get upright and move, she helps the baby to keep shifting downwards. Being upright in the second stage of labor means a shorter pushing time and more oxygenation to the baby (no pressure on major blood vessels this way). A physiologic birth is good for the baby too!

Finally, just as I wanted to be “all there” for the first meeting of my child, I wanted him to be “all there” too! It is widely acknowledged that babies whose moms receive medication during labor are more likely to be sleepy and have trouble suckling at birth. The drugs get to the baby too, and can interfere with initial bonding. Those first moments are so precious, and I really wanted my baby to be just as alert and aware as I was.


I do understand that in a true emergency interventions can be life saving, and I am certainly not opposed to them as a whole. Even in non-emergency situations, when the benefits of interventions outweigh the risks and they are needed for medically indicated reasons, they can sometimes make birth safer for mother and baby. I do believe that most of the aforementioned interventions exist for a reason, have a place, and can have some positive effects. It is less than helpful to vehemently deny them in every single circumstance. However, I strongly feel that it is important to know the risks and benefits of each intervention before signing up for any of them.

Also, for the record, I don’t believe that asking for an epidural or nartcotics makes you a sissy or a weakling. Every mom has her breaking point, and I don’t think any of us can judge when that might be for someone else. Sometimes having some pain medication (perhaps in an extremely long labor, for example) might be what can give rest or some peace of mind to the mom and allow her to look back on the birth as a positive experience.

Concluding Thoughts

I think the important thing here is that we weigh our choices in childbirth carefully, with full understanding of the risks and benefits of each intervention. That way, if mom does decide she needs medication, or if she truly does need Pitocin (as I did for post-partum hemmorage), or if a cesearean might actually be needed, she understands her options and is prepared to work with the outcome of her choices. This also helps her to feel more in control and more positive about her labor and delivery choices.

For me, the benefits of routine interventions didn’t seem like they could outweigh the risks, especially when there are so many effective natural means of pain relief and labor progression. Every intervention, even if effective, also creates side effects that may be less than desirable. I felt that labor went much more smoothly when I allowed my body to do what it was made to do naturally- work that little baby out! Overall, my natural childbirth was the best experience of my life. If my future health, labors, and babies allow it, I would love to do it that way again.

Much of this information gleaned from:

Goer, Henci. The Thinking Woman’s Guide to a Better Birth. The Berkley Publishing Group, New York, New York. 1999.


Pregnant Robot Trains Students

Okay. I’m feeling a little disturbed watching this. I know there are some good things about “Noel,” the pregnant robot, but I have some questions and concerns about this method of training.

“Everything is as it would be- the patient, the way she’s positioned on the table…”

Lithotomy Position: I just blogged on how uneffective this position is for labor and delivery, and how research has shown that being upright is almost always healthier for mother and baby. Besides, who says that every woman even wants to be on her back? Check out the post “Get Off My Back!” for a summary and additional links to information on this position.

Using her for study purposes…

I’m sure that Noel is an excellent study tool, and I do see the benefit of getting to learn some maneuvers on a robot first, rather than on a real woman. However, a robot can never effectively simulate the realities of interacting with a woman in the throes of the second stage of labor. This study must be supplemented with ample time observing real labors.

“She’s like a real patient in that she’s hooked up to a fetal monitor…

Hmmm, but what if a woman doesn’t want EFM and would rather intermittent listening? EFM has been shown through various studies to not be any more effective than intermittent listening, and can often show false positives of fetal distress. Can students practice intermittent listening on the robot as well?

“We have her hooked up to an IV…”

What if the woman doesn’t want an IV, but would rather have freedom to walk, move, eat, and drink as she pleases? If the woman isn’t receiving antibiotics, pitocin, IV drugs, or an epidural, then there is no real reason for an IV.

“Other complications, such as long labor time…”

Long labors are perfectly normal! In fact, it seems that hospitals’ time constraints on labor are far too tight to allow most mothers to progress naturally in a comfortable time frame (hence, the overuse of pitocin to augment labor in many hospitals). It is important to continue to check on both mother and baby during a long labor for potential problems (and of course take care of mom if she is exhausted), but the length of labor itself shouldn’t be considered a complication.

“Having a breech baby…”

If I’m correct,  the ACOG standard for breeches is a c-section.  However, I have heard of a late term undetected breech before, when no one knew about the breech until the baby was already on the way out. I doubt that’s a very common scenario, but I wonder if students ever get to try a vaginal breech delivery on Noel in case they encounter it in real life? (Note that there are still some doctors and midwives who practice the art of delivering breeches vaginally.)


I understand that there are definitely benefits to using a robot for training purposes. I think that if this is helpful to student doctors and makes for better, healthier experiences for mother and baby, then great! I’m glad that Noel is around! However, as with the advent of any new technology, we must carefully consider all pros and cons of using it. I am concerned that if this is what they are training students to think is the normal pattern of labor and delivery, then what will those students do when they have a woman who wants to squat or get on all fours? What if she won’t lie on her back hooked up to machines? What if she wants to birth naturally in a hospital setting? Can Noel effectively train students for this scenario? If not, will the student doctors get to train with real women with these wishes for birth?

Most importantly, deliviering a robot’s baby quite literally takes the humanity out of attending a birth. A woman in labor is going through probably one of the single most important and personal days of her life. She is facing one of the most difficult challenges she will ever experience, and is about to meet a little one who will change her entire being. I do hope that these student doctors are also getting a chance to train in communication, sensitivity, and patience. It may be silly, but this gives me an uneasy sensation that working mainly with a robot could lead to desensitization of the amazing range of emotions a woman is feeling as she is in labor. I hope that as students get to work with real women, they will learn the careful art of being low profile, gentle, and encouraging as they help the mother through the process of giving new life to the world.