When writing birth plans, most expectant mothers don’t anticipate they will need interventions during delivery—which includes everything from hormonal induction of labor to the use of forceps to a C-section. Yet current rates for cesarean births in the United States hover around 32%, more than 20% of births are medically induced and approximately 5% of vaginal births occur with “instrumental tools.”
According to a new study, many of these birth interventions are not only unnecessary, but have long-term implications for mothers and babies.
“Women progress much slower in labor than we previously thought. For 70 years, clinicians believed the cervix should dilate by 1 cm per hour,” say the authors of a study published in the journal Birth in an analysis of the research for The Conversation. “If the cervix was slower to dilate, intervention was initiated because labor was thought to have slowed.”
Although the authors note there are certainly cases where interventions are warranted, the actual rates of intervention exceed the labor and delivery guidelines from the World Health Organization. In their analysis of nearly 500,000 healthy, low-risk births in New South Wales from 2000 and 2013, as well as follow-ups with the children in the first 28 days and five years later, the researchers found unnecessary intervention may also create unnecessary health consequences.
“Instrumental births” are tied to struggles in the first month
Babies who were born with the use of forceps or a vacuum were at the highest risk for jaundice and feeding problems, which they hypothesize is linked to the babies’ response to the bruising or bleeding often caused by these interventions.
Babies born via C-section need more hospital treatment
Compared with babies born vaginally, those who come into the world by cesarean birth are more likely to be cold and need more treatment at the hospital, which the researchers believe is because skin-to-skin recommendations are not always followed. Babies born by emergency C-section are also higher risk for metabolic disorders, such as diabetes and obesity, by the age of 5.
All birth interventions create higher risks for some health struggles
Compared with babies born by spontaneous vaginal delivery, babies born with some intervention were at higher risk for respiratory infections, metabolic disorders and eczema. Researchers believe this may be because “vaginal birth provides an important opportunity to pass gut bacteria from mother to baby to produce a healthy microbiome and protect us from illness.”
What can we do to lessen the rates of interventions?
For medical providers, the authors of the study say they hope the takeaways will be to give labor more time to progress naturally and to ditch continuous electronic monitoring (CTG) in favor of regular, hand-held monitors for low-risk women. They say, “Continuous monitoring increases intervention rates for low-risk women and healthy babies without improving outcomes for babies.”
Another way to improve outcomes is to create systems that allow mothers to have continuity of care—meaning they see one medical provider through pregnancy, birth and postnatal periods.
For women, preparing to give birth can feel daunting enough, but it’s important to remember that these are our experiences. If you feel strongly about avoiding interventions, make sure your medical providers and birth support team knows your preferences ahead of time so they can advocate for you.
But also remember that while interventions may not be preferable, they represent just one moment in your baby’s life. And while the birth story does matter, the life story matters much more.