**NOTE** Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth. This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience. Improperly used interventions have led to harm and death of women and babies and obstetrics is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths.
**NOTE** This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research.
**NOTE** Chronological order allows users to find new data. It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.
INTERVENTIONS GENERAL INFORMATION AND MISCELLANEOUS INTERVENTIONS
C-sections are not the only interventions done that are not always medically necessary. When interventions are used for non-medical reasons they are often harmful.
There are other interventions which that are done often without medical reasons. These include such things as:
Restrictions on eating, drinking and IV fluids: A 1946 recommendation by Dr. Curtis Mendelson said that restricting food and fluids during delivery would prevent aspiration during general anesthesia. This practice became ingrained in medical literature (Sperling, et.al., 2016). While valid for at-risk births, there is no evidence that this should be done for low-risk births. Unlike in hospitals, in birth centers, home births, many European countries, oral intake encouraged to enhance comfort and for nourishment during labor (Sperling, et.al., 2016) resulting in better outcomes. Current research of women in active labor suggests that oral intake should not be restricted in women at low risk of complications, given there were no identified benefits or harms of a liberal diet (Sperling, et.al., 2016). Restriction of food and drink leads to IV fluids, which are usually not necessary.
Continuous electronic fetal heart monitoring: This practice came about in the 1970s, was not based on any valid medical research, yet became a standard of practice. Trials and research since then have found no difference in outcomes for women having electronic fetal monitoring versus intermittent auscultation (Doppler ultrasound). It has been found to increase the occurrence of C-sections or instrumental vaginal birth. “EFM disrupts normal physiology of labor by restricting movement and potentially interfering with appropriate labor support as providers and family watch the monitor. It certainly limits women’s access to comfort measures such as showers, tubs, and birth balls that naturally control pain and that ultimately can increase the chance that they will need an epidural and a further cascade of interventions” (Lothian, J. 2014) . And those cascading interventions often lead to c-sections.
Interference with natural labor and induction with drugs such as Pitocin has become all too common. Women are often told that they have labored too long (which can happen but is rare and often based on ignoring the fact that natural labor is not a short process). It should only be done when a medical issue is identified to avoid harm to mother/baby. It should not be done to maintain schedules or for non-medical reasons. Induction is rarely necessary. Labor can be a long process and natural labor is important to the health of mother and baby. It disrupts the natural hormone process of labor that readies the baby for birth and Increases pain often to intolerable levels leading to the use of drugs such as epidurals. It Interferes with the release of natural endorphins which the body produces to manage pain. The unnatural strength of contractions are difficult for mothers to manage and also put additional stress on uterine muscles. The use of epidurals or other drugs slow the progress leading to increased levels of Pitocin to speed up and a cycle occurs that often leads to c-sections (Lothian, 2014).
What are the average times of natural labor?
NATURAL LABOR (12 – 21 hours) and vary
First stage of labor has three phases (11.5 hours – 19 hours)
•Early Labor: The onset of labor until the cervix is dilated to 3-6 centimeters (8-12 hours)
•Active Labor Phase: Continues from 3 cm until the cervix is dilated to 7 centimeters (3-5 hours)
•Transition Phase – Continues from 7 cm until the cervix is fully dilated to 10 centimeters (30 min – 2 hours)” (American Pregnancy Association, 2022)
Second stage of labor
Pushing: Contractions will last about 45-90 seconds at intervals of 3-5 minutes of rest in between (20 min – 2 hours)
Third stage of labor: expulsion of placenta (5-15 minutes after birth)
WHAT DOES THE LITERATURE SAY?
GENERAL
2019
MACPAC (2019). Medicaid ipayment nitiatives to improve maternal and birth outcomes. Accessed https://www.macpac.gov/wp-content/uploads/2019/04/Medicaid-Payment-Initiatives-to-Improve-Maternal-and-Birth-Outcomes.pdf
- From Intro: Pregnant women in the United States experience delivery via cesarean and early elective deliveries at higher rates than medically recommended for positive outcomes (ACOG 2019, WHO 2015). Delivery via cesarean or induction may be desirable for complicated births, but when not medically indicated, such procedures pose health risks for both the woman and child, and may increase the length of a hospital stay and admissions to neonatal intensive care units, thereby increasing the cost of care (NCSL 2018, Ashton 2010, Kamath et al. 2009).
2018
Calik, K. Karabulutlu,, O. and Yavuz, C. (2018). First do no harm – interventions during labor and maternal satisfaction: a descriptive cross-sectional study: BMC Pregnancy and Childbirth. Accessed hhttps://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-2054-0
- From Conclusion: Unnecessary interventions without medical indications spoil the physiology of birth. A birth where physiology is spoiled is traumatic for the mother, hazardous for the baby and exhausting for the physician/midwife/nurse. Our study results show that interventions not supported by evidence-based studies (such as continuous EFM, enema, induction, frequent vaginal examinations, food/liquid restrictions, the closed glottis pushing technique, episiotomy, movement restrictions, manual preservation of the perineum, early clamping of the umbilical cord, delayed skin-to-skin contact) were routinely performed at the discretion of the medical staff and that the women were not happy with this. The women were not properly informed about the procedures performed on them and their approval was not sought
California Healthcare Foundation (2018). Infographic: The overmedicalization of childbirth. Accessed https://www.chcf.org/publication/infographic-overmedicalization-childbirth/
- While 74% of mothers agreed that childbirth should not be interfered with unless medically necessary, only 5% gave birth without interventions. Options and alterantives were not always explained
2014
Lothian, J. (2014). Healthy birth practice #4: Avoid interventions unless they are medically necessary. Journal of Perinatal Education, 2014 Fall; 23(4): 198–206. Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235054/
- CONCLUDED “”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
2013
Jansen, L., Gibson, M., Bowles, B. and Leach, J. (2013). First Do No Harm; Interventions During Childbirth. Journal of Perinatal Education. Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647734/ doi: 10.1891/1058-1243.22.2.83
- Abstract: Although medical and technological advances in maternity care have drastically reduced maternal and infant mortality, these interventions have become commonplace if not routine. Used appropriately, they can be life-saving procedures. Routine use, without valid indications, can transform childbirth from a normal physiologic process and family life event into a medical or surgical procedure. Every intervention presents the possibility of untoward effects and additional risks that engender the need for more interventions with their own inherent risks. Unintended consequences to intrapartum interventions make it imperative that nurse educators work with other professionals to promote natural childbirth processes and advocate for policies that focus on ensuring informed consent and alternative choices. Interdisciplinary collaboration can ensure that intrapartum caregivers “first do no harm.”
2006
Klein, Sakala, C., Simkin, P., Davis-Floyd, R., Rooks, J. P., & Pincus, J. (2006). Why Do Women Go Along with This Stuff? Birth (Berkeley, Calif.), 33(3), 245–250. https://doi.org/10.1111/j.1523-536X.2006.00110.x
- CONCLUDED: PREFACE: “Normal childbirth has become jeopardized by inexorably rising interventions around the world. In many countries and settings, cesarean surgery, labor induction, and epidural analgesia continue to increase beyond all precedent, and without convincing evidence that these actions result in improved outcomes (1,2). Use of electronic fetal monitoring is endemic, despite evidence of its ineffectiveness and consequences for most parturients (1,3); ultrasound examinations are too often done unnecessarily, redundantly, or for frivolous rather than indicated reasons (4); episiotomies are still routine in many settings despite clear evidence that this surgery results in more harm than good (5); and medical procedures, unphysiological positions, pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and early mother-infant separation are used unnecessarily (1). Clinicians write and talk about the ideal of evidence-based obstetrics, but do not practice it consistently, if at all. Why do women go along with this stuff? In this Roundtable Discussion, Part 2, we asked some maternity care professionals and advocates to discuss this question. (BIRTH 33:3 September 2006)”
RESTRICTIONS ON EATING/DRINKING AND IV DURING LABOR
2019
Terreri, C (2019) Why can’t I eat food during labor? Accessed https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/why-cant-i-eat-food-during-labor
- Eating and drinking during labor and birth has long been a known no-no. But in recent years, it has been found that, in fact, eating and drinking is safe for laboring people. This is great news because labor and birth is a monumental physical event that requires energy and hydration from food and drinks!
Terreri, C. (2019). What do know about an IV during labor and birth. Accessed https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/what-to-know-about-an-iv-during-labor-and-birth#:~:text=However%2C%20an%20IV%20is%20not,the%20normal%20process%20of%20birth.
- However, an IV is not required for many people in labor. Despite the fact that a large number of hospitals and care providers (doctors and midwives) routinely order an IV for people in labor, it is only truly needed in certain cases. Use of an IV in labor and birth is an intervention in the normal process of birth. When needed, it can be beneficial and even life-saving. When used unnecessarily, it can have negative impacts.
2016
Greenfield, R., Elbaz, M. Mozer, M. Mestechkin, D., Biron-Shental, T., et al (2016). Should we restrict food during labor? American Journal of Obstetrics and Gynecology. Accessed https://www.ajog.org/article/S0002-9378(20)31842-1/fulltext https://doi.org/10.1016/j.ajog.2020.12.466
- Conclusion: Eating during labor and delivery does not have an adverse effect on its progression and outcome. Our data support patient’s autonomy to choose whether to eat or not during their labors.
Sperling, Dahlke, J. D., & Sibai, B. M. (2016). Restriction of oral intake during labor: Whither are we bound? American Journal of Obstetrics and Gynecology, 214(5), 592–596. https://doi.org/10.1016/j.ajog.2016.01.166
- CONCLUDED: “Current labor management practices remain profoundly different from those of Mendelson’s era in 1946. The evidence suggests that the dramatic decline in aspiration complications during labor is a testament to advances in modern obstetric anesthesia practices and unlikely related to oral intake during labor. After discussing possible risks and benefits among the low-risk parturient, the decision to eat or drink in labor should be ajog.org Clinical Opinion MAY 2016 American Journal of Obstetrics & Gynecology 595 the woman’s. It is time to reassess the risk of aspiration among low-risk parturients and reevaluate the restriction of oral intake during labor.”
2015
American Society of Anesthesiologists. (2015). Most health women would benefit from a light meal during labor. Accessed https://www.asahq.org/about-asa/newsroom/news-releases/2015/11/eating-a-light-meal-during-labor
- Women traditionally have been told to avoid eating or drinking during labor due to concerns they may aspirate, or inhale liquid or food into their lungs, which can cause pneumonia. But advances in anesthesia care means most healthy women are highly unlikely to have this problem today and when researchers reviewed the literature of hundreds of studies on the topic, they determined that withholding food and liquids may be unnecessary for many women in labor.
EPIDURAL AND OTHER PAIN MANAGEMENT
2016
Newnham, Mckellar, L., & Pincombe, J. (2016). A critical literature review of epidural analgesia. Evidence Based Midwifery, 14(1), 22–28. Accessed https://www.researchgate.net/publication/301555797_A_critical_literature_review_of_epidural_analgesia
- CONCLUDED (from abstract “Findings: The biomedical literature on epidural analgesia concerned itself with particular outcomes, such as increases in caesarean section and instrumental birth rates, and yet maintained its narrative of epidural as a ‘safe and effective’ analgesic option. Implications: By exposing the contextual nature of knowledge, we offer another standpoint from which evidence and practice can be reviewed. In this critical literature review we provide an alternate reading of epidural text and challenge some of the assumptions made about epidural analgesia, and the practices that stem from these beliefs.”