The environment you labor in and the interventions that you have during labor can not only affect your baby’s health, but can also affect your recovery time. Thinking about these early on and making a decision about what you would do in different scenarios can ensure that you understand the risks and benefits of different options. When you’re in the middle of a contraction, or in the whirl-wind of just walking into the hospital during labor, you don’t have the time, energy, or mental capacity to give each decision consideration and thoughtfully choose what is right for you.
These are three decisions that you will need to make during labor, their pros and cons, and how they can affect your newborn’s health and your recovery time as well.
1. IV Fluids during labor
Most hospitals place an IV with fluids as soon as you are admitted into Labor and Delivery. Those fluids are usually normal saline, but medication like Pitocin can also be put in through the IV.
This can affect your birth and recovery time:
- Having an IV placed will inhibit you from freely moving around during labor. Women who move are better able to listen to their body’s signals of what position is most comfortable and productive for labor. For example, mothers who squat or birth on hands and knees increase their pelvic opening through this position change, and allow their babies to be born easier.
- Medications can be added to the IV bag without the laboring mother noticing. Most notable is Pitocin, synthetic oxytocin, which causes stronger contractions. Pitocin should only be used after understanding the pros and cons of the medication.
- The excess fluid can cause swelling in your body, which is uncomfortable, and causes the kidneys to work to extract it. It’s not uncommon for a first time mother to be in labor 24 hours or longer, and with an IV running the whole time, that’s a lot of fluid!
- IV fluids are not shown to be more effective than allowing the mother to drink to thirst during labor. (source)
This can affect your baby:
- Babies also are receiving an excess amount of fluids during labor when the mother has an IV placed (source). After birth as they lose these fluids and return to normal, care providers can become alarmed because it looks like too much weight has been lost. Mothers can be pressured to supplement with formula due to this large drop in weight, and the breastfeeding relationship is less likely to be successful.
2. Your Environment Immediately After Birth
The baby has been born, is nice and pink and is crying. Everything’s all okay now, right?
Not so fast.
The environment after birth is important both for baby to latch on and start the nursing relationship, and for mom to deliver the placenta safely and prevent postpartum hemorrhage. Skin-to-skin contact promotes temperature regulation in the newborn (source), helps them regulate their breathing, and allows them to breastfeed. Early breastfeeding provides the newborn with colostrum for nutrition, antibodies, and it may even help with establishing good gut flora (source).
Oxytocin is produced during labor and after delivery by both the mom and baby. This hormone is responsible both for the letting down of milk and the clamping down of the uterus. When left undisturbed, with the lights and voices low, oxytocin levels are high in baby and mom for at least the first hour after birth. When disturbed by bright lights, and even the happy excitement of family and friends, adrenaline competes with oxytocin within the body, which lowers the oxytocin levels (source).
Keep the lights dim, diaper the baby if desired, or just let him be skin-to-skin with mom for at least the first hour, covered in a receiving blanket. Leave the hat off of baby to allow the natural bonding take place between the parents and the baby that involves smelling the baby’s head, stroking his hair, and giving him kisses and nuzzles. Any vitals needed can be taken while baby is resting on mom, but a pink baby who is alert and breastfeeding can usually have the newborn exam put off for an hour or two.
3. Internal exams during labor
Internal (vaginal) exams are just a part of giving birth, right?
I’ve had three children and have never had a vaginal exam during labor. (I’m busy when I’m in labor doing other things, like, you know, birthing the baby!)
This is good news! Nobody likes vaginal checks, and they really don’t tell us much (source). A woman who is dilated to 3 can easily stay at a 3 for hours longer, or can quickly dilate up to a 10 in the next few minutes. Vaginal exams introduce bacteria into the birth canal, can cause distress to the mother (see above about adrenaline and oxytocin not getting along), and can be discouraging to a woman who has been in labor for hours only to hear that she’s just now dilated to a 5.
With internal exams comes the risk of rupturing the membranes (source), which can cause the water to be broken before real labor has started, can cause cord prolapse with the prematurely breaking water, and increases the risk of needing a cesarean delivery.
Can I refuse vaginal exams? Yes, you can. It may be hospital policy, or your doctor’s standard procedure, but you are well within your rights to refuse vaginal exams that you do not wish to have (some women do want to be checked to see if labor is progressing, some women check themselves, and some women opt out all together).
Educating yourself during pregnancy is important
It’s important to understand your choices well before you present to the L&D floor. You want to know what is and isn’t important to do during pregnancy, labor, and delivery. Reading about the pros and cons of different protocols and procedures well before you are in labor is imperative. When you’re in labor you won’t have time to thoroughly consider your options.
Need help advocating for yourself?
Doulas are wonderful advocates for the laboring woman. A doula can help remind you of your birth plan, can prompt you to ask questions of your care provider, and can help you achieve the birth you want – both in the hospital and at home. I strongly encourage families to interview local doulas while they are pregnant, and choose one that they feel comfortable with to help them during the birth.
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