The Risks & Benefits Of Medical Procedures During Childbirth

By Samantha Thurlby-Brooks

Here is a non-judgemental guide to the risks & benefits of the most common medical obstetric drugs and procedures used during childbirth. I’ve not included caesareans here as I’ll be writing another, more in depth, post about that. It’s important to be educated on the benefits and risks of medical procedures during childbirth so if faced with a situation you can make an informed decision (accept or refuse interventions) and weigh up the risks and benefits in your individual situation.

Risks & Benefits of Epidural & Spinal Block Anaesthesia

Benefits: 

  • Loss of feeling
  • Can wear off or be topped up
  • Can help an inconsolable woman to relax and dilate

Neutral:

  • Should only be given from 4cm dilation
  • Not normally given after 8cm dilation
  • Only available in hospitals with 24hr anaesthetist care
  • May have to wait a while to receive it
  • Have to sign a contract during labour

Risks:

  • 15% higher chance of fever than natural birth
  • Dangerously low blood pressure
  • 30% higher chance of baby getting stuck than natural birth
  • May be patchy; feeling contractions in certain spots but numb in others
  • Can cause chronic headaches
  • Chance of paralysis
  • Loss of feeling
  • Can cause chronic back pain
  • Higher chance of foetal distress than natural birth
  • Longer recovery
  • Effects Baby
  • Requires a catheter
  • Slows labour
  • Requires IV fluids
  • Requires synthetic oxytocin
  • 0.02% – 0.07% suffer life-threatening maternal complications, sometimes fatal
  • 6% higher chance of haemorrhage
  • 20% of epidurals do not work (includes labour and during a caesarean)
  • Higher chance of caesarean than natural birth
  • Reduces postnatal oxytocin levels
  • Cocaine based drug
  • 0.1% higher chance of chronic headaches with spinal block than with an epidural
  • 1% higher chance of prolonged foetal heart decelerations with spinal block than with an epidural
  • 0.6% of mothers suffer respiratory depression with combined spinal block and epidural

 


 

Risks & Benefits of IV Line & Fluids

Benefits: 

  • Increases blood pressure when epidural is administered

Neutral:

Risks: 

  • Distracting & uncomfortable
  • Can slow labour down
  • Restricts movement
  • Effects baby
  • NOT necessary as a precaution
  • Can cause inflammation and bruising at the site
  • Extra fluids cause water retention all over the body
  • Dilutes the blood too much, reducing iron concentration and fewer oxygen carrying cells per unit volume
  • Increases chances of haemorrhage
  • Glucose IV fluids (“dextrose” IVs) can raise maternal and foetal blood glucose to diabetic levels causing foetal distress and lower oxygen levels
  • Can make breasts too swollen to breastfeed
  • NOT necessary for hydration
  • After birth baby’s blood glucose can drop dangerously. Painful heel prick tests will be needed and possibly bottle feeding of sugar water or formula which can interfere with breastfeeding
  • Can cause newborn jaundice
  • Can cause ‘wet-lung syndrome’ a type of pneumonia and low blood sodium which puts newborn at risk of neurological problems such as apnea and seizures
  • Makes foetus retain water so when born baby is heavier than should’ve been & weight loss is more than expected

 

Risks & Benefits of Pethidine

Benefits:

  • Changes perception
  • Can still move around
  • Can make mother fall asleep
  • In pain but not caring about it
  • Midwife can administer quickly

Neutral:

  • Only to be given in early labour
  • You either like it or you hate it

Risks: 

  • Changes perception
  • Opiate based drug
  • Effects baby
  • Long term effects unknown
  • Baby can be born with trouble breathing
  • No one has tested the neurological effects of newer narcotics
  • Makes baby drowsy & confused
  • Can make mother fall asleep
  • Can feel sick
  • Mother often unable to speak or express self
  • Not available for homebirths

 

Risks & Benefits of Gas & Air

Benefits:

  • Can be used in any birth setting
  • Lasts for 15 seconds before excreted
  • Can keep dads relaxed!

Neutral:

  • You either like it or you hate it
  • Effects build the more it’s used

Risks:

  • Requires user to bite the mouth piece, tensing the jaw and thus tensing the perineal muscles
  • Can be distracting while baby’s being born
  • Effects baby
  • Long term effects unkown

 

Risks & Benefits of Forceps

Benefits:

  • Can save a birth from caesarean
  • Helps baby turn for correct positioning to be born
  • Can get a distressed baby out quickly

Neutral:

  • Can only be used by an obstetrician

Risks:

  • Chance of bruising and damage of baby’s face
  • 0.01% chance of neonatal death
  • Can affect baby’s early suckling ability & your confidence to breastfeed
  • 0.5% suffer damage to baby’s facial nerves
  • 0.2% suffer brachial plexus injury (nerve damage to shoulder & arm)
  • 0.01% higher Chance of shoulder dystocia
  • 0.1% higher chance of newborn seizures
  • Too dangerous to use if baby is too high in the pelvis
  • 19-47% higher chance of anal sphincter injury than natural birth
  • Causes the top of the head to elongate
  • Higher risk of maternal blood clots post birth than natural birth
  • Increase chance of urinary & anal incontinence than natural birth
  • Long term effects unknown
  • Higher chance of an excessively crying baby than natural birth

 

Risks & Benefits of Ventouse

Benefits:

  • Can save a birth from caesarean
  • Can get a distressed baby out quickly

Neutral:

  • Can only be used by an obstetrician

Risks:

  • Does not help to turn a baby
  • Higher chance of having an episiotomy than natural birth
  • Higher chance of damage to the pelvis than natural birth
  • Can only be used if baby is far enough down in the vagina
  • 1.1% higher chance of shoulder dystocia than natural birth
  • 8-18% suffer anal sphincter tears
  • 0.01% higher chance of facial nerve injury than natural birth
  • 5% of babies suffer skull fracture
  • Causes the top of the head to elongate
  • Higher risk of maternal blood clots post birth than natural birth
  • Increase chance of urinary & anal incontinence than natural birth
  • Can bruise baby’s head
  • Higher chance of vaginal tearing than natural birth
  • Long term effects unknown
  • Will require local anaesthetic if epidural is not in place
  • Can give baby a headache after birth
  • Higher chance of an excessively crying baby than natural birth

 

Risks & Benefits of Artificially Breaking Waters

Benefits:

  • Speeds labour up by an average of 20 minutes
  • Can help bring baby down in the pelvis

Neutral:

  • 79% of women with their waters broken will start labour within 12 hours. 95% of the remaining women will start labour within 24 hours
  • Without vaginal exams you can go for longer than 24 hours without antibiotics or induction

Risks:

  • Increases chance of infection
  • Not to be done if Group Strep B is present
  • Makes contractions more painful
  • Increases chance of cord compression
  • You will be pressured into having antibiotics if your waters have been broken for 12hrs or more
  • You will be pressured into an induction if your waters have been broken for 12hrs or more without onset of labour
  • Research shows no benefits of amniotomy (artificially breaking the waters)
  • Hospital puts pressure on the mother to birth within a certain time frame
  • Amniotomy Is a medical procedure and can only be done with your permission
  • If baby not born within a certain time frame antibiotics are given which can put baby at risk of Vitamin K Deficiency Bleeding (see below)
  • Can cause cord prolapse
  • Increases pressure on baby’s skull

 

Risks & Benefits of IV Pitocin / Synthetic Oxytocin For Labour Induction/Augmentation

Benefits:

  • Keeps contractions going when an epidural is administered

Neutral:

  • Can only be administered as an IV drip in hospital setting

Risks:

  • A high alert medication
  • Increases rate of foetal distress
  • High-doses increases uterine hyperstimulation without decreasing caesarean rates
  • Increases the risk of haemorrhage
  • Makes contractions longer and more intense, thus restricting oxygen to baby
  • Makes contractions more painful
  • Can cause fluid in the lungs of mother and baby sometimes leading to water intoxication, seizure and coma
  • Blocks the production of natural oxytocin which in turn affects the release of the body’s own endorphins
  • Does not produce the behavioural benefits of natural oxytocin
  • Requires constant foetal monitoring
  • Stays in the blood for 15 minutes so if baby is in distress action needs to be taken quickly
  • Not suitable for VBAC
  • Long term effects unkown
  • Effects baby
  • Natural oxytocin levels are lower after birth effecting bonding and breastfeeding
  • Delivered constantly through a drip as opposed to pulsing release of natural oxytocin
  • Due to intensity of contractions caused by synthetic oxytocin many women have an epidural and thus increase the risks

                    

Risks & Benefits of Prostaglandin Gel

Benefits:

  • 26% Less chance of needing synthetic oxytocin with misoprostol than with dinoprostone

Neutral:

  • First step of induction
  • Ripens the cervix and may start labour sooner than if left alone

Risks:

  • 13.3% suffer a hyper-stimulated the uterus with Misprostol
  • Not suitable for VBAC births
  • Not suitable for women with very high blood pressure
  • Check the label; Misoprostol is a dangerous drug
  • 27% of births end in caesarean
  • Long term effects unknown
  • Misoprostol does not have a UK or USA license to induce labour, so its use is described as ‘off-label’ www.nice.org.uk
  • 13% experience foetal distress with misoprostol
  • 4% experience foetal distress with dinoprostone
  • Once administered its effects cannot be stopped
  • Studies have not established a safe, effective dose

 

Risks & Benefits of Electronic Monitoring

Benefits:

  • Continuous monitoring only beneficial if synthetic oxytocin is being used
  • Intermittent monitoring is a safer alternative and is associated with a lower caesarean rate than continuous monitoring (except when synthetic oxytocin is used)

Neutral:

Risks:

  • Scalp monitor can cause infection & foetal distress
  • Continuous monitoring increases the caesarean rate
  • Continuous monitoring restricts mobility
  • High rate of disagreement in meanings of the data
  • Continuous foetal monitoring does NOT improve outcomes
  • Causes anxiety in the labouring woman
  • If the monitor isn’t picking up the heartbeat, the mother is instructed to be in particular positions
  • Inhibits spontaneous behaviour, making contractions more painful and inhibiting progress
  • Cannot be in the shower or birth pool with continuous monitoring
  • Everyone’s attention goes on the machine and away from the mother
  • Scalp monitors need the waters to be broken, increasing risk (see above)
  • Long term effects of ultrasound waves unknown

 

Risks & Benefits of Episiotomy

Benefits:

NONE

Neutral:

  • No one can predict that an episiotomy will cause less damage
  • Good nutrition helps elasticity of pelvic floor muscles
  • Women who exercise regularly have stronger pelvic floor and less likely to have anal tears from an episiotomy

Risks:

  • Does not prevent damage to the anal sphincter
  • Does not prevent incontinence or uterine/bladder prolapse
  • Increase chance of pain during sex
  • Does not shorten second stage labour
  • Increases the risk of infection, delayed healing or wound breakdown compared to tearing
  • Increased blood loss compared to tearing
  • Increases the risk of an opening between the vagina and rectum compared to tearing
  • There are NO benefits to routine episiotomy
  • More painful than tearing sometimes for weeks or months after
  • Is a surgical procedure and is illegal to be done without your consent.
  • In 2005, three out of four USA women who had an episiotomy were NOT asked for their consent
  • Controlled pushing increases the chance of tearing
  • In 1987 the USA episiotomy rate was 62%
  • An unnecessary episiotomy is considered female genital mutilation, illegal in western countries (but for many reasons very difficult to take to court)

 

Risks & Benefits of Vitamin K

Benefits:

  • Assists in blood clotting
  • Advised to be given to babies born by forceps, ventouse or caesarean where bruising may have occurred
  • Posterior births/back labours put unnecessary pressure on baby’s head. Vitamin K might be necessary in these instances
  • Research indicates that injecting Vit K is more effective than oral supplementation for late onset Vitamin K deficiency bleeding (VKDB)

Neutral:

  • Can be given orally or injected
  • ALL babies are born with low levels of Vitamin K
  • Breastmilk/colostrum contains small amounts of Vitamin K
  • Only a very small amount of vitamin K is necessary for blood coagulation in humans
  • The physiology of blood regulation in childhood differs considerably from that in adults and do not always reflect an underlying pathological condition.
  • Classical VKDB occurs between 24 hours and 7 days of life and is associated with delayed or insufficient feeding. Estimates of the frequency vary from 0.25% to 1.5% in older reviews and 0–0.44% in more recent reviews

Risks:

  • Injections are painful for babies
  • Long term risks of Vit K supplementation unknown
  • By routinely giving Vit K at birth we are interfering with natural physiology in ways we may not understand
  • Early Vit K deficiency bleeding (VKDB) presents within 24 hours of birth and is almost exclusively seen in infants of mothers taking drugs which inhibit vitamin K. These drugs include anticonvulsants, anti-tuberculosis drugs, some antibiotics and vitamin K antagonists (coumarin, warfarin). The incidence of early VKDB in babies of mothers taking these drugs without vitamin K supplementation varies from 6% to 12%
  • In fully breast-fed infants who did not receive vitamin K at birth, the incidence of VKDB is between 1/15,000 and 1/20,000. Babies with cholestasis or malabsorption syndromes are at particular risk
  • Check the other ingredients in the injection or oral drug for other potential risk factors

 

Risks & Benefits of Sweep

Benefits:

  • Slightly decreases the number of postdate pregnancies

Neutral:

  • A finger inserted into the cervix and lifts the amniotic sac off the cervix triggering the release of prostaglandins

Risks:

  • Routine induction for postdate pregnancies is questionable
  • Potential for rupturing the membranes
  • Potential for causing infection
  • Does not decrease the caesarean rate

 

Risks & Benefits of Vaginal Exam

Benefits:

  • Gives information on baby’s positioning
  • Results may be encouraging

Neutral:

Risks:

  • The number of vaginal exams correlates with the rate of infection. 2% rate with 3-4 vaginal exams to 5% with 8 or more vaginal exams
  • Can be painful during labour
  • Requires the mother to lie flat on her back putting baby at risk of presenting posterior and reducing oxygen/blood supply
  • Does NOT tell us how long birth will take
  • Results can be discouraging
  • Can interfere with a woman’s focus and relaxation
  • Repeated exams can slow labour down
  • Can rupture membranes if done during a contraction

 

Risks & Benefits of Instructed Pushing

Benefits:

NONE

Neutral:

  • 70%+ labouring women are instructed to push rather than left to follow their instincts

Risks:

  • Prolonged breath holding (more than 6 seconds) compromises baby’s oxygen causing foetal distress
  • Breath holding tenses the perineum causing swelling, bruising, damage and tearing
  • Prevents natural behaviour & positioning
  • Increases fatigue
  • More likely to require forceps/ventouse
  • Pushing doesn’t work when a baby is in the wrong position
  • Discouraging for the mother when told she’s ‘not doing it right’

References:

The Thinking Woman’s Guide to a Better Birth‘ Henci Goer

Optimal Care in Childbirth; The Case for a Physiologic Approach‘ Henci Goer

Vitamin K in neonates: facts and myths‘ Giuseppe Lippi and Massimo Franchini

Samantha Thurlby-Brooks is the creator and director of Mumanu Ltd; specialising in pregnancy massage, postnatal massage and BirthWorks antenatal classes in London, UK. Samantha supports her clients with kindness, understanding, knowledge and a damn good rub! She is also the creator of the award winning Mumanu Pregnancy Pillow
Read More >>

Related Posts

Leave a Reply

Your email address will not be published. Required fields are marked *