Why intervene when gravity can do the same job?
Recently, I spoke with one of my older sisters about her hospital birth experience with her second child. While reflecting, she mentioned that they [the hospital staff] “had to” use the vacuum on her daughter. As a result, I wondered to myself, was that necessary? What made the physician/nurse/midwife suggest such an intervention? With my current knowledge and experience, I would think that merely standing up would’ve brought that baby right out, or soon after. So why was this intervention warranted? Did the use of constant fetal monitoring cause the staff to worry about the infant’s well-being? Or perhaps, prior medical interventions caused the second stage of labor to stall long enough that the staff felt it necessary to intervene.
The Mayo Clinic website indicates that the most common reasons for the use of vacuum extraction are maternal exhaustion and/or fetal distress. If I had been a medical professional or even a doula present at this birth, I would have suggested a vertical delivery before even considering resorting to an invasive procedure such as vacuum extraction or the use of forceps. So how can we, as educated individuals and birth professionals, encourage vertical deliveries before employing alternative methods? Well, in my opinion, it all starts with education. My sister did not have someone present at or prior to her birth to both educate and advocate for her.
Had I been involved in birth work at that time, I would have informed her that there are other methods to try that could help bring the baby out without the need for intervention. I don’t understand why, nowadays, hospital staff professionals are not encouraged to suggest and support vertical deliveries. To me, it is common sense. Of course the mother is exhausted; she is pushing on her back, most likely with guided pushing, which in many cases has been shown to result in even more unnecessary interventions (alas, the cascade effect). Of course labor isn’t progressing-- the mother’s supine position requires her to fight against gravity.
Some of the risks of forceps and vacuum extraction to the mother, although minimal, include tears and wounds, short-term incontinence, perineal pain, difficulty urinating, anemia, pelvic organ prolapse, etc. Risks to the infant include scalp wounds, shoulder dystocia, skull fracture, and bleeding within the skull. On the other hand, there is little to no risk for allowing a mother to birth on her feet, or however she sees fit.
As for the argument for the infant’s well-being, that is another topic. I have learned that fluctuations in the fetal heart rate are perfectly normal during labor, and we need to stop treating them as an immediate emergency and instead, learn how to recognize the real signs of fetal distress (i.e. signs that the heart rate is not recovering after a contraction). Of course, in some situations it is safer to perform medical interventions for the health of the mother and baby; however, in a non-emergency situation, when an intervention is abused and used consistently without the suggestion of other non-medical techniques beforehand, there is a problem.
I truly hope that more medical professionals seek a wide-ranging education that teaches them the importance of allowing women to birth out of the bed, in whatever positions that come to them instinctively, as well as teaching the normalities of birth so we can stop overprescribing methods that are essentially, counterproductive.