top of page
Search
  • Nicole Ament

Interventions you can decline during your labor and delivery.

Updated: 5 days ago

And how that could affect your care.


It's true. You can say no to ANYTHING you're told they need to do to you and your baby during your labor and delivery. It's also true that doing so may cause you backlash from nurses and doctors, especially if you're Black, Brown, Indigenous or a part of the LGBT+ communities. Also true that having doula support during your birth can help with these issues. But not always.

It's important that you are a given accurate information about these choices. Informed consent includes:
  • the risk of choice - possible consequences, even death

  • the benefits of choice - things that could go better because of the choice

  • alternatives to that choice - what else can we do? (ASK THOSE BRAIN QUESTIONS!)


First, let's dive into your options with commonly used interventions when in labor and delivery having your baby.

Getting an IV - Some people are not a fan of the procedure of getting an IV started while others may simply find the 'necessity' overkill. You have options!
  • You can decline the IV altogether

  • You can ask for a saline lock, where they insert the IV but never hook you up to a line unless absolutely necessary/you give the okay

  • You can decline getting one upon admittance and wait until later in your delivery

  • You can be okay with them starting an IV line and hooking it up whenever they want

You should know that you will hear a lot of push-back and scare tactics about why NOT having any IV is a bad decision and that you're putting your baby, and yourself, at unnecessary risks, and while it is true that the risks do increase minimally, it's still an option that is yours to make. Some of the risks of NOT getting an IV at all include bleeding out while they're trying to get one in you, delaying an emergency c-section, delaying you getting life-saving medications, and you can't get an epidural or an induction without one.
Some of the benefits of not getting one are that your birth may feel less medical, it's easier to move about, and you're less likely to get an infection.

Vaginal exams - People refuse vaginal exams for a number of reasons. One major one is that they don't really tell anyone anything other than how your cervix is behaving at that exact moment. They don't predict when the next change is coming, they don't tell anyone how you or baby is tolerating your labor, and they can cause unnecessary stress to a laboring person just by hearing one thing when they were expecting to hear another, ie not being as far along in dilation as one might of thought they were. People are often told that the hospital can't admit you unless you get a vaginal exam of your cervix (that's absolutely false, also).

Your options include:
  • Waiting until you're in much more active labor to be checked, or for as long as possible

  • Having your provider be the one to check you so it's always someone more familiar to your care

  • Make a plan to check every so often rather than more frequently

Some risks of not having exams include not knowing if you're dilating, how baby is coming into your pelvis, or if your cervix is out of the way to begin pushing (your body has a good way of helping with this one). Some benefits include being able to listen to your body and let it guide you through the process (trust me, IT KNOWS HOW), less risk of infection with the exams, and even less trauma if those exams are an issue for you.

Pitocin - Whether it's being used to jumpstart labor or help cut down your risk of hemorrhage after the placenta comes out, you always have the option to decline the use of Pitocin. Just because your labor is taking longer than some would want it to doesn't mean that Pitocin is only method of getting things moving. For example, TRUE oxytocin release, such as when you're hugging and cuddling your partner, is an effective way to get contractions to be stronger and more regular. Oxytocin helps us to feel more intimate with our partners, reduces stress, and helps with pain management during labor.

There are times when Pitocin use is helpful in labor, such as when the birth person has serious health conditions such as gestational diabetes, preeclampsia, intrauterine growth restriction, etc. After labor, if bleeding can't be stopped, it can be a great tool for managing excess blood loss. It's not always necessary just because one has gone past 40 weeks gestation, for convenience of the doctor (they're going on vacation or it's a holiday weekend), or because baby is considered 'big.'

Pitocin alternatives include:
  • Waiting

  • Moving around

  • Changing positions

  • Nipple stimulation

  • Being intimate with your partner (think more than just sex, which may not be safe during labor and delivery)


Pitocin use can lead to other interventions, most commonly epidurals, continuous fetal monitoring, and IV fluids. It can increase your risk for PPD and PPA. You're suddenly on a very strict hospital clock as well once you agree to the use of this intervention. Labors tend to be longer with Pitocin use as well and the birth person has a higher risk of C-section and hemorrhage. It can be straining for baby and typically causes more intense contractions.

Continuous Fetal Monitoring - Monitoring during labor can be done in a number of ways or you can refuse to be hooked up to the machines and instead, opt for doppler checks instead, just as you would get in a home birth. Some studies have found that fetal monitoring increases the rates of unnecessary c-sections and deliveries that end up having to use vacuums or forceps, and it's not associated with better APGAR scores or lower rates of things such as Cerebral Palsy, developmental delays, or admissions into the NICU. Other risks of fetal monitoring include false alarms that can cause stress, limiting your ability to move around freely, and false concern for 'fetal distress' that often leads to c-sections.

If you are having a low-risk pregnancy, there's no reason they can't use alternatives to continuous fetal monitoring, such as:
  • Intermittent fetal monitoring - you're hooked up to the monitoring machines for about 20 minutes every hour or two

  • Occasional stethoscope and/or doppler machine

  • Internal monitoring

Fetal monitoring IS recommended if you're having a higher risk pregnancy, such as if you have Gestational diabetes, preeclampsia, or even bleeding during pregnancy.

Group B strep and antibiotics - Around week 37 of pregnancy, it's often suggested to be tested for Group B Strep, a type of bacteria that is very commonly found in our bodies. Usually, this bacteria is harmless but sometimes, it can affect the baby around the time of birth, where the baby can become ill, usually within a week after birth, but most babies who come in contact with the bacteria will stay healthy. Some infections that babies can catch because of it are sepsis, pneumonia, and meningitis. However, most babies make a full recovery with the help of medication and early treatment.

If you've tested positive, you'll be offered antibiotics from the start of labor and at intervals during, until the baby is born. You can refuse these antibiotics if that's not your thing! If you start showing signs of infection during your labor, you'll be offered them again. If you should go into labor before 37 weeks, and aren't even known to be GBS positive, they'll want you to take antibiotics then as well. They will monitor baby after birth if they're thought to be of higher risk and you decline the antibiotics for at least 12 hours, which includes assessing baby's general wellbeing, heart rate, temp, breathing and feeding.

Medicines for baby after birth - Vitamin K for blood clotting, eye ointment (erythromycin) can protect against bacteria including gonorrhea and chlamydia (which can cause blindness), Hep B which is passed through the blood and bodily fluids and can cause liver failure. Some states require all or some of these vaccines at birth, and you will be reported to the local Department of Health if you refuse them, but you're well within your rights to do so.

Vaccines reduce your risk of developing diseases by strengthening your babies immune system, which isn't fully developed at birth. Benefits of vaccination include helping to protect your baby and your family against disease, they can save your baby's life, and they can be quite effective. You'll sign a waiver to release the hospital from responsibility should something happen to your baby as a result of not getting vaccines.

This is only but a few of the most common things that patients in labor refuse at the hospital. And it's important to understand that while we all have the right to refuse ANYTHING that is offered or demanded of us at a hospital, that many things come into play as far as how one will be treated AFTER refusing these treatments. For instance, Black, Brown, and Indigenous communities experience a MUCH higher rate of disparity in maternal health, with a death rate that is 2-3 times higher than that of people the same age who are Caucasian. 1 in 6 women experience mistreatment in childbirth, but again, communities of color experience that mistreatment at much higher rates: 33% higher in Indigenous communities, 25% higher in Hispanic communities, 23% higher in Black communities, 24 years of age or younger, and lower income communities. The most commonly reported mistreatment include being shouted at, ignored, or forced into treatment.

So, it's one thing for me to sit here and tell you that you have the right to refuse EVERYTHING in labor, but I'm also fully aware that that reality is easier for some than it is for most. Ways that can help insure healthy, safe treatment while in labor: getting a doula, becoming fully informed of all your choices, making sure those desires are WRITTEN DOWN for everyone to see who helps you while you're there, and most importantly, be your own advocate! No one else knows your body, or your baby, better than you, and you have the right to make informed choices about the care of yourself and your baby, even when those risks include death.

If you're a birth doula, take diverse doula trainings so you can learn more about the discrepancies that occur in labor when you're NOT a Cis, hetero White woman, which helps you to become a better advocate for your clients. Taking community-based trainings is one way you can expand that knowledge. Write to legislators and representatives in your state about expanding access to Midwifery care to more people of color. Take the time to be more informed about different cultures and the struggles that they face while in labor, and in their postpartum. The more we help our clients to know their rights, and be fully informed in their decision making during their labors, the better chance we stand at actually making a change in maternal healthcare outcomes.



References:

American College of Obstetricians and Gynecologists. Approaches to Limit Intervention During Labor and Birth. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth Accessed 4/29/2022.

Buckley SJ. (2015) Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women and Families. Available from: http://www.nationalpartnership.org/research-library/maternal-health/hor… [Accessed 25th April 2018]

Racial disparities: https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html

Group B Strep Support and the Royal College of Obstetricians & Gynaecologists. (Group B Streptococcus in pregnancy and newborn babies https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-gbs-pregnancy-newborn-booklet.pdf (Published in December 2017 Next Update due 2020)

Medline Plus. https://medlineplus.gov/ency/patientinstructions/000625.htm

Vaccines: https://www.cdc.gov/ncird/index.html




6 views0 comments

Recent Posts

See All
Post: Blog2_Post
bottom of page