Interventions you can decline during your labor and delivery.
Updated: Jan 23
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:
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