Two Common Interventions You're Probably Not Thinking About
Between all the books you're reading (you are reading all the books, right?) and all the classes you're taking I'll bet you know a lot about all the possible interventions that may be presented to you during labor. Pitocin. Cervidil. Episiotomy. Epidural.
Is your head spinning yet? Yeah, mine too.
When thinking about your birth preferences there is so much to consider. So. Much. Do you want to push in different positions? Do you want wireless monitors? Do you not want to be offered pain medication? As birth doulas during your in-home prenatal visit we help you sift through all your options and, when you've made your choices, to draft a birth plan that you can share with your care provider.
But as birth doulas there are two very common interventions we see frequently that many pregnant people don't consider ahead of time: sweeping membranes and breaking water. What do these mean? Why and how are they done? Let's look at sweeping membranes first as this option comes up before labor begins.
How is it done?
During a vaginal exam, your care provider uses a gloved finger to make a circular motion inside your cervix to separate the amniotic sac from the cervix.
Why is it done?
Sweeping (also called "stripping") the membranes is used to induce labor in term pregnancies. The idea is that when the sac separates from the cervix prostaglandins are released and will encourage cervical softening and even bring on uterine contractions.
Pros vs. Cons?
The advantage here is that sweeping the membranes is considered a "natural" way of inducing labor and, if effective, may help you avoid medical induction. As doulas the big con we see is the discomfort and prodromal labor pattern it may cause, sometimes lasting for days, which can result in one exhausted mama by the time active labor kicks in. According to a study by The Cochrane Institute sweeping of membranes "does not seem to produce clinically important benefits."
Now onto a proposed procedure you might very well run into after labor has started, artificial rupture of membranes (AROM).
How is it done?
Your care provider inserts a long hook into your vagina and uses the pricked end to rupture the amniotic sac.
Why is it done?
AROM is used to speed up labor. The idea being that breaking the sac produces prostaglandins and also increases pressure on the cervix from baby's head.
Pros vs. Cons?
The pro is that potentially, AROM could decrease the length of your labor (unfortunately, research on this is hard to come by). The cons are that you'll have more uncomfortable contractions (there's no more cushion of water), are at increased risk of infection (why it's super important to limit vaginal exams after water is broken), and will be on a clock (ask your care provider how long after your water breaks they want baby to be delivered).
Both sweeping of the membranes and AROM are procedures that require your consent. As with anything else, if these options come up be sure to discuss them with your care provider and remember BRAIN:
B - what are the Benefits?
R- what are the Risks?
A - what are the Alternatives?
I - what does my Intuition say?
N - what happens if I say "No" or "Not Now"?
Get ahead of the curve: be thinking about these two interventions now for a smoother decision-making process later.
Offering expectant and new parents :
newborn and infant care
infant and child CPR
body (breastfeeding/chestfeeding) + bottle feeding
childbirth education
relaxation in birth
tools for partner support