When it comes to the serious and sometimes scary decisions that have to be made during labor, there is no substitute for a trusting, respectful relationship between a doctor or midwife and you, their patient. However, informing yourself about the pros and cons of various common labor interventions now can make you feel more confident and at ease when discussing your options with your healthcare provider both throughout your pregnancy and during labor itself.
There are many interventions sometimes recommended by doctors and midwives to help start labor or to speed up its progress, but here are some of the most common.
1. Stripping or sweeping your membranes. Your healthcare provider will insert their finger into your vagina and gently separate the amniotic sac (without rupturing it) from the uterus near the cervix. This triggers the release of hormones that can start labor.
Pros: This relatively minor procedure can be done during a routine exam towards the end of pregnancy and can hasten labor by softening and opening up the cervix and starting contractions.
Cons: This procedure can trigger painful cramps that can leave you tired or uncomfortable in the days leading up to labor.
2. Rupturing your membranes. For women whose water doesn't break naturally earlier in labor, your healthcare provider will use a medical instrument to puncture the amniotic sac and release fluids.
Pros: Immediately after this procedure, your contractions will get stronger and faster, making your labor shorter. This can also be an effective way to restart a stalled labor.
Cons: As soon as the amniotic "bubble" surrounding your fetus is broken, whether by natural or surgical means, there is an increased risk of infection for both mother and baby. That's why most healthcare providers do not allow women whose waters have broken to labor outside of the hospital or birthing center.
3. Cervical ripening. Your healthcare provider will rub a medical gel containing prostaglandin onto your cervix, causing your cervix to "ripen," dilate, and thin out.
Pros: This is a relatively minor procedure that can hasten labor, and it may also stimulate contractions enough on its own that Pitocin is not needed when it otherwise might be.
Cons: As with any intervention that hastens labor, some argue that this "rushes" your body through its natural processes, leading to an increased risk you will need further, more serious interventions as labor progresses.
4. Pitocin. Pitocin is a synthetic version of the naturally occurring hormone oxytocin that your healthcare provider will give you through an IV to start or speed up labor and make your contractions.
Pros: As with all of these labor-speeding interventions, the biggest pro is that they minimize how long you are in labor, which in turn can minimize the overall risks to both mother and baby, especially if either or both are in distress. In addition, Pitocin can start labor that hasn't started naturally, and is often given to mothers whose babies are overdue or who need to deliver early for medical reasons.
Cons: Pitocin substantially increases the pain of contractions, and causes many women who might otherwise have preferred a drug-free birth to opt for an epidural instead. Some argue that epidurals can lead to their own problems, including slowing down labor, increasing the risk for emergency C-sections, and dampening the body's natural chemical responses to pain and stress, perhaps even inhibiting bonding and/or breastfeeding.
Also, some fear that Pitocin is used too freely to speed up births that should be allowed to go at a more "natural" pace, especially when it's used on mothers who go past their due dates but show no signs of risk to themselves or their babies if they wait a little longer.
5. Episiotomy. Your healthcare provider will use a surgical scalpel to make a small incision in your perineum, between your vagina and anus, to assist you in pushing.
Pros: Some suggest that episiotomies can be a form of controlled "relief cut" that takes pressure off your perineum and can prevent more serious, out-of-control natural tears. They can also speed pushing, a stage that can be difficult and exhausting for many women, and cut down on problems associated with pushing too long, like decreased fetal heartbeat and other signs of fetal distress. It can also help babies that are "stuck" for various reasons, including difficult head or shoulder positioning. Sometimes episiotomies are also necessary to accommodate the use of other interventions, like vacuum extraction or forceps.
Cons: Other suggest that episiotomies may actually increase the risk of more serious tearing, as well as potentially leading to infection and long-term problems with urinary incontinence. Natural healthcare practitioners argue that there are other, less invasive ways of gently stretching and massaging the perineum to allow it to open wider with little or no tearing.