by Kerry Tuschhoff, HCHI, CHt

What most expectant parent don't realize is that they truly are in charge of their baby's birthing. They get to choose the way the labor and birth go, as well as their baby's care after birth. It is no different than any other service that you pay for, except that it is much more important. You are paying the doctor's nurse's and other staff's salaries, and you deserve to get what you want. If there are true complications, that's when the doc, midwife or nurses step in and help. Just like being a Lifeguard at a pool: No one needs to do anything except keep a watchful eye on things, and if anyone's in trouble, that's when they jump in to help.

Routine vaginal exams

Routine vaginal exams are very common in late pregnancy

Benefits: A routine vaginal exam at the end of your pregnancy actually has no benefits since your present dilation/effacement/station are not indicators of when your birthing time will begin.

Risks: There is a small risk of infection and PROM (Premature rupture of membranes) (See Henci Goer's The Thinking Woman's Guide to a Better Birth for realities for related studies pgs 204-209) Stripping of the membranes is often done as well during a routine vaginal exam, (see below) and can cause many days of cramping, bleeding and possible sleep loss without any benefit.

Alternatives: You can tell your care provider that you would prefer not to have one. And keep your panties on.

vaginal exams measure several things:

• Dilation & thinning of the cervix, at that time
• Position of the baby, at that time
• Station of the baby, at that time
• Position of the cervix, at that time

Vaginal exams do not measure:

• When the baby is coming
• Whether the baby will fit through your pelvis (in most cases)
• All the progress being made before or in your birthing time

Vaginal Exams during the Birthing Time

"Let's see how far along you are." Vaginal exams are administered in your birthing time to assess dilation of the cervix.

Benefits: This really has few benefits, as it tells you nothing about when the baby will be born, but has some risks. Having a vaginal exam when you feel "pushy" may be of help to ascertain if you are fully dilated.

Risks: Every time an attendant checks the mother's cervix, the risk of infection is increased, especially if her bag of waters is broken.

Vaginal exams may also cause the mother to tense up, and her ability to relax is reduced. Some women like to find out how far they are dilated, but this is not a reliable way to figure out how long a she has left. In fact, it might discourage her if she finds out she is dilated less than she imagined, and this emotional element is very important. If a woman is not dilating quickly enough, interventions may be instituted. This puts additional stress on the birthing woman.

Aside from obvious risks, vaginal exams can be very uncomfortable, especially if performed during a surge. (Ed.: Before one is done, take a deep breath and as you exhale, concentrate on your "Anesthesia" programming, "seeing" the anesthesia all around your cervix, and relaxing your pelvis.) Further, it is impossible to predict how long your birthing time will last from how far a woman is dilated. It would be well advised to pay attention to emotional signposts instead. They give a lot more clue to where a woman is progressing in birth.

Stripping the membranes

A procedure called "Stripping the membranes? consists of separating your bag of water from your cervix, during a vaginal exam. It may be done without your consent or knowledge, and this can be avoided by talking to your doctor before any internal exam.

Benefits: Some believe that it will bring on birthing surges within 24-48 hours. There is no scientific data to back this theory up.

Risks: There is a risk of infection and premature rupture of membranes, and it may be painful.

Alternatives: You can tell your care provider that you would prefer not to have the procedure done.

Inductions

Inductions are becoming increasingly common for varying reasons. There are no studies to prove that routine induction regardless of gestational age improves perinatal outcome. The average length of gestation for primiparas (first pregnancy) is 274 days and multiparas (second and beyond pregnancy) 269 days from ovulation so that translates to 41 weeks 1 day for first time moms and 40 weeks 3 days for subsequent babies. Research evidence shows that induction for "suspected big baby" results in higher c-section and operative vaginal delivery rates than waiting for the birthing time to start on its own, and there is no evidence that larger babies pose a bigger risk of problems during birth. Furthermore, there is currently no way to assess how big a baby will actually be at birth, and ultrasound is often erroneous by several pounds.

Benefits: When medically indicated an induction can improve the perinatal outcome. Medically indicated reasons would not include you being past 40 weeks or a suspected large baby but rather a physical problem with you or the baby, a BPP (Biophysical profile) indicating a possible problem, or a Stress or Non-Stress Test indicating a possible problem. Keep in mind that these tests are meant for a prolonged pregnancy and they have a high false positive rate. This is not a cut and dry subject; there are many variables, and for this reason it is very important to have a care provider you trust and be as educated as possible.

Risks: It may not work, and your chance of getting a Cesarean Section are higher than if you would have gone into your birthing time spontaneously.

Alternatives: There are many natural ways of inducing birthing waves such as using hypnosis, nipple stimulation, intercourse, herbs, enemas, castor oil, etc.

More Information on Inductions:
• Inducing Labor
• The Induction Seduction
• Natural Induction Techniques
• Getting what you want in your Birth Experience

Amniotomy

Amniotomy is the artificial rupture of the membranes with an amniohook (AROM). An Amniotomy can be done to either induce birthing surges or at some point during the birthing time.

Benefits: If it is done later in the birthing time it can get a stalled one started again.

Risks: There are quite a few risks involved with Amniotomy. The amniotic fluid provides a cushion for both you and the baby, therefore making the pressure surge more comfortable, and the baby's head protected from compression. The baby can get stuck in an unfavorable position because he/she can not maneuver as easily with the amniotic fluid gone. There is an increased likelihood of umbilical cord compression or cord prolapse, where the umbilical cord gets flushed out with the water when it breaks and gets kinked like a hose. Due to the sterile field of the amniotic sac being broken you also have a higher risk of developing an infection. From the time you have an Amniotomy you are on the "clock" so to speak. A lot of care providers require birth within 24 hours regardless of method. Also you may be restricted to bed and you will be restricted from showering and/or bathing.

Alternatives: It depends on what your care provider wants to accomplish with AROM. If they suggest AROM to speed the birthing time up or get a stalled one going again and your baby is showing no signs of distress, you can simply give your body time to do what it was made to do, or use natural birthing stimulation techniques. If they suggest AROM to induce birthing surges you can use Evening Primrose Oil, nipple stimulation or other ideas. There are many. Read more about amniotomy.

Pitocin

Pitocin is commonly used to induce birthing surges or increase the strength and/or duration of them. There are some problems associated with the use of Pitocin: