Hypnobirth Tip #9: Your Birthing Choices

Alternatives: Intermittent Fetal Monitoring; 20 minutes on and 40 minutes off. More:
• Monitoring FAQ
• Monitoring Resources
• Routine Electronic Monitoring

Internal Monitoring

This is sometimes more accurate than the electronic monitoring, does not use ultrasound, and can provide continuous monitoring for the high risk mother. It is done by screwing an electrode into the top of the baby's head and placing a probe into the vagina/uterus.

This method requires that your water be broken (An amniotomy will be performed if your membranes are still intact.), and that you be 2-3 centimeters dilated. Amniotomy adds risks of its own. However, the risks and benefits of each procedure must be weighed.

Benefits: This type of monitoring is mostly used in high-risk situations or when more accurate types of monitoring may prevent other unnecessary interventions.

Risks: Internal monitoring has been associated with fetal injury (from the electrode), high rate of infection for mother or baby, and also severely restricts movement. It could damage baby elsewhere if the top of the head is not the presenting part.

Alternatives: If there is not a high risk situation or emergency happening, you can choose to be monitored with intermittent EFM. For more information, read Internal Electronic Fetal Monitoring.

Epidural anesthesia

Epidural anesthesia uses repeated doses of a local anesthetic in the epidural space of the spinal area. It numbs the nerves from the uterus and birth passage without stopping the birthing surges.

Benefits: Epidural block provides effective analgesia in many cases and can be used to lower a birthing woman's blood pressure if too high.

Risks: Aside from not always working, or providing "patchy" relief, epidurals often lower the mother's blood pressure too much, which decreases the amount of oxygen for the baby, increasing the risk of fetal distress. Occasionally the medication is placed erroneously in the spine and goes up instead of down, creating respiratory failure or distress in the mother.

Often the mother's temperature rises (Epidural Fever) and can lead to hypothermia of the baby in which case a full workup after the birth is usually ordered to rule out infection, and that often includes a spinal tap on your newborn. Also, although an attempt is made to time the epidural right so that it can wear off so the mother can feel her pushing efforts, it is tricky and often unsuccessful. Pushing while anesthetized not only makes pushing less effective, it robs the mother of urge to push, which (as opposed to full dilation) should be what dictates when pushing begins. This also often results in the need for forceps and vacuum, extraction birth, which carry their own risks

It also makes the perineal and vaginal muscles slack and unable to turn the baby after the birth of the head, and sometimes results in sexual dysfunction weeks and months later. In addition, an epidural is associated with an increased risk of needing Pitocin to augment pressure surges, and a Cesarean Section for failure to progress, as it often slows down birthing surges dramatically, as well as short and long term postpartum back pain.

Alternatives: There are other ways of reducing any discomforts of birthing. Many women are helped by techniques learned in childbirth classes - (Ed: YAY, Hypno-birthing!) relaxation, massage, positioning, visualization, hypnosis, distraction, focusing and breathing that are done with the support of another person. These non-drug coping skills use your own strengths and place you in control of your own body. For more information, read Epidural Express.