Invasive Birth Interventions To Avoid Unless Necessary

Labour and birth have always carried risks, both for women and their babies, however, thanks to improvements in maternal health and maternity care, the global maternal mortality rate has been steadily falling in recent decades.

Unfortunately, in 2020, this still meant 152 deaths per 100,000 live births globally. In addition to this, many women also face the risk of health complications, birth injury and mental trauma following birth. Invasive interventions during labour and birth can contribute, and many organisations, such as The Association for Improvements in the Maternity Services (AIMS) have campaigned tirelessly to challenge the medicalisation of childbirth.

Here are some common procedures and interventions in labour and birth that shouldn’t be considered routine and should be avoided unless necessary.

Invasive Procedures in Labour & Childbirth

The following procedures may be offered or recommended to pregnant women as part of their care during pregnancy, labour and birth and can in some cases be life-saving and improve outcomes for women and their babies, however, when used unnecessarily, without clinical indication, they can also be harmful and negatively impact outcomes.

Women who have undergone these procedures may not discover until later, that they weren’t strictly necessary and that they – or their baby – have been harmed as a result. Some families may then choose to make medical negligence claims to seek compensation.

Induction of labour

Induction of labour is when labour is started artificially. This might be offered to pregnant women for a wide variety of reasons. In some cases, it may be that the mother or baby could be at risk if the pregnancy continues any longer due to a medical issue. In other cases, it may be because the baby’s estimated due date has passed by more than 10-14 days, which can present a risk of stillbirth.

Induction of labour is a medical intervention and as such, shouldn’t be undertaken without a good clinical reason. Induction can impact a woman’s experience of labour, making it more intense and harder to cope with. It can also increase the likelihood of needing further interventions as labour progresses and there is some evidence that induction can increase the risk of requiring a c-section.

Continuous monitoring in labour

Continuous monitoring in labour involves using a CTG (Cardiotocography) machine to monitor baby’s heart rate. This is recommended by The National Institute for Health and Care Excellence (NICE) when there are certain risk factors in labour, such as having an epidural or oxytocin drip, or if meconium is present.

However, evidence has shown continuous CTG monitoring in labour to increase the incidence of caesarean births or instrumental deliveries (where forceps or ventouse are used) but with no significant difference in outcomes for babies. Continuous CTG monitoring should therefore not be used unless clinically indicated and women’s wishes should be taken into account.

Episiotomy

An episiotomy is when a midwife or doctor makes a small cut in a women’s perineum to allow for the baby to be born. Episiotomies were performed routinely as part of maternity care in the United States and later the UK during the 1960s and 1970s, however, a landmark study in 1984 suggested that episiotomies did not improve outcomes for mothers or babies. This means that episiotomies should only be carried out with a woman’s informed consent and when there is a clinical indication to do so.

Caesarean Section

Caesarean births can undoubtedly be lifesaving for some mothers and their babies. For others, however, the benefits do not outweigh the many risks of a c-section, which include the risks of major abdominal surgery for the mother, plus risks to the baby, including possible respiratory difficulties. There are also risks for a woman’s future fertility and subsequent pregnancies.

NICE guidelines clearly state that women’s wishes need to be taken into account when it comes to caesarean birth.

In Summary

Some invasive procedures during labour and childbirth are necessary to prevent harm to women and their babies, however, these interventions should not be considered a routine part of normal labour or birth and should only be carried out if clinically necessary and with a woman’s informed consent.

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