Interventions
I have the privilege to have access to some of the most incredible research coming out of the birth world and I watched a keynote speaker Adriana Lozada and her talk totally changed my whole practice. I want to share the core message with you because it will be something that comes up in our prenatal and this gives me a chance to go over this either before or after that.
So the idea is that the goal for birth and labour is that the birther enters a space where they’re labouring and they feel supported and strong and can have the birth experience that they want (and whatever that might look like; some people want an epidural, others might want a cesarean, while there are also lots of families who want to try to give birth without medical pain management).
In the keynote speaker presentation, her idea about interventions is that typically we imagine that they are medical. Some examples might include, an IV, an induction, breaking the water, using pitocin, etc. An intervention essentially changes and affects the course of labour by affecting the hormonal flow of the birther. When we use a medical intervention very often include something to openly alter the hormonal balance of a birther, like the use of prostaglandins and pitocin for example, and encouraging the birther’s body to do something other than what it’s doing by manipulating that balance.
In the doula world, we encourage clients to avoid as many interventions as they can. Our thought is that the more we protect the natural flow of labour, the less interventions are needed, and often we can get closest to the families’ ideal vision for their birth. We also talk quite a bit about the cascade of interventions, the idea that when someone chooses the first intervention, often small and potentially medically unnecessary for the health of baby and birther, then there will most likely be another intervention that follows. A simple example of that would be consenting to an induction with pitocin use: first comes the IV of pitocin which often restricts movement and requires continuous fetal monitoring, then often comes epidural use to deal with the pain of the contractions brought on by the pitocin and the birther is now bound to bed, and we know that epidural and EFM use is also linked to higher likelihood of needing to use forceps, vacuum or a cesarean births. This is why I encourage families to think a couple steps ahead down the road they’re going to make sure that feels right; there’s no right or wrong choices in labour which is why I support families with all types of births plans, but I at least want families to feel like they understand their options and can make the right ones for them.
Adriana Lozada, however, reframed the idea of interventions in a light I hadn’t quite seen before. She talked about how there are many other kinds of interventions rather than medical; there are lots of things that happen in the months and weeks leading up to labour that can affect a birther’s mindspace, headspace and heartspace that are incredibly powerful and absolutely can change the flow of labour. An example of this would be ultrasounds and big babies; some birthers who get that news get freaked out by it and the hormones that are flooding their body are not oxytocin which helps labour but rather adrenaline and cortisol which makes them both stressed and want to run away from labour. Or perhaps their care provider gets the news and tells them they probably will need an early induction or cesarean, which for some, plants seeds of fear, of concern, of helplessness, of grief for potential loss of birth plan and power, of disappointment, of anxiety; none of which, as you can imagine are helpful for birth.
And, to be honest, even hiring a doula is an intervention. My presence compared to if I hadn’t been at the birth, absolutely alters the way that things go down. All the decisions that a birther and families are making are potential interventions. Self-induction is another amazing example; some birthers are so obsessed with doing all the induction things and that isn’t inherently right or wrong but I’ll always ask why. Why do you need to get the baby out early? Is it fear that your body is broken or bad or won’t be able to do it? Is there some sort of pride or underlying prize that comes with being able to start labour? Then with a birther spends 2, 3, 4, 5 weeks doing all these induction methods and we’ve arrived to 40, 40+2, 40+4 and the induction methods “aren’t working”, what’s the story that the birther begins to tell themselves? Because that story has the power to be an intervention; feelings or stories of failure, disappointment, worry, anxiety are creating hormones that are limiting and inhibiting the flow of hormones that cause labour to happen, therefore becoming an intervention.
My proposal to families and birthers is, does this decision or this intervention bring me closer to the feelings of love? Sounds hippie and crunchy, but it’s true. Does this make me feel fearless and powerful and confident and true to myself, or will this make me feel afraid and worried and anxious and upset? If the answer is love, then full steam ahead. If the answer is all that yucky stuff, then my advice would be to tread with caution and decide if that’s really an intervention that you want to proceed with. Some interventions aren’t avoidable, and I can totally acknowledge that, and then the work is to answer the question, “Well how can we make this feel better?”
I have the privilege to have access to some of the most incredible research coming out of the birth world and I watched a keynote speaker Adriana Lozada and her talk totally changed my whole practice. I want to share the core message with you because it will be something that comes up in our prenatal and this gives me a chance to go over this either before or after that.
So the idea is that the goal for birth and labour is that the birther enters a space where they’re labouring and they feel supported and strong and can have the birth experience that they want (and whatever that might look like; some people want an epidural, others might want a cesarean, while there are also lots of families who want to try to give birth without medical pain management).
In the keynote speaker presentation, her idea about interventions is that typically we imagine that they are medical. Some examples might include, an IV, an induction, breaking the water, using pitocin, etc. An intervention essentially changes and affects the course of labour by affecting the hormonal flow of the birther. When we use a medical intervention very often include something to openly alter the hormonal balance of a birther, like the use of prostaglandins and pitocin for example, and encouraging the birther’s body to do something other than what it’s doing by manipulating that balance.
In the doula world, we encourage clients to avoid as many interventions as they can. Our thought is that the more we protect the natural flow of labour, the less interventions are needed, and often we can get closest to the families’ ideal vision for their birth. We also talk quite a bit about the cascade of interventions, the idea that when someone chooses the first intervention, often small and potentially medically unnecessary for the health of baby and birther, then there will most likely be another intervention that follows. A simple example of that would be consenting to an induction with pitocin use: first comes the IV of pitocin which often restricts movement and requires continuous fetal monitoring, then often comes epidural use to deal with the pain of the contractions brought on by the pitocin and the birther is now bound to bed, and we know that epidural and EFM use is also linked to higher likelihood of needing to use forceps, vacuum or a cesarean births. This is why I encourage families to think a couple steps ahead down the road they’re going to make sure that feels right; there’s no right or wrong choices in labour which is why I support families with all types of births plans, but I at least want families to feel like they understand their options and can make the right ones for them.
Adriana Lozada, however, reframed the idea of interventions in a light I hadn’t quite seen before. She talked about how there are many other kinds of interventions rather than medical; there are lots of things that happen in the months and weeks leading up to labour that can affect a birther’s mindspace, headspace and heartspace that are incredibly powerful and absolutely can change the flow of labour. An example of this would be ultrasounds and big babies; some birthers who get that news get freaked out by it and the hormones that are flooding their body are not oxytocin which helps labour but rather adrenaline and cortisol which makes them both stressed and want to run away from labour. Or perhaps their care provider gets the news and tells them they probably will need an early induction or cesarean, which for some, plants seeds of fear, of concern, of helplessness, of grief for potential loss of birth plan and power, of disappointment, of anxiety; none of which, as you can imagine are helpful for birth.
And, to be honest, even hiring a doula is an intervention. My presence compared to if I hadn’t been at the birth, absolutely alters the way that things go down. All the decisions that a birther and families are making are potential interventions. Self-induction is another amazing example; some birthers are so obsessed with doing all the induction things and that isn’t inherently right or wrong but I’ll always ask why. Why do you need to get the baby out early? Is it fear that your body is broken or bad or won’t be able to do it? Is there some sort of pride or underlying prize that comes with being able to start labour? Then with a birther spends 2, 3, 4, 5 weeks doing all these induction methods and we’ve arrived to 40, 40+2, 40+4 and the induction methods “aren’t working”, what’s the story that the birther begins to tell themselves? Because that story has the power to be an intervention; feelings or stories of failure, disappointment, worry, anxiety are creating hormones that are limiting and inhibiting the flow of hormones that cause labour to happen, therefore becoming an intervention.
My proposal to families and birthers is, does this decision or this intervention bring me closer to the feelings of love? Sounds hippie and crunchy, but it’s true. Does this make me feel fearless and powerful and confident and true to myself, or will this make me feel afraid and worried and anxious and upset? If the answer is love, then full steam ahead. If the answer is all that yucky stuff, then my advice would be to tread with caution and decide if that’s really an intervention that you want to proceed with. Some interventions aren’t avoidable, and I can totally acknowledge that, and then the work is to answer the question, “Well how can we make this feel better?”