Avoiding Routine Interventions
in a Hospital Birth
By Deborah Boehle, IBCLC

When Hilary Swenson became pregnant with her second child, she knew she did not want to have the same interventions she had with her first birth, so she began searching for a doctor in Honolulu who would honor her wishes.

"During my first visit to her, I made a point of discussing my birth wishes," Swenson says. "I explained that I wanted no medications at all unless some complication arose where interventions would be necessary to save Baby and me. I also mentioned that I wanted the lights dimmed when the baby began to crown. I wanted no (continuous) monitoring through the labor and I wanted to be moving about, walking."

As her pregnancy progressed, Swenson continued to talk to her doctor about her birth. By the last month, she had a written birth plan that was placed in her chart at the hospital, so the nurses would know that her doctor agreed with her desire to have no routine interventions, including intravenous fluids, pain medication or an episiotomy.

In the end, everything went as planned, and Swenson was happy with the outcomes of her second and third births, because she took the necessary steps to plan her birth.

The first step in avoiding routine interventions is to find a caregiver who is supportive of your wishes. Swenson asked friends and relatives for recommendations, which is a great place to start. Ask your friends how their births were handled because most doctors and midwives do things in much the same way from one birth to the next. If your friend had continuous electronic fetal monitoring and intravenous fluids, it is likely you also will have them.

You also can call the hospital where you want to give birth and ask them for recommendations. The nurses who work at the hospital know the various practices of physicians and midwives who deliver babies there, and they can tell you who is willing to be flexible. If you call the hospital and are told that every woman in labor has an IV and routine amniotomy and monitoring, you might want to look at other hospitals.

After compiling a list of caregivers, call the office to ask the staff a few questions about whether or not the doctor or midwife performs the routine interventions about which you are most concerned. If you are unwilling to have a routine IV, ask the nurse how often this particular caregiver uses them.

Next, make an appointment to meet the doctors or midwives who sound the most agreeable to you. As a rule, midwives are willing to meet with potential clients for a free consultation to discuss the type of birth you want, but this practice varies greatly among physicians. It is best to meet with at least two or three potential caregivers. Even if the first one you meet seems wonderful, it is a good idea to meet another one, so you have something to compare.

Ask the caregivers what percentage of their patients have IVs, artificial rupture of membranes, episiotomy, continuous monitoring and other procedures you want to avoid. If the caregiver does not know these numbers, that is a bad sign. If any of these numbers are high, that means it is likely to happen to you also.

Although one doctor was highly recommended to Swenson, she felt very uncomfortable with her when they met, and she was quickly marked off Swenson's list of potential doctors.

"Unfortunately the doctor we went to first was intimidating," Swenson says. "She was very clear about using interventions and spelling out things that could go wrong."

When Swenson met her dream doctor and discussed her birth plans, the reception was very different. "The doctor took all of this in stride and seemed pleased but not surprised," Swenson said. "It was great to not have to convince her of any of this."

"It is really important that when women want to avoid intervention in labor, they feel very comfortable with their care provider," says Lisa Summers, CNM, DrPH, senior technical advisor of professional services at the American College of Nurse-Midwives.

Choosing a supportive caregiver, however, is only the first step. There is no way a mother could possibly discuss all of her concerns in one visit, so the dialogue needs to continue throughout pregnancy at each prenatal visit. Plus, most expectant mothers continue to read and educate themselves through pregnancy, so new concerns will surface, and those will need to be discussed.

Darcy Lewis of Riverside, Ill. chose a doctor who had a reputation for using few routine interventions, but throughout her pregnancy, she continued to discuss her concerns at her prenatal visits.

"I most certainly did (talk to him) to the point where he may have gotten tired of my requests, although he never showed any irritation," Lewis says. "Toward the end, every time I saw him, I reminded my OB of what I wanted during labor, if at all possible."

Because Lewis was high risk due to a previous bout with cervical cancer and a seizure disorder, she knew she would need an open vein during labor, so she had negotiated with her doctor to have only a heparin lock rather than an IV.

In addition to discussing your wishes with your doctor or midwife, it is important to write a birth plan by the seventh month of pregnancy. Take it to your prenatal visit, discuss it with your caregiver, have him or her sign it and have a copy placed in your file. Make copies of it to put in your birth bag so that when you are in labor, you can provide copies for nurses who will be helping you through labor.

A birth plan is not a legal contract or a list of ultimatums or demands. Rather, it is a written confirmation of the discussions you have had with your caregiver. When most mothers arrive at the hospital, they are met by a nurse they have never met before. She has no idea what the mother wants, and most laboring mothers are in no condition to succinctly and clearly explain their desires. And few birth partners can explain a mother's wishes as completely as she can.

The birth plan provides a snapshot of what a mother wants for her birth, and the nurse knows the mother has discussed the plan with her caregiver if it is signed by him or her. Many caregivers have standing orders at the hospital, stating that each patient should receive specific procedures upon admission during labor, so the nurse may still have to contact the doctor or midwife to verify the orders.

It is also important for parents and birth partners to be respectful of the nurse's role during labor and birth. Be polite and non-confrontational. Use "I" messages, rather than "you." For example, say, "I was hoping to avoid an IV during labor, and Dr. Smith agreed that would be OK," rather than, "You can't put that IV in me because my doctor said so!"

The nine months prior to birth are the perfect time to plan your special day. If at any time you begin to feel uncomfortable with your caregiver, remember, it is never too late to switch. Most women will only give birth two or three times in their lives, and nothing should be left to chance when planning such an important day.

Want to see more? Birthplan.com Just in Case: Making a Plan for Cesarean Birth Who Will Attend Your Baby's Birth? Choosing a Childbirth Educator

About the Author: Deborah Boehle is a childbirth educator, International Board Certified Lactation Consultant and writer.