How to Avoid Fetal Distress
1. Refuse EFM, Electronic Fetal Monitoring. This is your birth. This should be your choice. Many hospitals may ‘require’ you to be monitored using EFM; however, you have the choice to refuse! If you don’t have to guts to refuse a health professional, then I advise hiring a doula to speak for you. Why is this important? There is significant data that shows the increased risk of c-section with an increase of EFM use. Here’s a quote from the 2005 Practice Bulletin #70 of the American College of Obstetricians and Gynecologists:
“Despite its widespread use, there is controversy about the efficacy of EFM. Moreover, there is evidence that the use of EFM increases the rate of cesarean and operative vaginal deliveries. Given that the available data do not clearly support the use of EFM over intermittent ausculation, either option is acceptable in a patient without complications.” (Obstetrics and Gynecology, Intrapartum Fetal Heart-Rate Monitoring 106 (6), 1463-1561.)
What are the alternatives? You can get intermittent fetal monitoring. When nurses, midwives and doctors rely on EFM to monitor mothers, they spend less time paying attention to the mother. With intermittent monitoring, health care professionals must spend more time looking at the mother when they’re gathering fetal heart tones.
EFM has also been shown to give wrong readings–sometimes the sensors shift and don’t give accurate readings. The other problem with EFM is that you usually have to be lying on your back–the ONE POSITION YOU SHOULD AVOID during pregnancy, labour and birth! In case you didn’t know, there’s a main vein (inferior vena cava) that brings blood to the heart that gets pinched when you lie on your back. It becomes another hospital-caused injury since mothers are asked to lie on their backs, then the fetal heart rates drop, then the hospital rushes you off to do an ’emergency’ c-section.
2. Walk or change positions during labour. Just to reiterate, NEVER LIE ON YOUR BACK. Even if the midwife or doctor is asking you to lay back just for a moment while they do a vaginal exam or get fetal heart tones. If you are asked to sit and recline, do not go further than a 45-degree angle.
Let’s say that you do have EFM hooked up and they start noticing drops in heart rate. First of all, there are three different kinds: Early decelerations, Variable decelerations, and Late decelerations.
Early Decels – good, reassuring sign. the baby’s heart rate dips down as a contraction occurs, means the baby is dropping and baby’s head is being compressed. When the contraction is done, the heart rate goes back to its baseline.
Variable Decels – often a sign of cord compression, heart rate drops quickly but comes right back up quickly. Often mom will be repositioned and it will resolve. If it is continuous, they won’t like it and will start thinking about other interventions. Not bad, but not good.
Late Decels – the “bad” ones. Baby’s heart rate goes down AFTER the contraction so the baby is not tolerating the contraction. Oxygen can be given, a change in position, and mom will be monitored very closely. If there are continuous, prolonged (long) late decels, this is when they start saying baby is in distress.
Unfortunately, even if you know these things, you won’t be ‘allowed’ to interpret the monitor strip yourself, so you’ll have to just trust your health care provider.
3. Eat & Drink. The baby is relying on the mother the entire time in the womb, even after birth until the cord is cut. If you are dehydrated or hungry, baby is probably as well. This can also affect the heart rate. If you don’t get the nourishment you need to handle labour and birth, then the baby may also be weak to handle the contractions. Be sure to follow a healthy high-protein diet (at least 75g of protein daily). For more information, check out the Brewer Diet.
4. Avoid Pitocin or any other Drugs. Drugs are not natural. They’re medical. They cause the body to react in an unnatural way. For people in the US, pitocin (or, Pit) is a drug that causes unnaturally strong, hard, and long contractions. These kinds of contractions push on the baby stronger, harder and longer than a naturally-occuring contraction. It is only natural then that the baby may have difficulty sustaining good heart tones throughout these unnatural contractions. Even, if the doctor or midwife says they’ll only be giving you one or two drops of pitocin, there is no way to know how your body will handle the drug and may react to it terribly. There are mothers who have had 15-minute long contractions and basically suffocated the baby in the womb from these drugs.
Here in the UK, it is very common get the hormone drip of Syntocinon (another artificial form of oxytocin) to “move things along.” These are also unnatural. They have very similar negative effects on women as Pitocin does. These drugs and hormones that cause stronger-than-normal contractions become extremely difficult to handle without the use of pain relief (epidural, saddle block, spinal) and almost always end in the use of these narcotics (YES, these epidurals use narcotics).
5. Avoid getting a Membrane Sweep. This seems natural, right? It’s not like it’s a drug. Think again. Though a membrane sweep isn’t a drug, it is unnatural. A membrane sweep is when a health care practitioner takes their hand, sticks it up the vagina and uses fingers to separate the cervix from the amniotic sac to cause the body to release the hormone prostaglandins. They say it’s not painful, just uncomfortable and may result in blood. I’ve heard women say that was the most painful part of their birthing experience. A membrane sweep is often something midwives and doctors use to start the onset of labour. There are several problems with this.
1. Any kind of vaginal exam introduces bacteria. If the bag of waters is still intact, the bacteria will not reach the baby. If they have broken, then bacteria will reach the baby and you must monitor the baby closely.
2. Separating the cervix membrane from the amniotic sack may cause the baby to drop, regardless of baby’s positioning and rush towards the pelvis. It may result in an unfavorable position of the baby and then start contractions. Though the contractions are natural, they may be pressing on the baby with the baby in an awkward position (head might be sideways, and etc).
3. A membrane sweep may cause the bag of waters to break, also rushing baby’s body down towards the pelvis and getting stuck in whatever position it happened to be in at that point. Some women are lucky and their baby was already in a good head-down position. Others might find that their baby gets stuck (shoulder dystocia).
4. “A Cochrane systematic review showed that membrane sweeping seemed to hasten the onset of labor but conferred no clinically important benefits (e.g., mode of birth and maternal and newborn health were unaffected). Moreover, membrane sweeping resulted in an increase in the likelihood of pain, bleeding, and irregular contractions” (Boulvain, Stan, & Irion, 2005)
5. “Findings suggested that an increase in PROM will result in an increase in induction, the very intervention membrane sweeping is intended to avoid.” (ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists.[Obstet Gynecol. 2007])
It is important that baby has the opportunity to move around inside the amniotic sac into an optimal position for birth prior to the onset of labour (contractions). Any kind of rushing or artificially starting labour may cause an unfavorable position and poor fetal heart tones through contractions. The best way to have baby in optimal position is to have patience and wait for contractions to start naturally.
6. Avoid the Domino Effect of Interventions. If I haven’t already convinced you, the use of drugs that speed up labour and then drugs that relieve pain (which end up slowing down labour), all have negative impacts on the baby. If the baby’s average weight is 8 lbs and the mother’s average weight is 140 lbs, then the amount of drugs that pass through the placenta into the little baby’s body is almost 20 times too strong! Imagine the kind of effect it has on the baby–strong contractions crushing the baby, and then a narcotic that puts sends the baby’s brain into a dull state. They are basically drugged and their heart tones can sometimes even out (which some nurses and doctors prefer; however, it usually doesn’t show the good early decel fluctuations of the heart because baby is out of it). When this occurs, the baby is no longer aware of the action of birth that they are going through and cannot do the instinctual movements that they use to fit through the birth canal and begin first breath, and also breastfeed.
7. Take a Bradley Method® Class. You’ll learn how to prepare for a healthy pregnancy and birth. You’ll learn so much more about pros and cons of interventions, your options, becoming an informed decision-maker, and have the best chance at avoiding a c-section!
*Disclaimer: your birth is unique, not one is the same. Some births unavoidably end in c-sections due to several causes (placenta abruption, shoulder dystocia, etc). Other times the fetus really is in distress! However, my goal is to equip you with knowledge of options. My next topic to address is the cord wrapped around baby, stay tuned to learn more about how common, natural and safe it is to birth a baby with a wrapped cord!