Certain medical procedures used during a delivery are sometimes hard to justify Indeed there is not necessarily an agreement across the whole of the medical corps over which practices are really necessary. Here are a list of the major procedures to help you better understand your choices.

 
It's reassuring for a mother to understand what will happen during the delivery and to clarify beforehand her desires concerning which practices may be used or not.
 
 

Induced Delivery

Medical methods used to provoke a delivery are either mechanical or hormonal. In the mechanical case, the membrane will be ruptured or removed, whilst in the hormonal case, an injection of ocytocine will be given by intravenous injection. There are however alternatives ⁽¹⁾ to these procedures, for example, repositioning the baby through particular postures or osteopathy, sexual relations, acupunture, homeopathie, plantes, essential oils and stimulation of the mammary gland.

 
Induction is considered necessary when the term of the pregnancy has been largely passed (42 weeks). In addition, induction could be prescribed when the amniotic sac has burst but labour has not begun; if the baby is very large or in case of a medical complication such as hypertension.

Today, provoking a birth has become very common. This decision is often uniquely made to accommodate the timetable of the mother or the medical staff rather than being strictly necessary.

Yet there are risks linked to an induction: the increased chance of a cesarean section⁽²⁾, fetal sufferance⁽³⁾, postpartum hemorrhaging and neonatal jaundice^(4). An induction can also have psychological consequences for the future mother and/or for a baby who is forced out before they are ready to be born.


 
 

 
This is an operation that is painless for the mother. It consists of using a small hook to break the amniotic sac. The goal is to start or increase the contractions of the mother. It's also possible that this operation will be performed if monitoring is required directly on the baby.

In addition to the risks linked to induction, a premature rupture of the sac has particular risks. Over and above the increased risk of infection, in rare cases the umbilical cord can become compressed and pulled into the vagina risking fetal distress. 

 

 

 
An epidural is an injection between two vertebraes that numbs the waist downwards. In function of the  dose injected, sensations can be more or less strong. The injection must be made at a hospital by an anesthetist.

If you wish to witness an epidural, watch the following video. Be warned, this is very explicit and could be shocking.

 
The epidural is a great alternative to a general anesthetic practised during a cesaraen section. Besides the greater risks of a general anesthetic, the epidural allows a mother to stay conscious during the delivery and is able to welcome her child.

The use of the epidural has become more and more common, even systematic, in order to remove pain during childbirth. The rate of epidurals in France is around 60 to 70%, 80% in the US and Canada. In the Netherlands, however, it's only 15%. The risk are effectively numerous and must be compared to the comfort the injection brings.

There are several alternatives to the epidural to relieve pain. These include: relaxation, empathy, presence, comforting and massage.

Risks associated with the epidural include⁽⁵⁾: increasing the length of labour, reduction of the "push" reflex, fetal suffering, muscle weakening, reduction in mother's blood pressure. These risks can themselves lead to the need to perform other medical procedures such as: an episiotomy, forceps or ventouse⁽⁶⁾, hormonal induction⁽⁷⁾ or even a cesarean⁽⁸⁾. Besides, women who have had an epidural risk more post-partum complications. Research has also shown that the epidural can have an effect on the baby: less awake, less tonic, reduced interaction and difficulty to breast feed⁽¹⁰⁾.

The epidural shouldn't be a systematic practice as it is today. Choices of future parents should be made with a full understanding of the impact of each option. Yet a person's choice, made with full understanding of the consequences, must be respected.

The key role of an independent midwife

(6)  Thorpe et al.
(7) Ramin et al.
(8) Lieberman et al.
(9) Sepkoski et al.