Part 2: Seeking a Caregiver for Your Birth? Critical Questions to Ask…

Part Two: Labor Interventions

In this three-part blog series, Lena DeGloma (Certified Birth Doula, Licensed Massage Therapist, Clinical Herbalist, Certified Lactation Counselor, and Certified Childbirth Educator) discusses pertinent questions to ask when seeking a caregiver who is right for you. Part one suggests what to ask and what to listen for when choosing a caregiver who practices shared decision making and informed consent. Part two of our series will explore what questions to ask surrounding labor interventions. 

Question 1: What are your practice’s rates for common interventions such as cesarean sections, induction, and epidurals? 

When examining rates for common interventions, you’re not just looking for an individual practitioner’s rate. You’re looking at average rates for the whole practice. Unless you happen to be working with someone who is a solo practitioner and they are the only person who may be attending your birth (which is fairly uncommon), you’ll want to ask about the practice’s rates as a whole.

Cesarean Rates

The average cesarean rate among hospitals in New York State is currently about 35%. The average in the United States is around 31%. According to the World Health Organization, this is two to three times the acceptable rate, at which point cesareans are doing more harm than good. The World Health Organization’s recommendation states that the cesarean rate should be no higher than 10 to 15%. That includes all populations, including high risk and low risk. Unfortunately I see some practices give the excuse that their rate is high because they work with a large proportion of high risk patients. But this just doesn’t hold water as I personally know some excellent high risk specialist practices who have rates under 15%. Other practices say they have a high rate because they work with more “older” parents (over 35 or 40), however I would argue this just exposes their bias against older parents’ ability to give birth spontaneously than it does legitimate their higher cesarean rate!

Induction Rates

Unlike cesarean rates, there are no clearly agreed upon statistics surrounding average or ideal induction rates - and the rate of induction can vary widely among different practices and hospitals. However, we know ideally inductions are only performed for a specific medical indication and therefore should be a relatively small percentage. As important as learning how often this practice induces labor, is asking under what circumstances labor is induced. It is extremely common to induce simply based on being X number of weeks gestation (39, 40, 41) without any other medical indication and this is simply not evidence-based in the majority of cases in the absence of another medical reason.

Epidural Rates

While the rate of which a particular practice’s patients choose to get an epidural doesn’t always tell a whole lot about the practice itself (as this is essentially the choice of the laboring person), one thing to keep in mind if you are hoping to have an unmedicated birth, is whether or not this practice is experienced and comfortable supporting people who don’t have epidurals. Typical hospital rates for an epidural can be upwards of 90%. Even a practice who says they have a 50% or 60% epidural rate would be surprisingly low in a hospital setting. If you’re looking at a birthing center setting, you would expect the epidural rate to be very low (around 10% or less). This is because at a birthing center, the use of an epidural would mean the patient was transferred to a hospital as epidurals are not offered in birthing centers. On some level, the main thing the epidural rate tells you is whether the overall birth setting is centered around supporting coping with unmedicated labor or not.

Of course there are many other interventions that can come up during labor that you may want to ask about such as episiotomy, vacuum, forceps, and more. I often recommend clients check out the website www.evidencebasedbirth.com for more information - it is an incredibly useful and non-biased source. 

Question 2: What steps do you take to minimize unnecessary interventions during labor? Does the hospital or the birth center that you practice at support these practices? Or is this an uphill battle? 

The answer to this question will tell you a lot about whether a caregiver is going to attempt to work with the normal physiological labor process and only intervene where necessary. You should try to ask for details or examples of the ways they will work to minimize use of unnecessary interventions. All practices are going to say “I only ever intervene when necessary; I only ever perform a cesarean if necessary.” However, if a practice has a 30% cesarean rate, then they’re not only doing it when necessary. They may believe it’s necessary but statically we know that cannot be true. So for example, does your practice support intermittent monitoring of fetal heart tones or do they expect laboring parents to be connected to continuous electronic fetal monitoring?

Even when the birth setting (hospital) is not particularly supportive, if the practice you are considering does have low rates of interventions despite that setting, they may still be an option worth considering. I have seen a lot of practices that successfully navigate challenging hospital environments and work hard to fight for their patients to have a really excellent birth. Unfortunately, many of our hospital systems (in New York City in particular) aren’t always supportive of these types of low intervention practices. You want to know that your practice is going to fight for you and support what you need during labor and birth. Many practices will just fall into the routines of the hospital instead of working against the grain to reduce interventions.

Question 3: What routine interventions are to be expected while I’m in labor in this particular birth setting? 

Some routine interventions include electronic fetal monitoring, IV’s, augmentation of labor using pitocin, artificial rupture of membrane, etc. You want to get a sense of whether this practice tends to routinely use a lot of interventions or whether they prefer to support labor taking its own course when possible. 

Are you interested in learning more about what questions to ask when seeking a caregiver who is right for you? Be sure to follow us on Instagram (@redmoonwellness) to get updates on the release of Part Three: Labor and Birth. In the meantime, click here to book a private virtual birth consultation with Lena DeGloma.