I had no illusions that childbirth would be easy, but I at least pictured it starting with gentle contractions that gradually intensified until that final, monumental push. Instead, my labor started with a dose of Pitocin because my contractions were next to nil and ended with a snip of the doctor's big scissors for an episiotomy. In short, my experience was bracketed with medical interventions I hadn't expected.
The reality is, medical interventions are sometimes necessary to ease your baby's entry into the world. About 20 percent of deliveries are nudged along with Pitocin, more than 35 percent involve episiotomies, up to 15 percent enlist forceps or a vacuum, and more than 25 percent end as cesareans. While health concerns often dictate what's ultimately done, briefing your provider on how you feel about each intervention could offer clarity in gray areas. "If I know a mom wants to avoid a c-section, I may be willing to give a slow labor more time if the baby's not in danger," says Bruce Flamm, MD, professor of obstetrics and gynecology at the University of California, Irvine, and spokesperson for the American College of Obstetricians and Gynecologists (ACOG). "The key is to express your wishes in advance because it can be hard for some moms to think clearly in the midst of labor."
You're Your Own Advocate
Be prepared to introduce the topic yourself. "Most doctors are not likely to bring up the issue spontaneously," says Katherine Hartmann, MD, assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. For example, the first time Jen Loya heard about a vacuum delivery from her obstetrician was in the delivery room, when he announced he was going to use one. "My doctor and I had discussed pain medications ahead of time, but not the different interventions," says Loya, a mom of two from Fairfield, Connecticut. Fortunately, she'd been briefed in her childbirth class months beforehand.
"Only half of first-time parents take a childbirth class, so many women go into labor not knowing what the interventions are and what variables are involved," says Jane Hanrahan, president of the International Childbirth Education Association. (All ICEA-certified classes cover the interventions; to find a class in your area, go to icea.org.) You may not be keen on hearing how labor can require specific equipment, but the knowledge is empowering, she says. Here's a rundown of the birth interventions that you're most likely to face.