Rethinking the nature of intervention in childbirth

There is much awareness and conversation of what the routine interventions are that can occur during the labor and birth process within the hospital environment.  These interventions can include induction, augmentation with Pitocin, epidural, or cesarean. In all my professional and personal roles, I am privy to a great amount of pregnancy and birth stories. Within these experiences there are many “silent” yet obvious interventions that are hidden in plain sight under the guise of protocol, practice and societal expectation.

My current list of hidden in plain sight interventions in no particular order that can make a difference on how a woman labors and ultimately delivers her baby is below.

  • The uniform -Asking and expecting the mother to give up her clothes for the hospital gown.
  • Who’s on first? – If care provider is part of a large practice or on-call group a woman may have never met or have any knowledge of the person who’s practice style and philosophy is helping to guide and steer her labor and delivery. On-call CP may or may not adhere to the birth plan the laboring woman worked out with her own CP.
  • On a short leash – Continuous monitoring even if she is not high risk, medicated, or being induced/augmented.
  • The big drag around – Requiring IV running with absence of medical need.
  • Staying put – Asking or requiring the laboring woman to stay in bed for ease of staff without medical need.
  • Ice chips and Jello – Disallowing snacks and sometimes even actual water even though labor is hard work.
  • The marketing tool – Disallowing the laboring woman to get into the touted tubs or showers since it isn’t convenient for staff and she will not want to get out.
  • One is enough – Limiting the amount or type of support persons a woman is allowed to have with her.
  • I know more than you – Treating the laboring woman as if she knows nothing or shouldn’t know anything.
  • If you don’t… – Instead of giving informed consent and refusal, telling only what bad could, maybe happen.
  • Attitude and atmosphere – Negative, non-listening, lacking compassion, leaving the door open, ignoring requests, and the like when a woman is laboring.
  • Only if you ask – Though some wonderful practices are in place, they are only offered if a laboring woman or postpartum mother ask/insist on it.
  • Bait and switch – The official tour of labor and delivery and the reality of labor and delivery don’t fit together.
  • New with bells and whistles – The pretty with all the fancy bells and whistles like wi-fi, flat screen tv’s, etc. have to be paid for somehow. Because of this investigate the intervention rates there.
  • Routine vaginal exams – By and large VE’s are very subjective and can vary greatly between one person to the next on how they score a VE. This variation can deeply affect the course of a woman’s labor and delivery.  Women birthing in the hospital really only “need” a VE upon entrance for assessment of where she is in labor, if she desires an epidural/IV narcotics, if she is having a very prolonged labor, or if she feels pushy.
  • Pushing the epidural – When a woman is moving, moaning, making noise or just doing her thing in labor and it causes the staff discomfort or worry.  It could even be that anesthesiologist is going in to surgery and it can only happen now.

Simply because a societal norm is birthing at the hospital, as well as, what routinely goes on there, doesn’t mean the hidden in plain sight interventions are wise or harmless.

My goal here is to give pause and broader thinking to what intervention means for labor and delivery as another tool in planning and preparing for childbirth with eyes wide open.


  1. Birth In Joy on February 8, 2010 at 9:38 pm

    This is great, Des. Bookmarking this one.

  2. Dionna @ Code Name: Mama on February 9, 2010 at 1:17 pm

    I love this list, these things are so obvious (and so ignored/culturally accepted). They are all reasons we birthed at a Birth Center (not associated w/a hospital) for our son and will have a homebirth if we get pregnant again.

  3. JudyC on February 9, 2010 at 8:38 pm

    Desirre. As an Australian midwife who has been learning more of the American way of birth and becoming more horrified as I go, you have written a great list.
    My only comment is the vaginal examinations. I would not say that admission and feeling pushy are a clinical indication for an exam. I and my collegues prefer to palpate the head, look at her body language and listen to her story to get some idea of where she is at. If it then seems to be going on too long then we may check. Also with feeling pushy, in most cases, when a woman can’t help pushing, it is the right time. I no obvious progress in a little while, then check.
    I hope you and all your likeminded friends continue with the good work in trying to change a sick system.

  4. Chanda on February 11, 2010 at 12:05 pm

    Thanks for such a great list. I’m sharing this. The question is — how do we get this on the radar of those who need it most…

    • admin on February 11, 2010 at 5:41 pm

      Share it… Share it a lot.

  5. Kiki on February 12, 2010 at 9:38 am

    The gown is a great one. One minute a mother in labor, the next a patient.

    I like the wheelchair too. Sit in the wheelchair, to be wheeled to where you need to go, despite having probably just walked from your house, to your car, then from the car into the hospital.

    Good stuff!

  6. Marissa on February 13, 2010 at 3:17 pm

    This is great! Thank you so much for posting! I will definitely be sharing!

  7. Laura on February 15, 2010 at 9:40 pm

    Oh, I wish I had seen this list before I delivered my first! They pulled the “going into surgery” on me re the anesthesiologist right when I was in enough pain to be doing things minute-to-minute in terms of enduring. I took the epidural. I wish I had not.

    Not the only one from the list that I identify with, but the one that upsets me the most. DS and I came through decently, but I think it would have gone better had I ignored the “hint”.

    • admin on February 15, 2010 at 11:12 pm

      I am so glad it all went okay in the end for you and DS. I am glad it affirmed what happened in your situation. Please share the link if you think it will help others being discerning. I know so many women including me with my first that didn’t know these things and could have benefited.