Latest / The Birth Lounge Podcast / Ep. 484: Routine Doesn't Mean Required: What Hospitals Automatically Do During Labor (IVs, GBS Antibiotics, Induction, Monitoring & Growth Scans)

Transcript

Ep. 484: Routine Doesn't Mean Required: What Hospitals Automatically Do During Labor (IVs, GBS Antibiotics, Induction, Monitoring & Growth Scans) · The Birth Lounge Podcast

Hello, and welcome back to another episode of The Birth Lounge Podcast.
Can I share something super exciting with you? Ah, I've got something new launching.
Well, it's actually not really like a full launch.
It is, um, more of, like, a facelift or an upgrade.
So I used to teach this class, and it was my best tips to avoiding failure to progress and a C-section and all my tips to, to tearing.
And I wanted to bring back a new and improved class.
That stuff is...
I've taught it for so long, and so I asked my audience over on Instagram, if you're not following me over there, what are you doing? I share all my favorite tips and, uh, things to help you have a better birth and also my life with Saggy Boy and Mr.
HeHe and Maximus, our dog, and just, um, letting you into my world.
But anyway, that's @tranquilitybyhehe over on Instagram.
But I asked my audience over there, which I love so deeply, um, "What do you guys want me to teach about? Like, if you got to pick my brain, what would you want to hear about?" And they said how to avoid a C-section.
Like, I really don't want a C-section, but I don't know how to not have one unless it's absolutely medically necessary, which of course, so grateful for C-sections, but we don't want them to happen every one in three women that walk in the hospital, and that's what we have currently.
And so over the last 10 years, I've really gathered a bunch of tips and tricks that will actually truly reduce your risk for a C-section up to 50%, and, um, I wanna share those with you.
You can find my free class at thebirthlounge.com/csection
and I'm literally just going to brain dump all of my best tips of how to avoid an unnecessarean.
You get it? It's like an unnecessary cesarean, unnecessarean.
I love it.
Unnecessarean.
So, um, I'm gonna teach you how to not have one, and that way, when you get into the hospital, you don't have to be worried about the interventions that are coming your way.
You already know how to navigate those conversations.
It's totally free to join, so if you wanna hang out with me that is thebirthlounge.com/csection.
See you there.
Bye.
Today is kind of an opinion piece, if you will, although many of my opinions are very much backed up in data, in science.
Uh, so it's not completely off-the-wall opinions but I will be sharing kind of my personal thoughts.
There were so many of you on Instagram that said you wanted a, a episode of, like, what would HeHe do or what would HeHe say, so I thought this would be a really fun way to do it.
Today we're gonna talk about a bunch of things that are in routine care or considered just, like, part of routine care that I personally disagree with, and I don't think that they should be part of routine care And so for each of these, I'll tell you kind of when they would be more appropriately used or, um, and that's obviously in my opinion.
And, um, and I'll talk a little bit about the data that backs that decision up.
Remember, these are just my personal thoughts.
This is certainly not an episode to take as, you know, the word.
But certainly I'll be sharing some, some articles and stuff for you guys that you can read up on your own and, um, maybe these will prompt some conversations with your provider if any of these options sound like something you're interested in.
What I'm not gonna talk about is, you know, I'm not gonna talk about all the things that people commonly think about, like, "Oh, let them eat in labor," or like, "Don't do cervical checks in your prenatals," or, "We should use less Pitocin."
Duh.
Like, yeah, all of those are, they've been beat to hell and back.
We're still doing all of those.
So I'm really gonna talk about some nitty-gritty stuff that's you'll be able to kind of think about, does this apply to me? If it does, should I be asking these questions? If it doesn't, should I be asking these questions? And you'll be able to go back to your provider and hopefully have some really cool, thoughtful conversation that's gonna get you some really good, hearty, compassionate, individualized care that's, like, based on your body, your symptoms, your pregnancy, your goals versus just like, "Oh, this is a blanket statement."
So that's kind of my goal with today's episode.
All right, let's jump right in.
This one, of course, my very first one is so controversial.
And you see this big divide, right? You see healthcare professionals have, like, a really strong opinion on this because of their experience, and then you see moms and birthing people have very strong opinions 'cause they have their own experience, and that is IVs in labor.
And I'm talking specifically about the, the hep lock or the, the saline lock the IV that's placed, but nothing is running through it.
It is really well-known, super well-documented that you should not have routine fluids.
If you don't have a reason to have fluids, we should not be pushing fluids into you because your body is very delicate in birth, and it, it's a very delicate balance, and we don't wanna throw that off with adding something unnecessary.
But I'm talking about just having an IV placed.
Now, your nurses, your OBs, your surgeons, your anesthesiologists, they've all seen really bad things and/or if they haven't, then they've been told stories of really bad things happening So they really, really want you to have one.
That's their opinion.
They're very strong.
They're very steadfast in this belief of theirs that every single person, regardless of whether you need it or you have a risk of needing an IV, um, that things can go downhill quickly, and that is very true.
I want to validate that for sure.
If anyone is listening being like, "Oh, that's not true," no, it is true.
It is actually very true.
The problem is, though, that women, the number of women that have this IV that don't ever need it is very large and, and the, the real problem is that these women then say that it disrupted their labor, or they walked away and had bruises for, like, weeks or that it took their care team multiple pricks, um, a very painful and kind of treacherous road to get their IV placed, and they didn't even need it, and it, it interrupted their labor.
It threw them out.
It caused them a lot of pain.
It was very irritating.
Um, sometimes, depending on where it's placed, it can prevent you from getting into certain positions that you want to get into, and so the thought there is that if I really don't need the IV, then don't place it.
And I think that we can meet in the middle somewhere.
Surprise, shocker there that I think that there's a middle ground, and I really do.
I think that we can start to...
A lot of these conversations you're going to hear me talk about, like, stratifying individual risk, and so I think that this is one of those cases.
We can look and say, like, "All right, who is a high-risk labor? Who is likely to need an IV? Who already needs an IV for something else that's going on in their pregnancy?" You guys fall into the bucket of you have to have an I- not have to, like, you don't ever have to do anything, but you need an IV.
Here's the reason.
And then you've got the people who are super low risk.
They are unlikely to need an IV except in that rare case that something goes sideways very, very quickly, and they've been told about this risk, and they feel comfortable taking that risk on.
I personally, in my birth, I fell into this category, and so those people fall into the bucket of, like, you don't need an IV.
And then we've got this middle ground where you've got someone who is not high risk, but they're certainly not low risk, and The likelihood that something goes sideways very quickly in their birth is much higher than someone in that category of low-risk people.
And so these are the people that you should have a discussion with, and you should say, there's a chance that you don't need this IV, but there's also a chance that's big enough for us to believe that you would really benefit from having this IV even if we don't need it.
Here are the reasons that we think that that would be good for you."
And so that's why I think that routine IVs in labor should not be part of that whole generalized care plan.
I think that there are two groups of people that can be offered IVs.
I mean, and anybody can get an IV.
If you're low risk and you want an IV, go for it.
But, um, as far as, like, forcing that on women or saying that it's part of hospital policy or saying that you have to have it, I just don't think it's appropriate for people who have a very, very low risk, and they are willing to take on the risk of not having an IV if something goes sideways very quickly.
The other thing I always plug in here is, is, like, you know, think about where you're birthing, too, because if you're birthing in a hospital and something goes sideways, you're at a hospital.
That's why you birthed at a hospital.
You're around professionals that should know what to do.
If, if, you know, if they feel like they aren't able to handle a situation, then we really should evaluate are they comfortable and confident in their skills, and if not, we should get them, you know, some, some training and some better skills.
Like, help them be confident.
This is not to reprimand them but to say, like, "If you're not feeling fully supported, the hospital has a responsibility to help the care professionals feel the most supported."
That does not resolve the fact that, you know, things do go sideways, and if something goes really bad in a birth, those people have to live with that.
I understand all of that.
But just like the woman that's taken on the risk of not having an IV, by being a healthcare professional, you're taking on the risk that sometimes you will see things that you don't necessarily wanna see based on the decisions of someone else, and that is literally the point of being a healthcare professional, is you help anybody indiscriminately.
So it's just part of it.
There's risk on both sides, I guess.
Okay, the next thing is treating GBS with antibiotics just across the board.
Now, again, this is one of those super controversial things.
I probably have lost a lot of people, actually, by this point.
A lot of people have probably been like, "All right, you are a dodo bird, and I'm done listening to this."
That's fine.
If you really think about it, we could prevent so many people from having unnecessary antibiotics in labor, and there are other countries that do this really well.
We can look at those countries and see how are they stratifying their risk.
And so for most of them, they are using kind of like a wait and see approach versus what we use here in the US, which is called the universal GBS screening, and it is really, uh, more of a prophylaxis thing.
And so you're gonna test people in pregnancy knowing that GBS is cyclical, and by the time you have your baby, your GBS may have cleared.
It may not have, but it also may have.
And if you test positive, then you will get antibiotics regardless.
So I think there's a couple of things that we could do to better serve people and also reduce the number of unnecessary antibiotics.
I think that testing people, either, like, the day before, a couple days before, or even in labor, it would be really great if this was, like, a one to two-hour test.
And anyone who came into labor, we could just run this quick little test and see if they were GBS positive or not, and then that would determine if they needed the antibiotics.
And the other thing is that just because you're GBS positive and your waters are broken does not mean that GBS is going to get into your baby.
It means that they'll be exposed, but it doesn't mean that it's gonna manifest in a GBS infection, which is actually sepsis.
And so for me, I love to share, uh, this calculator that will help you actually look at your individual risk, and it's from Kaiser Permanente.
It's a neonatal sepsis calculator.
And so you're gonna plug in a bunch of like, individual stats about yourself.
Like, um, what was your highest maternal temperature, and how many hours have your waters been broken if they're broken? And did you know your GBS, uh, status? Like, was it positive? Was it negative? Did you...
Had you not been tested yet? Did you decline testing? Are you gonna get the antibiotics? How long have you been in labor? What gestation you are.
There's, like, so many things, right? And then it, you- then you mash calculate, and it's gonna calculate a risk for you.
And then you have these hard numbers that you can make a decision on.
Like, are we high risk? Are we medium, moderate risk? Are we high risk, low risk? Sorry, high, low, medium, moderate.
Where do we fall on this spectrum, and do I feel like I want to get antibiotics for me and my baby? This is just a much better, in my opinion, I mean, but what do I know? Should I be in the White House? Maybe.
I'm just saying, like, we don't have to be giving everybody G- we don't have to be giving everybody antibiotics just because you tested positive for GBS weeks before you had your baby.
There has got to be something better that we can give a much more, like, closely targeted round of antibiotics to people and, and really narrow in on the people who truly need it and get rid of the people who don't.
When you go to this website, I'll link it in the show notes for you guys.
It's just neonatalsepsiscalculator.kaiserpermanente.org,
which I know that's a lot.
I'll put it in the show notes so you can click directly on it.
They have this new little pop-up that, that came about and it said that ACOG has kind of changed their current recommendations.
Um, and so there is a choice now, there's an extra box that you need to click whether you want to use the original screening tool, which was based on no universal GBS screening, or the updated one, which does reflect the universal GBS screening, which remember, universal GBS screening is what we do here in the US.
It's where you screen every single pregnant person as long as they agree minus the people who either go into labor before the test happens, usually between 35 and 37 weeks in pregnancy or they decline the test.
Everybody else gets tested and then based on that test result is whether you are recommended antibiotics in labor or not.
So anywho, it's a fun little calculator and, and I really feel strongly that we're given a lot of antibiotics that people don't need, and I think that there are very, very easy ways that we could probably reduce that and, and truly target the people just that need the antibiotics and that are at a higher risk.
And otherwise, in those countries that they have the wait and see, the no universal screening, then they are just following also what home birth does in the US, but you just monitor your baby.
Monitor mom and baby primarily through temperature checks and, uh, just, like, how they're acting, uh, making sure that they're acting like a new newborn and they don't have any signs of infection, and then you as well.
So Yeah, that's my soapbox.
All right, the next one is kind of expected, like 39-week induction.
I'm not gonna spend a lot of time here.
But I do believe that instead of recommending it across the board, "You're 39 weeks, let's talk about induction," I feel like, no, don't do that, first of all.
Second of all, you need to be encouraging that woman to stay pregnant, and that her body is smart and her baby is smart, and that if there becomes a reason for them to have an induction, then we can.
It's absolutely a tool.
It is open.
It is for them.
They can even request it.
If they're tired of being pregnant and they're like, "Yes, I want to be induced, I want to go through that process," absolutely, request it, honor that.
But as far as, like, putting that into people's heads, uh-uh, that's not the default.
The default is you stay pregnant.
Your body and your baby are gonna do this really beautiful dance.
They will know when to birth your baby.
Your baby will know when to be born.
Your body will be ready to receive that and go through that process with your baby.
And if you need some help, if your baby needs help, your body needs help, you need mental help, like emotional, physical, I can't do this anymore help, let's use induction.
It's a tool in our toolbox.
But as far as being the default, cut it out.
We're not gonna do that anymore.
That's how I'm gonna leave that one.
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another one that's probably not very uh, like, mind-blowing is continuous fetal monitoring.
If you don't know IA, which is intermittent auscultation, which means they're gonna hold a Doppler up to your belly, that is what is recommended for low-risk women.
They do it intermittently, which means you don't wear the belly bands and it's not continuous, and they check in on your baby every so often based on where you are in labor.
When you are in early labor, not a lot of monitoring is, is happening really, because a lot of people should be at home.
You should be laboring at home for the most part, no matter what, um, unless you're high risk, right? But if you are low risk and you are just birthing in the hospital because you want to, then you should be doing early labor at home.
That is ACOG's recommendation.
I mean, they, they even say, like, this is a great way to just...
They say this is just a great way to reduce your risk of C-section, reduce your risk of infection, really get into a good labor pattern, avoid going to the hospital too early, uh, so many things.
So labor at home, early labor, you're not gonna have a lot of monitoring.
You get to the hospital and you're in active labor, they will check in on your baby every so often.
And then once you get to transition, they, they check on your baby a little bit more frequently.
And then when you're pushing, actually it's continuous, and so someone is gonna constantly be holding something up to your belly.
And then it eventually, like, slides all the way down in front of your pubic bone and, and it kind of follows your baby.
So as your baby drops into your pelvis, so will that person's monitoring.
The problem with CFM, continuous fetal monitoring, those belly bands and the paddles, those little circles that you're wearing on your belly, is that, you know, babies fluctuate in labor, and that is very, very, very normal.
Your contractions also fluctuate in labor.
And so if we are catching every single little fluctuation, sometimes it can falsely lead your medical team to make decisions based on those readings, when really those are very normal variations in labor.
We're looking more so for longer term patterns in your baby.
Now, I'm not talking 24 hours you're waiting from early labor all the way to pushing for us to be like, "Yeah, that has been a pattern the whole entire time."
No, no.
We're talking about, like, intermittent auscultation, we are finding a couple of the Doppler readings to have the same pattern.
And so then you might move to that continuous fetal monitoring to see is your baby really given a pattern? How concerning is it? The belly bands are gonna be a bit more sensitive than that Doppler is, right? And so the Doppler can pick up on early stuff.
We see that for a couple of times.
Now we are moving to the belly bands to get a little bit of a more let's say, a more specific read.
It's a deeper read.
It gives us more stats.
And then if there's really a problem there, now we have caught something.
Whereas if you're looking good on the Doppler the entire time, chances are you are good the entire time.
We know that for low-risk women, intermittent auscultation definitely reduces their risk of C-section because of this.
Because when we are picking up on every single thing, sometimes we result in a C-section, and we pull that baby out, and that baby was totally fine, absolutely 1,000% healthy, and it just happened to be that we were reading at a time that your baby had some fluctuations.
And instead of waiting to see if it was a real pattern- decisions were made based on that one reading.
And it is a very dangerous slippery slope, and it is a large reason why our country C-section continues to climb.
And so for me, I just don't believe that CFM should be our default.
I think IA should be our default, and if you are someone that has a medical condition that you need the belly bands, or you are high risk, or you are on Pitocin, or you have an epidural or anything that's been added to your labor that would require continuous fetal monitoring because we know things, you know, when we add things like Pitocin or induction medications or an epidural, then babies can sometimes react kind of funky, and we do wanna have a constant read.
But if you're low risk and you're laboring along, and for the most part you're unmedicated and you haven't had a lot of interventions there, we ought to be checking in on you and your baby intermittently because your main thing is we want you to feel safe.
We want you to feel undisturbed.
That birth process is a process.
It's organic, it's natural, it comes from your body.
It is like a spiritual thing.
It ain't a space for people to continue to be like, Hello.
Can I take your blood pressure?" "No, get the hell out.
I'm trying to labor.
Get out of here.
Get out of here right now."
And honestly, that leads me to thinking when your team does your vitals, they should be doing it all at one time.
Stick that blood pressure cuff, put the temperature, put the thermometer in my mouth, get the belly bands, do the IA, hold up the Doppler, scan my forehead, scan my wristband.
Whatever you need to do, let's do it now in one fell swoop, and then when you get out of my room, I am back to blissful birthing.
Literally dark, no lights, nice music, just the number of people that need to be in that room with you.
Nobody extra, nobody that's stressing you out, nobody that's causing you any sort of drama.
And then your team comes in, they check you out again, and they leave, and we're back to blissful birthing.
And that is the cycle that we go through until you're ready to push your baby out.
Okay, you ready for my last one? It's growth scans.
And just because, dude, they're just so unreliable.
I mean, what? How can you say I'm gonna scan your baby and then when they're born, they might or might not be this size, and it...
this could be off up to one to two pounds? So you're telling me if you scan a nine-pound baby and you're trying to scare me into a nine-pound baby, this nine-pound baby might, and has a very good chance, a 50% chance of coming out seven pounds? What? That makes absolutely no sense.
ACOG themselves actually say that routine growth scans should not be part of every single person's care.
We also know that the bigger your baby gets, not large babies, but just, like, as they grow, as they should, they're literally growing, right? That's, like, their whole job.
So it's, it's not the growth part that's the problem.
It's that as they grow, our ultrasound machines get less and less and less reliable.
So once you are, like, 39, 40, 41, 42 weeks, you're gr- you're dealing with, like, a full-grown baby.
Not a big baby.
I'm not talking about large babies.
I am not saying that ultrasounds are only off when it's a large baby.
I'm saying a full-grown baby of any size, the ultrasound is going to be more off because that baby has taken up so much space in the belly Not because they're big, but because they're full-grown.
Growth scans, in my opinion, are a crock of shit, and they really are, and they are used as a way to manipulate women into getting interventions that they do not need.
Instead, I think that we should, if we have a belly that is looking really big, if we have other clinical signs that are pointing to this may be a big ba- belly, if this mother is saying, "I think this baby is humongous," did you know, fun fact interjection here, that mom's estimation of baby's weight is actually more accurate than ultrasound or a doctor palpating the belly? Do you know what palpating means? It means that they put their hands on your belly, and they literally, like, press around and they, they kind of wiggle things around.
They feel down in your pelvis and at the top and on the sides and stuff, and they might even, like, grab your little baby's butt at the top of your belly or at the bottom if they haven't spun yet and wiggle it, and they're, they're estimating how big your baby is.
But your estimation as mom, that mother's estimation, is more accurate than both of those things.
That's crazy.
So if you've got a mom that's saying, like, "I think this baby is ginormous," yeah, we could...
I mean, we could check on it.
Do you wanna see what a growth scan looks like? It's, it could be off.
And actually, if your baby is big and because you're so late in pregnancy, we expect some sort of error.
Like, it's not gonna be spot on.
They rarely are.
Sometimes they are, but rarely are they.
Do you wanna check in on that? Or if you have, if you're a provider and you have a, a concern, you can go to that mom and you can say, "You know, I'm starting to see these signs clinically.
I know that a growth scan is not actually recommended for everyone, but for you, I was wondering if you might be interested to see what that estimation is.
It's gonna give us a range and it's usually, like, a two to three to four pound range of what your baby might weigh at the time of birth.
Um, so it's not super-duper accurate, but it may help you make decisions that, you know, we're looking at now, today, we might face in the future," whatever you need to say.
I just don't think growth scans should be used for everybody and I think that instead of saying, "Well, let's see how big your baby is," we should be having the conversation of, "No matter how big your baby is, your body can get that out.
No matter how big your baby is, your body knows what to do.
Who cares if it is a larger baby, you can do this.
I'm gonna be with you.
You're gonna have our nursing staff.
You've hired your doula, your partner.
You have so many people who love you and will support you, and we know a bunch of things to help you get this baby out, so no matter what size your baby is, you can do this."
That's what I think that we should be telling women.
But who am I? Who am I to say? Just a silly old doula.
Um, you know, I'm just trying to get people individualized care here.
And it really ain't that hard to do.
So I'd love to hear what you think should be not standardized care.
I think there's so many places that we could just, I mean, make women's health so jam up.
It would be so good.
It would be consensual and safe and shared decision-making, but ultimately, the decision is with that mom about her body and her baby and her experience.
And we would really include partners so that they felt included in that process, and we would have the proper supports for our hospital staff, um, whether that be physically staffing the units appropriately so people aren't stressed out, um, but also mental health and emotional support when things do go bad because that's just part of birth.
It is just part of birth.
But routine doesn't mean required, and I think that's really important for everybody to remember.
If you are a mom, if you're a patient, if you're about to have a baby, I just want you to remember just because something is presented as routine care or hospital policy, or we do this with everybody, you can ask yourself, "That is great, but do I need this? That's awesome that you do it to everybody.
You may not be doing it to me.
I need to think about that.
Is it gonna benefit me? Is it gonna benefit my baby? Or are there risks that I'm taking on that I'm not, I'm not so sure about, I'm not comfortable with? Do I need to ask more questions or have I made up my mind?" I think that's totally fine.
And then for healthcare professionals out there, you guys, it may be hospital policy, but do not forget that the number one cause of trauma is physicians and medical care providers forcing things onto people when they don't want it.
That is not your job.
That's not why you got into medicine.
You're here to help people.
You want people to walk away from their birth being like, "Oh my God, that doctor changed my life in the best way possible.
They made me feel so safe."
And you're not gonna get there by forcing people to do stuff.
Your conversation is, "These are your options.
Here's what I recommend clinically because I'm seeing X, Y, and Z.
What kind of questions do you have? How can I help you make this decision? Whatever your decision is, I trust you and I believe you.
I'm gonna share what I think you should do because that's my job as your doctor, but I want you to know that you're not gonna be unsafe if you disagree with me.
I'm not gonna treat you any differently, and I do trust that you know what you're doing.
Some decisions, I might have to have you sign a piece of paper saying that we had this conversation, and some decisions you won't."
But I do trust you.
That's what that conversation looks like.
You're trying to rebuild what's been broken, you guys, right? And, and people just really don't trust the hospital system right now.
It's not you as a doctor, but it's the system, and anytime we're in those four walls, we have to navigate these conversations.
Patients, we are moms, not patients, but moms.
We are trying to help our care providers understand where we're coming from and what our goals are, and healthcare providers, it is your job to be receptive to that and to be that safe space, and if you can't do that, you really should step away for just a brief little bit just to, like, collect yourself and think about, is this the role that's right for you? All right, you guys.
Cool.
Routine doesn't mean required.
I don't think so many things in routine care should actually be routine care for every single person.
I think it should be more stratified.
I think it should be individualized, and I think with that very simple change, literally very simple change, we could see such a ripple effect from reduced inductions to reduced birth trauma rates to reduced C-sections and probably saving us some damn money in this country on our healthcare.
So put her in the White House.
All right, guys.
I will see you next week.
Thanks for hanging with me I will see you in the next episode.
Be sure to follow me on social media and you can find me @tranquilitybyhehe and @the.birth.lounge.
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Bye.
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I'm HeHe, and this is the Birth Lounge Podcast.