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» Author: Peter Welsh BSc (Chiro),DC MRCC MEAC

Procedures you may want to think twice about during pregnancy

One of the biggest origins of back pain for any woman is pregnancy. Not only during, but often many, many years later, ladies will suffer from many spinal or joint conditions which some will never associate to their pregnancy...but it so often is..

To those pregnant patients I see, I have one major rule: always use gravity to help you push your baby out...don't lie on your back, basically pushing up hill with every contraction...when squatting, standing, leaning over a bed or a 'fitball' will aid you no end! Gravity may also help save more invasive procedures like ventouse extraction which will affect the boney shape of your child's skull...something chiropractors care a lot about!.

I have included a list of common procedures below which you also may wish to question if you are pregnant. Education on these matters is important, as you may need to decide in haste one day.

Procedures you may want to think twice about during pregnancy #1: Nuchal Translucency Screening

The Nuchal Translucency (NT) screening is performed by ultrasound between week 11 and week 13 plus six days. This test determines the likelihood of your baby having Down’s syndrome. Babies with Down’s syndrome tend to accumulate more fluid at the back of their neck. During the ultrasound, the sonographer measures this fluid to determine whether it is in the normal range. This test is between 70-75% accurate. If combined with a first trimester blood test, the accuracy increases to 82-93%. This is known as combined screening.

The limited accuracy of this test means some women choose to reject Nuchal Translucency screening during pregnancy. If you are considered low-risk, or feel that having a baby with Down’s Syndrome would not affect your decision to continue with the pregnancy, then you may feel that this test is unnecessary.

Procedures you may want to think twice about during pregnancy #2: Ultrasound After Week 24

Ultrasounds after week 24 are sometimes carried out by practitioners who are wanting to keep an eye on health concerns, for example, diagnosed fetal abnormalities or a very low placenta. Late ultrasounds are also performed privately for women and their partners who want another chance to see their developing baby before the birth.

Ultrasounds after week 24 have an increased margin of error than those performed earlier in the pregnancy, and are therefore not an ideal way to determine the due date or size of the baby. Research performed in 2009, analysing trials involving over 27,000 women, found that ultrasounds carried out after week 24 were linked to an increased risk of caesarean section.

Doppler ultrasound uses continuous waves, rather than the pulsed waves of a standard ultrasound. Dopplers are often used to detect intrauterine growth retardation (IUGR). If your healthcare provider is concerned about the size of your baby, more frequent monitoring using doppler ultrasound may be used. An Australian study into the safety of dopplers found that babies who received more than five doppler ultrasounds were 30% more likely to develop IUGR than babies who received standard ultrasounds.

Procedures you may want to think twice about during pregnancy #3: Automatic Repeat Caesarean

Vaginal Birth After Caesarean (VBAC) is possible – three quarters of women who opt for one are successful. Just because your first baby was born by caesarean, that doesn’t mean you must automatically have a caesarean for your next baby.

A caesarean is a major surgery, and carries risks for both mother and baby. In some circumstances, it is the best way to ensure the safety of both mother and baby. If you are able to have a vaginal birth, however, you will reduce your recovery time, and avoid some of the risks associated with caesarean birth. Speak to your healthcare provider for advice about your situation, and to find out whether VBAC is an option for you.

Procedures you may want to think twice about during pregnancy #4: Caesarean For Low Risk Birth

Caesareans can save lives, and may be the only way to ensure the safety of both mother and baby during a high risk birth. Only around 10% of pregnancies are considered to be high risk, and yet a third of all babies in Australia and the United States are delivered by caesarean section.

Some potential risks of caesarean section for the mother include infection, haemorrhaging and adhesions. Some risks for the baby include being born too soon, breathing problems, lower apgar results immediately after birth, and a 1.9% risk of being cut by the surgeon’s knife accidentally. Having a caesarean also leads to a longer recovery time, and can affect both breastfeeding and early bonding.

Unless necessary, caesareans are not the best option for mother or baby. The caesarean rates varies wildly in hospitals. Speak to your healthcare provider to find out the caesarean rate for low risk births at your local facilities.

Procedures you may want to think twice about during pregnancy #5: Unnecessary Induction

Inducing labour is sometimes medically necessary, for example if you are suffering from pre-eclampsia. If a pregnant woman has pre-eclampsia, an induction can be lifesaving, because the baby will need to be born sooner rather than later. However, many women are now being induced for convenience, rather than out of medical necessity, and this is dangerous. As soon as you begin an induction of labour, you become ‘high risk’ and are accepting all that comes with it. Around 50-60% of first time mothers who are induced end up with emergency caesarean sections.

Full term is considered to be between 37 and 42 weeks, and any babies born within that five week window are considered to have be born at the right time. Many pregnant women, however, are finding that pressure to induce begins as early as their ‘guess’ date, with healthcare providers keen to get them booked in for induction as soon as possible.

The synthetic hormones used during induction are different to the natural hormones released during natural labour. Induction leads to an increased risk of interventions including epidurals and assisted deliveries. A 2011 study found that babies born through induced labour were 64% more likely to end up in a neonatal intensive care unit than those born to women whose labours began naturally.

Procedures you may want to think twice about during pregnancy #6: Elective Early Birth

Ideally, babies should be born according to their own schedule. When medical necessity prevents this, babies should be born as close to their due date as possible. Babies born at 39 weeks or later are less likely to suffer from breathing problems, jaundice and cerebral palsy. They are also less likely to end up in a neonatal intensive care unit, and encounter fewer feeding problems.

If an elective birth is necessary, speak to your healthcare provider about the possibility of delaying this process until at least week 39 to give your baby longer to mature in utero. Even just a few days can make all the difference to your baby’s healthy.

Procedures you may want to think twice about during pregnancy #7: Internal Exams

Internal exams are sometimes assumed to be a necessary part of childbirth. Many women have come to expect this unpleasant exam during labour, and not many realise that it is possible to reject this procedure altogether. In some instances, an internal exam may be the best way to gather necessary information about the birth, and your healthcare provider should be able to explain if this is the case.

It is not necessary to have an internal exam to see how far along you are, healthcare providers can ascertain this information simply by spending time with you and observing your labour. Some hospitals have policies in place to perform internal exams at routine intervals, but this is not medically necessary.

If your healthcare provider asks for your permission to perform an internal exam, find out exactly why this is deemed to be necessary before consenting. If they can’t convince you of the need for the exam, then you can refuse to have it.

Procedures you may want to think twice about during pregnancy #8: Continuous (Electronic) Fetal Monitoring

Continuous fetal monitoring means you will be hooked up to a monitor, recording your baby’s heartbeat during labour. This not only restricts your movement, but has been shown to increase the risk of a forceps and caesarean section. Research has found that continuous fetal monitoring does not improve outcomes for babies during childbirth. In this Cochrane Database Review, they concluded:

“Continuous cardiotocography during labour is associated with a reduction in neonatal seizures, but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography was associated with an increase in caesarean sections and instrumental vaginal births. The challenge is how best to convey these results to women to enable them to make an informed choice without compromising the normality of labour.”

In some instances, continuous fetal monitoring may be advised, for example if you have a VBAC, induction or an epidural. But these days, unless you are high risk, it is not usually routine to have continuous, electronic fetal monitoring. Many hospitals like to do a ‘trace’ regularly to see what the baby is doing, but the problem is this: when they say they’ll be back in 20 minutes to take the monitor off, they may get busy with other patients – and you’re still stuck on the bed, which can hinder your labour.

The alternative is to check baby’s heart rate at regular intervals using a handheld device (i.e. a doppler). This has the added bonus of leaving you free to move around during labour, and does not restrict the positions you can use during the birth.

Procedures you may want to think twice about during pregnancy #9: Breaking The Waters

Breaking the waters, or rupturing the membranes, is sometimes considered to be a routine procedure used to strengthen contractions and shorten labour times. Research has found, however, that far from making labour easier, this practice may actually increase the risk of caesarean section. Most women find that their waters break spontaneously during labour, without the need for medical intervention.

Procedures you may want to think twice about during pregnancy #10: Routine Episiotomies During Births

An episiotomy is a cut made to enlarge the opening of the vagina. This is not a routine procedure and should not be considered standard birth practice. This procedure may be necessary in assisted deliveries, to allow for the use of forceps or ventouse. It should not, however, be a part of a standard delivery. Episiotomies take longer than heal than a natural tear, and may cause more damage. There is also an increased risk of infection following an episiotomy. Ask your obstetrician or midwife what their stance is on episiotomy so you can be aware in advance.

For more information or a personal consultation contact our clinic on 01709 828928