Thursday, January 24, 2013

Ask an OB: Fear of Unwanted Interventions

"Ask an OB" is our blog series with Dr. Maude "Molly" Gurein, MC, FACOG.  If you have a question you'd like to ask her, please share it with us here.

What do modern OB's really do, as far as all the "unwanted" interventions that the natural childbirth community talks about? ~ Confused Mom

      Q1: Are vulvas really still coated with Betadine? If so, why is this a good practice?
A1: Hahaha – that’s funny…no, I haven’t seen that done since 1978
Q2. Are women still "forced" (not my experience) to have their feet/legs in stirrups? If so, why? (As a doula, I've seen most dr.s totally ok with different birthing positions but this is not what the ncb community likes to claim).

A2. Stirrups? No, I haven’t seen anyone “forced” into stirrups…not sure how we would manage that. Women tell us how they are most comfortable and we accommodate them. I’ve delivered babies squatting, on their side, sitting, in bed, on the floor, in a Lazy Boy, in the shower, wherever they want to be.

Q3. Is routine separation of infant and mother demanded or only if the infant needs assistance?

A3. Babies are with moms 24/7 at Sparrow Hospital. I’ve actually had complaints from moms who WANTED to send their babies to the nursery and they were told NO, baby stays in your room with you all the time. Sparrow has focused on this for > 10 years, and is now pursuing “Baby Friendly” status, which is a national certification that is quite difficult to achieve.

Q4. What do dr.s think of moms who want low to no interventions, like no IV, no EFM, etc.?

A4. Doctors wonder about the motivation for these requests. Give me your reasons and let’s talk.  Let’s deal with the underlying issues first, then get down to the specific requests.

IV for instance – can we negotiate a heparin lock? That way you can move around freely, and I can have a fighting chance to save your life if you have a post partum hemorrhage. PPH is not uncommon, occurring in up to 5% of deliveries, and when it starts, your blood vessels constrict, making an IV start difficult/impossible. With the blood flow to the placenta at 750 cc per minute, it doesn’t take long to exsanguinate. So when someone refuses a heparin lock, I wonder if she is someone I feel comfortable getting into a possible life and death situation with.  

Monitoring…well if you are low risk and you elect intermittent monitoring instead of continuous monitoring, and are willing to accept Apgars a bit lower, then I can live with that.  For those who worry about being, "Tethered to a bed/not allowed to move around," I'd say you can go anywhere you want to as long as mom and baby are low risk and doing well. 

Q5. Can you address these other NCB claims: shaving the pubic area, routine episiotomies, and routine enemas?  


- Shaving the pubic area: hahaha – never have seen that, even in 1975 when I started med school.

- Routine Episiotomies: went out 10 - 15 years ago

- Routine Enemas: last saw one of these about 1979

Sounds like the NCB people you are referring to haven’t been in a hospital since the 1970s!


  1. In some countries, some of this stuff still happens, though. In Ecuador in 2007, my OB did the stirrups and routine episiotomy (even against expressed wishes). I wouldn't be surprised if there are locations in the US with "old school doctors" who also engage in practices that you consider long outdated. (I basically agree with your gist. My experience in US hospitals has been as you describe. I'd just be careful of blanket statements, for someone is bound to know of an exception and then they'll dismiss your words.)

  2. Thank you for your thoughts CT. I agree that there are likely OBs or places even in the US that do some of these things. I hope mothers can talk to their care providers about these kinds of concerns ahead of time, and choose an OB purposefully that doesn't function this way. I'm sure there are exceptions, just like I am an exception to perfect home birth. I appreciate your point, as it is an important one.

  3. There are a variety of providers, and unfortunately, some of these practices still occur in remote pockets with some old-timey docs. We had a local doc still doing sterile drapes, stirrups and betadine around here until just a couple years ago. But for the most part, many of these practices have vanished, I agree.

    I'm happy to say that where I live there are many local hospitals in my area that:

    Offer water birth

    Allow low-risk women to labor without a saline-locked IV

    Utilize intermittent monitoring of FHTs for low-risk women

    Also, we are fortunate to have many hospital-based nurse-midwifery practices which are excellent options for women wanting support in having natural, unmedicated deliveries.

  4. I've heard that at our local maternity center, that mothers can't leave the bed after the water breaks. I've been assured that yes, it's true, due to liability issues. I walked and walked (with a pad on) after my water broke, but it was twenty years ago in a different city. Dr. Molly, what is your hospital policy on that?