Episode Transcript
Kayla Quinn:
Some people might think, “well, if I’m in the hospital, it has to be X, Y, Z, this way.” And that’s really not true. You don’t have to have Pitocin, you don’t have to have an IV, you don’t have to push on your back if you’re in the hospital. That natural birth experience really can happen. It can happen in the hospital just as well as it could at home.
Courtney Collen (host):
Hello and welcome to “Her Kind of Healthy,” a podcast series brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. We are starting new conversations about age-old topics from pregnancy to postpartum, managing stress, healthy living, and more. “Her Kind of Healthy” is here to bring you the honest conversations about self-care, happiness, and your overall well-being with our Sanford Health experts.
In this episode, we are talking about a low-intervention birth and the options that you have at Sanford Health. I have two guests joining me for this conversation. Kayla Quinn and Stephanie Metzler are both certified nurse midwives at the Sanford Medical Center in Fargo, North Dakota. Kayla, Stephanie, welcome. Thank you both for being here.
Both guests:
Thanks for having us.
Courtney Collen:
Happy to have you. Let’s jump right in here. When we say low-intervention birth, what does that mean?
Stephanie Metzler (guest):
So low-intervention birth usually involves limiting the medical interventions. So I feel like that really starts with prenatal care, with providing education on pregnancy changes to be expected, what labor really looks like physiologically. And our goal really with low-intervention birth is to allow the body to go into labor on its own naturally and progressing through the birthing process without us adding a bunch of extra medical interventions that aren’t necessary.
So we do promote interventions when they’re appropriate for safe care, and we’re constantly evaluating that safety plan. So each individual client is different of what we’re doing, but the outcome is safety and best outcome for what Mom wants.
Courtney Collen:
Yeah, absolutely. Thank you for that. And at Sanford Health, what does that experience look like? In other words, how does a patient have a low-intervention birth? Like, what options do they have and how soon would they need to know that’s what they want?
Photo by: Sanford Health
Kayla Quinn (guest):
I think that it’s important to start thinking about those things early on in your pregnancy for a couple reasons. You know, at Sanford we have a lot of options for providers. You can see throughout your pregnancy, you have the options of OB/GYNs, obstetricians who are medical doctors, or you have the choice of certified nurse midwives. And a lot of it comes down to personality too, and really finding that provider that really meshes with you and someone you feel comfortable having a conversation with.
You know, low-interventional birth really comes down to planning and open communication more than anything. And so having the discussion in advance before you get to the labor part of, OK, what do you want? What does that mean to you? What does low intervention mean to you? Does that mean not breaking your water? Does that mean not having an induction? Does that mean no medication? Does that mean maybe just IV medication versus an epidural? It’s really kind of what does that mean for you?
And we do have all of those options at Sanford. You know, you can do low interventional with medication, you can have no medication and have interventions. And so you know, there really is a lot of options, but really having the conversation in advance is really important. What that might look like, though, would be if maybe … I don’t want to use the word avoiding, but kind of avoiding an elective induction or, like Steph said, trying to let labor just progress naturally on its own.
And there are things we can do to to help your body get ready for a natural labor, things like staying active, walking beyond the birth ball, using the miles circuit and spinning babies, raspberry leaf tea, pumping and nipple stimulation. These are all things you and your provider can work through prior to labor to try to get your body kind of set up in the best way possible to get it to go into labor naturally.
There are things during labor if you want low intervention, being up and moving, staying out of that bed is going to be really helpful. Being up and moving on the birth ball, walking, using the jacuzzi tubs and really just, you know, staying active up to that whole point. And being prepared before you come in is going to be the big thing.
Courtney Collen:
Yeah. Thanks, Kayla. Why would a woman opt for this type of birthing experience? And are you seeing an uptick in women wanting an unmedicated birth?
Photo by: Sanford Health
Stephanie Metzler:
Yeah, I feel like we are seeing more women that are seeking out this more natural, unmedicated birth option. And I know for each individual woman, it’s a very varied reason. It’s a very personal reason usually of why they’re wanting this natural birth. Sometimes they want to be more in control of their body throughout the labor experience. They want to experience the natural hormone cascade. They want that more bonding experience of being able to, you know, get up right away after having your baby and not having the epidural.
So there’s a lot of different reasons why people are wanting this experience. So I think it goes back to what Kayla had said – that communication piece of finding a provider that is wanting to support your experience and what that looks like for you.
And so having a low-intervention birth doesn’t necessarily mean you have to stick with not having any medications. You can go into labor with the plan of low intervention, and we can respect that and honor that. And sometimes that plan changes and evolves as labor progresses. And that looks like maybe adding a pain medication on board of labor, adding nitrous oxide to cope with the labor pains, or getting an epidural if it’s a longer labor. So I think, the choice of why you’re wanting that low intervention or unmedicated birth really is unique to each person. But we as providers, we want to come alongside and meet them where they’re at for what the reasonings are for that choice.
Kayla Quinn:
I do think that social media plays a part in this too. People see the good and the bad, right? I think a lot more patients have access to seeing other people’s stories. I think we talk about our birth stories a lot more now. And so if they see someone who had a poor birth experience or know someone who had a poor birth experience because of interventions, then they might be more wanting to have that low-intervention option.
So, I just think we’re talking about our birth experiences a lot more. And so it gives people the freedom to really think about, oh, I do have the options. What might that look like for me? And we see both sides. We see that “absolutely, I want nothing,” and we see the other side of “whatever you can do to get this baby out.”
Courtney Collen:
Yeah. Well, thank you for the insight there. And I would imagine social media and people sharing their stories does, you know, increases the conversation. Talk through the benefits of having this experience, like a more low-intervention experience, in a hospital setting.
Stephanie Metzler:
I think one of the biggest benefits of the hospital is the access to resources. If you’re needing interventions for either Mom or Baby, the resources are right there. You’re not having to wait for the drive time of either, you know, driving to the hospital to get those resources or a transfer with possibly EMS. So, I think that’s the biggest reason of choosing hospital versus home that some people like to consider.
Kayla Quinn:
I think we know that birth can be very natural in a very beautiful and peaceful process. But sometimes things can go wrong, and I think that the main benefit, like Steph said, is just being close if something does go wrong and having those options if you need them.
Courtney Collen:
Yeah. Thank you. At what point would more medical intervention be necessary?
Kayla Quinn:
There’s a few different points in a labor process. If it’s been a really prolonged labor and Mom’s been laboring for multiple days, but there’s really been no changes, that can be necessary for not necessarily even for fetal distress or anything, but just moms get exhausted. When you have a prolonged early labor phase like that, moms lose a lot of energy and sometimes need just a little help to get some of that energy back to make the rest of the process a little smoother.
Fetal distress is a big one where intervention might be necessary. I always tell my moms: you’re the boss of me. I want to make this a good experience for you. However, your baby is the boss of all of us. If Baby’s in distress, then that’s going to change how we react to things because our goal is just to have a healthy baby and healthy mom at the end of this.
Infection is another one. If Baby or Mom develops an infection throughout the process, that’s another big reason why we might discuss interventions.
Stephanie Metzler:
We’re constantly evaluating the safety of the labor, the safety of the birthing experience. So we’re listening to both Mom and Baby of what that looks like. So each labor is different and what we’re needing for interventions possibly could be different. So really just, you know, validating that everybody has a unique experience and if we see concerns, we’re talking about it. We’re constantly evaluating what plan of action is appropriate for this labor.
Courtney Collen:
Thank you. What questions do you hear most often from patients during their prenatal care journey about this topic as they look ahead to play in their own labor and delivery experience?
Stephanie Metzler:
Yeah, I think the biggest one that I hear from patients is do I need a high pain tolerance to be able to handle labor unmedicated? And the answer is no. I feel like somebody that can self-report saying that they have a very low pain tolerance, they can manage those contractions. The biggest thing that comes back to that is prepping yourself for labor. You know, doing that mental work ahead of time, knowing what it’s going to kind of take to have a vaginal birth and have a natural labor, low interventions.
So I think that’s the biggest question is like, do I need to have a high pain tolerance and how can I prepare myself for this natural birth? So that looks different for everybody.
Some people like a formal childbirth education class where they go in person and have structure of educating what labor looks like, what coping mechanisms, like how do we get from having labor to having a baby? What does that look like?
Other people choose online education, self-educating themselves, talking to their friend groups, looking at social media, kind of educating to prepare yourself for what labor and birth will look like and how you can best manage coping with it.
Kayla Quinn:
And I think sometimes people ask, OK, well what does Sanford have to help me with that? And we do, like Steph said, we’ve got the birthing classes. Once you get to the hospital, we have jacuzzi tubs, we have birth balls and peanut balls. We have combs that people can use to squeeze in their hands to help with counteracting the pain. We’ve got the peaceful music on for the room. You can bring your own music. We have Bluetooth speakers.
Stephanie Metzler:
We have an overhead star projector for like the calming atmosphere and battery-operated candle lights to kind of set the atmosphere a little bit calmer. We have little massage roller balls and like finger massage roller things. Coloring is an option. We do have interventions and tools with how to cope through those early labor, active labor pains.
And I think another question that sometimes comes up is, can I have an unmedicated or low-intervention birth for my first baby? Or do I have to have had a baby before to be able to do this? And the answer is yes, absolutely you can have an unmedicated, low-intervention birth for your first baby. I feel like women are so amazing and their bodies are amazing and they’re able to do it. So it’s definitely not something that’s off the table. You don’t have to have had a previous baby to be able to have an unmedicated or low-intervention birth.
Courtney Collen:
Sure. Thank you. Are there any common myths or misconceptions around a more natural birthing experience?
Kayla Quinn:
People might think you can’t have a natural birthing experience in the hospital, that that’s only something you can do as a home birth, which like we have talked about. We’ve got the tools to help you do it very naturally in the hospital as well.
Some other myths people have, well, as soon as I get there, they’ll put an IV in me. That’s a discussion you can have with your provider. Some providers are really comfortable with, if it’s not necessary, you don’t have to have one in until it becomes necessary, if it becomes necessary.
Other questions, you know, the myths of, well, if I’m in the hospital, I have to deliver on my back, and that’s absolutely not true either. Again, it’s having that conversation of I want to deliver in a different position, side lying, squatting hands and knees, whatever.
Some people might think, “well, if I’m in the hospital, it has to be X, Y, Z, this way.” And that’s really not true. You don’t have to have Pitocin, you don’t have to have an IV, you don’t have to push on your back if you’re in the hospital. That natural birth experience really can happen. It can happen in the hospital just as well as it could at home.
Courtney Collen:
Well, thank you for clarifying, because that is such an important piece to this conversation as well. Earlier, Kayla, you mentioned Baby’s the boss. If Baby is in distress, then you know, you and your team intervene as necessary. So for a mom and partner, this is maybe not part of the birth plan.
So when it’s time to kind of shift gears a little bit and you really need to ease any anxieties or fears because this is not going according to their plan, what do women, what do partners need to hear in those moments, and what do you tell them to ease their anxieties, to calm their fears, to keep them going?
Kayla Quinn:
A big thing for them to hear is, you know, our goal is to keep you and this baby safe. We’re all here to protect both of you. And it’s OK. It’s not their fault. I think sometimes when things don’t go according to a birth plan, moms feel guilty like they did something wrong, or it’s their fault that it’s not going right. And that’s absolutely not true. Although we know what our body should do, it doesn’t mean it always does do what it’s supposed to.
And so I think really just being reassuring and letting them know we’re here, our goal is still to have a healthy delivery, healthy baby, healthy mom.
And sometimes some interventions are just short-term. Maybe we just have to do a quick short-term intervention and then we can continue with the birth plan. Really just being there and then also, when we can, giving them the time and space to come to terms with the fact that things have changed.
But also I think it’s really important when things happen quickly, which we know they can, to give those parents the ability to talk about it afterwards and just be able to talk about what maybe didn’t go according to their plan so they’re not bottling it up because it can be a little traumatizing if things don’t go the way they want it to. And so really just, again, open communication, having the conversations with them about, you know, let’s talk about maybe why things didn’t go according to plan, or tell me how you’re feeling about it.
Stephanie Metzler:
I love that. Yeah. The open communication and talking through what we’re seeing, why we are making recommendations to do interventions when it’s happening. So things aren’t just being done to the woman. Like things aren’t out of their control. They’re still in control of things.
Maybe we’re making a recommendation that’s different than what their birth plan has, but this is why we’re making this recommendation. This is what we’re seeing, and yeah, we want a safe baby, we a safe, healthy delivery. That’s our ultimate goal.
But talking that through and then going back full circle after the delivery and say, “I know that X, Y, Z happened. This is why we had to move to this plan. You know, what are your feelings on this? How are you processing through this?” And making that space so they have that time to validate their feelings and feel heard and respected.
Courtney Collen:
Yeah. So important. Absolutely. What advice do each of you have for listeners of this podcast who might be looking ahead to their own birthing experience and may choose a more natural, unmedicated option?
Stephanie Metzler:
I feel like the most important thing is doing your research of what you want and what you want your labor to look like. Interview with providers. Have your first meeting for your initial OB appointment. And if you don’t jive with that provider, don’t be afraid to seek a different provider. Switch options and gather more information. Get recommendations from your friends, from family members of who they had for their experiences, and find somebody that you fit well with and somebody that, as a provider, will respect your wishes for what your labor plans look like.
If you’re wanting that low-intervention unmedicated birth and you’re low risk, maybe looking at a midwifery team and seeing if we’re a good option for you. There’s so many resources that we have available during pregnancy to prepare you for that labor and birth that making those decisions like Kayla had mentioned in the beginning of your pregnancy kind of helps guide the rest of the pregnancy.
Kayla Quinn:
And also really just doing your research about what to expect within unmedicated or low-intervention birth. And like we talked about – prepping for those things in advance. Looking at what are focal points or what breathing techniques are there. Talking with your partner, your support person, who’s going to be there on, how can they help? And starting to have those conversations. You know, how are they going to be able to help throughout your labor to keep you on track and help you through the pain of the labor.
And like Steph said, the conversations with your providers and kind of just that it’s really open communication. I think the absolute key point of having a low-intervention or an unmedicated birth is truly communication and just being prepared.
Stephanie Metzler:
The greatest birth plans sometimes don’t happen and that’s OK. We pivot all the time in the health care field during labors and births. And if you have this beautiful plan laid out and things have to shift, that’s OK. At the end of the day, knowing that, like Kayla said, it is not your fault that things had to shift. Baby is ultimately in control and it will help you process the shift in those plans. But we want to be there and support you along whatever journey that you have as providers to have a baby.
Courtney Collen:
That’s the beauty of the journey. Every pregnancy, prenatal journey looks different. Every labor and delivery experience looks different, and I’m sure the two of you have seen it all. Anything else that I didn’t ask you, Stephanie, Kayla, that you’d like to share on this topic?
Stephanie Metzler:
My biggest recommendation as a provider is those childbirth education courses. If you’re planning that unmedicated birth or more natural birth, being well-informed of what to expect is really helpful in achieving that goal.
Kayla Quinn:
And the beauty of it is, is you can do them in person, you can live online. There’s a lot of options now. And I agree, just having that preparation in place beforehand is really key.
Courtney Collen:
Well, this has been so insightful. Stephanie, Kayla, thank you so much for your expertise on this topic, for all that you do as certified nurse midwives in Fargo, North Dakota. We appreciate you and appreciate your time today.
Stephanie Metzler:
Thank you so much for having us.
Kayla Quinn:
Thanks.
Courtney Collen:
This episode was part of the “Her Kind of Healthy” podcast series by Sanford Health. For more by Sanford Health, visit Apple, Spotify and news.sanfordhealth.org.
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Posted In Fargo, Pregnancy, Specialty Care, Women's
