If you’ve had a baby, are planning to have a baby, or think you might ever have a baby you’ve probably heard talk about the state of birth management in America, the high rate of cesareans, and the widespread routine use of medical interventions in labor and delivery, for which there is really no solid medical evidence. As a doula, I spend a lot of time trying to stay current with published research, the varied practices of different providers, and the best evidence based data available. We have clients with all kinds of goals… some who’ve watched “The Business of Being Born” and want to avoid the cascade of interventions, some who just want to have as “normal and natural” a birth as possible in a hospital setting, and some who opt for home birth in hopes of avoiding most interventions altogether. Usually our birth doula clients hire us because they are hoping to minimize medical interventions and increase their satisfaction during their labor and delivery.
Well, guess what? If that’s you, I have some good news! You’ll be happy to know that the American Congress of Obstetrics and Gynecologists (ACOG) is recommending approaches to limit intervention during labor and birth. Do I hear applause? Yay! Now we all understand that sometimes the wheels of change turn slowly, so you’ll want to be informed about some of these recommendations from ACOG’s committee opinion published in Feb 2017. It’s not super technical and you can have at it and read it all for yourself (click here).
In the interest of a quick, easy list of the recommendations, read on:
Shared decision making and individualized labor management
Delayed admission to hospital until active labor (6cm dilation)
Offer of Expectant Management (rather than immediate admission & induction) if “water breaks” before contractions start
Routine IV fluids are not necessary
Intermittent fetal heart rate monitoring. Adopt protocols to use Doppler.
Non-pharmacologic methods of pain relief are advised (i.e. massage and bath)
Continuous labor support is associated with improved outcomes
Adoption of “coping scale” (not just “pain scale”)
Routine “breaking of water bag” during labor is not necessary
Freedom of movement and frequent position changes is advised
Resting for 1-2 hours before beginning to push (especially if on epidural) should be offered to women who are at 10cm, but not feeling ready to push
Breathing as is preferred during pushing (vs. coached to hold breath)
OBs and nurses should be familiar with and use these approaches
So, this is pretty cool, right? I love #13! As doulas, we feel like this is a huge step in the right direction and aligns both with what we see and what the evidence says. Of course there are caveats to these recommendations. It’s important to understand that ACOG is always talking about low-risk women who have gone into labor on their own. And they are always assuming that baby and mama are looking fine (or have what is called “reassuring status” and that can be a bit subjective.) So, if you are high-risk or being induced, you are in a different category- but it’s still really cool to know that the professional body that regulates a lot of the routine practices in L&D is onboard with limiting inventions, whenever possible. And why the heck are there so many inductions, you ask? It’s really getting crazy, huh? Well, that’s a discussion for another day.
And, umm… can I just say, don’t miss #7 on my list. Uh-huh. That’s us! That’s doula support! This support is “continuous one-to-one emotional support” given “in addition to nursing care.” So, that’s pretty neat. Do you want all the stats and studies that support these recommendations? Go to the link at the top. Do you have questions about what any of these recommendations really mean to you, what to include in your Birth Plan, how to talk them over with your OB or L&D nurse? Call your doula! We’re here to support your informed choices and help you have the best birth experience possible.