“The American College of Obstetricians and Gynecologists has issued a recommendation that, on the surface, doesn’t look like that big of a deal. The professional association of ob-gyns issued a committee opinion this month that basically says: Unless there’s someting wrong during labor, leave your patient alone.
What makes ACOG’s seemingly common-sense opinion profound, though, is that leaving laboring women to do their thing, on their own timeline, and with maximum amount of support and comfort that she chooses has not been the standard practice in hospitals around the U.S. Rather, the standard of care for decades has been lots of monitoring, inconsistent regard for a woman’s birth plan and limited resources when it comes to easying the pains of labor (e.g., epidural or eye rolls). Studies from the last decade or so have also shown that methods of inducing labor were often used in excess and unnecessarily. And, as an example of what felt cruel to many laboring women, they were denied food and water during the hours (often leading into days) of labor in the hospital. The results have been an increasing rate of birth via C-section and women who’ve suffered trauma from their births. Also? Unnecessary costs that someone has to cover (the person, their insurance, hospitals or taxpayers).
Instead, this opinion concludes that ob-gyns should collaborate with “midwives, nurses, patients and those who support them in labor” and “help women meet their goals for labor and birth by using techniques that are associated with minimal interventions and high rates of patient satisfaction.”
Their statement acknowledges that many common obstetric practices are of “limited or uncertain benefit for low-risk women in spontaneous labor“—for example, stripping her membranes and other forms of induction. The group also writes that there’s no evidence that breaking membranes during a labor that is already steadily progressing is necessary.
Continuous fetal heart-rate monitoring has long been known to not improve birth outcomes and yet has been standard—often required—practice in many labor and delivery floors of hospitals. Being confined to bed, on her back and hooked up to machines, meant that laboring women couldn’t move around to get comfortable, walk the halls or take a shower for pain relief. This new opinion states outright that the practice is not beneficial and that, when possible during a normal birth, a handheld Doppler should be used to intermittently monitor the fetal heart rate.
Another routine practice has been to administer intravenous fluids once labor gets going, but this new opinion questions whether it should be mandated for all women. At the same time, they say that drinking water—or even fluids containing sugar—did not increase negative outcomes at birth either for the mother or the baby. Drinking and eating during labor had previously thought to have put laboring women at risk for choking or breathing in fluids, but the new opinion allows for drinking. It does not go as far to recommend eating during labor, though many midwives not only allow but encourage it, rather the opinion says allowing snacks should be looked at and possibly reconsidered for the future.
The authors also acknowledge that methods of easing pain that don’t involve drugs can be used for laboring women, and that first-time moms who have received an epidural don’t have to be put on a timeline and “may be offered a period of rest for 1–2 hours before initiating pushing efforts.”
“Obstetrician–gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches for the intrapartum management of low-risk women in spontaneous labor,” the opinion summarizes.
And in a stunning blow to Hollywood scriptwriters everywhere, the organization hints that we may need to give the whole “push! push! push!” thing a rest. While they don’t call for an end to the so-called “Valsalva pushing,” they say women who prefer to spontaneously push (i.e., push when they feel like it and without coaching) should be allowed to do so. They also its OK to not instruct women to push immediately after the baby’s head has fully descended, and that waiting 1 to 2 hours—until she indicates her body feels like pushing—is fine.
This opinion in total is in stark contrast to experiences of many women’s labor experiences and states what birth advocates have been saying for years: “Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. In addition, some women may seek to reduce medical interventions during labor and delivery. Satisfaction with one’s birth experience also is related to personal expectations, support from caregivers, quality of the patient–caregiver relationship, and the patient’s involvement in decision-making.”
It’s a pretty big deal.”