ACOG Finally Recommends What Laboring Women Have Known For Centuries
Our Editor-in-Chief is also a birth doula and has supported nearly 100 women during their labors and deliveries. She has some thoughts on the new recommendations that the American College of Obstetricians and Gynecologists (ACOG) released this month.
As a birth doula, I have seen highly skilled, supportive and knowledgeable obstetricians attend deliveries with patience, kindness, and a truly hands off approach, letting the mama find her own path in her own time. I have also seen doctors bully, threaten, coerce and flat out lie to women in labor in order to hyper-control the situation and the laboring mama. One of the most important choices a woman can make when she’s expecting a child is the care provider or practice she chooses (also, hire a doula!). Ask questions early and often, and don’t be afraid to change caregivers, even if you’re late in your pregnancy. If you don’t feel supported or heard, listen to yourself and make a change. You and your baby are worth it.
First, I’d just like to take a minute to give a long, slow clap to ACOG for finally catching up with what labor support professionals and laboring women have always known, with these new recommendations. The full report is here, but I think it’s important to mention some highlights.
Hospital admission: “Admission to labor and delivery may be delayed for women in the latent phase of labor when their status and their fetuses’ status are reassuring. The women can be offered frequent contact and support, as well as nonpharmacologic pain management measures.”
Translation: Don’t go to the hospital too early. It’s been my experience as a doula that the longer you’re in the hospital, the more you will be exposed to unnecessary interventions. Hire a doula and plan to labor at home for as long as possible.
Intermittent monitoring: “…obstetrician–gynecologists and other obstetric care providers and facilities should consider adopting protocols and training staff to use a hand-held Doppler device for low-risk women who desire such monitoring during labor.”
Translation: Get laboring mamas away from those monitoring machines that restrict freedom of movement and other comfort measures, including bathing and showering while in labor.
One-on-one labor support: “Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor.”
Translation: Hire a DOULA!
Second Stage (pushing): “In the absence of an indication for expeditious delivery, women (particularly those who are nulliparous with epidural analgesia) may be offered a period of rest of 1–2 hours (unless the woman has an urge to bear down sooner) at the onset of the second stage of labor.”
Translation: If you’re fully dilated, but you don’t have the urge to push, don’t push; you’re going to wear yourself out quickly and your work won’t be effective. Wait until you feel the urge; your second stage will likely be shorter if you wait until your body and your baby are ready.
Oral hydration and non-pharmacological comfort measures: “When women are observed or admitted for pain or fatigue in latent labor, techniques such as education and support, oral hydration, positions of comfort, and nonpharmacologic pain management techniques such as massage or water immersion may be beneficial.”
Translation: Doula support, drinking fluids, changes in position, no restriction of movement help women cope. I’m bummed they’re still recommending limiting solid foods in labor without a lot of evidence that it’s safer (though they do say there may be changes in this recommendation as more research is done). This is another reason to stay home as long as possible and eat and drink whatever you need to stay strong and maintain the energy you need to make it through your labor and delivery.
These recommendations represent institutional progress that is in line with what labor support professionals have been saying for years, so I’m happy that they are easing up on the rigid, technological, hyper-vigilant management of labor. It is important, however, for all expectant mothers to make sure their provider practices in line with these new recommendations. It can often take obstetricians a long time to adopt new policies in their practices, so be sure everyone is on the same page so there are no surprises about policy when it’s time for you to deliver your baby.
Are you interested in learning more about the advantages of a “low tech” birth? This article in The Atlantic from 2012 gives a fantastic overview of the risks of hyper-management and use of technology on a laboring woman.
Mollie Michel is a South Philly resident and a Philadelphia public school parent. A recovering non-profit professional, Mollie is also an experienced birth doula, Certified Lactation Counselor, and the mom of two awesome girls and a sweet pit bull named Princess Cleopatra. In her spare time, she is usually trying to figure out how Pinterest works, training for a(nother) half-marathon with her dog at her side, or simply trying to keep up with her increasingly wily daughters.