The over-medicalization of birth has been a hot topic for several years, but it seems like OB-GYNs have finally listened. Now recommendations from the American College of Obstetricians and Gynecologists (ACOG) advise doctors not to rush to medical interventions for women with low-risk pregnancies. Instead, they should work to meet each woman's goals for her own labor and delivery.
Cue cheers from preggos everywhere! As long as everything's going okay, this means you can have more control over your birth experience, instead of feeling like you're being told what to do.
"For any intervention or technology, we [the doctors] should think about whether it's appropriate and needed in this particular patient, and what the alternatives are," author Jeffrey Ecker, MD, chief of OB-GYN at Massachusetts General Hospital in Boston, says. "Then we have a conversation with patients about the options so we can together choose a path that matches their values."
Not surprisingly, the guidelines were developed with the American College of Nurse-Midwives, experts in low-intervention labor.
Interventions that doctors should now think twice about include continuous fetal monitoring and IV fluids, which tether women to their beds.
"In many places the default is to use continuous electronic fetal monitoring, but for appropriate patients intermittent [monitoring] is a reasonable and supported alternative," Ecker says. It's more comfortable and easier to move around if you're not hooked up to stuff. The guidelines also say breaking the amniotic sac isn't always necessary. And if a woman's water breaks on its own, she might not need to be induced with drugs right away.
For women with low-risk pregnancies, the report recommends approaches like laboring in water, frequent labor position changes and a woman's preferred breathing technique while pushing. In addition, the guidelines allow for delaying admission to the hospital until women are as much as six centimeters dilated. Studies show women admitted early have higher rates of needing drugs to move things along. "This would fall under the banner of patience," Ecker says.
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The new approach also means more support for those who want to go med-free—not that there's anything wrong with epidurals, but it should be each woman's choice. "Both of these options are wonderful and can be supported," Ecker says. Instead of asking how much pain you're in, nurses and doctors can ask how well you're coping with it—a small but importance difference.
One thing pain meds can't do is ease anxiety, so the guidelines also recognize the importance of a support person, like a doula.
"Continuous support during labor has been associated in some studies with a reduced risk of cesarean delivery," Ecker says.
Besides cost-saving, the goal of the new guidelines is increasing patient satisfaction.
"Different folks have different values, and they imagine differently what's important to them and how they would like their labor to proceed," Ecker says. "Pregnancy is a state of health, so in as much as we can do things that go along with those values, we can make them more satisfied."
"With the increase in social media, we hear more stories of moms who were disappointed in their birth experience," says Clara Ward, MD, a maternal-fetal medicine specialist at McGovern Medical School at UTHealth and Children's Memorial Hermann Hospital in Houston, who was not involved in writing the report. "These recommendations reinforce to patients that as clinicians we are 'on their side' with a very clear goal: healthy mom and healthy baby."
She notes that even for high-risk women, some techniques might still be appropriate, like having a support person.
Talk to your doctor about what you want for your labor and delivery. Even when you're in the hospital, make your feelings known. You deserve to have the labor you want when medically possible—and now it's official.