The American College of Obstetricians and Gynecologists frequently updates their committee opinions and recommendations as they gain new knowledge and listen to consumer (that’s you!) demand. In the most recent update to the Committee Opinion titled, “Approaches to Limit Intervention During Labor and Birth,” there are several recommendations that reflect the growing demand from birthing women to be offered more support and fewer interventions during labor and delivery.
It has been well-known for years that interventions during labor, such as induction, epidural, continuous fetal monitoring, ect., can lead to a higher chance of the labor ending in a cesarean birth. Cesareans, while sometimes necessary and life-saving, present enough risks to mother and baby that avoiding them should be the goal of mothers and health care providers during a normal, healthy pregnancy and labor.
To that end, limiting interventions during labor is finally starting to be considered beneficial and “main stream” as compared to being viewed as something that only hippie home-birthers care about.
As a side not here before I share ACOG’s recommendations in regard to doulas, I would like to point out that while limiting interventions is just starting to become “popular” in the medical community, it is by no means a new concept. The wisdom of traditional midwives, doulas, mothers, and grandmothers has long shown that women need caring, continuous, female support while being allowed to work with the power and intuition of their own bodies. Sometimes, because the medical community is just starting to embrace these ideas, doulas and unmedicated birth can be seen as simply the “trendy” thing to do, or be treated as if it is some new, ridiculous standard women are setting for themselves. I encourage you to research a little about the history of birth if this is a topic that interests you, or if you have people telling you that you’re crazy.
With that side note, here are a few key quotes from ACOG regarding interventions during labor:
- 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.
- Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.
- When not coached to breathe in a specific way, women push with an open glottis. In consideration of the limited data regarding superiority of spontaneous versus Valsalva [provider directed, hold-your-breath] pushing, each woman should be encouraged to use her preferred and most effective technique.
Notice how suggestions of water immersion, massage, oral hydration, and education may be beneficial? Unfortunately, many nurses and providers are assisting multiple women at a time, and the type of care needed to facilitate all of these comfort measures is just not available in most hospitals. Not only is the doula an emotional support, which research suggests is helpful in and of itself, but a doula is going to be able to implement these wonderful recommendations during your labor.
You may be wondering why I have added the note on pushing in an article about doulas. Most women, once they are deep into labor-land, are going to basically do as they are told. Even if they went in with a desire to push spontaneously and avoid “purple face” pushing with held breath and countdowns, they may have a hard time asking for silence during pushing or they may feel pressured to follow the providers prompting to push on demand.
Having a conversation with a doula about your desire to push spontaneously can help in the labor room, as your doula can remind the care team of your wishes. She can also help remind you of your birth plan, while respecting your needs in the moment.
In light of ACOG’s most recent recommendations, it may be beneficial to ask your provider how they work with doulas in the delivery room, and if they are aware of the benefits doulas can provide to not only the birthing woman, but the entire care team. Most hospitals are very doula-friendly, but it never hurts to get an idea of just what to expect when she comes in with you!