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Having a baby soon? This one's for you.

March 14, 2017


If you're currently pregnant or planning to have a baby soon, this is for YOU.   The American College of Obstetricians and Gynecologists (ACOG) has new recommendations regarding labor and birth practices which are going to help reduce unnecessary interventions and ultimately, cesareans.  These recommendations are good for birth and just make sense.


ACOG is a group of OBs and GYNs whose priority is to improve health for women, and when they release new recommendations, the birth industry pays attention.  Recently, they put out a new statement, Approaches to Limit Intervention During Labor and Birth, which lists new opinions on current labor and birth practices.


When followed, these recommendations are going to have a great impact on birth outcomes.  If you like reading extensive texts of medical nature, go for it, but if not, Sharon Muza, an experienced childbirth educator and doula has a fantastic article summarizing the 6 most relevant items for doulas and their birthing clients.  Read it, and check out my take on each point in relation to birthing in the Nashville community and surrounding areas below. 


1.  Hospitals encourage laboring at home until active labor phase


The takeaway:

ACOG recognizes that women are less likely to have unnecessary interventions when they labor as long as possible at home prior to coming to the hospital.


If your goal is to avoid a cesarean, this is your first step.  Arriving at the hospital very early in labor increases your risk of unnecessary interventions which often lead to cesarean.  Most local hospitals will send you back home if you aren't at least 3 cm dilated when you arrive. 


If you're thinking how in the world you're supposed to know when you reach 6 cm when you're at home, this is something your doula is really good at assessing for you.  While she won't check your cervix, she is experienced at determining labor progress to help you decide when "it's time".  A good rule of thumb for first-time moms is if you're unsure whether you should go, it probably isn't quite time yet.



2.  Active and Expectant Management of PROM are both equally good choices


The takeaway: 

ACOG recognizes that waiting for contractions to start after water breaks produces the same outcomes as inducing contractions.  So, women should be allowed to wait, if they choose.


One exception to expectant management would be for women with Group B Strep to arrive at the hospital shortly after water breaks so that antibiotics can be administered in time before birth.



3.  Intermittent Fetal Heart Monitoring is Appropriate for Low Risk Labors


The takeaway: 

If you are low-risk, intermittent monitoring (usually 15 min or less of each hour) is all that is necessary during your labor.


Monitoring looks generally the same in most of our local hospitals.  Two stretchy belts are placed on the woman's belly, each with a device that measures either the strength of the contraction or the baby's heart rate.  If you're really lucky, your nurse will come in with a hand-held doppler each time and listen through a few contractions instead of strapping belts around you.  I see this every now and then.  A unique option is the wireless monitors used at Centennial Women's downtown.  They are waterproof, and require no belts or wires, so this is an amazing benefit to women who may require constant monitoring, but they're available to low-risk women, as well.  Ask about the monitoring practices at your hospital, and rest assured that your doula knows how to help your labor progress no matter the type of monitoring you receive.



4.  Artificial Rupture of Membranes is Not Necessary


The takeaway: 

Rupturing your membranes (AROM or "breaking your water") comes with risks.  With a normal progressing labor, there is no reason to have your water broken.  It will eventually break on it's own.


I see this type of labor augmentation offered at every hospital in our area.  While care providers may offer it as a means to speed up a stalling labor, it's important to know that there are risks involved.  For instance, a labor stall could be the result of baby not being in an optimum position for birth.  Releasing the amniotic fluid will take away the cushion and space he had, and make it more difficult to get where he needs to be.  AROM can also cause a prolapsed cord which always calls for an emergency cesarean.  Also, if your care providers aren't following the opinion of expectant management in item #2, then they will start expecting a certain amount of labor progress (dilation) to happen within a certain number of hours.  If your dilation isn't meeting the expectation, they will begin to discuss further means of labor augmentation, which means more interventions.  More interventions = increased risk of cesarean.


Discuss this with your care provider.  Ask them what you should expect in regards to rupture of membranes.  Make sure you're on the same page.



5.  Eat, Drink, and Labor On!


The takeaway: 

Laboring women need food and water to maintain stamina for birth.  No one expects marathon runners or mountain climbers to reach their destination without fuel. 


Usually, laboring women aren't eager to eat solid foods because they are hyper-focused on the important work of birth, and for some, it's unappealing.  However, eating light, high protein snacks is good for maintaining the energy needed for giving birth.  Without it, laboring women feel exhausted and their energy stores are rapidly depleted.  When this happens, they are more likely to request interventions to give them rest. 


It will take time for this to spread throughout our birth community and cause policy change in our hospitals.  Talk to your care providers to help give this matter attention.



6.  Labor Down and Push Spontaneously with the Urge to Push


The takeaway: 

Just because you're 10 cm, doesn't mean you, your body, or your baby are ready for birth.  Sometimes, babies are still high in the pelvis at 10 cm.  Wait until you feel the urge to push to prevent unnecessary time or precious energy being spent on pushing.


Even at 10 cm, your uterus is still busy bringing your baby to you.  When babies descend toward the birth canal, the now-emptied section of the uterus has to catch up behind him to continue contracting and pushing baby down.  This takes time, whether it is a few minutes or in some cases, hours.  Don't let that scare you.  It's rare for it to take that long, but it's happened.


Alternatively, if you need assistance with pushing, your nurse or doula will happily direct your pushing by helping you determine when the contractions are building to a peak.  This can be particularly helpful if you've chosen an epidural and aren't able to feel the contractions as they come on.



Talk with your care provider about these new recommendations  The more women are asking for these to be put into practice, the quicker we'll see them become commonplace in our local hospitals.  Be informed, be healthy, and give birth with intention.






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Dana Fuqua, owner of Sumner County Doula, is a certified birth doula providing professional, evidence-based support to growing families all over Middle Tennessee.