Tag Archives: Childbirth

ACOG Makes New Recommendations

Holy cow. Is it April 1st? No really, tell me if it is, because this is almost TOO GOOD TO BE TRUE: Approaches to Limit Intervention During Labor and Birth.

Just to have the new recommendations safely in more than one place, here they are, straight from the document:

  • For a woman who is at term in spontaneous labor with a fetus in vertex presentation, labor management may be individualized (depending on maternal and fetal condition and risks) to include techniques such as intermittent auscultation and nonpharmacologic methods of pain relief.
  • 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.
  • 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.
  • Obstetrician–gynecologists and other obstetric care providers should inform pregnant women with term premature rupture of membrane (PROM [also known as prelabor rupture of membranes]) who are considering a period of expectant care of the potential risks associated with expectant management and the limitations of available data. For informed women, if concordant with their individual preferences and if there are no other maternal or fetal reasons to expedite delivery, the choice of expectant management for a period of time may be appropriately offered and supported. For women who are group B streptococci (GBS) positive, however, administration of antibiotics for GBS prophylaxis should not be delayed while awaiting labor. In such cases, many patients and obstetrician–gynecologists or other obstetric care providers may prefer immediate induction.
  • Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor.
  • For women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring.
  • To facilitate the option of intermittent auscultation, 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.
  • Use of the coping scale in conjunction with different nonpharmacologic and pharmacologic pain management techniques can help obstetrician–gynecologists and other obstetric care providers tailor interventions to best meet the needs of each woman.
  • Frequent position changes during labor to enhance maternal comfort and promote optimal fetal positioning can be supported as long as adopted positions allow appropriate maternal and fetal monitoring and treatments and are not contraindicated by maternal medical or obstetric complications.
  • When not coached to breathe in a specific way, women push with an open glottis. In consideration of the limited data regarding outcomes of spontaneous versus Valsalva pushing, each woman should be encouraged to use the technique that she prefers and is most effective for her.
  • 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.

Do you have any idea how amazing this is? Women have been fighting for DECADES in this country, to have these very things be standard medical practice for the average woman with an average pregnancy. I spent years training expectant parents how to navigate the American medical system in order to BE LEFT ALONE DURING LABOR, unless something is actually wrong. I taught them how to negotiate with their doctor so the laboring woman could stay out of bed, move as much as she wanted, in whatever position helped her, and to deliver in whatever position helped her. To not be put on an arbitrary time table with the threat of C-section hanging like a club over her head.

And now, out of the blue… it’s here. Have we won the war? Will this actually happen? Will doctors take it to heart and incorporate it into their practice? Will medical schools begin to teach students how natural, intervention-free labor can be? Will they let their students see intervention-free labors during training? Will newly-trained obstetricians actually UNDERSTAND that birth is a natural process?

I’m almost hyperventilating, I’m so excited.

As long as it’s not April 1st.

 

 

 

 

Australian scientists discover new treatment for pre-eclampsia

Here’s a bit of hopeful news. Malnutrition can be a cause of pre-eclampsia, and for years, doctors have said they just don’t know what causes it, but lately, studies have been focused on the placenta. There’s been real progress with this. I hope this treatment works.

http://www.theage.com.au/victoria/australian-scientists-discover-new-treatment-for-preeclampsia-20151221-glsoi9.html

Doctors Urge Patience, And Longer Labor, To Reduce C-Sections : Shots – Health News : NPR

For many women, a safe, healthy labor lasts longer than the times cited as normal, according to guidelines from the nation’s obstetricians. Giving women more time ups the odds of a vaginal delivery.

Source: Doctors Urge Patience, And Longer Labor, To Reduce C-Sections : Shots – Health News : NPR

Physician’s Weekly for Medical News, Opinions, Features Articles

Too many women face authoritarian procedures and care providers when they go into labor. This is one of the biggest reasons why I teach natural childbirth. I want women (and their partners) to understand that they have the right to consent or not consent to any medical procedure.  In this case, the video clearly shows the women repeatedly saying “no” to an episiotomy. Her doctor essentially commits assault against her while she is helpless to stop him.

This article is by a surgeon who viewed the video. The post and the comments that follow are all worth reading.

I continue to hope this woman gets justice for what was done to her. I also hope that the doctor who did this to her loses his license. He should not be allowed to practice medicine!

Physician’s Weekly for Medical News, Opinions, Features Articles.

Birth wars just divert us from the facts: Childbirth is in crisis – Your Life News – Best Daily

I often run into the “birth wars” mantra when I put on my “natural childbirth teacher” hat. My tongue is raw from the number of times I’ve bitten it to keep from saying something hurtful to a new mother who trusts the system without question.

Like the author of this article, I’m not very good at sitting on the fence. When I speak up about the dangers in our current model of obstetric care, I’m not doing it to hurt someone’s feelings. I’m doing it because we need information to change the system. To force medical schools to include natural birth in their training. To make LESS intervention the mantra of obstetrics.

The quotes I’ve included say it pretty well, but rest of the article is important, too.

“… the message that should be getting out there is this: women are being let down. Intervention rates are way too high, the true meaning of birth is getting lost in a medical experience, and far far too many women are having a difficult, unpleasant or traumatic birth when it could be oh so different.”

But the guilt and the failure does not belong to women. It belongs to the system. The system is not any one individual, or even any one group of individuals. It is a culturally based, historically driven attitude to childbirth that has become so engrained that it is almost impossible for many people to perceive its failings or imagine another, better way.” 

Birth wars just divert us from the facts: Childbirth is in crisis – Your Life News – Best Daily.

St James Ethics Centre – The Ethics Centre

This is part two of an ethics debate regarding a pregnant woman’s right (or not) to make her own medical decisions. I think everyone knows where I stand on this debate, and this post very nicely explains it. Read part one for the “other side” of the argument.

St James Ethics Centre – The Ethics Centre.

How We Hate Women • Birth Anarchy

Only when women submit to authority are they acting in their own best interests.

Only when women lower their heads, offer a compulsory nod, lay back, and do as they’re told, are they good mothers.

Only when they concede their selfish autonomy to someone else who knows better, are they, themselves, to be trusted.

Only when women obey have they made the right choice.

How We Hate Women • Birth Anarchy.