When I was pregnant with my first child, I had painstakingly created a birth plan that made sense for me and my husband, who was my emotional support. At the core of our list of requests, we didn’t want drugs or any unnecessary intervention. We also wanted to be informed of any decisions being made by medical staff. So when our birth plan was ignored during labor — with drugs being given to me despite my protests and nurses and doctors ignoring our questions — I was crushed. Our birth experience could have been more positive, but in the end it left us feeling sad and confused.
So, it was with a grateful heart that I read that the American Congress of Obstetrics and Gynecologists released new labor guidelines that puts the needs of low-risk laboring women above the needs of medical schedules and strict rules.
In its recently published opinion, the ACOG has finally admitted that women in labor need emotional support, may not need constant intervention, and they definitely do not need to be put on a timeline that has been shown to benefit the medical staff’s schedule and not the health or comfort of the mother.
A few notable highlights of this report include:
“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.”
In other words, let the woman do her work and give her the support she needs — don’t immediately suggest labor meds if she wants to wait or insist on a path toward cesarean section.
The update also urges doctors not to force the water to break and instead, let nature take its course:
“For women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring.”
And if a laboring mother feels the natural inclination to push? Then by all means, she should:
“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.”
The report also seems to have a different position on the introduction of intravenous fluids and constant fetal heart rate monitoring. While the two procedures do not appear to make much of a difference in birth outcomes for low-risk moms, they do prevent her from moving around while laboring, which can slow progress and disrupt an otherwise natural process of birth.
There’s a lot of information to unpack in this new set of recommendations from the ACOG. But the major takeaway here is that as the formal voice and authority on fetal-maternal medicine in the United States, it’s a huge step forward that the ACOG is echoing the concerns of laboring mothers to be able to birth with less unnecessary intervention — not to mention more emotional support and trust in the natural process.
After all, a modern medical team is a phenomenal thing to have on hand, but nature has been doing this for eons; so why not let her take the lead more for low-risk mothers.