Author // Jade Spurka
Two exciting headlines appeared in the news this week favoring an improvement in American maternity care. First, the American Congress of Obstetricians and Gynecologists (ACOG) published a study with new guidelines to prevent primary caesarean delivery, and second, the Commission for the Accreditation of Birth Centers (CABC) has updated their policy on “Trial of Labor After Cesarean” (TOLAC).
ACOG published jointly with the Society for Maternal-Fetal Medicine new guidelines to prevent primary cesarean delivery that validate the need to honor the natural birth process. According to the study, in 2011 one in three women gave birth via caesarean. It has been clear with a rise in the rate of cesareans since 1989 (as well as a decrease in vaginal birth after cesarean) that the procedure is overused, and can be avoided. (1)
We are enthusiastic about this news, but not because it is a clinical validation of what we’ve known all along: respecting the women’s ability to give birth, trusting the natural birth process, eliminating unnecessary intervention and allowing the continued support of family midwives and doulas make healthy mothers and babies. More importantly, evidence-based care options for caesarean prevention are being covered by leading organizations in the field of birth, and steering the conversation of returning authority, right and responsibility properly back into the hands of the birthing woman.
ACOG summarized the following guidelines to prevent primary caesarean:
- Allowing prolonged latent (early) phase labor.
- Considering cervical dilation of 6 cm (instead of 4 cm) as the start of active phase labor.
- Allowing more time for labor to progress in the active phase.
- Allowing women to push for at least two hours if they have delivered before, three hours if it’s their first delivery, and even longer in some situations, for example, with an epidural.
- Using techniques to assist with vaginal delivery, which is the preferred method when possible. This may include the use of forceps, for example.
- Encouraging patients to avoid excessive weight gain during pregnancy.
As well as noting: “Increasing women’s access to non-medical interventions during labor, such as continuous labor support, also has been shown to reduce cesarean birth rates.”
Read the full press release from ACOG here: Nation’s Ob-Gyns Take Aim at Preventing Cesareans
As part of their mission to continue putting important information into the right hands, Evidence-Based Birth has created a handout on Failure to Progress. Share this with your clients, care providers, friends, and family.
“As a collective culture, we have somehow lost or abandoned any thread of belief in a woman’s ability and power to naturally conceive and give birth. These once-tight threads of belief have been constantly and consistently shredded, leaving behind unrelenting fear and a gaping lack of trust.”
-Teresa Robertson, C.N.M. M.S. Bear Wisdom: Reconnecting with Mama and Papa Bear, Issue #37
A change in policy was released today from the Commission of Accredited Birth Centers (CABC) that they may now offer “TOLAC” or Trial of Labor After Caesarean which, according to the release, is the clinically appropriate term for an attempt at VBAC (Vaginal Birth After Caesarean). (2) Previously guided by liability for care providers, the policy change reflects that women can manage informed consent and the responsibility of making decisions based on what’s best for her own care. As the press release points out, “It’s a very preference-sensitive decision – one that only women themselves can make, weighing which set of risks and potential benefits they are willing to accept, and what is best for them and their families.”
The release also notes that change will only be possible with the collaboration of birth centers and hospitals, as to ensure that in the event of emergency, a safe transfer is seamless. Reform for the reduction of unnecessary caesareans as well as allowing TOLAC will have to happen on many levels. As women, as birth educators, the most important thing we can do is to empower women to have confidence in their ability to give birth, to listen to their innate wisdom, to remind them that birth is a natural physiological process and to provide continuous support. We want to see these guidelines and policy changes fulfilled and we will continue to support and encourage that mission.
“Take the time and the effort to find the people who trust birth and will support you and your family in your journey. Your family deserves to be treated with respect, love, safety and trust during this time. “
-Teresa Robertson, C.N.M. M.S.
(1) Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:693–711.
(2) Pascucci, C (2014, February 26) Birth Centers Change the Conversation on VBAC retrieved from http://www.improvingbirth.org/2014/02/birthcentersvbac/
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Jade Spurka is the social media & blog coordinator for Pathways to Family Wellness and ICPA. As a community organizer and women’s rights activist, she is happy to contribute to the Pathways community by sharing resources and information that empower women and families to make the best decisions for their families. Interested in submitting an article for the Pathways Online Magazine?