Changing Routine Practices in Obstetrics

Encouraging Your Place of Birth and Provider to Follow Evidence

Apr 9, 2009

If the evidence says that some of the old practices are no longer valid, it is time to re-think them. Here are changes you should be asking for with regard to your care.

There is often a lag in applying new research to actual practice in the field of obstetrics. It is time for parent-consumers to expect more from their places of birth and care providers when it comes to practicing evidence-based medicine.

What are some areas that you, as an expectant mother or father, have the right to demand that practices should follow evidence?

Eating and Drinking During Labor

One of the routines in many hospitals around the world is to restrict food and fluids to the mother during labor. Thanks to a brand new study done in the UK, mothers who are seeking to have the option of eating and drinking during labor now have the evidential support to back up their preferences.

Mothers who were allowed to eat lightly and drink fluids had no difference in the length of their labor, use of pitocin, risk of an instrumental delivery or cesarean as well as no difference in complications with the baby as compared to mothers who were restricted to water. Contrary to popular belief that "whatever you eat will come right back up," the mothers who were permitted to eat lightly also did not have more difficulty with vomiting while in labor.

When you take your tour, find out what the policies are about eating and drinking during labor in your chosen place of birth. If the policy does not line up with the evidence (for example mothers are limited to water or ice chips), write a letter to the Director of Maternal Health and the Chief of Anesthesia and enclose a copy of the newest research on eating and drinking causing no additional risk to the mother or baby. Follow up with a phone call and perhaps a meeting if you can get one. Bring along your local childbirth educator or birth doula for support.

You can also work with your own care provider to see if he might allow more flexibility on eating and drinking, since he or she always has the option to overrule any hospital routine or policy.

Breaking the Mother's Bag of Waters/Amniotomy

For many years, breaking the mother's water to strengthen contractions and "to speed labor" progress was a routine part of the mother's care. Amniotomies are still performed frequently by some providers in the hopes of decreasing the duration of labor. Yet the latest research no longer bears this out.

Doctors at the University of Liverpool compiled 14 studies from the Cochrane Library and found that breaking the mother's water did not decrease the length of the mother's labor or increase her satisfaction with her birth. Though the difference was not statistically significant, breaking the mother's water did increase her chance of a cesarean. Researchers concluded that amniotomies should not be a routine part of a mother's obstetric care.

The issue of breaking your water needs to be discussed as a part of your birth plan. Find out when, if ever, your care provider would break your water. Inquire if he or she is aware of the evidence that performing amniotomies does not speed up labor and may in some cases, increase the chance of cesarean. If necessary, bring some of the research with you in hand to your prenatal visits when you discuss your plan for birth.

Episiotomies

The good news is that the rate of episiotomies has decreased in the last several years from about 70% to about 25%. Yet some experts speculate that difficult deliveries are now being managed by doing fewer vaginal births (including doing an episiotomy) and instead doing more cesareans. Perhaps this is one contributing factor to the 30% cesarean rate across the US?

Numerous research studies on the risks versus benefits of episiotomies are readily available on search engines such as the Cochrane Review and pubmed. The consensus in all of the recent studies has shown that routine episiotomies should not be performed and more often than not, do more harm than good. Many of the studies show that at least in the short term, women are exposed to a surgical cut that may be deeper than what would have naturally occured during labor.

This is a common discussion topic for interviewing a care provider since it tells a lot about how patient your care provider will be during labor. You will want to find out about other techniques they may use to decrease your chances of tearing. In fact, one study showed that your care provider can play a role in decreasing tearing if they encourage you to push more slowly during crowning. If you do get reassuring answers to your questions on episiotomies, you should be pro-active and find a new care provider.

Remember that changing routines does not just happen overnight, but you can make a big difference by advocating for yourself and making other choices if your place of birth or care provider are not following the evidence in their practices and routines.

The copyright of the article Changing Routine Practices in Obstetrics in Birthing Options is owned by Brenda Lane. Permission to republish Changing Routine Practices in Obstetrics in print or online must be granted by the author in writing.