Pregnancy

President Of ACOG Says We Should All Back Off Pregnant Women And ‘Let Nature Take Its Course’

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shutterstock_52133626The President of the American Congress Of Obstetricians and Gynecologists issued a statement yesterday. It basically says, “Can we all back off of pregnant women please?” Well, I’m paraphrasing – but close. James T. Breeden, MD has practiced ob-gyn for 35 years – so he has a little experience in the field. It seems he thinks we should trust natural labor a little more. He believes when it comes to the onset of labor, we should let nature take its course:

“’Let nature take its course.’ Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born. The start of natural labor is the main sign, but we’re not always patient enough to wait for it.”

He is speaking of course, about the medically community’s rush to perform inductions and c-sections when a woman is perceived as not laboring fast enough. An average of one in three babies is born by caesarean in America today. According to Breeden:

“The rate of labor induction is also at an all-time high. Unfortunately, many of these births occur before the pregnancy is considered ‘term’ at 39 weeks. These upward trends have long been a source of concern in the medical community, especially considering the increased risks to a baby who may not be fully developed at delivery.”

Any time I write a post about my own concerns about being rushed into a c-section or induction, I inevitably get attacked for not trusting my doctor enough, or trying to “Google” my own healthcare. I didn’t get these ideas out of nowhere. In my experience, an induction-free labor is hard to come by.

When I was pregnant with my first child, I asked my OB what the best way to assure that I would have no interventions with my birth was. He said, “arrive at the hospital when you’re crowning.” I laughed. He wasn’t kidding. I stopped laughing, and said, “really?” He explained that while I ultimately had control over my health-care, I had to be really careful about voicing my desires to not be induced in the hospital because they are trained to use some kind of induction techniques – almost every time.

Certain urgent situations—such as preeclampsia, eclampsia, multiple fetuses, fetal growth restriction, and poorly controlled diabetes—may make it necessary to deliver the baby before the onset of natural labor. However, newly issued guidelines from ACOGremind women and ob-gyns that in uncomplicated pregnancies, a vaginal birth that occurs after the natural onset of labor is ideal. Additional new ACOG guidelines reaffirm that cesareans and labor inductions should only be performed when medically-necessary.

I guess the problem now is – who defines “medically necessary?” It’s incredibly difficult to secure a VBAC (vaginal birth after caesarean) where I now live in Florida because hospitals and insurance companies will say that a caesarean is always medically necessary after you have already had one – a stance that is not supported by studies. The medical community needs to catch up with these studies so they can best inform women of their options – rather than scaring them into inductions and surgeries.

I hope that the statement by a well-respected doctor in the field of ob-gyn is a start to a wider acceptance of the role of nature in childbirth. Yes, intervention is necessary sometimes – but it should be the exception – not the rule.

(photo: Gladskikh Tatiana/ Shutterstock.com)

20 Comments

  1. Annie

    March 23, 2013 at 4:10 pm

    I think your stance (that of the American Congress Of Obstetricians and Gynecologists) would be more widely accepted if the adamantly pro-homebirth crowd didn’t take such statements and run with it.

    Just like animal welfare, buying organic, breastfeeding, and any other well-meaning movement, the crazily obsessed people who refuse to see a grey area ruin it for everybody.

    • Annie

      March 23, 2013 at 4:11 pm

      That isn’t to say that I don’t agree with this article, btw.

    • Guerrilla Mom

      March 23, 2013 at 5:11 pm

      I actually totally agree with you. It’s just such a frustrating thing to deal with.

    • Tinyfaeri

      March 23, 2013 at 7:55 pm

      I agree. And I find it annoying that the only options typically presented are giving birth at home in a kiddie pool with an unlicensed midwife or in a hospital with every possible medical intervention. There are so many things in between those two options, it’s crazy that they’re the only ones that get any attention. Hopefully the new recommendations can lead to more nuanced discussions.

    • Guerrilla Mom

      March 23, 2013 at 8:36 pm

      I wish that was the case for me. I’ve found midwives who are willing to honor my wish to attempt a VBAC. They, however, only do home births. I’m really not comfortable with that. My other option is delivering in the hospital and getting whatever ob happens to be on call. I have been unable to find an ob that will give me prenatal care and also commit to allowing me to attempt a VBAC. It’s incredibly difficult in Florida. I’m at a loss.

    • Harriet Meadow

      March 23, 2013 at 9:52 pm

      I’m so thankful to live in Boulder, where the nuances seem to be the norm. Midwives work with and in the hospital, and my OB does NOT believe in doing unnecessary procedures. She also says that the epidurals at our hospital – should I choose to get one, and she will not be pushing me to do so – tend to be pretty “light,” so that you can still move your legs and feel the pressure to push. Also, I will have a heplock “just in case” but will not be hooked up to an IV or have invasive monitoring unless I NEED it, and I can give birth anywhere in the hospital room that I want, in any position I want, and will be given an hour of skin to skin with the baby before they weigh him or anything (as long as he cries when he comes out). And that’s apparently standard procedure at that hospital! It’s great – I’ve got the safety of having an OB and any procedure I might need readily available, but interventions are not the norm.

    • Andrea

      March 24, 2013 at 4:05 pm

      I’m sorry you are going through this. From what I understand, doctors are just unwilling to do it because they run the risk of something going wrong and then being sued. It’s a shame, but the reality of living in such a sue-happy society.

      Bets of luck and remember that at the end of the day, all it really matters is that you have a healthy baby and a healthy mom.

    • whiteroses

      March 23, 2013 at 8:14 pm

      I agree. It’s like if you say that you’re going to give birth at home, people ask you which field you’re going to give birth in.

    • somethingobscure

      March 25, 2013 at 8:36 pm

      I don’t necessarily disagree with your first point, but how is “breastfeeding” a movement?? And why on earth does it fall into the same category as animal welfare and buying organic food?

    • Annie

      March 25, 2013 at 8:48 pm

      RE: Breastfeeding movement. People like this: http://www.thealphaparent.com/2011/10/why-way-you-feed-your-baby-is-my.html

      And I lump then in the same category as animal welfare and buying organic for the sake of argument, as they’re also topics people can get incredibly judgmental over.

  2. Diana

    March 23, 2013 at 5:57 pm

    Totally agree with you Maria. Common sense really.

  3. Justme

    March 24, 2013 at 9:17 pm

    I just want people to get off women’s choices about pregnancy, labor and delivery….period.

    I chose to induce a week earlier than my due date for very personal reasons. It ended in a c-section and I’m totally okay with that. But I totally support my friends who choose differently, as long as they are comfortable in their decisions.

    • Cassy C.

      March 25, 2013 at 9:24 am

      Agreed. I respect that every woman has the right to choose how she wants to bring her baby into the world. Why can’t we all do the same? As the absolute definition of the norm – a woman who went into labor naturally, then proceeded to the hospital where I promptly got an epidural – I still felt judgement from all sides. Some people baffled as to why I wasn’t induced earlier that week; others sneering at my epidural; still others judging my entire hospital experience. Back off, people!

    • Guerrilla Mom

      March 25, 2013 at 11:33 am

      I totally agree. The difference is, if you choose inductions and interventions you won’t get as much pushback from the hospital as if you don’t. I’m not addressing the judgement of others here – where you have a totally valid point. I think that women should be able to deliver however they choose.

    • Justme

      March 25, 2013 at 12:43 pm

      Absolutely. But I also hear the “my doctor forced me to” line quite a bit and I just wonder about their relationship with their OB prior to giving birth. Does that make sense? I chose my doctor because she has a no-nonsense attitude and isn’t one of those mushy-gushy types. I knew that when I was in labor and she said that a c-section was necessary, I trusted her opinion. I know not every woman has the luxury of having their OB at the delivery of their child, but do you think that the choosing of medical provider has something to do with the satisfaction of delivery? I’m not judging or blaming, just posing a question.

    • Guerrilla Mom

      March 25, 2013 at 3:35 pm

      Oh it absolutely does. Finding the right OB is totally necessary. That’s why I’m at such a loss 🙁

  4. somethingobscure

    March 25, 2013 at 8:37 pm

    Great article and great news from ACOG. Thanks!

  5. Janet MacColl

    April 3, 2013 at 10:14 pm

    Just be aware that the data used is retrospective and not adjusting for different risk groups. Also certain statistics do not show statistical validity. I would be curious to know what this doctor’s CS rate is? The average in the country is over 30% and the use of induction is being restricted. There are different types of induction of labor. Currently,in most retrospective analysis, inductions when there is already a medical emergency are grouped with preventive inductions done when baby and placenta are both healthiest, to avoid the onset of a disease state. Dr Nicholson with AMORIPAT (active management of risk in pregnancy at term (37-40.6 weeks. http://amoripat.com) has recorded sub 10% CS rate and improved birth outcomes (in low socioeconomic and high risk patients) with care that includes a risk scoring system that helps patients avoid high risk states, patients are actively involved in the choice to utilize induction, patience is used during the induction process, that includes adequate ripening of the cervix, and enough time to let the body respond – or to back away if it does not.
    I agree that informed mothers and family members need to be allowed to make the decision to give birth in a supportive and trusted environment. Having had two home births, with lay midwives, I do trust the process… but understanding the high national C-Section rate and the correlation to induction needs to be studied with best scientific standards of research. ACOGhas offered very few RCT (randomized control studies) in most areas of birth outcome research. Dr Nicholson and others have done RTC’s and are attempting to do more. Personal stories, experiences and insights are important but applying the highest level of research standards in an area that is so important to the health of our mothers and babies is essential .

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