How to Keep Normal Labor Normal – Part 13 – Summary

This blog series is designed to help women who are developing a birth plan join together with like-minded birthing professionals so as to have a shorter and safer labor and birth. In past blogs we’ve looked at my 10 “P’s” of keeping labor shorter and birth safer.

In this blog I’ll present some summary comments. Although written primarily for professional birth attendants, I hope information will be helpful to lay women planning their birth.

Summary

One critical review summed it up by stating, “Doing everything for everyone is neither tenable nor desirable. What is done should be inspired by compassion and guided by science … As(care givers), we are ethically bound to be sure that the tests, procedures, and treatments we provide are worth the money, pain, and inconvenience that they cost. The methods to assess technologies are well accepted and widely available; what remains to be seen is whether we as a profession and a nation have the moral courage to use them.”(67)

Said another way, “If you mess around with a process that works well 98% of the time, there is potential for much harm.” (29)

Symposia or round-table discussions of maternity caregivers are usually “notable, particularly for the extent of disagreement among … authorities concerning how labor should be managed”(17) however, maternity caregivers should all be willing to “… critically assess the effects of each medical practice or procedure on the childbearing family’s comfort and sense of mastery, as well as on their safety.

Aspects of care for which safety benefits are small or unproved should remain subject to the choices and preferences of the woman giving birth.” (5)

In conclusion, there appears to be a growing literature in avoiding unnecessary intervention and in studying mechanisms for increasing the occurrence of normal labor by reducing dystocia and misdiagnosed “fetal distress” so as to reduce unnecessary operative deliveries, thus increasing the occurrence of normal deliveries.

In many ways this literature discussed the delusion (fixed false belief) that technology can or will control the labor and delivery process and strives to balance non-intervention and intervention in such a way as to maximize outcome at the lowest possible cost while increasing our patients’ satisfaction with the birth process.

In some ways, this means that forward thinking maternity care providers will have to advance their patient care armentarium by abandoning some routines and procedures and, in a sense, going back or stepping back in time to combine the best of the “old style” with the best of “science.”

Since it appears that midwives are more likely as a group to practice the “10 P’s,” it seems reasonable that their considerable skills should be utilized more often in teaching family physicians and obstetrician-gynecologists.

One experienced practitioner described the “old ways” this way: “The editorial, ‘Family-centered birthing’(26) proves that medicine, like life, runs in cycles. The editorial brought back many memories of my early days in practice the 1950s in a southern Texas community of 2000 – 30 miles from two small country hospitals and 50 miles from more sophisticated care in San Antonio.” (88)

“My obstetrics professor at the University Medical Branch at Galveston offered the following five precepts for (keeping labor normal and) delivering babies at home:

  1. tell the men to boil water and collect newspapers — it gives them something (useful) to do;
  2. spread a thick layer of newspapers over the bed (they are sterile, comfortable, and) to protect the mattress (which reduces the mother’s anxiety about a dirty mattress – for lessening any worries increases the speed of the labor);
  3. after assuring yourself that the labor is progressing normally, take the leftover newspapers into another room and begin to read them (while smoking a slow smoking cigar in a slow rocking rocker);
  4. utilize the assistance of (as many) female family and friends (as you can find); and
  5. do not practice meddlesome obstetrics.”(88)

“After delivering several hundred babies at home (at $40 each, with payment not always guaranteed) by daylight, firelight, and flashlight, I found family-centered birthing was intellectually rewarding, emotionally satisfying and remarkably safe. (I lost no mothers and only one infant and that was because of a knotted cord).”(88)

How many of us would like at the end of a career to be able to report similar professional outcomes and similar patient satisfaction outcomes associated with similar perinatal morbidity and mortality?

Based upon this review, it does appear that there are a substantial number of potential interventions and non-interventions that maternity care providers and/or systems could and should consider to assist their laboring patients in increasing their (and our) chances in keeping normal labor normal.

It seems to be reasonable for maternity caregivers to replace the “3 P’s” of obstetrics with the “10 P’s” of family-centered birthing.

In this author’s opinion, maternity caregivers in America, particularly physicians, are “poised on the edge of an unequaled opportunity … to bring family-centered maternity care into the mainstream … It is an opportunity to ripe to resist, too grand not to grasp.”(26)

Midwives and doulas, for the most part, and to the shame of their physician colleagues or adversaries, are already there.

Here’s the entire series:
Introduction
The Costs of Abnormal Labor
The “10 Ps”:
Philosophy,
Partners,
Professionals,
Pain control,
Procedures,
Patience,
Preparation,
Positions,
Payment, and
Prayer
Summary
Citations:
    Citations:
    (5) Smith MA, Acheson LS, Byrd JA, et. al. A critical review of labor and birth care. J Fam Pract 1991;33:281-292.
    (26) Larimore WL. Family-centered birthing: history, philosophy, and need. Fam Med 1995;27:132-138.
    (29) Hon, E. In: Young D. Crisis in obstetrics-the management of labor. Int J Childbirth Education 1987, August: 13-5.
    (67) Grimes DA. Technology follies: the uncritical acceptance of medical innovation. J Am Med Assoc 1993;269:3030-3033.
    (88) Nixon SA. Am Fam Physician 1994;47:1353-1354.