I like to quote ACOG (the American College of Obstetricians and Gynecologists) in both my childbirth education classes and in trainings that I do for both new and experienced childbirth educators. The new (2010) edition of ACOG’s book for consumers, Your Pregnancy and Childbirth, recently came out. While updating some teaching materials, I have been checking to make sure that information from the 2005 book, Your Pregnancy and Birth, is also included in the 2010 edition. (I like to make sure my quotes are up-to-date!) I am alarmed to find the new edition is even less supportive of pregnant women who may be interested in natural childbirth than the 2005 edition.

Monitoring

2005 edition: This edition had a nice section on auscultation and stated that “auscultation has no known risks.” The authors presented the pros and cons of the two types of electronic fetal monitoring (external versus internal), but did fail to mention the increased risk for surgery section with continuous electronic monitoring.

2010 edition: There is no mention of auscultation. All it says about fetal monitoring is, “Your baby’s heart rate and your contractions likely will be monitored with electronic fetal monitoring.”

Nonpharmacologic Pain Management Strategies

2005 edition: In the section on labor, delivery, and postpartum on page 120, there is a list of ways to ease discomfort during labor which includes breathing and relaxation, massage, changing positions often, showers or baths (if permitted), ice packs, resting between contractions, and cool, moist cloths. These strategies are presented after the information on hospital admission so that it is clear that these nonpharmacologic strategies can be used in the hospital. There is also a box on page 130 with ”Labor and Birth Options.” Included in the box are birthing bed, birthing stool, birthing ball, squatting bar, and birthing pool/tub.

2010 edition:  In contrast, in this edition, most of the nonpharmacologic pain strategies are included in the section on early labor when the pregnant woman is clearly still at home.  After the mother is admitted to the hospital, the list of nonpharmacologic strategies is much shorter. In a paragraph titled, “What You Can Do” [in active labor], it says, “ It may help to move around in the bed to find a position that is most comfortable for you.” (In the bed!) The book authors do finally allow a woman in active labor out of bed by stating, “If you feel like it and your health care provider says it’s ok, walk the halls.” I could not find any mention of a birthing ball or birthing tub in the 2010 edition.

In the 2010 section titled “Pain Relief During Labor,” there is this quote about natural childbirth:

“Despite the expected pain of labor, however, some women worry that receiving medication to relieve the pain will somehow make the experience less natural. But many women find that pain relief gives them better control over their labor and delivery. Don’t be afraid to ask for pain relief if you need it.”

You get the idea. I have had labor nurses tell me that if a woman really wants a natural birth that she shouldn’t go to a hospital. I am naive enough to disagree. Just as a woman who wants an epidural in labor should have that option available to her, I believe that a woman who wants a natural birth in the hospital should have the support, freedom to move and change positions, and access to nonpharmacologic pain measures that she needs in order to have the birth she wants. In their new book for consumers, ACOG clearly has moved backwards in their support of a woman’s right to choose the birth she wants.