I finished another project I am so excited about! I wanted to put to pictures these 20 ACOG statements that came out in March with the goal to avoid a woman's first cesarean. Now some asked why the images didn't exactly match the recommendations. All I could reply back with was, some of these things, you wouldn't want to see in pictures, either because they would be boring, or because they would be graphic. But more to the truth is, I wanted the pictures to represent patience...we need to be more patient with labor. We need to give moms and babies more time to perform this task.
I am so grateful to all the families, doulas, and photographers who shared pictures with me -- the response was overwhelming. Because the focus is on preventing the initial cesarean birth, I am pleased that some of these moms are shown laboring toward what ended up being successful VBACs!
Patience is the key. Many of these are based on evidence that shows with more time, a woman can birth vaginally. And speaking of time -- research shows it can take 10-17 years before new evidence is implemented into practice. If we familiarize ourselves with these new recommendations, we can be the driving force behind ensuring the care we receive is current when our caregiver might still be doing things out of habit, comfort, or custom. Let's spread the word!
Pin these! Help raise awareness and get this information out there into the hands of the families that need it. The goal is to educate families, so they can enter into their providers' offices knowing what ACOG now recommends.
Stay tuned for August's adventures in celebrating World Breastfeeding Week and Breastfeeding Awareness Month. Like my Facebook page for resources that can be used by educators, doulas, and of course, breastfeeding mothers!
"Cesarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change."
I love this pic from a birth almost 5 years ago. This was the laboring mama and her own mother during an intense contraction.
I appreciate there is specific criteria that we can look to in making the decision to move to a cesarean birth. Basically, if a woman whose water has broken has not had any cervical changes (measurable progress, right?) after 4 hours of effective contractions, OR after 6 hours of pitocin, cesarean may be warranted.
One thing to keep in mind: there are more ways to progress in labor than just cervical dilation. Progress can be baby moving down in the pelvis, even if the cervix seems to be at the same dilation number (eg, first vaginal exam mom was 3 cm, baby was -4 station; next VE mom is still 3 cm, but baby is -1 station -- baby has come down regardless of where mom's cervix is, and that shows progress!).
Have you heard "6 is the new 4"? When looking at the stages of labor, it was taught that 0-4ish was latent or early labor, 4ish-7ish was active labor, and 7ish to complete (what we call "10") was transition. After seeing that we misjudged the amount of time in active phase, it is possible many women received cesarean births simply due to what was thought of as non-progressing labor, when in reality, with 4-6 more hours in that phase, birth would have happened on its own. Patience is not only a virtue, but it is also the safer way to birth for moms and babies.
Many of us are excited about these new evidence-based findings ACOG released in March. There are almost 20 statements that show how we can better support laboring moms to work in preventing a woman's first cesarean birth (knowing once she has had a cesarean birth, her chances of obtaining a vaginal birth after cesarean, or VBAC, are extremely low due to our climate). Basically what these statements boil down to are, women need more time in first and second stage, and we should not rush to cesarean delivery if mom and baby are doing well. Please share these.
I love Lamaze's amazing infographic which states it can take up to 17 years for medical practices to change when new information becomes available -- and Lamaze goes on to emphasize, as pregnant women, we don't have 17 years for our providers to catch up. It is all of our responsibilities to inform ourselves and present these best-care practices to our providers and see that we are treated accordingly.
"A prolonged latent phase (eg, greater than 20 hours in nulliparous women and greater than 14 hours in multiparous women) should not be an indication for cesarean delivery."
We have learned women don't line up with Friedman's Curve like we thought they should. So basically this new data tells us: dilation from 4-6 cm can take 4-6 hours longer than we thought! Patience is what we need -- give moms and babies more time when everything is going okay with them both.
♥ four young boys and a boy dog (offspring)