ACOG’s latest guidelines for minimizing interventions during labor are very reminiscent of the skills you’ll learn when you become a doula.
Yesterday on our blog, we talked about the American College of Obstetrics and Gynecology’s (ACOG) recommendation that all laboring women should have a doula. ACOG’s Committee Opinion, where this recommendation was published, contained additional guidelines that will interest anyone wanting to become a doula.
In brief, the Committee Opinion laid out a comprehensive plan for managing labor in low-risk women (that is, healthy women with a term delivery). Personally, I kept thinking about how doulas are already educating expectant mothers about the benefits of each of the suggestions. With the ACOG seal of approval, these practices should start to become more common place. And as they do, doulas will be in high demand.
Perhaps most interesting to those who want to become a doula is the adoption of the new “Coping Scale”.
The Coping Scale was developed to use in lieu of the more traditional Pain Scale. Therefore, instead of asking a laboring woman how much pain she is in on a scale of 1-10, she will be asked how well she is coping on a scale of 1-10. This change may seem slight, but the language is important. There are a lot of variables during labor, and everyone will respond to it differently. Depending on how well she is coping, providers will know which interventions to suggest (or not to suggest).
This is important, because the new guidelines aim to “minimize interventions” overall and avoid “unnecessary interventions”.
If you are planning to become a doula, you’ll learn that every woman wants and needs different support during labor. These new recommendations take individual needs into account. ACOG encourages providers to tailor interventions based on each woman’s needs and preferences. This should begin before she is even admitted.
Barring any issues with extreme pain or fatigue, they suggest that women not be admitted unless they are in active labor. If they are still in the latent, or early, phase of labor, providers should encourage them to labor at home. Additionally, they should give them a clear plan for reassessment and strategies for coping.
Once she is admitted, ACOG recommends a hands-off approach that respects the laboring woman’s intuition.
First of all, ACOG recognizes that there are many ways to manage labor pain, including the use of medical and non-medical techniques. The key difference is that non-medical approaches help women cope, but don’t remove the pain. Conversely, medical approaches lessen pain but do not help alleviate anxiety or suffering. Based on how the laboring mother is coping, medical and non-medical techniques can be used sequentially or in combination.
Some of the non-medical approaches presented in the article include:
- Education and emotional support
- Oral hydration in lieu of IV fluids
- Supporting position changes that help with the mother’s comfort, and encourage the fetus to descend
- Utilizing a shower or tub
- Encouraging women to push using their preferred technique
Furthermore, the article states that unless continuous electronic fetal monitoring (EFM) is required due to epidural anesthesia or similar, providers should opt to use hand-held dopplers. This will allow laboring women more freedom to move around. In the case of premature rupture of the membranes (PROM), a plan for expectant management should be discussed in lieu of starting an induction. Similarly, if there is no evidence of fetal compromise and labor is progressing normally, the updated recommendations state that there is no reason to break the sack of waters.
Again, these suggestions will sound very familiar once you become a doula.
The outlined techniques are “associated with minimal interventions and high rates of patient satisfaction”. They’re also the same techniques that you will master when you become a doula. As providers begin to adopt these guidelines, doulas will be highly sought after for their skills in these areas. There is no better time to become a doula and position yourself to fill this need.