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Book Review: Optimal Care in Childbirth: The Case for a Physiologic Approach Reviewed Through a Childbirth Educator’s Eyes

October 18th, 2012 by avatar

I had waited excitedly for the release of Henci Goer and Amy Romano’s new book for a long time and was delighted to receive it after it was published in May 2012. Optimal Care in Childbirth: The Case for a Physiologic Approach was a robust, updated successor to Henci’s previous book; Obstetric Myths Versus Research Realities which was a well used source on my office bookshelf.

Both authors have a long history with Lamaze International. Prior to her current position with Childbirth Connection, directing the Transforming Maternity Care Partnership, Amy launched Science & Sensibility, and provided a keen and critical eye when analyzing, reviewing and sharing research items with readers. Henci Goer has been the long time resident expert on the “Ask Henci” forum hosted by Lamaze International, providing and sharing resources on a wide variety of pregnancy and childbirth topics with consumers and professionals alike, as well as a regular contributor to this blog. Please read the full bios of Amy and Henci on their website, where you can find complete information on their work, background and other works that they have authored.

As the title clearly states, this book is about childbirth, and as such, you will not find information on pregnancy, breastfeeding or newborn topics. Nor is this the type of text that childbirth educators would hand out in class for consumers to use. This book is heavy with sources, study outcomes and insights into current obstetric practices. But, as a guide to best practice, the book becomes a great repository of information that allows consumers and professionals alike to learn and make decisions about care that can help keep birth as physiological as possible. The book focuses on what factors affect, both positively and negatively, birth, so that an optimal outcome can occur.

The authors define optimal outcomes as “the highest probability of spontaneous birth of a healthy baby to a healthy mother, who feels pleased with herself and her caregivers, ready for the challenges of motherhood, attached to her baby, and goes on to breastfeed successfully.”

The chapters are well organized, with the topic of cesareans starting things off. Cesarean rates have never been higher, and many of the topics that Goer and Romano discuss later in the book often have the unintended consequence of contributing to the skyrocketing cesarean rates in this country. I think it is an important topic and one that receives a thorough evaluation by the authors.

Each chapter starts off with “contradicting” quotes from researchers working in the field of obstetrics, and I have to say, that reading these at the beginning of each chapter was something I looked forward to, a nice added bonus and really made me pause and consider the different viewpoints and how they influence practice today. The lead in for chapter 12 on epidurals and spinals contains one of my favorites:

“There is no other circumstance in which it is considered acceptable for a person to experience untreated severe pain, amenable to safe interventions, while under a physician’s care.” ACOG 2006

“Epidural anaesthesia remains one of childbirth’s best exemplars of iatrogenesis. It is a wonderful intervention for managing labour complications, especially as an alternative to general anaesthetic for caesarean sections, but has significant side effects that constantly need weighing alongside benefits. Though its rising popularity almost grants it the status of normative practice on some [U.K.] maternity unites, it remains incompatable with physiological labour.” Walsh 2007

Each chapter begins with a wonderful perspective on each topic, sharing history and cultural practices so the reader can understand how standard protocols found in most birthing facilities have come to be, even when not backed up by research. I think it is critical to include this information, for if there is to be a shift to more evidence based care in the field of obstetrics, we need to be aware and acknowledge that some practices may have evolved for legal, cultural, social or policy reasons having nothing to do with sound research.

The authors ask and answer the very questions that I find myself asking out loud, helping the reader to understand why we continually observe care that is known to not improve outcomes. For example, when discussing electronic fetal monitoring, the question “Why does use of continuous EFM persist?” in normal low risk labors is asked (and thoroughly answered) with supporting references for further information.

Each chapter contains a brief summary of action steps that women can take to receive optimal care, along with the supporting research that backs up these steps. These lists are great talking points both for educators to integrate in their classrooms, but also for consumers to discuss with their health care providers and understand why their care might deviate from that supported by research.

The conclusion of each chapter has what the authors call a “mini-review” and neatly summarizes the important topic statements and provides (and references) outcomes of studies so that the reader can evaluate for himself or herself the validity of the research. Though these sections are called reviews, I found them to be a very helpful component of the book, when looking for solid sources.

At the end of each chapter, all of the sources referenced in that chapter are listed.

Henci Goer

I was very appreciative throughout the book, for the definitions that the authors provided when discussing a topic. It is important (and helpful) to know how terms are defined, so that the reader can best understand the discussion. For example, in one of the cesarean chapters, one can find a list of “rate” terms, so when “primaparous cesarean rate” is discussed, this term has already been explained.

Several places throughout the book, in various callout boxes, Goer and Romano discussed the selective language that health care providers use when talking about childbirth and presenting information to families. I found these small detours fascinating, as I am very interested in the language that HCPs use to discuss risk, procedures and events with their patients.

The last chapters of the book take a look at choice of birth location, what the ideal maternity care system might include and includes information on maternal mental health. The appendices speak to common “less than optimal” situations, such as the OP fetus in labor, meconium staining and other circumstances that frequently cause concern and labor interventions. Again, the authors include information on optimal care in these cases that can help.

It is clear from some of the phrasing, chapter titles and choice of words in some of the discussions, that the authors have a bias towards a childbirth process that unfolds in a natural and physiological manner. This language, while potentially off-putting to those who firmly believe in the medical model, is effective in causing the reader to consider standard practices that make no logical “sense”, and certainly, references are provided for further research should the reader wish to investigate further.

I must say that I very much enjoyed this book, and I will find it very useful in my doula and Lamaze childbirth education practice. It is the type of book that one thumbs through frequently, when asked a question by a student or client, or when helping a client to prepare to speak to their health care provider about best practices and birth preferences. I think that any birth professional would do well to have this book on their shelf and be able to refer to it when necessary. This book represents a significant amount of research and I find great comfort in knowing that all the resources and references supporting the statements made in the book are available for me to source myself.

Amy Romano

I look forward to the release of the e-book version of this title, expected this fall, for the Kindle, iPad and other tablets, so that I could have easy access from wherever I am. I would be delighted if the references and sources could be routinely updated as new research is released and published, so that I can use this guide for many years to come, confident that it reflects the newest and most valid research. I know that is a formidable task, but I would gladly pay a small subscription fee to have an updated version as often as necessary.

This book is available for purchase from both Amazon.com and the Optimal Care in Childbirth website. The book is on the expensive side, costing approximately $50.00, but very well may become the go-to source for evidenced based research on your office shelf, so worth the investment. If you choose to purchase from the book’s site, there are bulk and wholesale discounts available.  For purchases made from the book’s website, the authors are providing a 15% discount for our Science & Sensibility blog readers and conference attendees. Enter code UXJXI52F at checkout to receive the discount.

I hope that you are planning to attend the upcoming Lamaze International Innovative Learning Forum next week, where both Amy Romano and Henci Goer have been invited to speak. You will have an opportunity to meet these authors, ask them questions, purchase this book and hear their powerful presentations. As a General Session Speaker, Amy’s session will be available as part of the “Virtual Conference” option for those unable to attend the conference in person.

Have you read Optimal Care in Childbirth?  Are you using it already in your practice?  Please share your thoughts and comments in our comment section here on the blog.  I look forward to hearing your views. – SM

References

ACOG committee opinion. No. 339: Analgesia and cesarean delivery rates. Obstet Gynecol 206;107(6):1487-8.

Walsh D. Evidenced Based Care for Normal Labor and Birth. London: Routledge; 2007.

Book Reviews, Cesarean Birth, Childbirth Education, Epidural Analgesia, Fetal Monitoring, Healthcare Reform, informed Consent, Lamaze 2012 Annual Conference, Maternal Mental Health, Medical Interventions, New Research, Pain Management, Practice Guidelines, Research, Systematic Review, Transforming Maternity Care , , , , , , , , ,

On Our Radar

December 8th, 2011 by avatar

News, new research and interesting tidbits…

 

Saving Pregnant Women One Device at a Time
Of course the blogosphere lit up last week with the release of yet another study about a piece of technology pegged to “save” women from the dangers of childbirth.  This new device, a compilation of MRI screening and computer software entitled, Predibirth, was designed Dr. Olivier Ami and colleagues at the Antoine Béclères Hospital at Université Paris Sud, France.  The promise of being able to detect whether or not a fetus will successfully navigate the confines of his mother’s pelvis during labor and delivery come from a study including 24 pregnant women upon whom Predibirth’s technology was employed.  Interestingly, of those 24 women, a little over half—13—ultimately underwent a cesarean delivery.

The creation of such a device, I think, is based on the age-old anthropological understanding we have of pelvic tight quarters.  In short, when humans began walking upright some eons ago, our pelvic structures had to change to maintain our balance—thus creating a tighter space through which the large-headed fetus must pass during the birth process.  If you want an in-depth read about this process, go here.

That being said, I’m not sure how well the Predibirth takes into account factors such as hormonal fluctuations that influence pelvic diameters during the labor process and labor and birth positions which work to expand (or reduce) the pelvic inlet and outlet.  The other elephant in the room for this topic is the questionable effect of the magnetic fields and radiofrequencies associated with this type of imaging upon the fetus—for which very little research data is available.

Web-based Buzz on Labor Inductions
With the Lamaze International webinar on labor induction happening next week ( December 12), you may find interest in referring your patients and clients to the related discussion on Henci Goer’s, Ask Henci forum, in which induction for a woman aged 40 or above is addressed.

 

Forceps = Safe(?)
Reuter’s
recently covered a new study released in the American College of Obstetricians and Gynecologists’ Green Journal,  suggesting that forceps-assisted delivery is safer for the neonate, when looking at long term neurological outcomes, compared to vacuum extraction or cesarean delivery.  Data was pulled from over 1 million births that occurred in New York City between 1995 – 2003, with 122,507 vaginal surgical births ultimately analyzed.  Interestingly, births included in the study went down to 34 weeks gestation for nulliparous women delivering singleton babies between 500-5,000g, and excluded breech births, birth weights greater than 5,000g and cases of placenta previa.  Significant outcomes were considered to be: neonatal subdural hemorrhage, intraventricular hemorrhage, seizures, scalp laceration or cephalohematoma, fracture, facial nerve palsy, brachial plexus injury, or 5-minute Apgar score of less than 7.

A remark I read from a seasoned obstetrician and Director of Maternal Fetal Medicine in a Canadian facility suggested that these outcomes may be congruent with the limited use of forceps by (older and more experienced) clinicians who were once heavily trained in their use.  As forceps skills seem to have fallen out of the repertoire of many newer OBs (perhaps a “young” obstetrician will write in and correct any inaccuracy in this statement, if it exists) forceps usage in this study may have occurred in particularly adept hands while vacuum extraction and cesarean delivery were distributed more evenly.

Regardless, the findings of this large study are interesting—if not a bit chilling.  Last time I spoke with a woman who endured a forceps delivery, her description was a ghastly one, in exchange for a 4th degree perineal tear and a healthy baby.  What are your thoughts??? (HINT:  this is an invitation for YOU, the reader, to weigh in on this.)

 

Down into the Water, Baby.
University of Minnesota  and Twin Cities hospitals have been adding water birth to their compendium of birthing options with Amplatz Children’s Hospital being the latest to get on board.

Transform
Childbirth Connection has recently launched a new video on their Transforming Maternity Care Site, encouraging all of us to join in the process of ensuring childbearing women are cared for using best practices and the most up-to-date evidence.

 

What’s on YOUR radar?
Feel free to share (respectfully) what you’ve been reading with interest lately.

 

 

Posted by:  Kimmelin Hull, PA, LCCE, FACCE

On Our Radar , , , , , , ,