Today in the United States and Canada, we observe “Groundhog Day” - where a groundhog (woodchuck) emerges from its winter shelter and if it sees its shadow, we are doomed to another six weeks of winter and if no shadow is seen, the weather will be milder and swing toward spring. There is a common expression that refers to experiencing a Groundhog Day, when “a situation in which the same usually negative or monotonous experiences occur repeatedly or are felt to occur repeatedly with no change or correction.” In fact, there was a 1993 film, “Groundhog Day,” that reinforced what it could be like to have every day be the same, in effect, a Groundhog Day.

It is unfortunate that in the case of birth in the United States and many other parts of the world, expectant families are destined to receive “Groundhog Day” level care despite significant and compounding evidence that doing the same non-evidence based practices over and over is not improving outcomes or increasing birth satisfaction. It is also not being respectful of what best practice perinatal care should be. Even the American College of Obstetricians and Gynecologists (ACOG) acknowledges that “many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor” as cited in the Approaches to Limit Intervention During Labor and Birth released in February 2019 and reaffirmed in 2021.

Here are seven practices that are not evidence-based, yet people who give birth today in the United States, and other places around the globe, will routinely be subjected to when giving birth in a hospital.

• Admitting low risk people to the hospital in latent/early labor instead of waiting for active labor.
• Continuous electronic fetal monitoring for healthy low risk laboring people instead of intermittent auscultation. 
• Limiting oral intake instead of encouraging eating and drinking as desired by the laboring person and routinely administering IV fluids.
• Discouraging or not promoting the routine use of a doula, and limiting doula access in some circumstances such as triage, during epidural placement or a cesarean birth.
• Routinely breaking the bag of waters for a normally progressing labor.
• Limiting maternal positions during labor and birth to a supine position rather than supporting maternal choice, ambulation and upright positions.
• Coaching people who are pushing to hold their breath and push for a designated “count” rather than encouraging spontaneous, open-glottis pushing.

For most birthing people, their labor and birth experiences will mimic Groundhog Day, with the same outdated practices applied to their current experience, as were done in their previous experience and unfortunately, should they birth in the future, it likely will be similar again, with full disregard for current evidence and documented best practice. It is time for “Groundhog Day” for birthing people to become a thing of the past, not a situation of a perpetual rerun of the same outdated film everyone has seen before.

Childbirth education classes that provide information and resources built on a foundation of evidence and shared decision making, and provide opportunities for strengthening self-advocacy skills can encourage birthing consumers to seek out providers and facilities that support a positive experience grounded in what the research has demonstrated is necessary for improved outcomes. Consumers can and should find their voice and ask for evidence based care.

Resources

ACOG Committee opinion No. 766: approaches to limit intervention during labor and birth. Obstet Gynecol, 133(2), e164-e173.

Published: February 02, 2023

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