Ashley Ward gave birth in a hospital lift after it got jammed between floors

I came across the first edition of this book (2009) earlier this year on an ebay search for books on childbirth and the title leapt out at me. I had read half of it with increasing delight before I realised that it was a 21st century take on the Dublin method of Active Management of Labour, at which point I nearly threw it in the bin (it seemed to me that active management turned women into factory animals to be managed by the clock).

Up until that point, however, such was their condemnation of many modern practices that I had wondered why the authors’ colleagues hadn’t taken them before the Netherland’s equivalent of the GMC for bringing the profession into disrepute. They had highlighted all the problems with modern obstetrics, the ever increasing caesarean rates, the overuse of oxytocics and the widespread ignorance about normal uterine physiology. However, the book contained the best description of the physiology of the uterus I had ever seen in a mainstream textbook and the authors’ understanding of uterine action led them to question the widespread use of induction. Forcing labour on a uterus that isn’t ready for it is asking for trouble – hence the high caesarean rates. It seemed only reasonable to hear them out and read on. I was eager to see the second edition and it didn’t disappoint.

The authors know that there are misgivings about the Dublin version of active management and chose their title Proactive Support of Labor with care, specifically to emphasise the vital importance of continuous caring support in labour, the component of active management that was most likely to be ignored in clinical trials of active management in the past. Their understanding of the psychology of labour, particularly in the hospital environment, is well worth absorbing: “Like a tiny worm in a flawless apple, undue perception of risk progressively eats away at a person’s confidence and mental well-being. Both are difficult to restore.” The chapter on forgotten lessons from nature shows just how committed they are to preventing anxiety and stress because of the negative effect on the progression of labour.

I am not qualified to comment on obstetric management but remain very uncomfortable with the use of oxytocin to speed up labour, I would prefer that position changes and the techniques found on Gail Tully’s Spinning Babies website should be tried before resorting to artificial oxytocics, but the authors justify their position and their results are impressive in terms of their caesarean section rate and women’s satisfaction. However, I would take out every reference to clinicians at the ‘bedside’ – banning the bed could well reduce need for acceleration of labour.

Misgivings aside, I think that all involved in hospital obstetrics should read this book, if only to impress upon their minds the folly of induction for prolonged pregnancy before 42 weeks and the absolute commitment to providing caring and sensitive support for women antenally as well as during labour. However, the book is expensive and there may be a case for producing a cheaper slimmed down version for midwives. This work is already half done; scattered throughout the book are highlighted boxes containing a précis of the significant points on each page. If you read only these boxes you will be much the wiser.

Margaret Jowitt

Review (4 stars) at on 29 Nov. 2015


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