Effectively serving clients requires doulas to stay informed on changes in maternity care practices and guidelines. While we are not clinicians, we do provide up-to-date, evidence-based information to the families we support. Staying informed of policies and guidelines in the maternal care field also ensures that we can better prepare our families for the decisions they will make during labor, birth and the postpartum period. Keeping up with all of the updates that come out about maternity care and sorting through the headlines in social media and other news sources can be challenging.
DONA International, via our blog and the International Doula magazine, provides summaries specifically for doulas on noteworthy changes or updates to maternity care recommendations. We generally focus on those issued by the American College of Obstetricians & Gynecology (ACOG), which provides guidelines for maternity care physicians, since most families give birth under the care of an ob-gyn. ACOG issues updates and guidelines for the maternity care community throughout the year in the form of Practice Bulletins, Committee Opinions, and Practice Advisories. Since 2014, ACOG has also issued joint statements with the Society for Maternal-Fetal Medicine called the Obstetric Care Consensus Series. While all of these documents are clinical in nature and discuss practices that are outside the scope of doulas, we summarize them because it is important for doulas and to be aware of ACOG recommendations since they guide maternity care practices. Read on to learn about the different types of ACOG updates, a list of summaries currently available for doulas from DONA International, and information on the implementation for these guidelines (hint: it’s not instant).
If you’re familiar with these types of updates from ACOG, feel free to skip down to the list of summaries from DONA International. Subscribe to the blog to stay updated and get all of our articles directly to your inbox.
Documents & Publications from ACOG
Practice Bulletins are guidelines for care practices of maternity care physicians. They are updated with replacement bulletins as ACOG sees the need to do so with some Bulletins remaining unchanged for over a decade while others are updated within three years of original publication. Practice Bulletins are published online and in Obstetrics Gynecology, ACOG’s journal. They are considered a member benefit and not available to the general public. The journal can be accessed through a many university libraries. ACOG issues press releases about Practice Bulletins which are available to the public and how news sources often learn about them. DONA International’s publications team has access to the full text of Practice Bulletins as members of the media and uses the original document in our reporting on them.
Committee Opinions are reviews of research on what ACOG calls emerging issues in obstetrics and gynecology. Like Practice Bulletins, these are replaced with updated versions as ACOG determines there is enough new information warranting a new version. Committee Opinions come from, as the name suggests, various committees with the organization. Those most likely to pertain to doulas come from the Committee on Obstetric Practice. Opinions from the Committee on Ethics and Committee on Patient Safety and Quality Improvement have also provided information useful for doulas. Committee Opinions are available to the public via ACOG’s website under Resources and Publications/Committee Opinions
Practice Advisories are statements from ACOG on issues which require an immediate response, such as Zika virus. These documents are very fluid with updates to individual sections being provided as information becomes available. Practice Advisories are sometimes also issued in response to a decision by the FDA regarding a medication or medical devices. Advisories are available to the public on ACOG’s website under About ACOG/Newsroom/PracticeAdvisories
Obstetric Care Consensus Series
In 2014, ACOG partnered with the Society for Maternal-Fetal Medicine (SMFM) to issue joint Obstetric Care Consensus documents providing clinical recommendations for ob-gyns and maternal fetal medicine specialists. It appears that the organizations are attempting to provide greater consistency across both groups of physicians. As of this writing, the Obstetric Care Consensus Series has addressed the following topics – preventing the primary cesarean (doulas get a great shout out!), levels of maternity care, periviable birth, and severe maternal morbidity. These joint recommendations are available to the public on either the ACOG or SMFM website. DONA International has summaries most of these topics to highlight the elements which apply most to the doula profession (see below for links).
ACOG Summaries Available for Doulas
DONA International provides summaries that focus on those which are more applicable to doulas as birth and postpartum support professionals providing physical, emotional and informational support to expectant families. While not every recommendation from ACOG applies to doula support, we have covered a number of topics via the blog:
- APGAR score
- breastfeeding
- Laceration prevention for vaginal birth
- exercise in the childbearing year
- maternity health levels
- operative vaginal delivery
- periviable birth
- premature rupture of membranes and management of preterm labor
- reducing the primary cesarean rate (including the role of doulas)
- optimized postpartum care
Implementation of Guidelines & Recommendations
It’s important to note for ourselves as birth and postpartum support professionals and for the families we support, that it can take a very long time for new recommendations from ACOG or any other guiding organization to become standard practice. ACOG addressed this in Committee Opinion 629: Clinical Guidelines and Standardization to Improve Outcomes saying,
“It is important to note that there are barriers to putting the recommendations into practice. One such barrier is the physicians’ lack of awareness of all guidelines and the difficulty in applying the guidelines to practice. For 78% of medical practice guidelines, more than 10% of physicians are not aware of their existence (10). Therefore, Fellows should be familiar with the College’s practice recommendations and evidence-based guideline publications to make full use of them. The aforementioned College documents are regularly updated to ensure current relevance. Every practitioner should review new and existing College guidelines.” (emphasis added)
Doulas can, and should, share information on ACOG updates with their clients so that families can have informed conversations with their care providers. It is important to let clients know that their obstetrician may not yet be aware of the latest ACOG recommendations (see above) and that the organization is clear that physicians have a great deal of authority to use their professional judgement in the care of their patients. ACOG recommendations are just that – recommendations and do not dictate a required course of action. Coaching clients on how to raise ACOG recommendations that conflict with a provider’s stated plan of care is key to ensure smooth communication between patient and doctor. It is not within a doula’s scope of practice to provide care providers with information such as ACOG updates unless the provider specifically asks the doula to do so.
— Adrianne Gordon, MBA, CD(DONA)