BOOK REVIEW

Abstract

Paul Reuwer, Hein Bruinseand, Arie Franx. Proactive Support of Labor. The Challenge of Normal Childbirth. 276 pages. Cambridge University Press, United Kingdom, 2009. ISBN 978-0-521-73576-6. Price GBP 38.00. This book launches a new concept of obstetrics and how it is applied in practice. The book is divided into three parts. The first section is called ‘A Wake-up Call’ and deals with the fact that the cesarean birth rate is increasing without any improvement in neither maternal nor fetal outcome regarding morbidity and mortality. The authors confront both obstetricians and midwives and call for a change in childbirth practices, which requires more cooperation among the professionals on the maternity ward. The second section is called ‘Back to Basics’ and explores the basic biology and physics of labor. One of the main theses of the book is that many dogmas in obstetrics are neither verified nor based on evidence. The last section of the book explains in detail the ‘Method and Strategy’ of proactive support of labor. Proactive Support of Labor claims to provide a balance between natural birth and intervention, thus, enhancing women's satisfaction with their childbirth experience. The method aims at preventing poor fetal outcome and malpractice, and above all a decrease in cesarean and instrumental deliveries. This implies pre-labor education, personal psychological support during labor (such as the presence of a doula) and a well-defined birth plan, which includes a strict diagnosis of the onset of labor and proper and timely intervention to prevent protraction. The authors stand on the shoulders of Active Management of Labor, the philosophy of obstetrics coined by Kieran O'Driscoll in 1969. This philosophy was introduced to avoid cesarean deliveries performed because of prolonged labor, and has been published in four editions, most recently in 2005 (1). In Proactive Support of Labor the emphasis on the importance of the diagnosis of the onset of labor and prevention of protraction are also key points. The only new aspect of the diagnosis is that full effacement rather than 3 cm dilatation of the cervix is considered clinical evidence of the onset of labor. As for prevention of protracted labor, there is no news in making sure the progression of dilatation is 1 cm/hour, with the use of amniotomy and oxytocin if dilatation slows down. The book covers every aspect of delivery and advocates the practicing of timely care in the labor room. It is hard to disagree with any of the described practices, which are already the intention on most labor wards. As for the provision of a so-called birth plan, it is refreshing to be reminded of the importance of the presence of a professional once labor is diagnosed, and also of the value of an agreement or contract with the mother, so that she knows what to expect and for how long the labor will last. It is also good to be reminded of the sometimes futile discussions between the midwife and the obstetrician where cooperation is to be preferred. Whether obstetric practice should aim at a section rate of around 10%, as recommended by the authors is indeed worth a discussion as well. But the question is whether Proactive Support of Labor really offers new perspectives on obstetrics in practice. However, the book is very well written, and offers an easy and enjoyable introduction to the field of obstetrics. Whether read in parts or sections, it can be very stimulating, but if you read it all through you might get tired of repetitive statements and a feeling of being in a crusade. It is quite clear that the authors are very dedicated and enthusiastic and that the balanced conclusions are based on their clinical experience.