I have given birth to five children and yet before I became a birth-worker I had never heard the terms active management and expectant management. I may be wrong, but I can assume that a high percentage of expecting parents are also not familiar with these terms, what they mean and how they impact your birthing experience. In this article, I will touch on the different management styles of labor. So, let’s dig in…

Active Management

The Oxford English Dictionary definition of management is “the process of dealing with or controlling things or people.” The definition of the word active is “pursuing an occupation or activity at a particular place or in a particular way.” In terms of a woman’s labor and delivery, an active management approach would consist of the caregiver taking action to ensure an outcome within a specific amount of time. Some examples of active management would include but is not limited to induction, augmentation (speeding up) of labor via synthetic oxytocin or amniotomy (rupturing of waters), episiotomy and sometimes even c-section.

When a caregiver is practicing active management, they often will evaluate the progress of labor based on how many centimeters the cervix is dilating per hour. If by their definition the labor is progressing slowly, they may recommend interventions to speed labor up. Most commonly, the caregiver will either give a synthetic form of oxytocin through an IV or rupture the membranes, also known as breaking the waters.

The plus side of having these options are that if mom is overly exhausted and not doing well mentally, these techniques can help speed up labor.

The downside is that each of these methods of augmentation have their own individual risks and once you introduce interventions into the labor, the risk of more interventions being needed greatly increases. In the birth world, many call this the “cascade of interventions.”

Expectant Management

Expectant management is the opposite of active management. Rather than acting based on time limits and routines, it is a “watch and wait” type of labor management. When a caregiver is using expectant management, they are monitoring mom and baby but are only taking action when there is an indication that it is medically necessary to intervene. Time limits are not imposed and when a labor seems to slow down, they are supportive of using natural techniques such as position changes and rest. C-sections are not performed solely based on the length of each stage of labor but rather if there is a true imminent danger to mom or baby.

No Management

Some expectant moms choose to have no management over their labor. This is frequently called a “freebirth” or “unassisted birth”. In a freebirth, the mom is laboring and delivering at home without a midwife or medical professional. There is no monitoring of mom or baby and the mom and/or her partner deliver the baby themselves.

Choosing your provider and where to birth

It’s so important when choosing your provider and where to give birth that you reflect on what kind of birth you are envisioning and what is most important to you. Talk to your provider and understand what type of management they practice in labor and what their routine practices are. If you are birthing in a hospital, understand what hospital policies are in place regarding your and your babies care during labor, delivery and postpartum. Remember this is YOUR birth and YOU are in control of how and who is managing your labor… make sure you feel safe and heard.

If it’s of interest to you, I’d love to chat about your upcoming birth and whether I can support you in any way!

XOXO,

Katie