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ACOG: Limit intervention during labor, birth in low-risk pregnancies
Labor and delivery methods that reduce medical intervention should be considered for low-risk pregnancies by OB/GYNs and other maternity care providers, according to new recommendations recently released by The American College of Obstetricians and Gynecologists (ACOG).
“Practitioners always put the best interests of moms and babies at the forefront of all their medical decision-making, but in many cases those interests will be served with only limited intervention or use of technology,” Jeffrey L. Ecker, MD, Committee Opinion author and chief of the obstetrics and gynecology department at Massachusetts General Hospital, said in a news release. “These new recommendations offer providers an opportunity to reexamine the necessity of obstetric practices that may have uncertain benefit among low-risk women. When appropriate, providers are encouraged to consider using low-intervention approaches that have been associated with healthy outcomes and may increase a woman’s satisfaction with her birth experience.”
In its Committee Opinion, ACOG suggests that hospital admission may be delayed for women with a low-risk pregnancy until dilation is at 5 to 6 centimeters. It also advises that it may not be necessary to rupture the amniotic sac in women who are progressing normally. Before inducing labor in a term pregnancy with premature ruptures of membranes, arranging a short phase of expectant management should be considered if there are no reasons to accelerate delivery, according to ACOG.
The guidance also recommends that women receive continuous emotional support and nonpharmacological approaches to control pain such as massages, water immersion in the first stage of labor, relaxation techniques and support from trained doulas. In addition, ACOG recommends that health care practitioners use a coping scale instead of a pain scale to assess the experience of labor.
“Techniques such as an epidural can relieve pain but may not ease anxiety or suffering,” Tekoa L. King, CNM, MPH, ACNM, liaison committee member and lead author, said in the release. “Providing emotional support and coping mechanisms have proven positive outcomes, therefore, it’s recommended that providers consider instituting policies that allow for the integration of support personnel in the labor experience. This strategy may be beneficial for patients and cost effective for hospitals due to an association with lower cesarean rates. It is important that midwives, OB/GYNs and other care providers collaborate to support women both emotionally and physically over the course of labor.”
For low-risk pregnancies, ACOG also advocates for intermittent use of fetal heart monitoring when appropriate, frequent changes in labor positions for optimal comfort and positioning of the baby and using the pushing technique most preferred by the woman.
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