In February 2017, the American College of Obstetricians and Gynecologists (ACOG) issued a new Committee Opinion recommending that maternity care providers restrict use of many common labor and birth interventions that offer limited or uncertain benefit to low-risk women. By “lowrisk,” they mean a woman who would not benefit from a specific intervention. The Committee Opinion states that maternity care providers and women want to avoid unnecessary interventions during labor and birth. It recommends individualized care to help each woman meet her childbirth goals by providing care that minimizes use of interventions and increases satisfaction with the birth experience. The recommended practices also facilitate physiologic processes that benefit women and newborns. Thus, widely-accepted, currently-used labor and birth interventions are not necessarily the safest care for women and babies.
Unfortunately, it often takes many years before health care providers reliably carry out the recommendations of professional organizations. So, it is important for pregnant women themselves to become informed and take an active role in securing high-quality care for themselves and their babies.
Stay home until "active" labor (when the cervix is open – “dilated” – about 6 centimeters1 ), and carry out a plan for self-care and coping. This helps women avoid cesarean birth and many other labor interventions. If admitted to the birth facility before this time (in “early” labor), women may benefit from education, support and immersion in water and other drug-free pain relief measures.
Keep track of the baby’s heartbeat with a hand-held device. Periodic listening with a “Doppler” or a fetal stethoscope reduces a woman’s likelihood of cesarean birth or of a vaginal birth with forceps or vacuum extraction. Not being connected to an electronic fetal monitor frees a woman to move and use positions she prefers.
Obtain continuous, one-to-one support from a labor companion such as a doula. This shortens labor and reduces the likelihood of cesarean birth, use of pain medications, and dissatisfaction with one’s childbirth experience, among other benefits.
Drink clear liquids during labor. Best evidence does not support an outdated labor practice restricting fluids by mouth and using intravenous (IV) lines to keep women hydrated. IV lines can limit freedom of movement. The Committee Opinion notes that some people interpret the best available evidence to support eating solid food during labor if desired, and it calls for continued assessment of the issue (though it does not recommend solids by mouth in labor).
Avoid a procedure to break the membranes (bag of waters). Best evidence finds that breaking membranes doesn’t offer benefits such as shorter labor or fewer cesareans. Left alone, they will generally break on their own before birth.
Use upright positions and/or move about during labor. In comparison with laboring in bed, being upright and/or moving around shortens labor and reduces the likelihood of a cesarean birth.
Try various drug-free pain relief methods. Unlike pain medications, drug-free methods have no adverse effects on the woman, her baby and labor progress. There are many options. Multiple measures can be used at the same time or one after another. Continuous support, being upright and/ or moving about, and immersion in water are examples of drug-free measures that reduce use of pain medications.
Use position of comfort and choice when pushing and giving birth. For many decades, most women have given birth while lying on their back, versus such other options as lying on their side, being upright or on hands and knees. However, back-lying positions do not offer clear advantages for the woman or baby. Best current evidence supports flexible use of positions that are most comfortable for a woman and enable her to push effectively.
Rest and await the urge to push after full dilation. For many decades, many women have been directed to bear down and push when their cervix is fully opened (about 10 centimeters). However, resting and giving the baby time to move down through the birth canal will generally lead to a strong, effective “urge to push” that results in the birth.
Push according to one’s own urges and preferences. For many decades, hospital personnel have called out to direct women to push, once the cervix is fully opened. Forceful coached pushing has not been found to offer advantages, and possible adverse impacts have not been well researched. Women may thus benefit by letting their own bodies guide them in effective pushing.
The Committee Opinion also offers guidance for when membranes break on their own before labor has begun at 37 weeks or beyond. In the past, many women with this situation experienced one or more drugs or other methods to try to start, or induce, labor. However, nearly all women do go into labor on their own in the hours after “spontaneous rupture of membranes at term.” The statement recommends counseling women about the options and pros and cons of waiting versus inducing labor, and offering women the choice of watchful waiting when intervention does not offer clear benefit.
Other Guidance for Safe, Healthy Birth
In addition to the 2017 Committee Opinion, ACOG has recently indicated support for healthy and underused practices for women and babies just after birth, including:
Delayed cord clamping
Immediate skin-to-skin contact of women and their newborns
Early and continued breastfeeding on cue from the baby and with effective professional support
This resource was published by https://www.nationalpartnership.org/ and written by Childbirth Connection- a program of the National Parternship for Women & Families. This information can also be found here: https://www.nationalpartnership.org/our-work/resources/health-care/maternity/professional-recommendations-to-limit-labor-and-birth-interventions.pdf
