New Recommendations for Safer Care During Labor and Birth (ACOG)

Safer Care Labor Birth

Recent guidelines from the American College of Obstetrics and Gynecologists (ACOG) suggest that less medical intervention during low-risk births can result in a more satisfying experience.

For half a century the organization of  58,000 obstetricians, gynecologists and women’s health care professionals, has analyzed the latest research to recommend the best childbirth practices. In 2017 their recommendations focused on the need to reduce medical interventions during labor and delivery, if the mother-to-be has experienced an uncomplicated pregnancy and labor is proceeding normally.

The ACOG recommendations suggest that obstetricians, working with midwives, nurses and other support personnel, can use alternative techniques to improve satisfaction rates and in some cases prevent complications. Here are a few of their recommendations:

Emotional support  personnel can improve labor outcomes.

In addition to regular nursing care, emotional support provided by a doula or birth coach, results in shorter labors, less need for anesthetics, and higher overall satisfaction rates. Women who received continuous support were less likely to have a c-section or a newborn with a low Apgar score.

There is an alternative to electronic fetal monitoring in low risk births:

Continuous electronic monitoring of the fetal heart rate was introduced to protect babies but research has not demonstrated an advantage in low-risk births. Since monitoring requires a woman in labor being tethered to a machine, it has the disadvantage of keeping patients from being able to walk around or to try different positions during labor. A less restrictive option may be to intermittently use a handheld Doppler device for monitoring.

Labor induction may not be necessary.

Inducing labor by rupturing the amniotic sac has long been standard practice when a woman’s waters have not yet broken but other signs of labor are present. Induction is often used in conjunction with an oxytocin drip to help speed labor. However, recent research suggests that it may not be necessary. A review of 15 studies found that rupturing the amniotic sac—combined with oxytocin—did not significantly shorten the duration of labor or lower the incidence of c-sections. For women whose labors are progressing normally and whose babies show no distress, there’s no need to induce labor

Relaxation techniques can help women cope with labor pain.

It’s important that women have the option of taking pain relief medication but healthcare providers can also encourage patients to use alternatives such as massage or water immersion to help cope with labor pain. Research has not shown any evidence that pain interventions such as acupuncture or massage have hurt mothers or babies or slowed the progress of labor. Relaxation techniques, acupuncture and massage have been shown to help laboring women cope.

Intravenous fluids may not be necessary.

Women in labor should not automatically receive a continuous infusion of intravenous liquids, which can restrict movement during labor. Whether or not to infuse intravenous liquids should be determined during labor, and may be recommended, for example,  if the patient shows signs of dehydration or the labor lasts a long time. Current guidelines do permit the drinking of clear fluids during labor.

No single labor position is best.

It’s not unusual for women to want to change positions during labor and research has not shown definitive advantages for any particular position. While research shows that sitting upright may result in a shorter labor, that position has also been shown to increase the likelihood of perineal tears. Changing position frequently can help mothers feel more comfortable. Doctors do not need to recommend any one position, as long as mother and baby can be monitored, if needed, and there are no complications.

Delaying admission an be a good idea

How dilated are you? Less than five or six centimeters? If both mother and baby are doing well, your doctor may recommend staying in touch but not immediately checking into the hospital or birth center. Delaying hospital admission until the mother is five to six centimeters dilated may cut the risk of c-sections, which in the U.S. count for 31.9 percent of all births.

The ACOG concluded that many common practices have little or no benefit during a low-risk birth. Many women want a birth with as few medical interventions as possible and if such interventions are not necessary, doctors can offer options.

Joan MacDonald
Joan Vos MacDonald has written about health and fitness for newspapers, magazines and websites. She is a member of the National Association of Science Writers and the author of two books on health-related topics, "Tobacco and Nicotine Dangers," for young adults, and "High Fit Home," a design book about fitness and architecture. She lives in upstate New York near her children and grandchildren.

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