I can hardly believe what I am reading. The American College of Obstetrics and Gynecology, which for years has recommended various interventions in childbirth, has released an official committee opinion that many common obstetric practices are of little or unknown benefit for low-risk women in spontaneous labor. Here are a few key points:
- For pre-labor rupture of membranes, expectant management is recommended rather than admission and induction.
- For a normally-progressing labor and no evidence of fetal compromise, artificial membrane rupture (breaking the bag of waters) is not necessary.
- The widespread use of continuous electronic fetal heart-rate monitoring in low-risk pregnancies has not improved neonatal outcomes. Care providers and facilities should consider adopting protocols and training staff to use a hand-held Doppler device for low-risk patients who desire intermittent monitoring in labor.
- Multiple nonpharmacologic (water immersion, massage, etc.) and pharmacologic techniques can be used to help reduce labor pain.
- Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support of a supportive partner or doula is associated with improved outcomes.
- IV fluids are not necessary for people in spontaneously progressing labor.
- For most labors and births, no single position is mandated; changing of positions should be encouraged.
- When following instinct, women push with an open glottis. In consideration of the limited data regarding outcomes of spontaneous versus Valsalva pushing (“purple pushing”), each person should be encouraged to use the technique that they prefer and is most effective for them.
- For first babies, persons who have an epidural and no indication for swift delivery may benefit from a rest period of 1–2 hours before initiating pushing efforts, allowing the baby to “labor-down”.
Read the full article HERE!