The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice has issued a committee opinion on limiting intervention during labor, as many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor, according to the guideline. Among the ACOG recommendations and conclusions:
- For a woman who is at term in spontaneous labor with a fetus in vertex presentation, labor management may be individualized (depending on maternal and fetal condition and risks) to include techniques such as intermittent auscultation and nonpharmacologic methods of pain relief.
- Admission to labor and delivery may be delayed for women in the latent phase of labor when their status and their fetuses’ status are reassuring.
- Obstetrician–gynecologists and other obstetric care providers should inform pregnant women with term premature rupture of membrane (PROM [also known as prelabor rupture of membranes]) who are considering a period of expectant care of the potential risks associated with expectant management and the limitations of available data.
- Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor.
- For women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring.
- In the absence of an indication for expeditious delivery, women (particularly those who are nulliparous with epidural analgesia) may be offered a period of rest of 1 to 2 hours (unless the woman has an urge to bear down sooner) at the onset of the second stage of labor.
Approaches to limit intervention during labor and birth. Committee Opinion No. 687. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;129:e20–8.
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