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Limiting Interventions During Labor and Birth

Obstet Gynecol; 2017 Feb; ACOG Comm on Obstet Prac

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.

Citation:

Approaches to limit intervention during labor and birth. Committee Opinion No. 687. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;129:e20–8.