Intervention during labor and birth: new recommendations from ACOG
Women with low-risk pregnancies can benefit from minimal intervention during labor and delivery.
Women with low-risk pregnancies can benefit from labor techniques that are associated with minimal interventions, according to an updated committee opinion released by the American College of Obstetricians and Gynecologists (ACOG).
The committee defines low-risk as “a clinical scenario for which there is no demonstrable benefit for a medical intervention.” It notes that many obstetric practices have a limited or uncertain benefit for low-risk women in spontaneous labor, and some women may seek to reduce medical interventions during labor and delivery. Therefore, obstetrician-gynecologists should consider using low-interventional approaches when it is appropriate for intrapartum management of spontaneous labor.
A summary of the recommendations from ACOG is as follows:
- Labor management may be individualized for a woman who is at term in spontaneous labor with a fetus in vertex presentation. Management techniques may include intermittent auscultation and nonpharmacologic methods of pain relief.
- Labor and delivery can be delayed for women in the latent phase of labor when their status and their fetuses' status are reassuring. Women can be offered contact and support and nonpharmacologic pain management measures.
- Women who are admitted for pain or fatigue in latent labor can benefit from techniques such as education and support, oral hydration, positions of comfort, and nonpharmacologic pain management techniques such as massage or water immersion.
- Obstetric care providers should inform women with term premature rupture of membrane (PROM) of the potential risks associated with expectant management. The choice of expectant management may be appropriately offered for informed women if there are no other maternal or fetal reasons to expedite delivery.
- Continuous one-on-one emotional support in addition to regular nursing care is associated with improved labor outcomes.
- Amniotomy does not need to be undertaken for women with normally progressing labor without fetal compromise unless it is required to facilitate monitoring.
- Obstetric care providers should consider adopting protocols and training staff to use a hand-held Doppler device to facilitate the option of intermittent auscultation for low-risk women who desire such monitoring during labor.
- Obstetric care providers should use the coping scale in conjunction with nonpharmacologic and pharmacologic management techniques to meet the needs of each woman.
- Frequent position changes to enhance maternal comfort and promote optimal fetal positioning can be supported as long as the positions allow for appropriate maternal and fetal monitoring and are not contraindicated by maternal medical or obstetric complications.
- In regards to limited data regarding the outcomes of spontaneous vs Valsalva pushing, each woman should be encouraged to push using the technique that she prefers and is most effective for her.
- Women who do not have an indication of expeditious delivery, particularly those who are nulliparous with epidural analgesia, may be offered a period of rest of 1 to 2 hours at the onset of the second stage of labor.
- The American College of Obstetricians and Gynecologists. Committee Opinion Number 687: Approaches to Limit Intervention During Labor and Birth. Published February, 2017. Accessed February 8, 2017.