The American College of Obstetricians and Gynecologists has released new guidelines encouraging OB-GYNs and other birth practitioners to re-examine the necessity of various interventions that may not necessarily benefit low-risk moms.
The new committee opinion does not signal a dramatic shift in best practices for managing uncomplicated labors, but it is a clear acknowledgement from ACOG that technological interventions can often times interfere with a natural process rather than help it along.
“This committee opinion is the first one, to my knowledge, that specifically addresses low-risk patients,” author Dr. Jeffrey L. Ecker, chief of the Obstetrics and Gynecology department at Massachusetts General Hospital told The Huffington Post. “It says, very clearly, that there are some times when watchful waiting is appropriate. Just because we have the technology, doesn’t mean it has to be used in every patient.”
Many doctors and hospitals already embrace measures to limit intervention when appropriate, he said. But for others, this will likely shift the standard care.
The new opinion asserts, for example, that a woman and her health care provider may consider delaying hospital admission until she is five to six centimeters dilated, so long as both she and the fetus are doing well and she and her provider are regularly in touch with one another.
The guidelines also call for intermittent fetal heart rate monitoring when appropriate, rather than routine continuous monitoring. The latter requires that women be hooked up to a machine throughout labor, which can restrict mobility at a time when many laboring mothers want, desperately, to move.
Furthermore, the committee’s opinion supports the idea that continuous one-on-one emotional care ― a service often provided by a professional doula ― is linked with improved outcomes for women in labor.
“The emotional component they’re pointing out here is a key issue that we—all of us—need to pay more attention to, and then we’d have much more ‘normal’ labors, if you will,” said Dr. David Eschenbach, chair of Obstetrics and Gynecology with the University of Washington School of Medicine.
The new statement also supports the use of non-pharmacologic pain reduction and relaxation techniques for women who do not necessarily want an epidural, such as massage and spending time in water in the early stages of labor. ACOG says mothers should be allowed to move freely throughout labor, and be allowed to push in whatever position they want.
Of course, the challenge for providers remains determining who is truly low-risk. The term generally applies to any woman who has had an uncomplicated pregnancy and who goes into labor spontaneously when she is full-term, but in childbirth, things can change very quickly.
“Teaching labor to residents is one of the more difficult things to teach, because usually you want to just not intervene. On the other hand, you have to really be actively monitoring in the background, because there are those rare events where even a ‘normal’ mother and baby come into labor and suddenly something happens,” said Eschenbach.
Yet ultimately the new guidelines—which were endorsed by the American College Of Nurse Midwives—are further evidence that ACOG is taking steps to address the high caesarean rate in the United States, which is currently 32 percent.
“Many nudge us as obstetricians and obstetric providers and say, ‘You’re all about doing interventions. Why do you always have to do things?’” Ecker said. “I think this says, ‘You’re right. We agree that we don’t want to telegraph to patients and providers that intervention is always better.’”