Approaches for Ob-gyns and Maternity Care Providers to Limit Intervention During Labor and Birth in Low-Risk Pregnancies

ACOG released new guidance advising providers to consider “low tech, high touch” approach to care for low-risk women.  The Midwifery Model of Care as delivered in the birth center setting has studied this approach, and our data also supports the low-intervention approach as providing a SAFER model of care, avoiding the risk of unnecessary intervention.  It is wonderful to see ACOG endorsing this evidence-based model, and also acknowledging that emotional support is an important factor in providing safe standard of maternal care.  Bravo, ACOG!

From their press release:

“Practitioners always put the best interests of moms and babies at the forefront of all their medical decision-making, but in many cases those interests will be served with only limited intervention or use of technology,” said Committee Opinion author, Jeffrey L. Ecker, M.D., chief of the Obstetrics & Gynecology department at Massachusetts General Hospital. “These new recommendations offer providers an opportunity to reexamine the necessity of obstetric practices that may have uncertain benefit among low-risk women. When appropriate, providers are encouraged to consider using low-intervention approaches that have been associated with healthy outcomes and may increase a woman’s satisfaction with her birth experience.”

What constitutes “low-risk” will vary depending on a laboring woman’s condition and medical circumstances but generally involves a clinical scenario in which a woman presents at term in spontaneous labor and has had an uncomplicated course of prenatal care. For such women in the early stages of labor with reassuring maternal and fetal status, patients and providers may consider delayed hospital admission until approximately five to six centimeters dilated. Also, for women who are progressing normally and do not require internal fetal monitoring, it may not be necessary to rupture the amniotic sac. In the case where a woman at term experiences premature rupture of membranes, patients and providers may consider planning a short period of expectant management before undertaking labor induction if there are no maternal or fetal reasons to expedite delivery.

The recommendations also suggest that women benefit from continuous emotional support and the use of non-pharmacologic methods to manage pain. Support offered by trained labor coaches such as doulas has been associated with improved birth outcomes, including shortened labor and fewer operative deliveries. In addition to considering use of medications or epidural anesthesia to manage pain in labor, practitioners are encouraged to offer women coping techniques, such as massage, water immersion in the first stage of labor, or relaxation techniques. Recognizing that the complete absence and elimination of pain is not what all women value, use of a coping scale rather than pain scale is recommended to evaluate the multifactorial experience of labor.

The Committee Opinion, “Approaches to Limit Intervention During Labor and Birth,” #687, will be available in the February 2017 issue of Obstetrics and Gynecology.

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