Six ACOG Guidelines to Reduce Interventions
To best support our clients, Dara and I are always reading the latest research and recommendations, so that we can then share that same information with our clients.
In February 2017, the American College of Obstetricians and Gynecologists (ACOG) released a new Committee Opinion on Approaches to Reduce Interventions During Labor and Birth. It's definitely worth reading yourself and not too terribly technical, but for those interested in a clear synopsis, I have written out the six main points of the article. These six key points are important to know about so that you can advocate to receive evidence-based care.
Labor At Home Until Active Labor
First off, it should first be noted that in recent years, the definition of active labor has changed from 4cm to 6cm. This then means that clients should be prepared to labor A LOT outside of the hospital (24 hours is normal for this stage). ACOG recognizes that for low-risk pregnant women, intervention is much more likely to be avoided if they are first admitted to the hospital, already in active labor.
Active and Expectant Management of PROM for Term Pregnancies
Ok, the basics: PROM stands for premature rupture of membranes. Did you know that the release of membranes before contractions have begun only occurs about 10% of the time? But when it does occur, best practices have shown that outcomes both for the parent and the newborn is about the same, whether the parent stays home for 24+ hours and waits for labor to start spontaneously (expectant management), or heads to the hospital to begin an induction (active management). Clients need to know that they have the choice of waiting or going in. I should note here that this does not pertain to those clients who are GBS+ where an induction of labor may be appropriate.
Intermittent Fetal Heart Rate Monitoring
ACOG now recognizes the evidence that intermittent fetal monitoring is appropriate for low-risk labors, and prevents unnecessary interventions.
Artificial Rupture of Membranes (AROM)
ACOG now recognizes that artificially breaking the waters has little benefit and may actually increase the likelihood of complications.
Eat and Drink During Labor
ACOG recognizes that drinking during labor is preferable to IV hydration. Also, risks of eating during labor are almost non-existent and in fact it helps keep a pregnant person strong and energized.
Labor Down and Push With the Urge
We often hear that 10cm is the goal; it means you are complete and ready to push! But the uterus is strong, and can move baby down the birth canal on its own. Only when the pregnant person has the urge to push, should they begin to push. Also, rather than holding the breath and being told how long to push, it is recognized that blowing out, or sounding while pushing is more beneficial.
That about wraps it up! Here again is the link to the ACOG Committee Opinion.