In February 2013, the American Congress of Obstetricians and Gynecologists released a list of five things physicians and patients should question, as part of their “Choosing Wisely” campaign.
In March of 2016, they added five more evidence-based recommendations to encourage physicians and patients to make wise decisions for their healthcare. Four out of the ten procedures addressed directly impact the care being offered to pregnant women.
Here they are:
1. ACOG does not recommend elective, non-medically indicated induction of labor before 39 weeks.
Research is convincing more care providers that waiting for labor to start naturally is important. Dr. Mendelson at UT Southwestern Medical Center in Dallas says, “We found that a protein within lung surfactant serves as a hormone of labor that signals to the mother’s uterus when the fetal lungs are sufficiently mature to withstand the critical transition to air breathing.” Some insurance companies are changing their coverage of early elective inductions, as well, as they become aware of risks to mothers and babies. ACOG itself sites “increased risk of learning disabilities and a potential increase in morbidity and mortality” for delivery prior to 39 weeks
2. ACOG does not recommend elective, non-medically indicated inductions of labor between 39 weeks and 41 weeks unless the cervix is deemed favorable.
According to this study, a woman is more likely to have a cesarean when induced if she has a low Bishop Score. This test checks five factors: cervical dilation, cervical effacement, cervical consistency, cervical position and fetal station. If a woman is given a score of less than 8, she is not likely to achieve a vaginal birth.
3. ACOG doesn’t recommend performing prenatal ultrasounds for non-medical purposes.
ACOG suggests that while ultrasounds for medical tests are deemed safe, they do not suggest them solely for keepsake photos or videos. This article suggests more testing is needed to ensure the safety of prenatal ultrasounds.
4. ACOG does not routinely recommend activity restriction or bed rest during pregnancy for any indication.
This research shows many side-effects of bed rest during pregnancy including: “muscle atrophy, bone loss, maternal weight loss and decreased infant birthweight in singleton gestations, and psychosocial problems including depression, anxiety, stress, family disruption and financial burden.” ACOG states plainly that “information to date does not show an improvement in birth outcome with the use of bed rest or activity restriction.”