Recent recommendations by the American Congress of Obstetricians and Gynecologists (ACOG) show a movement toward less intervention when it comes to women giving birth, as well as the inclusion of professionals like doulas for better maternal outcomes.
The association continues to make progress toward family-centric births, as well as mother-centered with fewer recommendations for intervention, as well as a push for limited interventions during the childbirth process.
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 impacted the care being offered to pregnant women.
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.”
And, in December of 2018, ACOG updated recommendations that suggested more approaches that would limit intervention during labor and birth.
1. “When women are observed or admitted for pain or fatigue in latent labor, techniques such as education and support, oral hydration, positions of comfort, and nonpharmacologic pain management techniques such as massage or water immersion may be beneficial.”
The committee recommends that alternative methods of pain relief and/or fatigue for women who are in labor also include comfortable positions, oral hydration, support and education. This recommendation suggests that massage and water immersion may be beneficial, and all we want to ask ACOG to do is repeat that louder for ALL to hear! Too often women are tricked into believing there’s only one way to manage labor pain, and that’s pharmacology. While we know that pharmacological interventions do have their place, we agree with ACOG in that they shouldn’t always be first place.
2. “Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.”
In the same vein that alternative pain relief methods may be beneficial to laboring women, ACOG also acknowledges evidence that supports the help of doulas in the child birthing process can lead to improved outcomes for both mother and baby. They of course advocate for regular nursing care, but value the work of doulas who give one-to-one emotional support and help with more than just the clinical aspect of pregnancy.
3. “Frequent position changes during labor to enhance maternal comfort and promote optimal fetal positioning can be supported as long as adopted positions allow appropriate maternal and fetal monitoring and treatments and are not contraindicated by maternal medical or obstetric complications.”
Finally. We’re all on the same page that laying in a bed with stirrups is not necessarily the most comforting for a laboring mother, nor does it really enhance fetal positioning. Why defy gravity? Why work against Mother Nature? Yes, sometimes monitoring and treatments require certain positions for mama’s and baby’s safety, but more often than not? Mothers and babies who work with their bodies tend to have better outcomes and satisfaction with the birthing process.
4. “For women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring.”
That’s code for: breaking a woman’s water to hurry things along doesn’t need to happen. Our waters break when we are ready to give birth, and unless there is a reason (and again, mamas, we must and do understand that sometimes, there are reasons and they’re not our fault) for your clinician to break your water, you should just let it be. And heck, you may even be a mama who gives birth with baby en caul. Yes, it does happen and yes, it’s freaking amazing!
5. “Birthing units should carefully consider adding family-centric interventions (such as lowered or clear drapes at cesarean delivery) that are otherwise not already considered routine care and that can be safely offered, given available environmental resources and staffing models. These family-centric interventions should be provided in recognition of the value of inclusion in the birthing process for many women and their families, irrespective of delivery mode.”
Again, YAY! We’re all about inclusion in all things, particularly in the birthing process, and we love that ACOG sees the value of making sure mamas and their supportive families are truly involved as a new human joins the crew. Even in situations where it’s medically indicated to have a cesarean delivery, they recommend making it routine for the drapes to be lowered or clear so mama can have as much engagement as she can.