New guidelines recommend hands-off pregnancies

By TREA WESSEL

The January 25, 2017, issue of the MedPage Today published an article on new guidelines suggesting that less intervention in low-risk births is better. A similar articles based upon the same guidelines also appeared in a number of publications including the Huffington Post.

The American College of Obstetricians and Gynecologists (ACOG), which represents over 58,000 members, put out a release titled, "Approaches for Ob-gyns and Maternity Care Providers to Limit Intervention During Labor and Birth in Low-Risk Pregnancies." This release brings new guidelines that emphasis less medical interference with the birth process.

There has been much written over the past few years suggesting that the birth process has moved from a natural and normal process to a medical procedure. The discussion of how much intervention is really needed for a safe and normal birth has left many expectant mothers confused.
The ACOG has attempted to decrease the intervention at childbirth by issuing new guidelines for low-risk births. The new recommendations have also been endorsed by American College of Nurse-Midwives and the Association of Women's Health, Obstetric and Neonatal Nurses.

The new guidelines include the following:
•Consider allowing low-risk women to labor at home on their own for longer.
•Avoid rupturing the amniotic sac if a woman is progressing normally.
•Avoid constant fetal heart rate monitoring when appropriate to allow women to move around.
•Allow women to switch positions and push in whatever manner works best for them during labor.
•Offer women non-pharmacologic pain relief techniques.

In prefacing the guidelines committee opinion author, Jeffrey L. Ecker, M.D., chief of the Obstetrics & Gynecology department at Massachusetts General Hospital stated, "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. Dr. Ecker continued, "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."

The conclusion of the ACOG sums up the new guidelines, "Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. In addition, some women may seek to reduce medical interventions during labor and delivery. Satisfaction with one's birth experience also is related to personal expectations, support from caregivers, quality of the patient-caregiver relationship, and the patient's involvement in decision making. Therefore, obstetrician-gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches, when appropriate, for the intrapartum management of low-risk women in spontaneous labor."

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