In February 2017, the American College of Obstetricians and Gynecologists published a Committee Opinion titled “Approaches to Limit Intervention During Labor and Birth” (Number 687). In February 2019, this document was updated (Number 766) and has been reaffirmed in 2021.
The revisions were done “to incorporate new evidence for risks and benefits of several of these techniques and, given the growing interest on the topic, to incorporate information on a family-centered approach to cesarean birth.”
These recommendations reflect an important shift toward evidence-based, individualized care. ACOG recognizes that many common obstetric practices offer limited or uncertain benefit for low-risk women in spontaneous labor, and that reducing unnecessary interventions can improve outcomes and birth experiences for both mothers and babies.
What This Means for Care During Labor and Birth
The updated Opinion continues to emphasize that care should be tailored to each woman’s needs, preferences, and clinical situation. For healthy, low-risk women at full term, this includes:
Early Labor and Admission
If a mother and baby are healthy and labor is still in early labor, admission to the hospital may be delayed. In this case, care providers should offer support, maintain contact, and suggest pain management methods that do not involve drugs.
This means that healthy mothers with typical pregnancies can often remain at home and should be given guidance from their care providers while they cope. The committee cites studies showing that admission during early labor is associated with a higher use of interventions, and some studies have found a higher rate of cesarean birth.
Shared Decision-Making and Individualized Care
A mother who goes into labor on her own at full term should be given individualized care, including choices around monitoring, pain management, and interventions.
This means the mother should be actively involved in making decisions about her care. Evidence shows that outcomes improve when a woman is informed, supported, and given options throughout labor.
Labor Support and Comfort Measures
Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor.
Mothers should also be offered non-medical comfort measures such as movement, massage, hydration, and position changes, along with a full range of pain management options.
This means that drugs do not have to be the first response to discomfort. A mother should be supported, kept hydrated, and given options to manage pain in ways that work best for her.
Movement and Positioning
Frequent position changes during labor can enhance comfort and help the baby move into an optimal position for birth.
This means that not only will a mother often feel more comfortable if she moves around, but doing so can also support the progress of labor.
Interventions and Monitoring
For low-risk women, intermittent fetal monitoring is appropriate instead of continuous monitoring. Routine amniotomy (breaking the water) is not necessary unless clinically indicated, and continuous IV fluids are not usually required (updated recommendation).
To support this approach, care providers and facilities should be trained to use hand-held Doppler devices for intermittent monitoring.
This means that low-risk mothers do not need routine, continuous intervention and can safely experience more freedom of movement during labor.
Rupture of Membranes (Water Breaking)
When a mother’s water breaks at term (PROM), care providers should recommend labor induction if she is a candidate for vaginal birth. However, after appropriate counseling, some women may choose expectant management for a limited time (typically 12-24 hours) if there are no other maternal or fetal reasons to move toward delivery more quickly.
This means that the care provider should discuss a woman’s individual situation, preferences, and the possible risks of waiting. For women who are Group B Strep positive, antibiotics should not be delayed while waiting for labor to begin, and many patients and providers may prefer immediate induction.
Pushing and Second Stage Labor
When not coached to breathe in a specific way, women naturally push in the way that feels most effective for them. Each woman should be encouraged to use the technique that works best for her.
Updated guidance: For first-time mothers with an epidural, ACOG now recommends beginning active pushing at full dilation rather than delaying. This is a change from the earlier recommendation that allowed time to rest before pushing.
Family-Centered Cesarean Birth (New Addition)
The updated Opinion includes recommendations to make cesarean births more family-centered, such as allowing a view of the birth, keeping the mother’s arms free, and encouraging early skin-to-skin contact.
This means that even when a cesarean birth is needed, families can be more involved and the experience can be made more personal and supportive.
Key Takeaways
ACOG’s updated guidance continues to support a lower-intervention approach for low-risk labor while incorporating new evidence and more patient-centered practices.
A summary of recommendations to increase health and satisfaction:
- Shared decision-making between providers and parents
- Continuous one-to-one emotional support
- Routine interventions such as continuous IV fluids or amniotomy are not required for women with normally progressing labor
- Intermittent monitoring, along with movement and position changes
- Support for both medical and non-medical comfort measures
- Inclusion of family-centered options, including during cesarean birth when safely possible
Overall, the goal is for care providers to carefully select and tailor interventions based on clinical needs and each woman’s preferences.
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Revised March 25, 2026
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