ACOG Encouraging Limited Interventions: Updated

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). 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.”

Many of the original recommendations remain the same, outlined in our previous post.

A few key changes include:

  • The addition that continuous IV fluids are not usually necessary.
  • For women giving birth for the first time and using an epidural, ACOG cites increased risks for waiting to push (sometimes called "laboring down"). The new recommendation is to begin actively pushing at complete dilation. This is a reversal from the original recommendation.
  • The addition of techniques to include parents in cesarean births, such as leaving arms free, providing a view of the birth, and early skin-to-skin time.

The goal of the updated Opinion is “to ensure that the...care provider carefully selects and tailors labor interventions to meet clinical safety requirements and the individual woman’s preferences.” In other words, the emphasis is for providers to individualize care. Many of the recommendations given to care providers are for full-term, low-risk women in spontaneous labor.

A summary of recommendations to increase health and satisfaction:

  • Shared decision-making between providers and parents
  • Continuous one-to-one emotional support (such as that provided by a doula)
  • No need to routinely break the water or run IV fluids
  • Intermittent monitoring, movement and position changes
  • Support a wide range of both medical and non-medical comfort measures
  • Offer family-centered amenities and options, recognizing that mothers/families should be included in the birthing process (including cesarean birth)

Incorporate this information into your classes:

Many of us have already been teaching this information to parents, so you may not have to make a big adjustment to your lesson plans. Instead, you can add this updated Committee Opinion as a new resource and point out that care providers may take many years to put these recommendations into practice, so it is important for parents to ask questions and get to know their provider's approach.

Birth Choices, the brand new book from Plumtree Baby, includes these recommendations, as well as a reference to the full text Committee Opinion for families who want to go into even more depth. Birth Choices can be used to teach a class on planning and communicating for birth, or it can be given to expectant parents as an at-home, interactive guide to simplify and inform their goals and plans for birth. Take a look at a preview and see for yourself!

 


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