ACOG Takes “Less Is More” Approach for Low-Risk Moms in Labor

By Jess Sinrich | Published January 26th, 2017 on What To Expect | Featuring Dr. Sherry Ross

The American College of Obstetricians and Gynecologists just released new guidelines encouraging OB/GYNs and other maternity care providers to limit the use of medical interventions during labor and delivery for low-risk moms.

This is likely coming off the heels of recent studies, one which found that extending the amount of time women are allowed to spend in active labor may cut the risk of C-section in half. With the U.S. C-section rate at 32.2 percent, more than double the ideal rate recommended by the World Health Organization, updating these labor and delivery guidelines is a step in the right direction. Another study found that continuous emotional support during labor, provided by trained labor coaches such as doulas, is associated with improved birth outcomes, including shortened labor and fewer C-section and operative deliveries.

“We’re seeing that more women want a natural and laid-back experience during childbirth,” said Sherry Ross, MD, OB/GYN, women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. “So these new guidelines allow healthy, low-risk women a better chance at experiencing that with less doctor and hospital involvement.”

In general, “low risk” means that you’re in good health, have had an uncomplicated pregnancy and are assumably having only one baby (multiples are always in the high-risk category). Since the majority of pregnancies fall under the low-risk category, these new guidelines will ensure that more and more doctors and hospitals will begin to embrace measures that limit intervention when appropriate.

WHAT IS RECOMMENDED IN THE NEW GUIDELINES

  • Patients and their providers may consider delaying hospital admission until the patient is five to six centimeters dilated, as long as she and baby are both doing well and she’s experienced an uncomplicated pregnancy thus far.
  • Labor induction may be delayed and potentially avoided in cases where the patient is progressing normally and does not require internal fetal monitoring, and when there are no maternal or fetal reasons to expedite delivery.
  • For women who are progressing normally and do not require internal fetal monitoring, it may not be necessary to rupture the amniotic sac. In the case where a woman at term experiences a premature rupture of membranes, patients and providers may consider planning a short period of expectant management before undertaking labor induction if there are no maternal or fetal reasons to expedite delivery.
  • In addition to considering use of medications, practitioners are also encouraged to offer patients coping and relaxation techniques such as massage or water immersion in the first stage of labor.
  • Practitioners should offer patients the option for intermittent use of fetal heart rate monitoring when appropriate, as opposed to continuous, which can often limit the patient’s ability to move around, walk or practice certain positions during labor. This encourages women to choose a pushing technique they feel most comfortable with.

WHAT THIS MEANS FOR YOU

While the majority of pregnancies are considered to be low-risk, it’s important for your practitioner to know where you stand so he or she can anticipate the best course of action for your labor. If you are low-risk and continue to remain low-risk throughout your pregnancy, as well as during labor and delivery, these new guidelines from ACOG will only give you and your birth practitioner more freedom to use less aggressive interventions and more emotional support.

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