New Recommendations for Less Interventions During Birth Line up with Lamaze!

On Wednesday this week, the American College of Obstetricians and Gynecologists (ACOG), which is the non-profit organization responsible for researching, reviewing, and releasing current and new practice guidelines for OBs, released new recommendations (called a "Committee Opinion") called "Approaches to Limit Intervention During Labor and Birth." The opinion paper issues several recommendations that call for fewer interventions during labor and birth for low-risk people. The recommendations reduce many of the commonly used obstetric interventions that have little or questionable benefits, as well as increase a person's satisfaction with their birth experience.

For maternal-child health advocates who practice and teach evidence-based information about safe and healthy birth, these new recommendations coming from a widely respected and followed practitioner organization is important and exciting! What's more, is that the recommendations fall in line perfectly with the Lamaze Six Healthy Birth Practices, which were researched and created several years ago in an effort to teach families about the most important practices that can lead to healthier births. Read below to see my summary of the new ACOG recommendations from "Approaches to Limit Intervention During Labor and Birth" and how they fall in with the Lamaze Six Healthy Birth Practices.

Lamaze Healthy Birth Practice: Let Labor Begin on Its Own

New ACOG Recommendation:

• Those who experience premature rupture of membranes at the end of pregnancy (in other words, water has broken, but labor has not started), should be provided an appropriate period of time to let labor begin on its own (which it usually does) before inducing unless there are other complications.

Lamaze Healthy Birth Practice: Walk, Move Around and Change Positions Throughout Labor

New ACOG Recommendations:

• Pain and fatigue in early labor can be addressed with education, support, hydration with water, position changes for comfort, massage, and laboring in water.
• More facilities should train staff to use a hand-held Doppler (monitoring) device for those who are low-risk and desire intermittent (rather than continuous) monitoring.
• Frequent position changes during labor increase comfort and help baby get into the best position for birth and should be encouraged as long as they do not conflict with any complications or interfere with necessary interventions.

Lamaze Healthy Birth Practice: Bring a Loved One, Friend or Doula for Continuous Support

New ACOG Recommendation:

• Continuous one-on-one emotional support (like that provided from a doula) is associated with improved outcomes in labor.

Lamaze Healthy Birth Practice: Avoid Interventions that Are Not Medically Necessary

New ACOG Recommendations:

• In a full-term pregnancy, when baby is head down, and labor begins on it's own, intermittent monitoring and non-medicinal pain relief methods should be offered.
• If mother and baby are healthy and doing well and are in the early stages of labor, they can wait to be admitted to the hospital and instead labor at home with frequent contact and support and non-medicinal pain management measures.
• If labor is progressing normally and baby is doing well, routinely breaking your water does not need to take place unless you require internal fetal monitoring.
• OBs and other care providers can best manage pain when using the coping scale in conjunction with non-medicinal and medicinal pain management techniques, according to the needs of each person.

Lamaze Healthy Birth Practice: Avoid Giving Birth on Your Back and Follow Your Body's Urges to Push

New ACOG Recommendations:

• When pushing during birth, a person will naturally push with an open glottis (pushing while grunting/making noises and taking intermittent breaths). Instead of bring coached to breathe a certain way and pushing with a closed glottis/valsava pushing (pushing while holding breath for 10 seconds), every person should be encouraged to use the technique that is preferred and most effective.
• Unless mom or baby need to give birth quickly for health reasons, a laboring person should be offered 1-2 hours to "labor down" at the beginning of the pushing stage (unless the urge to bear down/push happens sooner). This is especially true for those giving birth for the first time with an epidural.

Lamaze Healthy Birth Practice: Keep Mother and Baby Together -- It's Best for Mother, Baby and Breastfeeding

New ACOG Recommendations:

ACOG did not specifically address anything related to skin-to-skin care or separation of mothers and babies. However, many of the interventions that were addressed could lead to complications that require mother and baby to be separated.

Please, check out the ACOG Committe Opinion paper and read it for yourself in full. This is an exciting time for those of us in the field and for those who will benefit from improved care practices. If you are currently pregnant, I encourage you to take some time to discuss these new recommendations with your care provider. Does he follow them already? If so, great! If not, find out more and consider whether a new provider would be best for you.

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