Committee Opinion author, Jeffrey L. Ecker, M.D., writes the best interests of moms and babies can be served with only limited intervention or use of technology 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.”
“For such women in the early stages of labor with reassuring maternal and fetal status, patients and providers may consider delayed hospital admission until approximately five to six centimeters dilated.” This is in line with ACOG’s previous revision of what is considered “active labor” (5cm for multiparous women – those who have previously given birth, and 6cm for nulliparous women – first time mothers). This designation was part of the advisory on preventing the first-time cesarean and re-classifying “active labor” past the previous 3-4 centimeters dilation to prevent unnecessary surgery for “failure to progress” with reassuring maternal and fetal status.
As for the standard practice of breaking the bag of waters, ACOG now advises that “for women who are progressing normally and do not require internal fetal monitoring, it may not be necessary to rupture the amniotic sac.” ACOG also now advises, “In the case where a woman at term experiences premature rupture of membranes (spontaneous rupture of the bag of waters prior to the beginning of labor), 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.”
And lastly, the recommendations again state that “women benefit from continuous emotional support and the use of non-pharmacologic methods to manage pain. Support offered by trained labor coaches such as doulas has been associated with improved birth outcomes, including shortened labor and fewer operative deliveries.”
Thank you, ACOG, for continuing to see the value in experienced, professional labor support!
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