It is estimated around 97% of women who give birth in hospitals will have some form of intervention during labour.
These interventions range from procedures such as continuous fetal monitoring, and routine vaginal exams, to inductions, episiotomies, and c-sections.
Most of these women have had healthy, low-risk pregnancies, and should have uncomplicated labours and births.
In spite of this, the induction and c-section rates in many high income countries are continuing to rise.
Reducing Unnecessary Birth Interventions For Low Risk Women
For some time, health experts have warned that many, if not most, of these interventions are unnecessary.
The American College of Obstetricians and Gynecologists (ACOG) has released new guidance for maternity care providers, suggesting they consider labour and birth approaches that encourage normal labour, and limit medical intervention in low risk pregnancies.
What Does ACOG Recommend?
The guidelines underpin what has been known for some time: interfering with birth and using a one-size-fits-all approach doesn’t benefit all women and babies.
These are some of ACOG’s conclusions and recommendations:
- One to one emotional support, such as that of a professional birth doula or a known midwife, has been shown to improve outcomes for women.
- Admission to hospital to be delayed, when the woman and baby are doing well.
- Intermittent fetal heart rate monitoring to be used, rather than routine continuous monitoring. Maternity care providers should be equipped with handheld Doppler devices, and trained in their use.
- Women who are experiencing pain or fatigue in early labour to be provided with support techniques, including massage, water immersion, and positions of comfort; this reduces the early use of drug-based pain relief.
- Routine rupturing of membranes is not necessary in a normally progressing labour, where there are no signs of fetal distress.
- Coached or ‘purple’ pushing during second stage is unnecessary; during this stage women should adopt the techniques they feel most comfortable with.
- Unless there is a medical emergency requiring the immediate birth of the baby, a rest period of 1-2 hours between full dilation and pushing is normal and should be supported, especially when an epidural is in place.
- Position changes are recommended, to encourage optimal fetal positioning, and provide maternal relief during labour.
What Does This Mean?
The ACOG Committee Opinion has been endorsed by The American College of Nurse–Midwives, and The Association of Women’s Health, Obstetric and Neonatal Nurses.
The guidance points out that many routine and common obstetric practices have limited or uncertain benefit for women who are low risk and have not been induced.
Beginning with one ‘routine’ procedure, such as continuous fetal monitoring or induction for post dates, interventions often escalate, whether or not there is any medical need for these procedures, and regardless of whether they are evidence-based practice.
Once we interfere with the normal process of labour, further interventions are usually needed. Keeping contractions going after they have been artificially started, monitoring baby’s health, requiring a labouring woman to be positioned on the bed – all these procedures lead to what is known as a cascade of interventions.
One to one emotional support, from doulas or known midwives, has been shown to reduce interventions. A Cochrane Review found women who had continuous support during labour were significantly less likely to have a c-section, a forceps or vacuum birth, epidural, induction, or prolonged labour.
You can read more about doula support.
The overall message from ACOG is that maternity care providers should consider each individual labour, and work collaboratively with the birthing woman to minimise unnecessary interventions.
Fewer interventions can mean better care for women who have had a healthy, low risk pregnancy. They are more likely to go into labour spontaneously, have improved birth outcomes, and be more satisfied with their birth experience.
Future pregnancies and births will also be affected. Women who have positive birth experiences and avoid unnecessary birth interventions are more likely to go on to have positive birth outcomes for subsequent pregnancies.