The American College of Obstetricians and Gynecologists (ACOG) recently updated their recommendations about monitoring and care for women in labor. With the new recommendations, the common picture of a laboring mother stuck on her back with continuous monitors will hopefully change.
So what are the new recommendations?
- The management of labor can be individualized for low-risk women who naturally began labor with a baby who is head down. This can include offering intermittent monitoring and offering forms of non-medical pain relief.
- A woman in the latent (early) phase of labor does not have to be admitted right away if the baby is doing ok. The care provider can offer frequent check-ins instead, which can keep the mother more independent and comfortable. The care provider can also suggest methods of non-medical pain relief.
- If a woman is admitted in early labor due to fatigue or pain, she should be offered education, non-medical pain relief methods, changing positions for comfort, and further support. Specifically, this includes allowing the woman to drink liquids during labor and utilizing non-medical pain relief methods such as massage and allowing the mother to relax in a tub or birth pool.
- If a woman's water breaks, but labor does not start in the next hour, then the mother may choose to wait and see what happens instead of needing to be quickly induced. In order for the woman to make this choice, she should understand that there is limited data to show how safe this expectant management is, and she should understand any associated risks. If the woman does understand and still makes this choice, then her decision should be supported.
- Evidence has shown that one-on-one continuous support (not including nursing support) improves labor outcomes. Sound familiar? This is exactly what a doula provides- continuous support!
- As long as labor is progressing normally and the baby is tolerating labor well, then there is no reason to artificially break the amniotic sac (in other words, don't make the water break)
- In order to help facilitate offering an intermittent monitoring option, staff should be trained in how to use a hand-held Doppler device.
- Pain relief can be tailored to the individual woman by using both non-medical and medical methods of pain relief.
- Women should be permitted to move around during labor since frequent position changes can help the mother's comfort while allowing baby to find the best position. However, movements may be limited if treatments or further monitoring is necessary.
- Coached pushing should not be expected of every woman. It is now recognized that many women push better by following instincts than they do by following coaching orders. The pushing technique used should be whichever works more effectively for the woman.
- Unless the baby needs to be born quickly, the mother should be offered a chance to rest if she wishes before she begins the pushing stage. Women who do not have an urge to push and women who have an Epidural can greatly benefit by resting. If a woman has the urge to push, then she may go ahead and do so.
The new recommendations may seem a bit overwhelming, but they are a great step towards offering women evidence-based individualized care. Although there will always be room for improvement, and new research will always bring some changes, these new recommendations should go a long way towards improving care for laboring women.