Approaches To Limit Intervention During Labor And Birth

by Bonita Katz, BA RN ICCE ICBD IAT CLC

For most women the childbearing process is a healthy one.  The American College of Obstetricians and Gynecologists (ACOG) recognized this and encouraged fewer interventions with the publication of their Opinion #687 “Approaches to Limit Intervention during Labor and Birth” first published in February 2017.  A recent update to that opinion offers even stronger support for fewer interventions and for family-centered care.

Doula Care

Although the earlier edition of this opinion recognized the benefits of doula care, the 2019 update takes note of the potential cost-savings that doulas provide.  Labor support by a skilled birth attendant has been shown to lower the cesarean rate.  For this reason this committee suggests that “…obstetric care providers and health care organizations may want to develop programs and policies to integrate trained support personnel into the intrapartum care environment to provide continuous one-to-one emotional support to women undergoing labor.”

Coping with Labor Pain

Rather than using the traditional pain scale the committee suggests using the pain coping scale, recognizing that it is difficult to quantify labor pain (especially if you have never experienced labor before). When a woman estimates her ability to cope with the pain she gives the caregiver more pertinent information.

Positions during Labor

Additionally, the opinion cites evidence that a variety of positions may be helpful in labor.  Risks of the traditional supine position are noted as are the benefits of upright positions. Women should be encouraged to find positions that are most comfortable for them and that encourage optimal fetal positioning.

Pushing Techniques

This committee opinion questions the value of the Valsalva maneuver (closed glottis, holding the breath) during the second stage of labor.  Although this is common practice in the US no significant evidence exists to support this. Women are encouraged to use the breathing method that they prefer.

Although not an explicit emphasis, this committee opinion frequently refers to the mother’s emotional well-being.  We applaud this recognition of birth as not only a healthy physical process, but also a deeply emotional event in the life of a woman – and of the entire family. This reflects ICEA’s long-held philosophy. Lowering the rate of unnecessary interventions brings us closer to achieving ICEA’s vision: a nurtured world through professionals trained in family-centered maternity and newborn care.