tooby3 (tooby3) wrote,
tooby3
tooby3

ACOG finally catching up

I'll high five them, even though the length of time it took to arrive to this point is deplorable. But in case you missed it, take note of ACOG's new guidelines. They've finally acknowledged what the natural birth and midwifery communities have been saying (to EXTREME criticism I'll add) for years.

To share a few:
Slow Labors Are Normal, Don't admit til 6 cms: Slow but progressive labor in the first stage should not be an indication for cesarean. With a few exceptions, neither should prolonged latent phase (greater than 20 hours in a first time mother and greater than 14 hours in multiparous women) should not be an indication for cesarean.
Relearn how to use forceps: Instrument delivery can reduce the need for cesarean. The authors note concern that many obstetric residents do not feel competent to do a forceps delivery.
Stop Freaking about the Fetal Monitoring: Recurrent variable decelerations appear to be physiologic response to repetitive compressions of the umbilical cord and don't mean dead baby is imminent. There is an in depth discussion of fetal heart rate patterns and interventions other than cesarean to deal with this clinically.
No Inductions before 41 0/7 weeks unless there are maternal or fetal indications. Induction of labor can increase the risk of cesarean.
No more "Big Baby" Card from U/S, in fact late term U/S is Useless: Ultrasound done late in pregnancy is associated with an increase in cesareans with no evidence of neonatal benefit. Macrosomia is not an indication for cesarean.
Doulas Matter: Continuous labor support, including support provided by doulas, is one of the most effective ways to decrease the cesarean rate. The authors note that this resource is probably underutilized.


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