We’ve known for some time now that the cascade of interventions can contribute to an abnormally high rate of cesarean section deliveries.  Not that the life saving technique doesn’t have it’s place, but with their recent committee opinion, ACOG seems to be acknowledging that just because interventions are available doesn’t mean they may be the best option.







cascade effect of OB intervention

In its abstract, ACOG encourages OB-GYNs to collaborate with midwives, nurses, the patients themselves and their support team (doula) to promote the use of labor techniques that “are associated with minimal interventions and high rates of patient satisfaction.”

Data suggest that in women with normally progressing labor and no evidence of fetal compromise, routine amniotomy is not necessary. The widespread use of continuous electronic fetal heart-rate monitoring has not improved outcomes when used for women with low-risk pregnancies. Multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. For most women, no one position needs to be mandated nor proscribed. Nulliparous women who have an epidural and no indication for expeditious delivery may be offered a period of rest for 1–2 hours before initiating pushing efforts. Obstetrician–gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches for the intrapartum management of low-risk women in spontaneous labor [emphasis added].

If you’ve taken my Lamaze class, you’ve seen one of my favorite videos (“Birth by the Numbers’ – see below).  You’re also familiar with Healthy Birth Practices that do not require medical intervention and are best for managing labor of women who are having a low-risk pregnancy.  All of these are things that ACOG discusses in it’s opinion:


Source: Approaches to Limit Intervention During Labor and Birth – ACOG