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Labor & Delivery: Resource Overview

In preparation for labor and delivery, a woman must work closely with her health care provider on such matters as whether to have a vaginal or cesarean delivery, pain management, and recognizing the signs of labor. Ob-gyns, physicians whose primary responsibility is women’s health, are dedicated to providing patients the most current information and treatments during pregnancy and childbirth.

Here are the key publications and resources for ob-gyns, other women’s health care providers, and patients from the American College of Obstetricians and Gynecologists (ACOG) and other sources.

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Resources for Ob-Gyns and Women’s Health Care Providers
Resources for Women and Patients
External Organizations

Resources for Ob-Gyns and Women’s Health Care Providers

Practice Bulletin: Operative Vaginal Delivery (members only)

“Operative Vaginal Delivery,” issued by ACOG in November 2015, addresses circumstances in which operative vaginal delivery may be indicated and makes recommendations regarding the use of forceps and vacuum extractors for delivery.

Obstetric Care Consensus: Levels of Maternal Care

Levels of Maternal Care, issued jointly by the Society for Maternal-Fetal Medicine (SMFM) and ACOG in February 2015, recommends uniform designations of maternal care for facilities that provide antepartum, intrapartum, and postpartum care for the pregnant woman. “Levels of Maternal Care” builds on the 1976 March of Dimes report “Towards Improving the Outcome of Pregnancy,” which articulated the concept of an integrated system of regionalized perinatal care. However, “Levels of Maternal Care” is unique in its efforts to specifically address maternal care, which refers to all aspects of antepartum, intrapartum, and postpartum care of the pregnant woman.

Committee Opinion: Immersion in Water During Labor & Delivery

“Immersion in Water During Labor & Delivery,” issued by ACOG in April 2014,  concludes that immersion in water during the first stage of labor may be associated with decreased pain and labor duration. However, immersion in the second stage of labor has not been associated with maternal or fetal benefits, and case reports of rare but serious adverse effects in the newborn have been reported, so it should be considered experimental. For facilities that plan to offer immersion for the first stage of labor, the Committee Opinion lists rigorous protocols that should be implemented, such as candidate selection, equipment maintenance, infection control, and maternal and fetal monitoring.

Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery

“Safe Prevention of the Primary Cesarean Delivery,” issued jointly by the Society for Maternal-Fetal Medicine (SMFM) and ACOG in March 2014, presents data on the increase of primary cesarean deliveries in the United States, as well as approaches in specific circumstances to safely reduce the rate of this procedure. It includes national and state-by-state data, maternal and neonatal risks and benefits, indications for primary cesarean deliveries, and the challenges in changing cultural and professional attitudes.

Committee Opinion: Definition of “Term Pregnancy”

“Definition of 'Term Pregnancy,'” issued by ACOG in November 2013, explains that ob-gyns are discouraging use of the phrase “term pregnancy” in favor of more specific labels—early term, full term, late term, and postterm—to improve newborn outcomes and expand efforts to prevent nonmedically indicated deliveries before 39 weeks.

Committee Opinion: Cesarean Delivery on Maternal Request

“Cesarean Delivery on Maternal Request,” issued by ACOG in April 2013, offers evidence-based guidelines for primary prelabor cesarean delivery on maternal request. It provides research on risks to both mother and child, physical and psychological factors in decision making, and topics for patient counseling. In the absence of maternal or fetal indications for cesarean delivery, the Committee Opinion states, a plan for vaginal delivery is safe and appropriate and should be recommended to patients.

Committee Opinion: Planned Home Birth

“Planned Home Birth,” issued by ACOG in February 2011 (reaffirmed 2013), advises that women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. It examines available research and outlines specific risks, appropriate candidates and health care professionals for this type of delivery, and other procedures to help reduce perinatal mortality rates and achieve favorable home birth outcomes.

Committee Opinion: Oral Intake During Labor

“Oral Intake During Labor,” issued by ACOG in September 2009 (reaffirmed 2013), relaxes previous recommendations of restricting women to ice chips during labor. It states that although guidelines on prohibiting solid food while in labor or before scheduled cesarean surgery remain the same, women with uncomplicated labor and uncomplicated patients undergoing a planned cesarean may drink modest amounts of clear liquids during labor.

Committee Opinion: Timing of Umbilical Cord Clamping After Birth

“Timing of Umbilical Cord Clamping After Birth,” issued by ACOG in December 2012, reviews recent clinical trials and studies on the effects of early versus delayed umbilical cord clamping, as well as umbilical cord milking, on infant and maternal health outcomes. It concludes that evidence supports delayed cord clamping in preterm infants, but that evidence to support or refute benefits for term infants is insufficient. It suggests directions for further research.  

Committee Opinion: Pain Relief During Labor

“Pain Relief During Labor,” issued by ACOG in July 2004 (reaffirmed 2008), advises that pain management should be provided whenever medically indicated. It states that women requesting epidural analgesia during labor should not be deprived of pain management based on their insurance and that labor nurses should not be restricted from participating in the management of pain relief during labor.

 


Resources for Women and Patients

Patient FAQ: Medications for Pain Relief During Labor and Delivery

“Medications for Pain Relief During Labor and Delivery,” issued by ACOG in March 2014, is a resource for patients explaining the types of pain-relieving medications available for labor and delivery, such as systemic analgesics, local and general anesthesia, epidural block, and spinal block. Each method is described along with its effects and risks. A brief glossary is also included.

Patient FAQ: Fetal Heart Rate Monitoring During Labor

“Fetal Heart Rate Monitoring During Labor,” issued by ACOG in August 2011, is a list of questions and answers for patients explaining fetal heart rate monitoring, why it is performed during labor and delivery, types of monitoring (auscultation and electronic), external and internal monitoring, and what happens if there is an abnormal reading. A brief glossary is also included.

Patient FAQ: How to Tell When Labor Begins

“How to Tell When Labor Begins,” issued by ACOG in May 2011, is a list of questions and answers for patients that outlines the signs of approaching labor, describes false labor, and explains how to tell the difference between true and false labor.

 


External Organizations

National Child & Maternal Health Education Program, a component of the National Institute of Child Health & Human Development, provides a forum for reviewing, translating, and disseminating new research in the field of maternal and child health.

 


The American College of Obstetricians and Gynecologists (ACOG), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 57,000 members, ACOG strongly advocates for quality women’s health care, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.

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American Congress of Obstetricians and Gynecologists
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