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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: External Cephalic Version

“External Cephalic Version,” issued by ACOG in February 2016, explains the use of ECV to achieve a vertex presentation, as a means of reducing cesarean deliveries, particularly in the case of breech presentation. Because there is a low risk of adverse events as a result of ECV, women who are near term with breech presentations should be offered an ECV attempt if there are no contraindications.

Practice Bulletin: Premature Rupture of Membranes (members only)

“Premature Rupture of Membranes,” issued by ACOG in October 2016, provides evidence-based guidelines for the diagnosis, treatment, and management of premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM). PROM is the rupture of membranes, or water breaking, before the onset of labor. When PROM occurs before 37 weeks of gestation it is referred to as PPROM.


Practice Bulletin: Management of Preterm Labor (members only)

“Management of Preterm Labor,” issued by ACOG in October 2016, explains that preterm birth is the leading cause of neonatal mortality, and the most common reason for antenatal hospitalization. It addresses treatment and the use of antenatal corticosteroids.

Practice Bulletin: Management of Late-Term and Postterm Pregnancies (members only)

“Management of Late-Term and Postterm Pregnancies,” issued by ACOG in August 2014 (reaffirmed 2016), defines late-term postterm and posterm pregnancyies and addresses antepartum fetal surveillance and induction of labor as strategies to decrease the risks of perinatal morbidity and mortality associated with late-term and postterm pregnancies.

Practice Bulletin: Use of Prophylactic Antibiotics in Labor and Delivery (members only)

“Use of Prophylactic Antibiotics in Labor and Delivery,” issued by ACOG in June 2011 (reaffirmed 2016), explains that the use of antibiotics to prevent infections during the antepartum, intrapartum, and postpartum periods is different from the use of antibiotics to treat established infections. It provides a review of situations in which prophylactic antibiotics are frequently prescribed, and weighs the evidence supporting the use of antibiotics in these scenarios.

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 (reaffirmed 2016), 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 November 2016, 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 (reaffirmed 2016), 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 (reaffirmed 2015), 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 (reaffirmed 2015), addresses 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.

Committee Opinion: Planned Home Birth

Planned Home Birth,” issued by ACOG in April 2017, 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 2015), 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: Delayed Umbilical Cord Clamping After Birth

“Delayed Umbilical Cord Clamping After Birth,” issued by ACOG in January 2017, states that delayed umbilical cord clamping appears to be beneficial for term and preterm infants. Given the benefits to most newborns and concordant with other professional organizations, ACOG recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.

Committee Opinion: Approaches to Limit Intervention During Labor and Birth

“Approaches to Limit Intervention During Labor and Birth,” issued by ACOG in February 2017, recognizes that the desire to avoid unnecessary interventions during labor is shared by health care providers and pregnant women, and reviews labor care practices that minimize intervention for appropriate women who are in spontaneous labor at term.

Committee Opinion: Umbilical Cord Blood Banking

“Umbilical Cord Blood Banking,” issued by ACOG in December 2015, explains that umbilical cord blood is known to contain potentially life-saving hematopoietic stem cells, and that when used in hematopoietic stem cell transplantation, offers several advantages over bone marrow or peripheral stem cells. It states that the collection of umbilical cord blood should not compromise obstetric or neonatal care. Balanced and accurate information regarding the advantages and disadvantages of umbilical cord blood banking should be provided if a patient requests information.

Committee Opinion: The Apgar Score

“The Apgar Score,” issued by ACOG in October 2015, explains that the Apgar score is an accepted method for reporting the status of a newborn infant immediately after birth and the response to resuscitation if needed. However, it does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. The Apgar score alone should not be used to establish the diagnosis of asphyxia.

Committee Opinion: Newborn Screening and the Role of the Obstetrician-Gynecologist

“Newborn Screening and the Role of the Obstetrician-Gynecologist,” issued by ACOG in January 2015 (reaffirmed 2016), explains that newborn screening is a mandatory state-based public health program with the goal of decreasing morbidity and mortality by screening for disorders in which early intervention will improve neonatal and long-term health outcomes. It recommends that ob-gyns make resources about newborn screening available to patients during pregnancy via brochures, electronic sources, and through review or discussion during the course of prenatal care.

Committee Opinion: Delivery of a Newborn With Meconium-Stained Amniotic Fluid

"Delivery of a Newborn With Meconium-Stained Amniotic Fluid," issued by ACOG in March 2017, explains that infants with meconium-stained amniotic fluid should no longer routinely receive intrapartum suctioning, but that the condition requires the availability of an appropriately credentialed team with full resuscitation skills, including endotracheal intubation.

Practice Bulletin: Shoulder Dystocia

"Shoulder Dystocia," issued by ACOG in May 2017, provides evidence-based information about the management of pregnancies and deliveries complicated by shoulder dystocia.

Practice Bulletin: Obstetric Analgesia and Anesthesia

"Obstetric Analgesia and Anesthesia," issued by ACOG in April 2017, discusses methods of analgesia and anesthesia for labor pain.

Committee Opinion: Vaginal Seeding

"Vaginal Seeding," issued by ACOG in November 2017, discusses the clinical considerations and risks associated with vaginal seeding, and emphasizes the need for additional research on the safety and benefits of the practice.


Resources for Women and Patients

Patient FAQ: If Your Baby Is Breech

“If Your Baby Is Breech,” issued by ACOG in April 2015, explains the difference between vertex and breech presentation, and factors that may contribute to breech presentation. It also provides an explanation of external cephalic version (ECV), an attempt to turn the baby so that he or she is head down. A brief glossary is also included.

Patient FAQ: Assisted Vaginal Delivery

“Assisted Vaginal Delivery,” issued by ACOG in February 2016, explains scenarios in which assisted vaginal delivery, or delivery with the help of forceps or a vacuum device, may be performed. A brief glossary is also included.

Patient FAQ: Cord Blood Banking

“Cord Blood Banking,” issued by ACOG in February 2016, explains the advantages and disadvantages of using cord blood to treat disease. A brief glossary is also included.

Patient FAQ: Medications for Pain Relief During Labor and Delivery

“Medications for Pain Relief During Labor and Delivery,” issued by ACOG in March 2014, explains the types of pain-relieving medications available during 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, explains 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, 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 58,000 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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