A breakdown of ACOG’s new recommendations

Recently ACOG (The American college of Obstetricians and Gynecologists) released a committee opinion report titled “Approaches to Limit Intervention During Labor and Birth”. This new report has a list of steps that care providers can implement to create a safer and more satisfying birth experience.  ACOG has had a long standing stance on the benefit of doula support and it is great to see that on the list.

Here is the breakdown of the new recommendations:

Continuous Support During Labor: Doulas –  “Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor. Benefits found in randomized trials include shortened labor, decreased need for analgesia, fewer operative deliveries, and fewer reports of dissatisfaction with the experience of labor.”

Allow Women to Move/Change Position –  The report calls for “Frequent position changes during labor to enhance maternal comfort and promote optimal fetal positioning.”  While ACOG does not recommend one position over another, they warn that women who labor exclusively on their backs can have a higher rate of complications. As doulas we are able to help our clients move into different positions even while enjoying an epidural.

Not Admitting To The Hospital Before Active Labor; Even If Your Water Breaks – They state it could take up to 28 hours for a woman to go into labor after her water has broken, so her care provider should help her manage her labor instead of admitting and inducing her. However, they state care providers will need to administer antibiotics and may choose to induce a women who is Strep B positive.

Use Intermittent Fetal Monitoring –  They stress that intermittent monitoring is just as effective as continuous monitoring and allows the aforementioned freedom of movement that is so helpful.

Support Methods of Pain Relief and Coping – While medication can help relieve pain, they do not help with coping  or relieving anxiety.  ACOG states that having continuous support during labor helps women to reduce their anxiety and cope better. Sometimes reducing or even eliminating the need or desire for medicinal pain relief. Some ways of offering coping support are hydrotherapy, relaxation techniques, massage, use of a TENS machine, redirection, childbirth education, and un-interrupted emotional support.

Allow Water And Food During Labor – ACOG says, “Oral hydration can be encouraged to meet hydration and caloric needs.” Unfortunately, the committee still remains uncertain about solid foods.

Different Ways To Push –  Care providers have long encouraged their patients to push while holding their breath for 10 seconds at a time (kown as the Valsalva Maneuver). ACOG now states that “Each woman should be encouraged to use the technique that she prefers and is most effective for her.” While for some people that means directed pushing it can also mean following your own instincts to push.

Allow First-Time Mothers A Rest Period After Dilation, Before Pushing –  The report encourages a rest period at 10 centimeters dilatation before pushing. Know as delayed pushing, laboring down, or passive descent; this technique can save the patients energy and allow the baby to rotate and descend on its own. This rest period can last a few minutes or up to two hours depending on baby’s tolerance and the patients natural urges.


ACOG is constantly updating their recommendations for OB/Gyn’s to continue to create a safe and satisfying birth experience.  Lancaster Doulas would like to take a moment to recognize their dedication to anyone giving birth.

If you would like any more information about any of these recommendations, please reach out to us at 717-393-7667 or Info@LancasterDoulas.com !



Lancaster Doulas LLC:  Adams, Berks, Chester, Cumberland, Dauphin, Lancaster, Lebanon, Montgomery, Schuylkill and York Counties.

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