Obstet Gynecol. 2019 Feb;133(2):406-408. doi: 10.1097/AOG.0000000000003081.
Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that require minimal interventions and have high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted to the labor unit, a process of shared decision making is recommended to create a plan for self-care activities and coping techniques. Admission during the latent phase of labor may be necessary for a variety of reasons, including pain management or maternal fatigue. 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. Data suggest that for women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring. The widespread use of continuous electronic fetal monitoring has not been shown to significantly affect such outcomes as perinatal death and cerebral palsy 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 or proscribed. Obstetrician-gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches, when appropriate, for the intrapartum management of low-risk women in spontaneous labor. Birthing units should carefully consider adding family-centric interventions that are otherwise not already considered routine care and that can be safely offered, given available environmental resources and staffing models. These family-centric interventions should be provided in recognition of the value of inclusion in the birthing process for many women and their families, irrespective of delivery mode. This Committee Opinion has been revised to incorporate new evidence for risks and benefits of several of these techniques and, given the growing interest on the topic, to incorporate information on a family-centered approach to cesarean birth.
妇产科医生与助产士、护士、患者以及支持他们分娩的人员合作,可以通过使用干预措施最少且患者满意度高的技术帮助女性实现分娩和生育目标。许多常见的产科实践对于低风险自然分娩的女性来说,益处有限或不确定。对于处于潜伏期且未入院分娩的女性,建议采用共同决策过程来制定自我护理活动和应对技巧计划。由于各种原因,包括疼痛管理或产妇疲劳,可能需要在潜伏期入院。有证据表明,除了常规护理外,由支持人员(如导乐)提供的持续一对一情感支持与改善分娩女性的结局相关。数据表明,对于进展正常且无胎儿窘迫证据的女性,除非需要监测,否则不需要常规行羊膜穿刺术。广泛使用连续电子胎儿监护并未显示在用于低风险妊娠的女性中显著影响围产儿死亡和脑瘫等结局。可以使用多种非药物和药物技术来帮助女性应对分娩疼痛。进展正常的自然分娩的女性可能不需要常规持续输注静脉液体。对于大多数女性,不需要强制或禁止任何一种体位。妇产科医生和其他产科护理提供者应熟悉并考虑在适当的情况下使用低干预方法,用于管理自然分娩的低风险女性。分娩单位应仔细考虑增加家庭为中心的干预措施,这些干预措施在不考虑常规护理的情况下是安全的,并且可以在可用的环境资源和人员配备模式下提供。这些以家庭为中心的干预措施应提供,以认识到许多女性及其家庭在分娩过程中参与的价值,无论分娩方式如何。本委员会意见已修订,纳入了这些技术的一些风险和益处的新证据,并考虑到该主题的兴趣日益增加,纳入了以家庭为中心的剖宫产方法的信息。