The health and safety of a birthing parent and their baby depends on the dyad getting the best and right care at the right time. This is the basis behind the new "Choosing Wisely" initiative, developed by the American Board of Internal Medicine (ABIM) Foundation in conjunction with the American Academy of Nursing (AAN). As part of the initiative, AAN has created a list of 25 things that nurses and patients should question. These items of concern help people choose care that is:

• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary

On the list, four of the items address routine care in labor and birth that can be harmful and should be questioned. They are:

Don’t automatically initiate continuous electronic fetal heart rate (FHR) monitoring during labor for women without risk factors; consider intermittent auscultation (IA) first.

In other words, continuous electronic fetal heart rate monitoring (monitoring the baby's heart rate continuously throughout labor via bands/monitors around the mid-section) should not be performed automically unless the birthing person has risk factors that require it. The alternative is intermittent (usually 20 minutes out of every hour) heart rate monitoring. The reason for this guideline is that continuous monitoring is associated with increase risk for cesarean and use of vacuum and forceps, without showing any improvement in outcomes for babies. Read more from AAN here. Learn more about electronic fetal monitoring from Lamaze here. You can also check out these resources from the Choosing Wisely campaign available in several languages on this topic here.

Don’t promote induction or augmentation of labor and don’t induce or augment labor without a medical indication; spontaneous labor is safest for woman and infant, with benefits that improve safety and promote short- and long-term maternal and infant health.

Spontaneous labor -- that is, going into labor on your own and allowing baby to intiate labor -- is almost always better for the parent and the baby. It's the only way to ensure that baby is born at the right time for his/her growth, and it reduces the risks of interventions that are associated with induction. Learn more about induction from Lamaze here.  

Don’t separate mothers and their newborns at birth unless medically necessary. Instead, help the mother to place her newborn in skin-to-skin contact immediately after birth and encourage her to keep her newborn in her room during hospitalization after the birth.

Research has shown that skin-to-skin and rooming in are the best places for baby to be after birth. The benefits are manifold. Unless there are medical issues that need to be tended to immediately, routine newborn procedures can wait until the new parent and baby have had ample time to be together skin to skin. To learn more about routine separation, and the benefits of keeping the new parent and baby together, check out these resources from Lamaze.  

Are you talking to the families that you work with, to help them negotiate receiving evidence based care that encourages healthy parents and healthy babies?  Consider sharing the "Choosing Wisely" resources to help them to do so.

About Cara Terreri

Cara began working with Lamaze two years before she became a mother. Somewhere in the process of poring over marketing copy in a Lamaze brochure and birthing her first child, she became an advocate for childbirth education. Three kids later (and a whole lot more work for Lamaze), Cara is the Site Administrator for Giving Birth with Confidence, the Lamaze blog for and by women and expectant families. Cara continues to have a strong passion for the awesome power and beauty in pregnancy and birth, and for helping women to discover their own power and ability through birth. It is her hope that through the GBWC site, women will have a place to find and offer positive support to other women who are going through the amazing journey to motherhood.

Published: June 28, 2016

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