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Medicine is rarely so straightforward that it can offer a “one size fits all” pattern. In fact, there is a reason it is called the “practice” of medicine or the “art” of medicine — because oftentimes a doctor or midwife needs to carefully consider his or her patient. One treatment may work wonderful for one woman, while for another it would do very little. This is why it can be normal for one woman’s pregnancy or labor to be managed a bit differently than another.

However, sometimes these variations in tests and treatments also lead to doctors and midwives continuing to practice medicine using outdated methods that are not evidence-based. This can lead to unnecessary treatments, tests, procedures, costs, and may even lead to harm to a mom or her baby.

To help prevent this, the American College of Obstetricians and Gynecologists has released a list called “Choosing Wisely: Five more things physicians and patients should question.” This is a list of 10 things total (the first five were announced in 2013) that we know can lead to problems. Here are the four recommendations specific to pregnancy: 

1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks, 0 days gestational age. The reason for this recommendation is that we now don’t consider babies to be full term until 39 weeks (previously, we used 37 weeks as a cut-off). Lots of important development happens in those last few weeks, from brain development to the maturing of the muscles in a baby’s mouth so he or she can latch and feed better. If a medical reason for delivery exists, such as preeclampsia, then certainly an early delivery may be necessary, but in the absence of such indications, women (and their doctors!) should be patient. 

2. Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks and 41 weeks, 0 days unless the cervix is deemed favorable. Just because a woman is 39 weeks pregnant doesn’t mean her induction should be scheduled ASAP — how “favorable” her cervix is should be taken into consideration. A woman with a cervix that is unfavorable (or not dilated or shortened at all) is at a much higher risk of needing a C-section if she is induced early. To avoid possibly needing a delivery by C-section, women should wait to schedule an induction of labor until their cervix is more favorable … or wait for labor to start on its own! 

3. Don’t perform prenatal ultrasounds for non-medical purposes, for example, solely to create keepsake videos or photographs. Ultrasounds are a wonderful tool that allow us to monitor pregnancies in a much more accurate way than when we didn’t have this technology. We can know exactly how many babies a woman is carrying and also monitor things like growth. However, it is a tool that we should only use when needed, because we don’t know for sure if repeated ultrasounds (especially done at non-medical facilities where they may not be using the safest standards) have any negative effects. 

4. Don’t routinely recommend activity restriction or bed resting during pregnancy for any indication. This practice continues to be so common, yet it has been shown to have no benefit when it comes to treating complications like preterm labor or high blood pressure. The resulting risks to mom are huge, too.

Takeaways

  • Elective inductions or C-sections should not be scheduled before a woman is full term.
  • Ultrasounds should only be ordered when medically necessary.
  • Bed rest in pregnancy should not be recommended.

References

  1. ACOG President. “Choosing Wisely: Five more things physicians and patients should question.”
  2. American Congress of Obstetrics and Gynecology. Choosing Wisely.

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