BORN IN THE U.S.A.
Guide to Safe and Effective Care During Labor and Birth

The individual maternity care practices below are grouped into four categories based on their benefits or potential for harm when applied to low-risk women.

SAFE AND USEFUL: Research shows that these practices are safe and useful, and should be encouraged.

• Planning each woman's care based on a birth plan in which she has stated her preferences for care during labor, birth and the period after the baby is born.
• Informing women about the benefits and risks of all potential birth sites (hospital, birth center and home) and respecting their informed choice about where to give birth.
• Providing each woman with as much information and explanation as she desires on all aspects of pregnancy and birth.
• Assessing each woman's risk status through pregnancy, labor and birth.
• Allowing a woman to drink fluids during labor.
• Guaranteeing every woman the consistent presence of a caregiver trained to provide empathetic support and encouragement throughout labor and birth.
• Monitoring the baby's heartbeat using a stethoscope or a doptone device rather than continuous electronic fetal monitoring.
• Providing nondrug methods of pain relief during labor, such as massage and relaxation techniques.
• Allowing a woman to get out of bed, walk and move at will during labor and to choose a comfortable position for giving birth.
• Promoting skin-to-skin contact between mother and baby immediately after birth and unlimited mother-baby contact thereafter.
• Helping mothers to begin breastfeeding within one hour after giving birth.

USE WITH CAUTION: There is not enough evidence to recommend these practices as safe, so they should be used with caution until more research has been done.

• Using certain nondrug methods of pain relief during labor, such as herbs.
• During the first stages of labor, routinely rupturing the membranes that enclose the fetus and amniotic fluid.
• Pushing down on the top of the uterus through the woman's abdomen during labor in order to speed the birth.
• Routinely using the drug oxytocin or nipple stimulation after the birth of the baby to speed expulsion of the placenta.
• Clamping the baby's umbilical cord quickly after birth.

FREQUENTLY USED INAPPROPRIATELY: Although these practices are necessary in some cases, they should not be used without sufficient reason.

• Controlling a woman's pain by use of epidural anesthesia.
• Controlling a woman's pain by use of drugs taken by mouth, by injection or by inhalation.
• Restricting a woman's intake of food or fluids during labor.
• Using continuous electronic fetal monitoring.
• Frequently examining the vagina, especially if this is performed by more than one caregiver.
• Using the drug oxytocin to increase the strength or frequence of labor contractions.
• Moving the laboring woman to a different room to "deliver" her baby.
• Inserting a catheter tube into a woman's bladder to empty it of urine.
• Encouraging a woman to push, even if her cervix is fully dilated, before she feels the urge to bear down.
• Setting time limits for second-stage labor when there has been progress and the mother and baby are in good condition.
• Performing an episiotomy, an incision made just before birth in order to enlarge the woman's vaginal opening.
• Performing a cesarean birth (c-section): the surgical delivery of a baby through incisions in the woman's abdomen and uterus.

HARMFUL OR INEFFECTIVE: Research shows that these practices are harmful or ineffective, and should be eliminated.

• Routinely administering an enema to a woman in labor.
• Shaving a woman's pubic hair.
• Routinely using intravenous fluids during labor.
• Requiring a woman to lie flat on her back during labor and/or birth.
• Requiring any unnecessary separation of a woman and her baby.

This guide by the Maternity Center Association is based on a worldwide review of research conducted by the World Health Organization, measuring the effects of specific maternity care practices during the labors of women who have no known medical complications and are anticipating a normal birth.