Choosing Wisely - Things You Should Question About Your Care in Pregnancy & Birth

choosing wisely.jpgThe health and safety of you and your baby depends on you 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 conjuction with the American Academy of Nursing (AAN). As part of the initiative, AAN has created a list of 15 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 your baby's heart rate continuously throughout labor via bands/monitors around the mid-section) should not be performed automically unless you have 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


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 mom and 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 mom and baby have had ample time to be together skin to skin. To learn more about routine separation, and the benefits of keeping mom and baby together, check out these resources from Lamaze.  

1 Comment

Skin to skin contact after birth

July 6, 2016 02:49 PM by Kurt Domine

Good read, and it made me think about the importance of skin to skin contact immediately after the baby is born. My wife had to have a C-section so unfortunately, she was not able to have skin to skin contact right away. I knew how important it was so I had as much skin to skin contact as possible with my baby girl until my wife was able to take over. One of my most precious memories that I will forever cherish.

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