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ACNM Recommends No Change in Practice in Response to Study on Induction of Labor

The American College of Nurse-Midwives Affirms Its Support of Normal Physiologic Birth.

RELEASE: February 1, 2018

Silver Spring, MD -- The American College of Nurse-Midwives (ACNM) affirms its support for normal physiologic birth in light of findings presented at the Society for Maternal Fetal Medicine Annual Meeting today.  The preliminary results of "A Randomized Trial of Induction Versus Expectant Management (ARRIVE)" suggest that elective induction of labor in women with low risk pregnancies at 39 weeks may reduce the need for a cesarean delivery versus waiting for spontaneous labor to occur on its own. The difference in the reduction of cesarean birth was 19% in the induced group versus 22% in the spontaneous labor group.


ACNM President Lisa Kane Low, PhD, CNM, FACNM, FAAN cautioned against any rush to change practice and noted that all of us involved in maternity care should be seeking improvements to reduce the incidence of unnecessary cesarean births. However, we should not lose sight of the fact that there are a number of evidence-based ways to accomplish this goal. ACNM has resources available for health care providers and consumers at www.BirthTOOLS.org that support changing the culture of maternity care and optimizing health outcomes for families. "ACNM has consistently noted there are a number of potentially negative implications when we disrupt the normal physiological processes of labor and birth," Kane Low said. Research related to the longer-term effects of induction of labor is emerging, but is still insufficient to determine its full impact. Additionally, spontaneous labor offers substantial benefits to the mother and her infant, as ACNM has affirmed in its Consensus Statement on Physiological Birth.

ACNM continues to stand by its current recommendations and encourages its members and other providers to refer to its formal position statements for guidance, including its statements on Induction of Labor and Appropriate Use of Technology In Childbirth. The Society for Maternal-Fetal Medicine has also stated it will not be updating its guidelines until further evaluation has been conducted.  Kane Low added, "We acknowledge the importance of the aggregate outcome of the study, but we also honor birth as an individual and personal experience that requires a process of shared decision-making  to meet the needs of those we serve."

"We look forward to the peer-reviewed publication after which we will be better able to review the full study and consider the implications," Kane Low continued. "Until that time, we urge health care providers to be responsible, accurate, and cautious in their messaging to childbearing families before embarking on the use of induction of labor as an intervention to reduce the risk of cesarean delivery."

About ACNM

With nearly 7800 members, ACNM is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. ACNM promotes excellence in midwifery education, clinical practice, and research. With roots dating to 1929, our members are primary care providers for women throughout the lifespan, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. ACNM provides research, administers and promotes continuing education programs, establishes clinical practice standards, and creates liaisons with state and federal agencies and members of Congress to increase the visibility and recognition of midwifery care.

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