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Labor, Delivery, and Postpartum Issues - American Family Physician

Oct 15, 2019 - This collection features AFP content on labor, delivery, and postpartum issues and related topics, including breastfeeding, cesarean delivery, episiotomy, labor pain management, postpartum hemorrhage, preterm labor and birth, shoulder dystocia, umbilical cord blood storage, and vaginal ...

American Family Physician : AFP By Topic

https://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=16

Cognitive Behavior Therapy for Postpartum Depression - FPIN's Help Desk Answers - ...

Aug 15, 2019 - In women with postpartum depression, the addition of CBT reduces depressive symptoms more effectively than usual care alone (medication and other therapies), with a medium effect size at the end of the intervention and a residual small effect size six months later.

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2019/0815/p244.html

Skin-to-Skin Contact for Improved Duration of Breastfeeding - FPIN's Help Desk Answers ...

Aug 1, 2019 - Skin-to-skin-contact in the immediate postnatal period should be recommended to all mothers because it is associated with a higher likelihood of exclusive breastfeeding at hospital discharge and for up to six months afterward (number needed to treat [NNT] = 5 to 8).

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2019/0801/od2.html

Risks of Elective Labor Induction vs. Expectant Management - FPIN's Help Desk Answers -...

May 1, 2019 - Elective labor induction at 39 weeks’ gestation leads to a mean 145-g (5.1-oz) lower birth weight compared with expectant management, but there is conflicting evidence about the effects on rates of cesarean delivery, perinatal mortality, operative vaginal birth, and admission to the ...

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2019/0501/p587.html

Complementary and Integrative Treatments for Pain Management in Labor - Cochrane for ...

Feb 1, 2019 - There is evidence that all of the studied interventions have some benefit in labor, but the evidence is of low to very low quality. Massage, thermal interventions (warm and cold packs), relaxation techniques, yoga, and music reduce pain during latent labor, but not during active labor.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2019/0201/p154.html

Effectiveness of Intrapartum Antibiotics for Meconium-Stained Amniotic Fluid - Medicine...

Nov 1, 2018 - This review concluded that there is insufficient evidence to recommend prophylactic intrapartum antibiotics in laboring women with meconium-stained amniotic fluid because of the lack of difference in rates of neonatal sepsis between the antibiotic and placebo groups.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2018/1101/od1.html

Breastfeeding: Common Questions and Answers - American Family Physician

Sep 15, 2018 - All major health organizations recommend breastfeeding as the optimal source of infant nutrition, with exclusive breastfeeding recommended for the first six months of life. After six months, complementary foods may be introduced. Most organizations recommend breastfeeding for at least ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0915/p368.html

Chewing Gum for Reducing Post-Cesarean Section Ileus - Medicine by the Numbers - ...

Sep 1, 2018 - Although the current body of literature suggests a need for higher-quality, more robust research, the simplicity, frugality, and safety of chewing gum makes it a viable option to offer women undergoing cesarean section.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2018/0901/od2.html

NSAIDs for Postpartum Perineal Pain - FPIN's Help Desk Answers - American Family Physician

Jun 1, 2018 - Women with third- or fourth-degree perineal lacerations or who received an episiotomy can be given oral NSAIDs to reduce perineal pain in the first six hours postpartum.

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2018/0601/od3.html

Maternal Obesity and Labor Induction - FPIN's Help Desk Answers - American Family ...

May 15, 2018 - Pregnant women who are obese have nearly double the rate of cesarean delivery, and obesity increases the median duration of active labor by up to four hours when labor is induced. The difference in cesarean delivery rate is larger in obese primigravida patients presenting with cervical ...

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2018/0515/p671.html

Oral NSAIDs for Perineal Pain in the Early Postpartum Period - Medicine by the Numbers ...

May 1, 2017 - Oral nonsteroidal anti-inflammatory drugs were able to adequately relieve perineal pain for many postpartum women at four hours and longer.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2017/0501/od1.html

Postpartum Hemorrhage: Prevention and Treatment - American Family Physician

Apr 1, 2017 - Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor should be used routinely to reduce its incidence. Use of oxytocin after delivery of the anterior shoulder is the most important and effective ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0401/p442.html

Membrane Sweeping to Decrease Rates of Postdate Induction - FPIN's Help Desk Answers - ...

Jan 1, 2017 - In uncomplicated pregnancies, membrane sweeping at 38 to 40 weeks' gestation safely decreases the rate of postdate inductions. Membrane sweeping increases the incidence of spontaneous labor, especially in the subsequent seven days, and results in fewer pregnancies extending beyond 41 ...

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2017/0101/p35.html

Identification and Management of Peripartum Depression - American Family Physician

May 15, 2016 - Peripartum depression affects up to one in seven women and is associated with significant maternal and neonatal morbidity if untreated. A history of depression is the strongest risk factor for developing peripartum depression. The U.S. Preventive Services Task Force recommends screening...

American Family Physician : Article

https://www.aafp.org/afp/2016/0515/p852.html

Management of Spontaneous Vaginal Delivery - American Family Physician

Aug 1, 2015 - Most of the nearly 4 million births in the United States annually are normal spontaneous vaginal deliveries. In the first stage of labor, normal birth outcomes can be improved by encouraging the patient to walk and stay in upright positions, waiting until at least 6 cm dilation to ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0801/p202.html

Antenatal Perineal Massage to Prevent Birth Trauma - Cochrane for Clinicians - American...

Mar 1, 2014 - Antenatal digital perineal massage in the final month of pregnancy is safe and well tolerated. Women who have not had a previous vaginal delivery and perform digital perineal massage in the final month of pregnancy experience less perineal birth trauma, mostly through fewer ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2014/0301/p335.html

Impact of Breastfeeding Support - Cochrane for Clinicians - American Family Physician

Feb 1, 2013 - Proactive support in many forms, provided by health care professionals or laypersons, increases the duration of any breastfeeding (including partial and exclusive) and exclusive breastfeeding. Face-to-face support is superior to telephone-based interventions. Support for continued ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2013/0201/p176.html

Epidural Analgesia for Labor Pain - Cochrane for Clinicians - American Family Physician

Aug 1, 2012 - Compared with other types of analgesia or no analgesia, epidurals offered better pain relief, but were associated with a longer second stage of labor and increased risk of instrumental vaginal delivery, maternal fever, and oxytocin (Pitocin) administration. There were no statistically ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2012/0801/p241.html

Labor Analgesia - American Family Physician

Mar 1, 2012 - Regional analgesia has become the most common method of pain relief used during labor in the United States. Epidural and spinal analgesia are two types of regional analgesia. With epidural analgesia, an indwelling catheter is directed into the epidural space, and the patient receives a ...

American Family Physician : Article

https://www.aafp.org/afp/2012/0301/p447.html

Rationale for a 39-Week Elective Delivery Policy - Editorials - American Family Physician

Dec 15, 2011 - Several organizations have called for obstetric care professionals to decrease the number of elective (non-medically indicated) deliveries before an estimated gestational age of 39 weeks to prevent iatrogenic neonatal harm. Approximately one out of every three births in the United ...

American Family Physician : Editorials

https://www.aafp.org/afp/2011/1215/p1335.html

Magnesium Sulfate and Other Anticonvulsants for Women with Preeclampsia - Cochrane for ...

Jun 1, 2011 - Magnesium sulfate should be considered first-line treatment to prevent eclamptic seizures during labor.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2011/0601/p1269.html

Management Options for Early Incomplete Miscarriage - Cochrane for Clinicians - ...

Feb 1, 2011 - For the management of incomplete miscarriage, limited-quality evidence shows that medical treatment with misoprostol (Cytotec), expectant care, and surgical evacuation have a completion of miscarriage success rate between 80 to 99 percent in pregnancies at less than 13 weeks' ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2011/0201/p258.html

Increasing Patient Access to VBAC: New NIH and ACOG Recommendations - Editorials - ...

Jan 15, 2011 - The increasing rate of cesarean deliveries and the lack of access to TOLAC have created a major public health concern. Maternal morbidity and mortality seem to be increasing in the United States, partly as a result of the increase in repeat cesarean deliveries.

American Family Physician : Editorials

https://www.aafp.org/afp/2011/0115/p121.html

Preterm Labor - American Family Physician

Feb 15, 2010 - Preventing preterm delivery remains one of the great challenges in modern medicine. Preterm birth rates continue to increase and accounted for 12.7 percent of all U.S. births in 2005. The etiology of preterm delivery is unclear, but is likely to be complex and influenced by genetics and...

American Family Physician : Article

https://www.aafp.org/afp/2010/0215/p477.html

Intrapartum Fetal Monitoring - American Family Physician

Dec 15, 2009 - Continuous electronic fetal monitoring was developed in the 1960s to assist in the diagnosis of fetal hypoxia during labor. Continuous electronic fetal monitoring has been shown to reduce the incidence of neonatal seizures, but there has been no beneficial effect in decreasing cerebral ...

American Family Physician : Article

https://www.aafp.org/afp/2009/1215/p1388.html

Vacuum-Assisted Vaginal Delivery - American Family Physician

Oct 15, 2008 - The second stage of labor is a dynamic event that may require assistance when maternal efforts fail to effect delivery or when there are nonreassuring fetal heart tones. Therefore, knowing how to perform an operative vaginal delivery with forceps or vacuum is vital for family physicians...

American Family Physician : Article

https://www.aafp.org/afp/2008/1015/p953.html

Spontaneous Vaginal Delivery - American Family Physician

Aug 1, 2008 - Vaginal delivery is a natural process that usually does not require significant medical intervention. Management guided by current knowledge of the relevant screening tests and normal labor process can greatly increase the probability of an uncomplicated delivery and postpartum course. ...

American Family Physician : Article

https://www.aafp.org/afp/2008/0801/p336.html

Why Can't I Get My Patients to Exclusively Breastfeed Their Babies? - Curbside ...

Jul 15, 2008 - A recent report from the Agency for Health-care Research and Quality has confirmed the numerous benefits of breastfeeding to mothers and their babies.

American Family Physician : Curbside Consultation

https://www.aafp.org/afp/2008/0715/p265.html

Predicting the Likelihood of Successful Vaginal Birth After Cesarean Delivery - ...

Oct 15, 2007 - The American College of Obstetricians and Gynecologists and the American Academy of Family Physicians recommend that pregnant women with a single previous cesarean delivery and a low-transverse incision be offered a trial of labor.

American Family Physician : Point-of-Care Guides

https://www.aafp.org/afp/2007/1015/p1192.html

Dystocia in Nulliparous Women - American Family Physician

Jun 1, 2007 - Dystocia is common in nulliparous women and is responsible for more than 50 percent of primary cesarean deliveries. Because cesarean delivery rates continue to rise, physicians providing maternity care should be skilled in the diagnosis, management, and prevention of dystocia. If labor ...

American Family Physician : Article

https://www.aafp.org/afp/2007/0601/p1671.html

Prevention and Management of Postpartum Hemorrhage - American Family Physician

Mar 15, 2007 - Postpartum hemorrhage, the loss of more than 500 mL of blood after delivery, occurs in up to 18 percent of births and is the most common maternal morbidity in developed countries. Although risk factors and preventive strategies are dearly documented, not all cases are expected or ...

American Family Physician : Article

https://www.aafp.org/afp/2007/0315/p875.html

Preventing Postpartum Hemorrhage: Managing the Third Stage of Labor - American Family ...

Mar 15, 2006 - Postpartum hemorrhage is a significant cause of maternal morbidity and mortality. Most postpartum hemorrhages are caused by uterine atony and occur in the immediate postpartum period. Expectant or physiologic management of the third stage of labor has been compared with active ...

American Family Physician : Article

https://www.aafp.org/afp/2006/0315/p1025.html

Preterm Premature Rupture of Membranes: Diagnosis and Management - American Family ...

Feb 15, 2006 - Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks' gestation. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory ...

American Family Physician : Article

https://www.aafp.org/afp/2006/0215/p659.html

Vaginal Misoprostol for Cervical Ripening in Term Pregnancy - FPIN's Clinical Inquiries...

Feb 1, 2006 - Low-dose (25 mcg) intravaginal misoprostol appears to be safe and effective for cervical ripening in term pregnancy for patients without a history of cesarean section. Compared with other cervical ripening methods, misoprostol has an increased rate of vaginal delivery within 24 hours ...

American Family Physician : FPIN's Clinical Inquiries

https://www.aafp.org/afp/2006/0201/p511.html

AAFP Releases Guidelines on Trial of Labor After Cesarean Delivery - Practice ...

Nov 15, 2005 - The American Academy of Family Physicians (AAFP) has released an evidence-based clinical practice guideline on trial of labor after cesarean delivery (TOLAC).

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2005/1115/p2126.html

Management of Pregnancy Beyond 40 Weeks' Gestation - American Family Physician

May 15, 2005 - A post-term or prolonged pregnancy is one that reaches 42 weeks' gestation; approximately 5 to 10 percent of pregnancies are post-term. Studies have shown a reduction in the number of pregnancies considered post-term when early ultrasound dating is performed. Maternal and fetal risks ...

American Family Physician : Article

https://www.aafp.org/afp/2005/0515/p1935.html

Prevention of Group B Streptococcal Disease in the Newborn - American Family Physician

Mar 1, 2005 - Group B streptococcus (GBS) is a leading cause of morbidity and mortality among newborns. Universal screening for GBS among women at 35 to 37 weeks of gestation is more effective than administration of intrapartum antibiotics based on risk factors. Lower vaginal and rectal cultures for ...

American Family Physician : Article

https://www.aafp.org/afp/2005/0301/p903.html

The ALSO Article Series - Editorials - American Family Physician

Apr 1, 2004 - ...CHARLES J. CARTER, M.D.Atlanta Medical Center Family Medicine Residency Morrow, Georgia BARBARA APGAR, M.D., M.S.University of Michigan Medical Center Ann Arbor, Michigan Am Fam Physician. 2004 Apr 1;69(7):1610-1613. In this issue of American Family Physician, we begin an article...

American Family Physician : Editorials

https://www.aafp.org/afp/2004/0401/p1610.html

The Nature and Management of Labor Pain: Part I. Nonpharmacologic Pain Relief - ...

Sep 15, 2003 - Pain in labor is a nearly universal experience for childbearing women. A recent evidence-based symposium on the nature and management of labor pain brought together family physicians, obstetricians, midwives, obstetric anesthesiologists, and childbirth educators to discuss a series of ...

American Family Physician : Article

https://www.aafp.org/afp/2003/0915/p1109.html

Methods for Cervical Ripening and Induction of Labor - American Family Physician

May 15, 2003 - Induction of labor is common in obstetric practice. According to the most current studies, the rate varies from 9.5 to 33.7 percent of all pregnancies annually. In the absence of a ripe or favorable cervix, a successful vaginal birth is less likely. Therefore, cervical ripening or ...

American Family Physician : Article

https://www.aafp.org/afp/2003/0515/p2123.html

Caregiver Support for Women During Childbirth: Does the Presence of a Labor-Support ...

Oct 1, 2002 - This review indicates that continuous caregiver support during childbirth has a number of benefits with minimal to no risks. It was less likely that women would need pain medications or have an operative vaginal delivery, a cesarean section, or a five-minute Apgar score of less than 7 ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2002/1001/p1205.html

Promoting and Supporting Breastfeeding - Editorials - American Family Physician

Sep 15, 2001 - ...Georgetown University School of Medicine Washington, D.C Am Fam Physician. 2001 Sep 15;64(6):931-932. Related Article Family physicians, as doctors of women and children, are in the ideal position to promote and support breastfeeding. The American Academy of Family Physicians'...

American Family Physician : Editorials

https://www.aafp.org/afp/2001/0915/p931.html

Management of Suspected Fetal Macrosomia - American Family Physician

Jan 15, 2001 - Fetal macrosomia, arbitrarily defined as a birth weight of more than 4,000 g (8 lb, 13 oz) complicates more than 10 percent of all pregnancies in the United States. It is associated with increased risks of cesarean section and trauma to the birth canal and the fetus. Fetal macrosomia is...

American Family Physician : Article

https://www.aafp.org/afp/2001/0115/p302.html

Vacuum Extraction: A Necessary Skill - Editorials - American Family Physician

Sep 15, 2000 - ...state unequivocally that vacuum should be applied intermittently—on during contractions, off between contractions—and for a specified number of pulls, minutes or pop-offs. One randomized, controlled trial12 using the M-type cup helps answer this question, showing no difference in...

American Family Physician : Editorials

https://www.aafp.org/afp/2000/0915/p1269.html

Promoting and Supporting Breast-Feeding - American Family Physician

Apr 1, 2000 - The family physician can significantly influence a mother's decision to breast-feed. Prenatal support, hospital management and subsequent pediatric and maternal visits are all-important components of breast-feeding promotion. Prenatal encouragement increases breast-feeding rates and ...

American Family Physician : Article

https://www.aafp.org/afp/2000/0401/p2093.html

Why Are We Using Electronic Fetal Monitoring? - Editorials - American Family Physician

May 1, 1999 - ...However, more recently, a number of systematic reviews of randomized controlled trials have been published that do not support the routine use of EFM, especially in low-risk women.2–5 The data show that neurologic abnormalities are not caused by intermittent episodes of asphyxia...

American Family Physician : Editorials

https://www.aafp.org/afp/1999/0501/p2416.html

Postpartum Major Depression: Detection and Treatment - American Family Physician

Apr 15, 1999 - Postpartum major depression occurs in approximately one of 10 childbearing women and is considerably underdiagnosed. If left untreated, the disorder can have serious adverse effects on the mother and her relationship with significant others, and on the child's emotional and psychologic ...

American Family Physician : Article

https://www.aafp.org/afp/1999/0415/p2247.html

Epidural Analgesia During Labor - American Family Physician

Nov 15, 1998 - Epidural analgesia is a commonly employed technique of providing pain relief during labor. The number of parturients given intrapartum epidural analgesia is reported to be over 50 percent at many institutions in the United States. The procedure has few contraindications, the primary ...

American Family Physician : Article

https://www.aafp.org/afp/1998/1115/p1785.html

Prevention of Neonatal Group B Streptococcal Infection - American Family Physician

Jun 1, 1998 - Neonatal group B streptococcal infection is the primary cause of neonatal morbidity related to infection. It can often be prevented by identifying and treating pregnant women who carry group B streptococci or who are at highest risk of transmitting the bacteria to newborns. Increasing ...

American Family Physician : Article

https://www.aafp.org/afp/1998/0601/p2713.html

Preterm Labor: Diagnosis and Treatment - American Family Physician

May 15, 1998 - Preterm labor and delivery are among the most challenging obstetric complications encountered by the family physician. In the United States, preterm delivery affects approximately one in 10 births and is the cause of at least 75 percent of neonatal deaths, excluding those related to ...

American Family Physician : Article

https://www.aafp.org/afp/1998/0515/p2457.html

Examination of the Placenta - American Family Physician

Mar 1, 1998 - A one-minute examination of the placenta performed in the delivery room provides information that may be important to the care of both mother and infant. The findings of this assessment should be documented in the delivery records. During the examination, the size, shape, consistency ...

American Family Physician : Article

https://www.aafp.org/afp/1998/0301/p1045.html

Transcervical Amnioinfusion - American Family Physician

Feb 1, 1998 - Amnioinfusion is being used to treat intrapartum problems known to be associated with fetal compromise, including prophylactic treatment of oligohydramnios during labor and after premature rupture of the membranes, treatment of severe variable decelerations during labor and reducing the...

American Family Physician : Article

https://www.aafp.org/afp/1998/0201/p504.html

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