The safety and effectiveness of routine interventions during labor, birth, and the immediate postpartum period is the subject of a literature review by Mercer and colleagues.

“Evidence-Based Practices for the Fetal to Newborn Transition,” published in the May 2007 issue of Journal of Midwifery & Women’s Health, examines the evidence for routine newborn care practices including labor medications, umbilical cord clamping, temperature control, suctioning, and resuscitation.

According to Mercer and colleagues, “Recent research is beginning to identify some older practices that should not have been abandoned and some current practices that should be stopped.”

A summary of the results, listed below, are prefaced by the statement, “An important tenet of practice for all health care personnel is to first do no harm. This idea takes on additional importance when dealing with newborns, as there is almost no long-term data on the safety of many procedures.”

Maternal Analgesia: There is limited data regarding the safety of maternal analgesia (parenteral opioids or epidural or combined epidural/spinal anesthesia with or without opioids) and its effects on the newborn. In addition to the need for further study, judicious use of medications during labor is recommended.

Umbilical Cord Clamping: Delaying clamping of the umbilical cord appears to offer protection from anemia without harmful effects, therefore the practice of immediate clamping should be discontinued.

Skin-to-Skin Care: Skin-to-skin care should be the mainstay of newborn care. It is safe, economical, and effective. Birthing facilities that separate mothers and babies in an effort to prevent cold stress actually increase the risk of cold stress. In addition, separation interferes with bonding and delays the initiation of breastfeeding.

Routine Suctioning: Routine suctioning of the infant at birth should be abandoned. In addition, meconium-stained babies should not be suctioned and/or intubated unless they show evidence of respiratory distress.

The authors conclude by saying, “…some of these practices are so firmly entrenched that it will take a large body of research to change the standard.”

In clinical settings, they refer to it as history and habit.