Obstetrics Guidelines Introduction

Introduction

The Clinical Guidelines for Obstetrical Services at CRICO-insured Institutions are intended to provide guidance for clinicians and to support the optimal outcomes for patients receiving care by CRICO-insured clinicians.¹ The recommendations for practice included in this document were arrived at through careful consideration of the available evidence. These Guidelines offer a framework for provision of obstetrical care, rather than an inflexible set of mandates. Clinicians involved in obstetrical care must use their professional knowledge and judgment when applying any recommendations to the management of individual patients. These Guidelines are subject to revision at regular intervals as changes in clinical practice evolve.

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Principles

Optimal care requires a collaborative process among obstetrical clinicians who respect the right of the patient to make informed decisions for themself and their fetus. CRICO recognizes that obstetrical care providers treat people of all gender identities.

Resources

The Guidelines are a codification of:

• Existing best practices
• Recommendations of the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives
• Guidelines for Perinatal Care (American Academy of Pediatrics and ACOG), and
• Practice Guidelines for Obstetrical Anesthesia (American Society of Anesthesiologists).

Revisions

The 2026 revisions to the Clinical Guidelines for the Obstetrical Services were guided by a multi-disciplinary group of clinicians, including obstetricians, nurse leaders, nurse midwives, and anesthesiologists from several CRICO-insured institutions. The clinical leaders of the obstetrical departments of the CRICO-insured institutions have approved the current version of these guidelines. Questions regarding this document should be directed to the Patient Safety Department at CRICO, Boston, Massachusetts.

1. As of November 2025, the following institutions insured through CRICO provide obstetrical service: About Women by Women, P.C., Anna Jaques Hospital, Associated Physicians of HMFP at BIDMC, Atrius Health, Inc., Beth Israel Deaconess Medical Center, Inc., Beth Israel Lahey Health Primary Care, Inc., Beth Israel Lahey Health Specialty Care, Inc., Boston Obstetrics & Gynecology, LLC, Brigham And Women’s Physicians Organization, Inc., Brigham Faulkner Ob/Gyn Associates, P.C., Brookline Village Ob/Gyn, LLC, Cambridge Health Alliance, CHMC Surgical Foundation, Inc., Commonwealth Ob-Gyn, P.C., Cooley Dickinson Hospital, Inc., Core Physicians, LLC, Diagnostic Ultrasound Associates, P.C., Essex County Ob/Gyn Associates, Inc., Harvard Medical Faculty, Physicians At BIDMC, Inc., Lahey Clinic Foundation, Inc., Martha’s Vineyard Hospital, Inc., Mass General Brigham Community Physicians, Inc., Mass General Brigham Incorporated, Mass General Brigham Medical Group Northern Massachusetts, Mass General Brigham Medical Group Western Massachusetts, Massachusetts General Physicians Organization, Inc., Massachusetts Institute of Technology, Medical Care of Boston Management Corporation, Mount Auburn Hospital, Mount Auburn Professional Services, Inc., Nantucket Cottage Hospital, New England Ob-Gyn Associates, Inc., Newton-Wellesley Hospital, Newton-Wellesley Obstetrics & Gynecology, P.C., North Shore Medical Center, Inc., Seacoast Affiliated Group Practice, Inc., The Brigham and Women’s Hospital, Inc., The Children’s Hospital Corporation, The Massachusetts General Hospital, Wellesley Women’s Care, P.C., Wentworth-Douglass Physician Corporation