Normal Birth: A Thing Of The Past?

Main Category: Pregnancy / Obstetrics
Also Included In: Pediatrics / Children's Health
Article Date: 10 Jan 2008 - 2:00 PDT

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At a time when nearly one in three US births are cesarean and the rate of medical intervention in maternity care continues to rise, the January/February issue of the Association of Women's Health, Obstetric and Neonatal Nurses' Journal of Obstetric, Gynecologic and Neonatal Nursing (JOGNN) explores the evolution and implications of current high-tech birthing practices and offers nursing recommendations for a return to normal birth.

The "Reclaiming Normal Birth" issue features articles that explore evidence-based nursing practices to promote normal physiological birth - that is, birth that occurs naturally with minimal medical intervention. Also discussed is how to balance these care practices in today's current birthing climate where interventions have become routine.

According to the article, "Promoting, Protecting, and Supporting Normal Birth: A Look at the Evidence," six evidence-based care practices adopted from the World Health Organization (WHO) can be implemented by nurses to promote physiological birth:

- Care Practice 1: Labor begins on its own;

- Care Practice 2: Freedom of movement throughout labor;

- Care Practice 3: Continuous labor support;

- Care Practice 4: No routine interventions;

- Care Practice 5: Spontaneous pushing in nonsupine positions; and

- Care Practice 6: No separation of mother and baby.

The article reviews evidence surrounding each of these care practices and determines that interventions that are not medical necessary increase the risk of complications for mother and baby during birth. However, nurses, as the most prominent, hands-on caregiver in the labor and delivery environment, are in a unique position to reintroduce care practices that support normal birth.

In "The Emergence of High-Tech Birthing," Elaine Zwelling, RN, PhD, a perinatal nurse consultant with the Hill-Rom Company, details the transition from pregnancy and birth as a normal, intervention-free event to a high risk and high-tech event.

Zwelling makes the case that normal birth, as defined by the six parameters adopted from WHO, may be difficult to achieve in the United States today due to routine high-tech interventions.

"As the primary caregivers for women during labor, nurses often find themselves walking a fine line between the wishes of the consumers and the preferences of the women's medical care providers," states Zwelling in the article. She recommends that nurses strive to balance high-tech with high-touch rather than selecting one over the other.

Both articles make the case that hospitals are well-equipped for high-risk, complicated births, but not set-up for normal birth due to policies, protocols and physical infrastructure. Therefore, advocating for normal birth is a challenge for nurses in the current maternity care environment and will require dramatic changes in the typical American hospital.

Continuing Nursing Education Credit may be earned by nurses who read and complete an online post-test and evaluation for the article, "Promoting, Protecting and Supporting Normal Birth: A Look at the Evidence," by Amy M. Romano, MSN, CNM, a perinatal research and advocacy coordinator at Lamaze International, and Judith A. Lothian, RN, PhD, LCCE, an associate professor at the College of Nursing, Seton Hall University in South Orange, New Jersey.

AWHONN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

About JOGNN

The Journal of Obstetric, Gynecologic and Neonatal Nursing (JOGNN) is the bimonthly peer-reviewed journal of the Association of Women's Health, Obstetric and Neonatal Nurses.

About AWHONN

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) was founded in 1969 and is the foremost nursing authority that advances the health care of women and newborns through advocacy, research and the creation of high quality, evidence-based standards of care.

AWHONN's 22,000 members worldwide are clinicians, educators and executives who serve as patient care advocates focusing on the needs of women and infants. A leader in professional development, AWHONN is the first and only association to be awarded the designation Premier Provider by the American Nurses Credentialing Center for innovation and excellence in Continuing Education.

Association of Women's Health, Obstetric and Neonatal Nurses