Tuesday, March 18, 2008

A sigh of relief

I just finished reading a fabulous article. Check out "Off Her Back" by Cynthia Overgard. It tells of her paradigm shift as she navigated the confusing waters of her first pregnancy and ultimately found the path that felt right for her. It's always so encouraging to read about women who educate themselves and take charge of their pregnancies and births.

Cynthia was alarmed when she asked her obstetrician about her cesarean rate. Here's an excerpt:
At my 12-week checkup, I asked my own obstetrician a straightforward question: her cesarean rate. Her response was that she had no idea; the obstetrics practice hadn't bothered to calculate those numbers in years.

"The national average is around 27 percent [2003]," I said. "Would you guess this practice comes in higher or lower?"

"Definitely higher," she said.

Anxiously, I demanded to know how much higher. "Is it greater than 30 percent? Thirty-five percent?" She looked at me regretfully. I pressed on. "Forty percent?!"

She finally nodded. "Yes, at least, but I don't have exact numbers."

This exchange was stunning to me, but it simultaneously confirmed what I often see around me. It sometimes feels like all the women I know end up with c-sections. Fortunately, Cynthia swiftly changed providers. I so wish there were more stories like Cynthia's!

Go read this article! It'll give you warm fuzzies.

Thursday, March 6, 2008

"Promoting, Protecting, and Supporting Normal Birth: A Look at the Evidence"

Check out this article from the Jan/Feb 2008 issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing. Here's the abstract:
Interfering with the normal physiological process of labor and birth in the absence of medical necessity increases the risk of complications for mother and baby. Six evidence-based care practices promote physiological birth: avoiding medically unnecessary induction of labor, allowing freedom of movement for the laboring woman, providing continuous labor support, avoiding routine interventions and restrictions, encouraging spontaneous pushing in nonsupine positions, and keeping mothers and babies together after birth without restrictions on breastfeeding. Nurses are in a unique position to provide these care practices and to help childbearing women make informed choices based on evidence.
And here are the concluding paragraphs which I love!
Nurses have an opportunity to provide leadership in pushing hospitals to provide evidence-based care that promotes healthy outcomes. Nurses will begin to question orders that do not reflect best evidence in the same way that we question medication orders that are not appropriate. We can begin by asking ourselves and our colleagues why a care practice is happening in the first place. Is it for the convenience of the staff or "hospital efficiency" or is it for the best interest of the individual mother and baby? Does it reflect outdated research or the best available evidence? Is it rooted in fear of a poor outcome or a lawsuit or in confidence in women’s ability to give birth normally? Is it based on rituals and routines or individualized care?

While changing practice will take hard work and challenge some of our long-held beliefs, nurses will reap great benefits, along with mothers, babies, and families. Reducing interventions and easing restrictions will change the focus of intrapartum nursing from medical management to nursing care. And there will finally be time for providing comfort and support, the traditional hallmarks of labor and delivery nursing care.