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 Does it reflect outdated research or the best available evidence?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.

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