References for:

C. Preparing for an Optimal Birth Experience

1A. Consider all birthplace options, recognizing that birth experiences are enhanced in home, birth center, or hospital settings that support parent's informed choices for the labor, birthing, and postpartum process.

  1. Birth experiences are enhanced by freedom for the birthing woman to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication).

References:

  1. Albers, L., Anderson, D., Cragin, L., Daniels, S., Hunter, C., Sedler, K., & Dusty, T. (1997). The relationship of ambulation in labor to operative delivery. The Journal of Nurse-Midwifery, 42(1), 4-8. (abstract)
  2. Rossi, M., & Lindell, S. (1986). Maternal positions and pushing techniques in a nonprescriptive environment. Journal of Obstetric, Gynecological and Neonatal Nursing, 15, 203-208. (abstract)

Abstract 1:

Albers, L., Anderson, D., Cragin, L., Daniels, S., Hunter, C., Sedler, K., & Dusty, T. (1997). The relationship of ambulation in labor to operative delivery. The Journal of Nurse-Midwifery, 42(1), 4-8.

Premise: Ambulation during first-stage labor possibly decreases the incidence of operative deliveries, use of narcotics, and incidence of fetal distress.

Research Question: Does significant ambulation during labor decrease the rate of operative delivery?

Subjects: Data were collected from 1,678 intrapartum patients from three different practices by certified nurse-midwives. The women were low-risk and at term. They also demonstrated vertex singleton pregnancies with spontaneous labor and an unremarkable prenatal course.

Study Design: Ambulation was recorded for those patients who were upright or mobile for at least one-half of the labor. Subjects were not assigned to ambulate but were given a choice.

Variables: Specific demographic data on the women (age, parity, level of education, race, mental status, and source of payment) were also recorded. Care measures (including fetal monitoring, narcotic analgesic, and fluid intake) were included. Outcome variables included type of delivery, fetal distress, infant birth weight, and prolonged first-stage and second-stage labors.

Findings: Forty-six percent of the intrapartum patients were ambulatory for a significant portion of their labor. Of those who ambulated, a 50% reduction occurred in the incidence of operative delivery (defined as cesarean delivery, vacuum extraction, and/or use of forceps). Ambulation was also associated with a lower use of narcotic analgesia and less fetal distress.

Research reviewed by Jamie Kates, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.

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Abstract 2:

Rossi, M., & Lindell, S. (1986). Maternal positions and pushing techniques in a nonprescriptive environment. Journal of Obstetric, Gynecological and Neonatal Nursing, 15, 203-208.

Premise: Low-risk women should be given choice in selecting their birthing positions in second-stage labor.

Research Questions: In a nonprescriptive environment, what birthing positions do women assume? In a nonprescriptive environment, what pushing methods do birthing women employ? In a nonprescriptive environment, what are the birth outcomes?

Background: The majority of infants worldwide are born with mothers in an upright position. In contrast, the recumbent position is most often used for labor and birth in western civilizations.

Variables: Second-stage labor pushing positions, pushing techniques, and breathing techniques.

Subjects: A total of 50 women, primarily Caucasian, who were at 28-40 weeks gestation, with low-risk pregnancy, and with fetus in cephalic presentation.

Study Design: Prior to the onset of the second stage of labor, a birth observer was positioned in a room to view and record birthing positions and breathing techniques and to identify the director of the events. The nurse-midwife care providers were under direction not to give any specific instruction or intervention in positions, breathing, or pushing during the second stage of labor.

Findings: The study subjects chose nine birthing positions. These positions included reclining, sidelying, lateral reclining, supine, sitting, and al-fours. The actual number of position changes ranged from one change for 28 women to seven changes for two women. Regarding position change: 13 women were self-directed, 16 were directed only once by the caregiver, and 44 chose their initial position for pushing. Six of the nine positions were chosen for the actual birth. Three breathing methods were used, 18 women used open glottis, 12 used the closed glottis, and 10 used intermittent exhalation techniques. The mean length of the second stage of labor was 34.1 minutes. Birthing in a nonprescriptive environment did not lengthen second-stage labor. The incidence of episiotomies, use of drugs, and Apgar scores was not different from the standard practice at the sites selected. Thus, positions and/or breathing chosen by the subjects neither increased nor decreased the incidence of episiotomies or use of drugs, nor did they influence Apgar scores. No reason for denying choice was evident.

Research reviewed by Jamie Kates, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.

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