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Promoting Normal, Non-Interventional Labour & Birth

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Portia G

on 29 March 2015

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Transcript of Promoting Normal, Non-Interventional Labour & Birth

Promoting Normal, Non-Interventional Labour & Birth
Portia Gunthorpe, Semester One, 2015
Promoting Normal Birth
What is Normal Birth?
Importance of Normal Birth
Promoting Normal Birth:
Strategies during Pregnancy.
Trusting Relationship
Link to PBL
The most widely accepted definiton of a normal birth is by World Health Organisation (1996):
"spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition."

- artificial rupture of membranes (if not part of an induction of labour)
- use of nitrous oxide, opiods
- free from intervention
- intermittent fetal auscultation

What strategies would the midwife suggest to promote normal, non-interventional labour and birth? Consider strategies throughout the mothering journey.
In this Presentation:
1.1 Apply evidence within the midwifery partnership to promote normal, non-interventional choices for women during labour, birth and post-partum including breastfeeding.
- Define & discuss 'Normal Birth'
- Strategies to promote normal birth during mothering journey (pregnancy)
- Strategies to promote normal birth during labour
- Link to PBL

Pairman et al., 2010; World Health Organisation, 1996; Sidebotham, 2012; Devane et al., 2012.
Aspects of a Normal Birth:
-> cochrane review conducted by Devane et al., 2012 suggest the use of electronic fetal monitoring should be avoided in low-risk women (normal birth) as cardiotocography (CTG) can increase the risk of C/S.
Global increases in the rates of caesarean section have been observed.

Generally attributed to fear of birth.
- Questionnaire conducted by Fenwick et al., in 2013 found that 50%
of women held moderate fear about birth, and 26% had intense fear
towards birth.

- Percieved lack of control
- Disbelief in body's ability to birth safely
- Previous negative/traumatic birth experience

However, C/S rates and multiple C/S results in associated negative outcomes:
- Difficult C/S surgery
- Hysterectomy
- Increased length of stay

There remains some controversy as to the efficacy of birth plans, however most research supports their use in pregnancy. The majority of the negative comments regarding birth plans were made based on personal opinion rather than research findings.
Reason for fear:
Continuing research into the reduction of fear regarding birth:
- Current Queensland-based study investigating the efficacy of midwife counselling for
those fearful of labour, set for completion in 2016.
Increased interventions have also been associated with reduced bonding with the baby
Donna, 2011; Fenwick et al., 2013; Bergan, 2015
What do you think Normal Birth means/ What do you think it involves?
- Evidence:
woman-centred care & continuity of care
informed choice and consent
educate mother about pregnancy and birth
exposure to normal birth and reducing stereotypes
evidence-based practice.
- Trusting relationship:
- Empowerment:
- Education:
- Exposure:

- Provide woman-centred care

- Build rapport with the mother

- Provide culturally competent care
- Utilise active listening skills
- Respect woman's wishes
- Advocate for woman

The midwife should strive to:
- Focus on the woman's care, needs, questions and concerns.
- Individualised, holistic care encompassing woman's physical, psychosocial,
emotional, spiritual and cultural needs.

- Enables open information-sharing, comfortability with healthcare
provider, encourages trust between midwife and mother.
Continuity of care in promoting normal birth:
- Research has shown a high level of continuity in care can reduce interventions at birth
- The COSMOS study conducted in 2012 found that women receiving continuity in
their care are more likely to have a natural birth.
- Continuity of care has also been linked to higher levels of patient satisfaction.
Promoting Normal Birth: Strategies during Labour.
Birth Plan
Empowering the woman can provide strength and courage for the birth, and put the woman in a position of control.
The midwife can empower the woman by:
- Informing the woman on when to call the midwife/hospital
- Giving the woman the choice of where should would like to have her birth
(where this can be facilitated)
- Giving the woman the choice of her type of care e.g. hypnobirthing, MGP
- Affirming the woman's capacity to birth her baby
- Encouraging the woman that her efforts will birth the baby, not the midwife.
- Educating the woman on pain relief options so she can make informed choices during labour.
Empowering the woman can:
- Reduce fear
- Reduce the need for intervention
- Increase feelings of control and strength
- Enable the mother to exercise informed choice and consent
- Enable the mother to question before receiving interventions
*This can predominantly be achieved through education and exposure*
Education allows the woman to understand her body, pregnancy & labour and allows for informed decison making, and can reduce a woman's fear of birth.
The midwife can educate the woman on:
- The process of birth

- Changes during pregnancy
- Options during labour
- Pain relief during labour
- Methods to reduce anxiety during pregnancy and labour

- Education by the midwife during antenatal appointments and labour
- Childbirth preparation sessions/antenatal classes

- Tour of the labour ward to familiarise self
- Birth Talk
Education available to women:
-> Focus should be on childbirth, practical ways to support the physiology of birth
-> Work with the mother to explore helpful relaxation techniques
-> Use knowledge to challenge stereotypes & societal views of birth.
-> Help women understand the process of birth through discussion about labour & the use of visual aids
-> Helps to reduce fear and mystery surrounding labour
-> Empowers women and builds confidence
Exposure to normal birth can help change a woman's perceptions and beliefs, and can educate her about physiological birth in order to empower her to strive for a normal birth in her own pregnancy.
Midwives can encourage exposure by:
- Answering questions the woman may have about birth
- Utilising visual aids and demonstrations when discussing normal birth

- Suggesting a tour of the birth suite
- Breaking down stereotypes and the media's portrayal of birth through education

-> this can help the woman visualise and understand what happens with her body
-> many women may have based their opinions of birth from mothers and friends who may have given birth during a time where birth was highly medicalised
Midwives can also work towards changing the expectations of women such as the fact that they
won't be "strapped down to a monitor"
, they can
mobilise freely
, and can
birth in their home
or a birthing centre if that is their desire and they are a low-risk pregnancy.
The midwife can promote normal birth by providing evidence-based care for the mother during pregnancy and labour.
The midwife should:
- Follow protocol and ward policy when caring for a woman
- Base actions upon the latest research, approved by the hospital

- Question own actions based on knowledge to ensure the best care for women
- Encourage a professional culture with positive attitudes towards normal birth
- Encourage the collaboration of knowledge and skills between professionals
- Provide evidence-based antenatal care which promotes normal birth
-> e.g. cochrane review by Devane et al., 2012 concluding cardiotocography (CTG) should not be used on admission for low-risk women as it has been linked with increased risk of C/S and instrumental birth.
-> e.g. discussion and development of a birth plan

Discomfort & Pain

Mobilisation & Position
*As there are such a large number of strategies the midwife can use during labour, for the purpose of this presentation I haven't gone into too much detail, however in your booklets I have listed many more strategies.*
- Encourage women to stay at home as long as possible
- Private, calm, & safe e.g. lowered lighting, music, aromatherapy
-> decreasing a woman's anxiety has been associated with wellbeing
and uncomplicated birth.
- Presence of support person(s) and continuous support from midwife
(although contradictory evidence)
- Offer comfort measures to woman e.g. heatpacks, ice chips, shower, bath, massage
-> encourage mother to eat, drink, make noise freely
- Incorporate relaxation techniques where appropriate
- Accomodate complementary & alternative therapies requested by the woman (where possible)
- Non-pharmacological pain relief e.g. breathing techniques, sterile water injections
- Pharmacological pain relief e.g. nitrous oxide, pethidine
- Can increase woman's sense of control through self-regulation and distraction
- Encourage woman to walk freely during first stage
-> walking and upright positions during the first stage are associated with a reduction in the
length of first stage by approx 1hr.
- Avoid long periods with mother lying supine
*Refer to Birth Plan*
- Allows woman to learn about her options before labour.
- Allows for more pain relief options to be tried during labour as the woman is
more educated and aware of her available options.
- Allows woman to feel more prepared for labour and can reduce stress and fear.
For the Woman:
For the Midwife:
- Useful tool in educating and empowering women.
- Values informed consent and autonomy.
- Allows the midwife to advocate the woman's wishes.
- Allows the midwife to become proactive in offering pain relief.
- C/S rates are not higher in women with birth plan compared to those without.
- Women with birth plans report more satisfaction with their birth experiences.
Promoting normal birth during labour:

-Encourage food and drink
-> important in maintaining stable BSL
- Check BSL every hour to ensure within
normal levels
- Respect and incorporate cultural beliefs
and practices at birth
Promoting normal birth during pregnancy:

- Attended antenatal classes
- Educated on how GDM affects labour
- Educated that keeping BSLs stable will
increase her chances of a normal birth
- Discussed birth plan
- Discussed support person(s)
Promoting normal birth during labour:

-Low-risk pregnancy, no specific precautions
- All strategies to promote normal labour
should be provided where appropriate
Promoting normal birth during pregnancy:

- Attended antenatal classes
- Developed birth plan
-> empowerment
-> knowledgeable about options
- Discussed labouring at home first
- Discussed support person(s)
-> can decrease length of labour

List the 5 main strategies during pregnancy which were discussed to promote normal birth
Bergan, C. (2015). Midwives promoting normal birth [Powerpoint Slides]. Retrieved from MIDW2001, Univeristy of Queensland, Blackboard Online: http://

Department of Health and Ageing. (2012). Clinical Practice Guidelines Antenatal Care- Module 1. Canberra: Australian Government.

Devane, D., Lalor, J.G., Daly, S., McGuire, W., Smith, V. (2012). Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment
of fetal wellbeing (Review). The Cochrane database of systematic reviews(2). Doi 10.1002/14651858.CD005122.pub4.

Donna, S. (Ed.). (2011). Promoting normal birth: Research, Reflections & Guidelines. United Kingdom: Fresh Heart Publishing.

Fenwick, J., Gamble, J., Creedy, D.K., Buist, A., Turkstra, E., Sneddon, A., ... Toohill, J. (2013). Study protocol for reducing childbirth fear: a midwife-led psycho-education
intervention. BMC Pregnancy and Childbirth, 13(190). doi:10.1186/1471-2393-13-190

Fontein,J. (2010) The comparison of birth outcomes and birth experiences of low risk women in different sized midwifery practices in the netherlands. Woman and Birth,
23: 103-10

Journal of Midwifery & Women’s Health. (2014). Writing a Birth Plan. Journal of Midwifery & Women’s Health, 59(2), 227-228. doi 10.1111/ jmwh.12192

Kemp, J., Sandall, J. (2010). Normal birth, magical birth: the role of the 36-week birth talk in caseload midwifery practice. Midwifery, 26(2), 211-221. doi:10.1016/j.mi

McLachlan HL, Forster DA, Davey MA, Farrell T, Gold L, Biro MA, Albers L, Flood M, Oats J, Waldenström U. Effects of continuity of care by a primary midwife (caseload
midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG 2012 (in press). Epub 2012 Jul 25. Available from: http://dx.doi.org/10.1111/j.1471-0528.2012.03446.x

National Institute for Health Care and Excellence. (2015). Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal
period. Retrieved from http://www.nice.org.uk/guidance/ng3 /chapter/1-recommendations#intrapartum-care-2

Pairman, S., Tracy, S., Thorogood, C., Pincombe, J. (2010). Midwifery. Australia: Elsevier.

Queensland Maternity and Neonatal Clinical Guidelines Program. (2012). Normal Birth. Retrieved from http://www.health.qld.gov.au/qcg/ documents/g_normbirth.pdf

Sidebotham, M. (2012). Promoting normal birth the easy way. The Practising Midwife, 15(10), 23-25.

Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM. (2013). The Journal of Perinatal Education,22(1), 14–18. doi:10.1891/1058-1243.22.1.14

World Health Organization. Care in normal birth: a practical guide. Report of a technical working group. Safe motherhood practical guide.
1996 [cited 2011 January 27]; WHO/FRH/MSM/96.24. Available from: http://whqlibdoc.who.int/hq/1996/WHO_FRH_MSM_96.24.pdf.

White-Corey, S. (2013). Birth Plans: Tickets to the OR? American Journal of Maternal Child Nursing, 38(5). 268-273. Doi 10.1097/ NMC.0b013e31829a399d
Sidebotham, 2012; Bergan, 2015
Department of Health and Ageing, 2012; Bergan, 2015; McLachlan et al., 2012; Fontein, 2010
Sidebotham, 2012; Kemp & Sandall, 2010
Sidebotham, 2012; Fenwick et al., 2013; Queensland Maternity and Neonatal Clinical Guidelines Program, 2012; Kemp & Sandall, 2010
Sidebotham, 2012; Queensland Maternity and Neonatal Clinical Guidelines Program, 2012; Kemp & Sandall, 2010
Queensland Maternity and Neonatal Clinical Guidelines Program, 2012; Sidebotham, 2012
Pairman, 2010; Queensland Maternity and Neonatal Clinical Guidelines Program, 2012; Donna, 2011; Journal of Perinatal Education, 2013
Fenwick et al., 2013; Journal of Midwifery & Women's Health, 2014; White-Corey, 2013
National Institute for Health Care and Excellence, 2015; Queensland Maternity and Neonatal Clinical Guidelines Program, 2012
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