“Let the Woman Lead in the Dance of Birth”
Today I attended an in-service training for labor nurses and educators in our hospital maternity services (Yale-New Haven Hospital) concerning the new guidelines on second stage, or pushing, from AWHONN. These guidelines are being implemented on our labor and birth floor. This change comes not a moment too soon!
Not only are women telling us that they dislike the medicalization of birth, but also that they perceive potential dangers to them and their offspring inherent in some common in-hospital practices. One such practice is the use of the Valsalva maneuver, also called “directed” pushing, in which you hold your breath and bear down hard. Unfortunately, it causes hemodynamic problems, damages tissue and stresses mother and baby.
Our educator today, Louise Ward, RN, MSN, took us through the second edition of the AWHONN guidelines, with their focus on following the woman’s urges, helping her stay mobile and upright, and supporting her physically, emotionally, instructionally and psychologically. She covered laboring down, the process of allowing the mother to wait until she felt sufficient pressure or has the urge to begin pushing. She covered accommodating women with epidurals, helping them distinguish between pain and pressure. And, we discussed how to help women accept and focus on letting the baby emerge.
Many of the topics we covered were items I had learned about by reading the research studies that allowed AWHONN to develop these evidence-based guidelines. But, it was an exciting moment for me. Many of the women that I work with in various prenatal classes tell me they want to give birth at the hospital because they want to be in a safe place in case of an emergency, but do not want to be subjected to much of the medical intervention they hear about. I agree. And so, I am glad to learn what our hospital is doing to bring the evidence – which my clients have read – into practice.
Our hydrotherapy tub is up and running…plumbing finally fixed! We are committed to letting the mother lead in pushing, to support breastfeeding and nurture new families. Next, we may even get back to intermittent auscultation! These things are happening in part because of consumer pressure and in part because of mandates to reduce the number of unnecessary, ineffective and costly medical procedures throughout the health care system.
I’m glad to see that evidence, mother’s instincts and financial pressures are all pointing toward the same solution…birth is primal behavior and works best when we follow the woman’s lead.
