#1: labor begins on its own

In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the benefit of allowing labor to begin on its own is discussed and presented as an evidence-based practice that helps promote, protect, and support normal birth. The paper is written for childbearing women and their families. The accompanying commentary-written by a leading home-birth midwife and prominent national and international speaker on maternity care-describes further evidence of the disadvantages of inducing labor. The indications for and risks of induction are also explored. Lamaze International recommends that, unless there is a medical indication for induction, labor should be allowed to begin on its own.     

Research summaries for normal birth

In this column, the author presents summaries of four research studies that further support the benefits of normal birth. The topics of the studies address midwifery care practices, labor induction and increased medical costs, vaginal birth after cesarean, and labor support from student nurse-doulas.     

米索前列醇用于晚期妊娠促宫颈成熟与引产的效果分析

为了观察晚期妊娠引产使用米索前列醇的可行性、有效性和安全性,选择有引产指征、无米索前列醇使用禁忌证的胎膜完整、单胎、头位晚期妊娠妇女150例,随机分为A、B两组,其中米索组80例,缩宫素组70例,并且对该两组引产时效、母儿并发症的发病情况作分析比较．结果表明：米索组较缩宫素组可明显改善宫颈成熟度,缩短引产至分娩时间（P〈0．01）,两组母儿并发症差异均无统计学意义（P〉0．05）．因此,在严格掌握米索前列醇引产的适应症情况下米索前列醇用于晚期妊娠引产及促宫颈成熟有价格低、性质稳定、易于保存、效果肯定,安全易掌握、引产成功率高等优点,值得临床推广尤其适合基层医疗机构应用．     

Patients' perspectives on the role of prepared childbirth education in decision making regarding elective labor induction

The purpose of our study was to explore reasons why nulliparous women chose to have an elective labor induction and to identify the influence of prepared childbirth classes on their decision. The study included 1,349 nulliparous women at term who participated in a survey regarding their choices for childbirth, their attendance at prepared childbirth classes, and their experience with labor and birth. Sixty-three percent of women who attended childbirth classes and did not have elective induction reported that classes provided helpful information to assist in their decision-making process. Study results suggest attendance at prepared childbirth classes can be an effective source of information regarding elective labor induction and influential in women's decisions regarding whether or not to have elective labor induction. Women perceive prepared childbirth classes positively and find the information provided valuable.     

医院输液自动呼唤装置的设计

随着科技的进一步发展,医疗设备不断更新,从而使医院为人们提供的医疗服务日臻完善。我们研制的医院输液自动呼唤装置,旨在减轻护士劳动强度,提高护理工作效率,保证医疗质量,减少医疗事故的发生,而且对促进医院现代化、信息化建设具有现实意义,应用前景十分广阔。     

Misoprostol-is more research needed?

Misoprostol (Cytotec) is a synthetic prostaglandin E1 analogue that was designed for the prevention and treatment of peptic ulcer associated with the use of nonsteroidal anti-inflammatory drugs. In obstetrics, misoprostol has been administered for induction of first and second trimester abortion, for induction of labor in the third trimester, and to control postpartum hemorrhage. None of these uses has been approved by the Food and Drug Administration. Nevertheless, misoprostol is widely used in the United States and throughout the world. Advantages are cited as reduced rate of cesareans, shorter time from induction to birth and, particularly in developing countries, lower cost, oral, vaginal or rectal administration, and stability without refrigeration. Disadvantages are uterine hyperstimulation and, in rare instances, uterine rupture and death. Mothers should be informed of both the risks and the possible benefits of misoprostol. Further research with large samples is necessary to determine whether the risks outweigh any possible benefits.     

Position paper: promoting, supporting, and protecting normal birth

This updated position paper contrasts medical management of labor and birth with the normal physiology of birth and describes the care practices that support and facilitate the normal process. Lamaze International urges care providers to adopt these care practices as the standard of care, unless evidence-based medical reasons dictate otherwise. The roles of Lamaze-certified childbirth educators and the Lamaze Institute for Normal Birth in protecting, preserving, and promoting normal birth are described.     

Healthy Birth Practice #1: Let Labor Begin on Its Own

As cesarean rates have climbed to almost one-third of all births in the United States, current research and professional organizations have identified letting labor begin on its own as one of the most important strategies for reducing the primary cesarean rate. At least equally important, letting labor begin on its own supports normal physiology, prevents iatrogenic prematurity, and prevents the cascade of interventions caused by labor induction. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #1: Let Labor Begin on Its Own,” published in The Journal of Perinatal Education, 16(3), 2007.     

Listening to Mothers II: Knowledge, Decision-Making, and Attendance at Childbirth Education Classes

In this column, a woman describes her concern that her childbirth classes did not provide the information she needed to make informed decisions during labor and birth. The results of the Listening to Mothers II survey suggest that this experience is not unusual. Although most women (97%) who participated in the survey wanted to know all or most of the potential risks of epidural, induction, and cesarean before consenting to have the intervention, the majority-including mothers who had experienced the intervention, women who were experienced mothers, and women who had attended childbirth classes-did not know the complications of induction or cesarean. These findings raise important questions about the outcomes of childbirth education. The factors that may contribute to these findings are discussed, and suggestions are made for insuring that women have the knowledge they need to make informed decisions about their maternity care.     

Each One Unique

A young mother shares the stories of her two sons'' births. Her first birth experience was complicated by muscle spasms and changes in her baby''s heart rate during labor and, later, by medical problems with her baby in the days after birth. The mother''s strength and commitment shine through at every twist and turn during labor and the days after her son''s birth. Two years later, in contrast to her first son''s birth, the mother''s second son was born so quickly that labor presented a different set of challenges. The mother''s confidence in birth and in herself are essential facets of the stories of the births of her two sons.     

Finding our way

LONG BEFORE I GOT PREGNANT, MY HUSBAND AND I BEGAN TO PREPARE FOR THE KIND OF BIRTH I HAD ALWAYS IMAGINED FOR MYSELF: peaceful, normal, and without medication or unnecessary medical intervention. In the fall of 2008, I got pregnant. At that same time, I started a new career as a labor and delivery nurse in a hospital that specializes in high-risk labor and birth. My daughter's journey into this world turned out to be the beautiful normal experience we had always imagined. This special experience also helped shape the kind of care I offer as a new labor and delivery nurse.     

浅谈我国物流业存在的问题和对策思考

物流产业是现代社会化大生产和专业化分工不断加深的产物,是促进经济发展的“加速器”和“第三利润源泉”。通过归纳法,从国内外物流业发展的现状入手,总结我国物流业的特点,分析中国物流业在发展过程中出现的问题,提出了对物流业的一些思考。     

内蒙古农村牧区人力资本开发的制度分析

内蒙古农村牧区人力资本存在着受教育程度低、医疗保健水平低、农业技术水平低、剩余劳动力转移困难等问题。这是由教育制度不健全、社会保障制度不完善、相关法律制度不健全、户籍管理制度的制约性和政府监管制度的缺失等制度因素导致的。对此,笔者提出了调整教育体制、加强职业教育、提高政府对农村牧区医疗保健的投资、进一步改革户籍管理制度、加强政府监管力度等方面的建议和措施。     

国际劳务市场高技能人才需求状况探析

当前，国际劳务市场需求结构发生变化，对高技能劳务人才提出了新的要求。发达国家及新兴工业化国家和地区朝阳产业对高技能人才的需求量增大，部分职业岗位人员短缺，高技能劳务人才需求旺盛。目前，医护、高级海员、IT专业、家政服务等七类人员成为需求热点。     

论生产性劳动的外延

生产性劳动应由狭隘的物质生产部门扩大到非物质生产部门:部分政府部门的劳动是第二种含义的社会必要劳动,精神产品使用价值由物质和非物质生产部门共同创造,科技劳动对物质生产起主导作用,教育劳动对象化于人力资本,服务部门的活劳动直接满足人的需要."非生产劳动"部门对经济运行的重要作用,说明和谐社会里的所有劳动都是生产性劳动,只有冗员的劳动和非法经济的劳动才是非生产性的.     

论我国劳动关系三方协调机制的法律保障

劳动关系三方协调机制是规范和协调劳动关系的有效途径.目前,我国劳动关系三方协调机制的职能尚不完整,运行中还存在着一些制约因素,而缺乏法律保障是我国劳动关系三方协调机制存在不足的重要原因.为了加强我国劳动关系三方协调机制建设,充分发挥其在协调劳动关系中的重要作用,对我国劳动关系三方协调机制的法律保障提出一些建设性的意见,以期完善我国劳动法律体系,发展和谐稳定的劳动关系.     

Research summaries for normal birth

In this column, the author presents summaries of four research studies that further support the benefits of normal birth. The topics of the studies address cord clamping of term infants, the association of multiple cesareans and placental abnormalities, induction of labor at 41 weeks, and the World Health Organization's recently released pediatric growth charts.     

The Freedom to Birth—The Use of Cytotec to Induce Labor: A Non-Evidence-Based Intervention

The off-label use of Cytotec (misoprostol) to induce labor has increased over the past few decades. The increase in medical interventions in childbirth, many of which are not based on scientific evidence, and the rise in maternal and infant morbidity and in maternal and infant mortality cannot continue to go unrecognized. This column serves as a teaching tool for childbirth educators and provides an example of two unnecessary, potentially avoidable deaths that occurred during a birth with questionable medical interventions.     

农民工劳动合同中存在的问题及原因分析

劳动合同是劳动者与用人单位确立劳动关系、明确双方权利和义务的协议。劳动合同对保护劳动者的合法权益非常重要,农民工由于各种原因在劳动关系中处于明显的弱势地位,尤其需要运用劳动合同来保护自身的合法权益。     

#4: no routine interventions

In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the benefit of no routine interventions during birth is discussed and presented as an evidence-based practice that helps promote, protect, and support normal birth. The paper is written for childbearing women and their families. It presents evidence related to restrictions on eating and drinking, use of intravenous fluids, continuous electronic fetal monitoring, artificial rupture of the membranes, augmentation of labor, and epidural analgesia. The accompanying commentary-written by an award-winning medical writer-supports and expands on the benefits of no routine interventions during birth. Lamaze International recommends that laboring women avoid restrictions on eating and drinking. The organization also recommends avoidance of IVs, continuous electronic fetal monitoring, epidurals, and efforts to speed up labor, unless a clear indication for their use is evident.