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.     

#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.     

#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.     

#3: continuous labor support

In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the benefit of continuous labor support 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. Women with continuous support are less likely to have a cesarean, an instrument delivery, and regional anesthesia. They are also less likely to report dissatisfaction with or negatively rate their childbirth experience. The value of the doula for both the laboring woman and her labor partner is discussed. The accompanying commentary-written by a leading proponent of maternity care practices-supports evidence that promotes continuous labor support. Lamaze International encourages women to plan for a supportive birth environment that includes continuous support.     

#6: no separation of mother and baby with unlimited opportunity for breastfeeding

In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the value of keeping mothers and their babies together from the moment of birth is discussed and presented as an evidenced-based practice that helps promote, protect, and support normal birth. The paper is written for childbearing women and their families. Babies held skin-to-skin with their mothers cry less often, breathe easier, and stay warmer than babies who are separated from their mothers. They also instinctively attach to the breast and begin breastfeeding, usually within one hour of birth. The advantages of rooming-in for mother and baby are also discussed. The accompanying commentary-written by two leading professionals in the field of maternity care and pediatrics-provides further evidence to support the practice of keeping mothers and their babies together after birth. Lamaze International encourages women to give birth in settings that do not separate mothers and babies after birth.     

Continuing education module-lamaze parents magazine: more than a giveaway

The Lamaze Parents magazine is an annual publication produced by Lamaze International to inform parents and childbirth educators on issues related to healthy birth preparation, normal birth, and parenting. The author of this column introduces teaching strategies for childbirth educators and doulas to use in tandem with the magazine's content in order to enhance their efforts in sharing current, evidence-based information with expectant parents.     

#5: Non-Supine (e.g., Upright or Side-Lying) Positions for Birth

In this position paper—one of six care practice papers published by Lamaze International and reprinted here with permission—the benefit of non-supine positions for 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. Upright and gravity-neutral positions facilitate rotation and descent of the baby and result in reduced duration of second stage, a reduction in episiotomies, and fewer abnormal fetal heart rate patterns. The accompanying commentary—written by a leading proponent of maternity care—supports these benefits. Lamaze International recommends that laboring women not push until they feel an urge to do so, and that they choose positions for birth that are most comfortable for them.     

Innovation in Practice: Preparing Doulas to Support Cesarean Births

Despite growing initiatives to support patient-centered labor and birth care, implementation of this care in the operating room is still limited. Doulas can be utilized in the operating room to facilitate evidence-based practices such as skin-to-skin contact for patients and newborns during cesarean birth. This article evaluates a curriculum and training method that was developed to educate doulas to provide safe and effective care during the cesarean birth experience. This intervention was found to be effective at improving doulas'' self-perceived confidence in skills essential to support cesarean births and may serve as a model for other institutions to address barriers to the implementation of patient-centered evidence-based care in the operating room.     

#2: Freedom of Movement throughout Labor

In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the benefit of allowing freedom of movement throughout labor 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 well-known author of numerous articles and books on childbirth-compares the activities of women in two birthing environments: the conventional medicalized setting and the unconventional naturalistic setting. Reasons why women may not move in labor are presented. Lamaze International encourages women to use movement in labor in order to make labor more comfortable and more efficient.     

Fetal Monitoring: Creating a Culture of Safety With Informed Choice

The dominant culture in labor and birth is the medical model, not the midwifery model of woman-centered care. Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM). Barriers impact the laboring woman’s ability to give informed choice regarding fetal monitoring. Lack of informed choice denies a woman her right to be in control of her birth experience, and is in opposition to a woman’s right to autonomy and self-determination.     

Reflections on the “Push for Your Baby” Campaign

In this editorial, a board member of Lamaze International describes the “Push for Your Baby” campaign to urge women to advocate for more evidence-based practice for better births. She also reflects on her hopes and worries about the “Push for Your Baby” campaign launched by Lamaze in May 2012. Discussing the realities of current maternity care practice, she asks how we can work with obstetric nurses and providers to have them support what most women value—vaginal birth.     

Safe and healthy birth: the importance of data

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses the mismatch between data commonly collected at the time of birth and the data needed to measure optimal care for physiologic birth. Selections include the importance of documenting duration of skin-to-skin contact after birth, the role of qualitative research in improving care in the second stage of labor, and pitfalls of meta-analyzing data on the safety of planned home birth.     

Healthy Birth Practice #6: Keep Mother and Baby Together— It’s Best for Mother,Baby, and Breastfeeding

Mothers and babies have a physiologic need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and babies together is a safe and healthy birth practice. Evidence supports immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. Unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding,” published in The Journal of Perinatal Education, 16(3), 2007.     

Really teaching lamaze: what about pushing?

A reader is justifiably puzzled when a Lamaze childbirth educator tells her that directed pushing is the Lamaze way. The author of this column discusses second stage in the context of normal, natural birth, guidelines for pushing, evidence-based practice, and strategies to access and incorporate evidence into practice.     

Continuing Education Module Top 10: Tips on Teaching Lamaze Classes

Lamaze classes should help women think differently about birth, dispel myths, and ultimately make informed decisions that are right for them. In the current maternity care environment, this is a monumental task. In this column, the authors discuss 10 teaching tips that serve as a guide for teaching childbirth classes and ultimately facilitate learning.     

Many women and providers are unprepared for an evidence-based, educated conversation about birth

Findings from recent Canadian studies on the knowledge and beliefs about birth practices among first-time pregnant women and among obstetricians and other birth providers indicate that many women are inadequately informed and many providers deliver non-evidence-based maternity care. Consequently, informed decision making is problematic for pregnant women and their providers. New strategies are needed to inform pregnant women about key procedures and approaches that might be used in birth so they can have an educated, shared discussion with their provider and successfully advocate for their preferred birth experience. In addition, providers can be encouraged to supplement their knowledge with current, evidence-based maternity care practices. To avoid a lack of informed decision making and to ensure that natural, safe, and healthy birth practices are based on current evidence, pregnant women and providers must work together to inform themselves and to add childbirth to the women's health agenda.     

From hospital deliveries to home birth

Working in a busy labor/delivery unit gave me insight into the care that my Lamaze childbirth education students would encounter. I was troubled by the number of interventions taking place. The interventions interfered with a woman's ability to work with her labor; some interventions were actually creating problems or even crises. My experiences at this hospital motivated me to become involved with home birth, restoring my belief that birth is a normal process.     

Promoting Optimal Care in Childbirth

In 1996, the World Health Organization set out guidelines for normal birth. Because that time birth in the United States has continued to be intervention intensive, the cesarean rate has skyrocketed and maternal mortality, although low, is rising. At the same time, research continues to provide evidence for the benefits of supporting the normal physiologic process of labor and birth and the risks of interfering with this natural process. This article reviews the current state of U.S. maternity care and discusses research and advocacy efforts that address this issue. This article describes optimal care in childbirth and introduces the Lamaze International Six Healthy Birth Practices.     

Continuing Education Module: How to Connect With Parents by Using Updated Lamaze Messages

Lamaze International partnered with Edelman, an international public relations firm, to re-brand the organization through its messaging to elevate its relevance among key stakeholders. Sound primary and secondary research revealed new ways to communicate the Lamaze message to women, their families, and their care providers. Various tips and tools are presented in this article to enable childbirth educators, care providers, and birth advocates to communicate these new messages more effectively to parents.     

Continuing Education Module Styles Vary When Teaching Expectant Parents About Medications

In this column, the author presents information from prominent Lamaze childbirth educators and from the literature to describe various options that educators can share with expectant parents regarding the use of pain relief medications during labor and birth. Ann Tumblin teaches about epidurals in a hospital class without losing sight of evidence-based practices that support normal birth. Jessica English focuses her classes on the natural processes of giving birth and spends only a little time presenting information about pain medications. Judith Lothian encourages educators to consider a new framework for Lamaze classes that involves letting go of the details and incorporating Lamaze’s six Healthy Birth Practices and storytelling.