Avoiding Unnecessary Medical Intervention During Labor
Though the physiologic process takes precedence over induced labor, the latter is sometimes considered when an expectant mother feels it's best. Katie Moriarty explains the significance of allowing shared decision-making between mother and midwife.
Editor’s Note: The opinions expressed in this blog post are solely those of the author.
Spoiler Alert: This post discusses events in Call the Midwife Season 5 Episode 2
“In the early 1960s the entire world still seemed to flow through the London docks… issuing in an image of plenty and it encouraged us to want and made us hungry for more.
For some these new luxuries brought ease and wonder into tough hard working lives BUT for others... they made it more difficult to accept the lot that was truly theirs.”
Episode 2 deals with issues that are still all too familiar to those in maternal child health in the year 2016: breastfeeding versus bottle feeding (along with the guilt no matter which choice is made); stress and the impact that it has on the body (along with ways to potentially decrease its effects); trying to meet the needs of a diverse population (loved Nurse Crane learning Spanish); efficiency and the push for doing more while attempting to do it better; and, induction of labor.
The World Health Organization (WHO) has called for eliminating unnecessary intervention in childbirth. Unfortunately in the United States we are at an epidemic level with medical interventions. The induction of labor rate has more than doubled (Martin et al., 2012; Zhang, Yancey, & Henderson, 2002) and the cesarean section rate is now over 30 percent (Martin et al., 2012).
There are campaigns to try to support the physiologic process of birth (below are links to the campaigns). The Association of Women’s Health, Obstetric, and Neonatal Nursing (AWHONN) has Go the Full 40, March of Dimes has a fabulous campaign called Healthy Babies are Worth the Wait(HBWW) and the American College of Nurse-Midwives (ACNM) has the Healthy Birth Initiative, which aims to maximize women’s opportunity to have a healthy birth using their own natural physiology while avoiding unnecessary procedures that may interfere with that process! The ACNM initiative has a three-pronged approach, equipping women, maternity care providers and quality managers, hospital policymakers and payers with the tools to inspire better care, better health and lower costs. Take a look at the links listed below.
In this episode Barbara was focusing on her client and truly listening to the family and their need of having the husband meet his child before his death from leukemia. I have had a situation where I had a woman that was full-term and wanted an induction of labor as her husband was being deployed. Just like the entire team at Nonnatus House, our nurse-midwifery service discussed the case and then I worked with the family trying to balance the situation with informed consent by having a discussion of the evidence, benefits and risks, and what their options were.
With a shared decision-making model of care we discussed ways to naturally encourage labor to continue to support the normal physiologic birth process or being more aggressive with an induction of labor. With extreme cases such as the one in this show or with the family I described that was about to be separated by war, it seems obvious to discuss these choices. However, for the majority we need to really focus on supporting the physiologic process.
“It was a world promising all that we could desire NEWER, BETTER, BRIGHTER. We put our faith in the dreams they sold: Machines to save us labor; Clothes to make us more alluring; Furnishings to give us greater comfort... Yet the one thing we could not do without – could never be bought -- no matter how generous the term. And it was love—LOVE and all its forms PRECIOUS, FRAGILE, and ENDURING. The priceless gift that made our lives worthwhile… Invisibly upholding us, demanding no repayment, offered in silence MORE PRECIOUS THAN GOLD.”
References & Resources
American College of Nurse-Midwives. Healthy Birth Initiative™
Bingham, D. Ruhl, C., & Davis Cockery, C. (2013). Don’t rush me . . . Go the full 40: AWHONN’s Public Health Campaign promotes spontaneous labor and normal birth to reduce overuse of inductions and cesareans. The Journal of Perinatal Education, 22(4), 189–193. doi: 10.1891/1058-1243.22.4.189
March of Dimes, Healthy Babies are Worth the Wait
Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J., Wilson, E. C., & Mathews, T. J. (2012). Births: Final data for 2010. National Vital Statistics Reports, 61(1), 1–72. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf
Zhang, J., Yancey, M. K., & Henderson, C. E. (2002). U.S. national trends in labor induction, 1989–1998. The Journal of Reproductive Medicine, 47(2), 120–124.
Katie Moriarty, PhD, CNM, CAFCI, FACNM, RN is a professor on faculty at Frontier Nursing University and a Certified Nurse-Midwife with WSUPG CNM Service at Hutzel Women’s Hospital in Detroit, Michigan. Katie serves on the Board of Directors for the American College of Nurse-Midwives as the Region IV Representative. Previously she was the Associate Director of the Nurse-Midwifery Education Program at the University of Michigan.
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