How birth doulas help clients adapt to changes in circumstances, clinical care, and client preferences during labor.

This study examined how doulas adapt to challenges in client's labors. There were 104 Canadian and 92 American doulas who responded to a survey distributed at a doula conference. We report results from open-ended questions in which doulas describe how they manage changes deviating from the mother's birth plan and how they navigate differences of opinion between themselves and providers.

Moving beyond the debate: a holistic approach to understanding and treating effects of neuraxial analgesia.

Neuraxial analgesia is here to stay, yet, spirited debate continues over potential harms and the quality of research that fails to identify them. This paper proposes moving beyond the debate and examining holistically the impact of neuraxial analgesia on the psychophysiology of mother and baby. A review of alterations in functioning of many systems is followed by a suggested four-part protocol to partially restore normal physiology and emotional well-being, and improve outcomes of neuraxial analgesia.

The language of birth.

Our language both reflects and influences our attitudes and behavior. This Roundtable Discussion explores the language used in obstetrics and in the interactions between caregivers and women or their families: What do practitioners say to mothers and families during labor? At birth? In consultations? To describe what is happening? To encourage a woman's efforts? To lighten the atmosphere? When advising about possible interventions? Medical terminology in perinatal care can often be deceptive or confusing, not only for mothers but for caregivers. The authors of this Roundtable, representing health professionals from different specialties and interests in the field, have examined some examples of such language use, misuse, and abuse in perinatal care.

Pain, suffering, and trauma in labor and prevention of subsequent posttraumatic stress disorder.

In this column, Kimmelin Hull, community manager of Science & Sensibility, Lamaze International's research blog, reprints and discusses a recent blog post series by acclaimed writer, lecturer, doula, and normal birth advocate Penny Simkin. Examined here is the fruitful dialog that ensued-including testimonies from blog readers about their own experiences with traumatic birth and subsequent posttraumatic stress disorder. Hull further highlights the impact traumatic birth has not only on the birthing woman but also on the labor team-including doulas and childbirth educators-and the implied need for debriefing processes for birth workers.

The fetal occiput posterior position: state of the science and a new perspective.

Background: The fetal occiput posterior position poses challenges in every aspect of intrapartum care-prevention, diagnosis, correction, supportive care, labor management, and delivery. Maternal and newborn outcomes are often worse and both physical and psychological traumas are more common than with fetal occiput anterior positions. The purpose of this paper is to describe nine prevailing concepts that guide labor and birth management with an occiput posterior fetus, and summarize evidence to clarify the state of the science.

2020 vision for a high-quality, high-value maternity care system.

A concrete and useful way to create an action plan for improving the quality of maternity care in the United States is to start with a view of the desired result, a common definition and a shared vision for a high-quality, high-value maternity care system. In this paper, we present a long-term vision for the future of maternity care in the United States. We present overarching values and principles and specific attributes of a high-performing maternity care system.

Why keep on keeping on?

As a noted author of childbirth education articles, books, and videotapes, Penny Simkin muses over the changes in maternity care during her career and the lessons she has learned. She searches for reasons to keep on working to bring normal birth to women, especially in an era when medical intervention based on editorials rather than evidence continue to increase.

#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.

Why do women go along with this stuff?

Normal childbirth has become jeopardized by inexorably rising interventions around the world. In many countries and settings, cesarean surgery, labor induction, and epidural analgesia continue to increase beyond all precedent, and without convincing evidence that these actions result in improved outcomes (1,2). Use of electronic fetal monitoring is endemic, despite evidence of its ineffectiveness and consequences for most parturients (1,3); ultrasound examinations are too often done unnecessarily, redundantly, or for frivolous rather than indicated reasons (4); episiotomies are still routine in many settings despite clear evidence that this surgery results in more harm than good (5); and medical procedures, unphysiological positions, pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and early mother-infant separation are used unnecessarily (1).

Update on nonpharmacologic approaches to relieve labor pain and prevent suffering.

The control of labor pain and prevention of suffering are major concerns of clinicians and their clients. Nonpharmacologic approaches toward these goals are consistent with midwifery management and the choices of many women. We undertook a literature search of scientific articles cataloged in CINAHL, PUBMED, the Cochrane Library, and AMED databases relating to the effectiveness of 13 non-pharmacologic methods used to relieve pain and reduce suffering in labor.

Supportive care during labor: a guide for busy nurses.

Removing the barriers to the provision of supportive nursing care during labor will require much effort by multidisciplinary teams within each institution. Yet even without such reform, an individual nurse can easily provide crucial elements of supportive care. This article suggests many practical techniques that nurses can use to support women during the stresses of labor.

Nonpharmacologic relief of pain during labor: systematic reviews of five methods.

Nonpharmacologic measures to reduce labor pain have been used throughout history. Despite reports that some of these methods reduce pain, increase maternal satisfaction, and improve other obstetric outcomes, they have received limited attention in the medical literature and are not commonly available to women in North America. The controlled studies of nonpharmacologic methods are limited in number and sometimes provide conflicting results.

The nature and management of labor pain: executive summary.

This report describes the background and process for a rigorous project to improve understanding of labor pain and its management, and summarizes the main results and their implications. Labor pain and methods to relieve it are major concerns of childbearing women, with considerable implications for the course, quality, outcome, and cost of intrapartum care. Although these issues affect many women and families and have major consequences for health care systems, both professional and public discourse reveal considerable uncertainty about many questions, including major areas of disagreement.