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Proactive Support of Labor The Challenge of Normal Childbirth - 1st Edition (FULL VERSION DOWNLOAD)

The book 'Proactive Support of Labor' discusses the challenges of normal childbirth and critiques the excessive medical interventions that have arisen in modern obstetrics. It advocates for a balanced approach that emphasizes proactive support during labor to enhance maternal satisfaction and improve outcomes. The authors aim to provide a comprehensive, evidence-based plan for healthcare professionals involved in childbirth, promoting a more humane and effective birthing experience.

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246 views14 pages

Proactive Support of Labor The Challenge of Normal Childbirth - 1st Edition (FULL VERSION DOWNLOAD)

The book 'Proactive Support of Labor' discusses the challenges of normal childbirth and critiques the excessive medical interventions that have arisen in modern obstetrics. It advocates for a balanced approach that emphasizes proactive support during labor to enhance maternal satisfaction and improve outcomes. The authors aim to provide a comprehensive, evidence-based plan for healthcare professionals involved in childbirth, promoting a more humane and effective birthing experience.

Uploaded by

moac.hhoangkua.ngphach
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Proactive Support of Labor The Challenge of Normal

Childbirth - 1st Edition

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Proactive
Support of
Labor
The Challenge of Normal
Childbirth

Paul Reuwer
Hein Bruinse
Arie Franx
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo

Cambridge University Press


The Edinburgh Building, Cambridge CB2 8RU, UK
Published in the United States of America by Cambridge University Press, New York

www.cambridge.org
Information on this title: www.cambridge.org/9780521735766
© P. Reuwer, H. Bruinse and A. Franx 2009

This publication is in copyright. Subject to statutory exception and to the


provision of relevant collective licensing agreements, no reproduction of any part
may take place without the written permission of Cambridge University Press.
First published in print format 2009

ISBN-13 978-0-511-50829-5 eBook (NetLibrary)

ISBN-13 978-0-521-73576-6 paperback

Cambridge University Press has no responsibility for the persistence or accuracy


of urls for external or third-party internet websites referred to in this publication,
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
This book is dedicated to Kieran O’Driscoll, great
obstetrician and distinguished teacher, forerun-
ner in the development and evaluation of con-
ceptual birth care. His fundamental insight and
inspiring work provided the starting point of this
treatise.
Contents

Foreword page ix

Acknowledgments xi

Web-Forum xiii

1. General introduction 1

Section 1: A wake-up call 7


2. Medical excess in normal childbirth 9

3. Iatrogenic causes of failed labors 19

4. Harmful birth care practices 27

5. Destructive territorial disputes 35

6. Self-sustaining mechanisms 42

Section 2: Back to basics 53


7. Lessons from nature 55

8. Elementary biophysics of birth 59

9. First-stage labor revisited 70

10. Second-stage labor redefined 79

11. Definitions and verbal precision 84

Section 3: Proactive support of labor 93


12. Introductory synopsis 95

13. Nulliparous versus parous labor 104

14. Diagnosis of labor 110

15. Prevention of long labor 121

vii
viii Contents

16. Personal continuity and continuous


support 131

17. Amniotomy and oxytocin 138

18. Labor pain in broader perspective 150

19. Prelabor preparation 157

20. Medical pain relief revisited 163

21. Dynamic dystocia unraveled 175

22. Mechanical birth obstruction 190

23. Curtailed use of induction 202

24. Intrapartum care of the fetus 210

25. Prevention of litigation 225

26. Organizational reforms 230

27. Continual audit and feedback 241

28. Quality assessment 245

29. Hospital statistics 248

30. Sum of the parts 253

Index 259
Foreword

Improvements in the care of the pregnant woman


and fetal patient during the birthing process have
been a success story for modern obstetrics. Less than
a century ago maternal mortality during labor was
commonplace in most developed countries, and fetal
mortality and morbidity were even more common.
The keystone of modern obstetrics was the introduc-
tion of hospital and safe cesarean deliveries in the
early 20th century. However, too much of a good thing
can sometimes lead to other problems.
In their book Proactive Support of Labor, Drs Reuwer,
Bruinse and Franx make an important contribution to
modern obstetrics by providing a critical counterbal-
ance to technologic interference in labor and delivery.
The authors introduce the concept of “Proactive Sup-
port of Labor” as an acceptable alternative to traditional
labor and delivery management in order to shorten
labor and ultimately ensure a safer delivery. They pro-
pose that results of improved labor and delivery man-
agement should be evaluated not only in physical terms
(e.g., reduced morbidity and mortality) but also in terms
of emotion and patient satisfaction. This concept is
designed to not only improve the overall outcome but
also patient satisfaction.
We agree that the perspective provided in this book
should be carefully considered by all providers of
healthcare to women in labor. The call for humanistic
and evidence based obstetric care in labor and delivery
by including the emotional needs of women in labor
should be embraced throughout the world.

Amos Grunebaum
Director of Obstetrics, New York Weill Cornell
Medical College, New York Presbyterian Hospital

Frank A Chervenak
Chairman of Obstetrics and Gynecology,
New York Weill Cornell Medical College,
New York Presbyterian Hospital

ix
Acknowledgments

Women’s satisfaction with the childbirth experi-


ence, when caregivers have followed the strategy of
proactive support of labor, as well as the unremit-
ting enthusiasm of birth professionals who made
this approach their own, were the motivating
forces in writing this manual. The authors wish to
express their special gratitude and thanks to Vanessa
Stubbs, Simone Valk, Lo Pistorius, and Gerrit Jan
Noordergraaf for their help, advice, support, and
criticism.

xi
Web-Forum

Readers are encouraged to share their opinions


about proactive support of labor in the interactive
web-forum: www.proactivesupportoflabor.com

xiii
1

General introduction

The natural process of birth increasingly involves emotional impact of childbirth. The principles and
medical intervention, but the benefits of this trend proposed practices are universally applicable.
are questionable at best. The inexorable growth in
operative delivery rates is not validated by tangible
improvements in perinatal outcomes. Rather, The objective is to enhance women’s childbirth
maternal morbidity has risen significantly. Apart experience by improving professional labor and
from its physical impact, giving birth is one of the delivery skills and the overall quality of obstet-
most profound emotional experiences in a rical care.
woman’s life, but women’s satisfaction with child-
birth remains a cause for common concern. Despite
all good intentions, modern maternity care is often 1.2 Target readership
perceived as professional but impersonal, and labor
is not infrequently described as a traumatic or even This manual is directed to:
“dehumanizing” experience.1–3 This must be  All professionals who are primarily responsible for
changed. the quality of childbirth: obstetricians, midwives,
and labor room nurses. Obstetricians are in the
prime position to improve all standards of care by
1.1 Purpose creating the conditions for nurses and midwives to
execute their labor support tasks properly.
The purpose of this manual is to present a cohe-  Medical students and student-midwives engaging
sive, evidence-based plan for the care of the nor- in their first practical contacts with childbirth.
mal, healthy woman in labor, specifically designed  All other health care providers involved in birth
to restore the balance between natural birth and care such as family practitioners, childbirth
medical intervention: proactive support of labor. educators, doulas, physiotherapists, sonogra-
The main target is to improve professional labor phers, anesthesiologists, and home health nurses.
and delivery skills in order to promote spontaneous  Hospital administrators, health care policy-
delivery and to enhance women’s satisfaction with makers, and health insurers, since high-quality
childbirth. Proactive support of labor is a carefully care in labor requires a sound organization
orchestrated and audited expert team approach which should coincide with sound economics.
involving the laboring woman, nurse, midwife, and  Interested lay persons. No experience with child-
obstetrician committed to a safe and normal birth is needed to understand the significance of
delivery for both mother and baby. Emphasis is proactive support of labor. Mothers-to-be have
placed as much on the physical challenge as on the the most to gain from supportive care during

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