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Abstract
In this professional paper, published by Lamaze International and reprinted here with permission, Lamaze International identifies six care practices-adapted from the work of the World Health Organization-that promote, protect, and support normal birth. The six care practices are: labor begins on its own; freedom of movement throughout labor; continuous labor support; no routine interventions; non-supine (e.g., upright or side-lying) positions for birth; and no separation of mother and baby with unlimited opportunity for breastfeeding. Evidence to support each care practice is presented. Health-care providers and places of birth are encouraged to adopt these care practices as standards of care. Additionally, women are encouraged to choose health-care providers and places of birth whose care practices promote, protect, and support normal birth.
Journal of Perinatal Education, 13(2), 1-5; normal birth, care practices, childbirth education.
INTRODUCTION
Birth in the 21st century is characterized by interventions designed to start, continue, and end labor by routine medical management that "expects trouble" rather than allowing the normal, natural physiologic process of birth to unfold.
The outcomes of the medical management of birth include an induction rate of over 20% and a primary cesarean rate of 26.1% (Hamilton, Martin, & Sutton, 2003). The Listening to Mothers survey (Declerq, Sakala, Corry, Applebaum, & Risher, 2002), a recent U.S. survey of childbearing women, reported a 44% induction rate with more than half of the reported labors also stimulated to move more quickly. Over 60% of the American women in the survey received epidural anesthesia during labor, and almost 10% of the vaginal births were instrument deliveries. More than 90% of the surveyed women had electronic fetal monitoring (EFM) rather than intermittent auscultation, although the routine use of EFM increases the cesarean rate with no change in infant mortality or morbidity (Thacker, Stroup, & Chang, 2003; Enkin, et ah, 2000).
These statistics are alanning because there is no research suggesting that medical birth is safer for women and babies. In fact, an increasing amount of research indicates that medical birth increases the risks for mother and baby (Enkin et ah, 2000). Despite the evidence of its risks, medically managed birth, or "expecting trouble," is the norm.
Lamaze International believes that the safety of birth is enhanced not by "expecting trouble" but by respecting...