Research Summary

Opinion Statement: I felt that this article was very good to help me understand some of the reasons that women would optimally choose natural birth over inductions and cesarean sections whenever possible. The article also touched briefly on the actual process of labor and how certain hormones play a role in birth which really was interesting and helped me understand why certain tings occurred.

Point 1: Conventional theories of the physiology of normal labor focus on the activity of Oxycontin, however clinical observations have led to the suggestion that a women's emotional state can also effect her labor. This has led to an interest in the role of stress hormones in labor. There is a gradual rise in stress hormones as labor progresses and with excessive fear or anxiety a women's contractions can actually slow down. Similarly when a women first comes into the hospital her contractions slow a little until she is used to the environment which people believe is an instinctual action to make sure the mother delivers in a safe environment.

Point2: According to a recent review comparing elective and sponaneous labor, elective induction increases the need for analgesia, epidural anesthesia, and neonatal resuscitation, results in more cesarean surgeries, and may increase the likelihood of instrumental vaginal delivery, intrapartum fever, shoulder dystocia, low birthweight, and admission to the neonatal intensive care unit. A postterm pregnancy is defined as one that has extended to or beyond 42 weeks of gestation. However, a survey of ACOG Fellows and Junior Fellows found that 43.1% considered 41 weeks gestation or greater to be postterm and 73% routinely induced patients at low risk at 41

weeks gestation. A study found that average low risk patients delivered at 41 weeks 1 day in primiparous women and 40 weeks and 3 days in multiparas.

Point 3: More than one third of women in the United States are starting labor before their bodies have. Induction of labor can set the stage for medically managed labor and birth characterized by intravenous lines, electronic fetal monitoring, and very often epidural analgesia. This makes the overuse of induction of labor the greatest risk to normal physiological birth. This is ironic that normal physiology prevails as one of the most important modifiers of induction success. Induction is safer and more effective when the womans own body has begun the work of beginning labor on its own.

Point 4: Standing, walking, rhythmic swaying, leaning forward, and assuming the hands and knees position are examples of spontaneous movements that women instinctively use in response to pain or other sensations during labor. Labor may move more effectively if the women responds in these positions instead of staying still in one position.Freedom of movement in labor can cause a shorter labor, increased contractions, greater comfort, and a reduced need for pain medication after birth. Position changes can help correct certain maternal complications.

Point 5: While 82% of women labored with a spouse or partner continuously and found them to be effective and helpful, a recent study shows that having a doula present has particular beneficial effects. Beneficial effects of continuous labor support are thought to come from a reduction in maternal anxiety and a related decrease in stress hormones. A recent analysis concludes that women had greater benefit from continuous labor support when the person

providing the support was not employed by the hospital, when the support began earlier in labor, and when labor took place in a setting where epidural analgesia was not readily available. Doula care also appears to be most effective at reducing epidural rates among low-income women without another source of labor support .

Citation: Romano, Amy."Promoting, Protecting, and Supporting Normal Birth: A Look at the Evidence."Journal of Obstetric, Gynecologic, & Neonatal Nursing.Wiley Online Library. AWHONN, January 22, 2008. Web. 12 Oct 2013.