Have you heard of the International MotherBaby Childbirth Initiative? (IMBCI) If you haven’t, you should. It’s an important movement, summarized in the 10 Steps to Optimal MotherBaby Maternity Services (see end of post for all 10 steps), that has the revolutionary potential to shape maternity care as we continue to strive to meet the Millennium Development Goals.
Today, Step 6 is on my mind.
Step 6: Avoid potentially harmful procedures and practices.
Please note that the recommendation to avoid the following procedures and practices applies to avoiding them in the course of a normal labor and birth. Herein lies a particular challenge — how to teach what a normal labor and birth is. But, it has been made more difficult than necessary because care providers routinely use the following procedures and practices in NORMAL labor and birth, thus complicating the process and often causing the normal labor and birth to move into the abnormal category.
Avoid potentially harmful procedures and practices that have no scientific support for
routine or frequent use in normal labor and birth.
Here is a list (from the IMBCI) of practices and procedures that SHOULD NOT BE PART OF NORMAL LABOR, BIRTH, and IMMEDIATE POSTPARTUM care:
- Shaving, enema
- Sweeping of the membranes
- Artificial rupture of the membranes (AROM)
- Medical induction and/or augmentation of labor
- Repetitive vaginal exams
- Withholding food and water
- Keeping mother in bed
- Intravenous (IV) fluids
- Continuous electronic fetal monitoring
- Pharmacological pain control
- Insertion of bladder catheter
- Supine or lithotomy position
- Caregiver directed pushing
- Fundal pressure
- Vacuum or forceps delivery
- Manual exploration of the uterus
- Primary and repeat cesarean section
- Suctioning of the newborn
- Immediate cord clamping
- Separation of the mother and baby
Are you a midwife? Do you routinely “do” any of these practices and procedures? Be honest. Change starts with each individual care provider who is already in the field. Change continues as we pass down our wisdom, knowledge, experience, and teach EVIDENCE BASED BEST PRACTICES to our students.
PLEASE! If you work in the MotherBaby continuum and find yourself doing any of the above (whether because you were trained to, it has just become habit, or because it seems like the best thing to do in your particular environment), then STOP these practices and procedures that are not evidence based in NORMAL BIRTH (and, by the way, birth IS NORMAL).
PLEASE! If you are a student midwife, teach yourself not to begin using these practices and procedures in the course of normal birth.
PLEASE! If you are a teacher of midwives — teach EVIDENCE BASED practices (and, coincidentally, you can conveniently use the above list as a guideline regarding some typical practices and procedures that you should NOT be teaching students to use in the course of normal labor, birth, and postpartum).