Supporting a Physiologic Approach to Pregnancy and Birth The optimal role of the attendant—whether physician or midwife—is to be vigilant without being meddlesome. R. A. Rosenblatt, MD Supporting a Physiologic Approach to Pregnancy and Birth A Practical Guide Edited by Melissa D. Avery, PhD, CNM, FACNM, FAAN Professor Chair, Child and Family Health Co-operative University of Minnesota, School of Nursing Minneapolis, Minnesota A John Wiley & Sons, Inc., Publication This edition first published 2013 © 2013 by John Wiley & Sons, Inc Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. 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Contents Contributors ix Foreword by Holly Powell Kennedy xi Acknowledgments xiii Section 1 Understanding a physiologic approach 1 1 The case for a physiologic approach to birth: An overview 3 Melissa D. Avery 2 The physiology of pregnancy, labor, and birth 13 Cindy M. Anderson 3 A supportive approach to prenatal care 29 Carrie E. Neerland 4 Supporting a physiologic approach to labor and birth 49 Lisa Kane Low and Rebeca Barroso Section 2 Interventions and approaches 77 5 Promoting comfort: A conceptual approach 79 Kerri D. Schuiling 6 Continuous labor support 91 Carrie E. Neerland 7 Techniques to promote relaxation in labor 105 Kathryn Leggitt 8 Touch therapies in pregnancy and childbirth 119 Deborah Ringdahl 9 Water immersion for labor and birth 157 Michelle R. Collins and Dawn M. Dahlgren-Roemmich 10 Aromatherapy in pregnancy and childbirth 173 Linda L. Halcón 11 Acupressure and acupuncture in pregnancy and childbirth 197 Katie Moriarty and Kennedy Sharp viii Contents Section 3 organizational approaches to supporting physiologic pregnancy and birth 227 12 Rethinking care on the hospital labor unit 229 Emily Higdon, Rachel Woodard, Kristin Rood and Heidi Jean Bernard 13 Out-of-hospital birth 251 Marsha E. Jackson and Alice Bailes 14 Educating health professionals for collaborative practice in support of normal birth 275 Melissa D. Avery, John C. Jennings and Michelle L. O’Brien 15 Women’s health and maternity care policies: Current status and recommendations for change 301 Heather M. Bradford Resources for physiologic pregnancy and childbirth 331 Index 335 Contributors Cindy M. Anderson, PhD, RN, Heather M. Bradford, MSN, CNM, WHNP-BC, FAAN ARNP, FACNM Associate Professor Certified Nurse-Midwife Department of Nursing Evergreen Health Midwifery Care College of Nursing and Professional Kirkland, Washington Disciplines Affiliate Faculty University of North Dakota Department of Family and Child Nursing Grand Forks, North Dakota University of Washington Seattle, Washington Melissa D. Avery, PhD, CNM, FACNM, FAAN Michelle R. Collins, PhD, CNM Professor Associate Professor of Nursing Chair, Child and Family Health Director, Nurse-Midwifery Program Co-operative Unit Vanderbilt University School of Nursing Director, Nurse-Midwifery Program Nashville, Tennessee School of Nursing University of Minnesota Dawn M. Dahlgren-Roemmich, MS, Minneapolis, Minnesota CNM Alice Bailes, CNM, MSN, FACNM Certified Nurse-Midwife Co-Founder Jordan, Minnesota Birth Care and Women’s Health Alexandria, Virginia Linda L. Halcón, PhD, MPH, RN Associate Professor Rebeca Barroso, DNP, CNM School of Nursing Faculty, Frontier Nursing University University of Minnesota Staff Nurse-Midwife Minneapolis, Minnesota HealthEast Nurse-Midwives St. Paul, Minnesota Emily Higdon, RN, MSN Heidi Jean Bernard, RN, ADN PhD Student and Jonas Scholar Staff Nurse Staff Nurse Department of Labor and Delivery Department of Labor and Delivery University of Iowa Hospitals and Clinics University of Iowa Hospitals and Clinics Iowa City, Iowa Iowa City, Iowa x Contributors Marsha E. Jackson, CNM, MSN, Michelle L. o’Brien, MD, MPH, FACNM IBCLC Director and Co-Founder Adjunct Faculty Birth Care and Women’s Health Assistant Professor Alexandria, Virginia Department of Family Medicine and Community Health John C. Jennings, MD University of Minnesota Medical School Professor of Obstetrics and Gynecology Minneapolis, Minnesota Texas Tech University Health Sciences Odessa, Texas Deborah Ringdahl, DNP, RN, CNM Reiki Master Kathryn Leggitt, MS, CNM Clinical Assistant Professor Certified Nurse-Midwife School of Nursing Hennepin County Medical Center University of Minnesota Minneapolis, Minnesota Minneapolis, Minnesota Lisa Kane Low, PhD, CNM, FACNM Kristin Rood, RN Assistant Professor and Director Maternal and Infant Staff Nurse Nurse-Midwifery Education Program Children and Women’s Services Division School of Nursing and Women’s Studies University of Iowa Hospitals and Clinics Department Iowa City, Iowa University of Michigan Ann Arbor, Michigan Kennedy Sharp Licensed Acupuncturist Katie Moriarty, PhD, CNM, Masters in Oriental Medicine CAFCI, RN NCCAOM Certified Clinical Assistant Professor sharpacupuncture.com Associate Director Nurse-Midwifery Minneapolis, Minnesota Education Program School of Nursing Kerri D. Schuiling, PhD, CNM, University of Michigan FACNM, FAAN Ann Arbor, Michigan Dean Certified Acupuncture Foundation of School of Nursing Canada Institute Oakland University Rochester, Michigan Carrie E. Neerland, MS, CNM Certified Nurse-Midwife Rachel Woodard, RN, BSN, RNC-oB Women’s Health Specialists Obstetrical Nurse Specialist University of Minnesota Physicians Staff Nurse Labor and Delivery Adjunct Faculty Departments of Pediatrics and Nursing University of Minnesota School of University of Iowa Hospitals and Clinics Nursing Iowa City, Iowa University of Minnesota Medical School Minneapolis, Minnesota Foreword Birth is an event that carries our universe into the future. Each pregnancy and birth holds the promise of fresh life, renewed faith in our survival, and awe at the magnificence of human reproduction and the power of woman. Every birth is unique and every birth changes the person fortunate enough to witness the emergence of a new life. Melissa Avery has brought together midwives, nurses, physicians, and other health practitioners in a collective, in-depth discussion of how to support a woman’s physiologic capacity to carry and birth her child. This long overdue book is founded on the premise that pregnancy and birth are normal physiologic processes. It takes a direction often missing in traditional texts—that birth is more than simple mechanical, physical processes that can be inherently controlled. Rather, it acknowledges that although there is much we fully understand, there is still much to be learned. Thus, she and her colleagues have expertly woven current scientific evidence and theory with practical clinical expertise for helping women and their families during this life-producing and life-changing event. The first section grounds the reader in a woman’s physiology during pregnancy and birth. Avery starts the section off with a “real-life” scenario that clinicians who attend birth are often faced with each day. This is followed by an exquisite description of the physiologic intricacies of pregnancy and parturition that leaves us breathless in its detail and design and sets the stage for understanding how it all works. Prenatal care is empha- sized as the place to work with the woman to establish her confidence in her body and its capabilities. The section closes with a stunning overview of how to keep the woman and her needs central during childbirth. The authors review the evidence on routine maternity care practices that can disrupt normal labor and birth and describe approaches to care that provide step-by-step support of a woman’s physiology. Taken together, these four chap- ters provide the essential elements of the book and lay the underpinning for the following sections, which explore specific techniques and policy. The second section provides an overview of specific strategies in caring for childbearing women. Different theories and evidence for care strategies are presented, always return- ing to why and how they support normal physiologic birth. The section begins with an introduction to the theories of “comfort,” helping the reader understand how to meet each woman at the intersection of her life and her perception of pain and discomfort. The com- plexity of labor pain is disentangled through creative descriptions of pain modulation through the release of naturally occurring neuropeptides. The theoretical basis of comfort is extended by presence—the act by which the labor attendant creates a space in which the woman feels safe and thus her body’s physiology is supported to do the work of labor. Techniques of relaxation, healing touch, therapeutic use of water, aromatherapy, and