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The Essential Forces of Labor Revisited: 13 Ps Reported in Womens' Stories
Abstract
The purpose of this study was to analyze women's birth stories. Women's perspectives were used to expand the current model of the essential forces of labor (the three Ps: powers, passenger, and passageway).
This was a qualitative descriptive study analyzing women's birth narratives.
Narratives consisted of women's spontaneous responses to the request to tell their birth stories in any way they wished. Fifteen Midwestern women (eight primiparas and seven multiparas) were interviewed, resulting in a total of 33 birth stories. Content and thematic analyses of verbatim transcripts of the birth narratives were done to elicit women's personal meanings of control during labor.
Women identified many essential forces of labor that exerted control or direction over their labors. Some of the forces were internal to the women, such as maternal psyche and position, as well as the classic three Ps (powers, passenger, and passageway). Others were external forces such as professional providers and procedures. An expanded model is proposed to demonstrate the complexity of labor and the multiple interacting forces.
The educational model, consisting of three essential forces that currently appears in textbooks, is inadequate. Maternity nursing practice can be improved by including a broader array of the essential forces of labor, thus attending more adequately to the complexity of caring holistically and contextually for laboring women. Women indicated that nurses have a profound impact during labor. Nurses are in a position to make positive change by working with women to share control.
... In review, the impact of authoritative knowledge on American, Mayan, and Jamaican women has been documented as to its significance in each of the respective cultures. Each study (Davis Floyd, 1990;Sargent & Bascope, 1996;Simkin, 1991;VandeVusse, 1999) acknowledged the potential of role played by health care providers in aiding women in viewing their birth experience as a positive one. Sargent and Stark's (1989) investigation called for further study of the importance of how women are socialized about birth by family and friends. ...
... Although the importance of formalized learning about birthing has been validated (Hanson, et al., 2001;Simkin, 1991Simkin, , 1992VandeVusse, 1999), many of these studies have omitted investigating the impact of pre-existing knowledge. What influences women to seek informal information, to whom do they turn, and what is the lived experience of obtaining that knowledge, that wisdom? ...
... Some of the participants expressed a need to hear other's stories. Birth storytelling is well documented as an effective way for expectant mothers to learn about birth (Armstrong & Feldman, 1990;Davis-Floyd, 1992;Drake, 2002;Leight, 2002;Livo & Ruitz 1986;McHugh, 2001;Razak, 1993;Sargent & Stark, 1989;VandeVusse 1999;Zwelling, 2000).The development of personal knowing through mutual relationality may be facilitated through storytelling to fully comprehend the storyteller as if the listener were inside her world (White, 1995). ...
Research on knowing in childbirth has largely been a quantitative process. The purpose of this study was to better understand the ways nine, first-time mothers learn about birth. A phenomenological approach using a feminist view was used to analyze two in-depth interviews and journals to understand first time expectant mothers' experiences of knowing in childbirth. The findings demonstrated a range of knowledge that contributed to issues of control, confidence, hope, and conflict. The participants also described an increased dependency on their mothers and a lack of intuition contiguous to the birth process. These findings contribute understanding as to how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding and may even exacerbate it. Childbirth educators may want to include instruction on negotiating power differential in relationships encountered during childbirth, and to assess the expectant mother's view of birth and her expectations for birth. Schools of nursing should consider the inclusion of women-centered care curricula in schools of nursing at both the undergraduate and graduate levels. Clearly, the politics surrounding birthing remain in place and must be removed to provide a supportive environment for normal birth.
... Women brought with them their personal expectations regarding the type of labor support that they hoped to receive from professional caregivers during the birth experience (Halldórsdóttir & Karlsdóttir, 1996b; Hanson, VandeVusse, & Harrod, 2001; Tumblin & Simkin, 2001; VandeVusse, 1999b). Women expected to have pain during labor and delivery; however, they also expected to receive culturally appropriate interventions to help them control and manage their pain. ...
... I knew all that but it didn't occur. (VandeVusse, 1999b, p. 181) In addition to her personal expectations of labor, each woman approached labor with certain societal expectations concerning the types of behaviors considered " acceptable " for women to exhibit during labor. These expectations exerted an influence on the women's selfappraisals of her labor experience (VandeVusse, 1999b). ...
... Women valued information, explanations, advice, and individualized nursing care while in labor (VandeVusse, 1999b). Personalized information from the nurse was important during all stages of labor, especially prior to the performance of procedures (Walker et al., 1995). ...
To review and synthesize qualitative research studies of women's perceptions of professional labor support.
Journal articles dated from 1990 to 2001. Search terms included labor support, labor and delivery, childbirth, birth, and caring during labor. Qualitative studies and combined quantitative/qualitative studies with open-ended questions were included.
The focus of the 17 studies was laboring women's rather than nurses' perceptions of labor support or care during labor.
Data describing methods, samples, and findings were extracted from study reports.
Similarities reported in the study findings were synthesized using a model of labor support. Synthesis of the study findings was reported using exemplary statements in the words of women who experienced labor support. Categories included expectations of labor support, physical comfort, caring and emotional support, interpersonal communication style, communication of information and instructions, advocacy, and competence of the professional.
There were a limited number of qualitative studies of labor support. Professional labor support was influenced by the interpersonal communication style of the caregiver. Cultural differences existed in caregiver actions considered supportive.
... As previously noted, used a narrative approach to explore experiences of choosing among couples who received abnormal prenatal diagnoses. Analysis of birth stories has been used to explore the interplay of forces in women's labor experiences (VandeVusse, 1999b), decision making in labor (VandeVusse, 1999a), and the professional socialization of student midwives (Ulrich, 2004). One researcher noted that sharing birth stories provides an opportunity for integration of a major event into the framework of women's lives (Callister, 2004). ...
... The narrative research approach shares a common constructivist philosophical foundation with theories of grief and bereavement that are likely to be relevant to PH research. Narrative methods have been successfully employed in areas of research interest related to PH, such as maternal transition (Carolan, 2004; and child birth (Callister, 2004, VandeVusse, 1999a1999b). Together, these factors suggested that narrative analysis would be an appropriate methodology for PH research. ...
Technology has made it possible to detect abnormal fetal conditions, including lethal anomalies, prior to birth. Women who receive lethal fetal diagnoses during pregnancy face the decision whether to continue or terminate their affected pregnancies. The purpose of this study was to explore and describe women's experiences after the continuation of pregnancies affected by lethal fetal diagnoses and the subsequent loss of their infants. A qualitative, descriptive methodology was chosen for this exploratory study. Fifteen women participants who learned during their pregnancies of lethal fetal diagnoses and chose to continue their pregnancies were recruited from perinatal hospice (PH) support organizations in three states of the Midwestern USA. Participants' stories of their PH experiences were recorded in individual face-to-face interviews. Narrative analysis techniques were used to identify themes and develop suggestions for care. The participants identified themselves as mothers and their fetuses or newborns as babies. Mothers valued caring for and interacting with their babies. Health professionals who affirmed their status as mothers, the value of their babies, and the significance of their losses were perceived as supportive. Invalidating attitudes and behaviors caused significant distress. The element of time was prevalent in mothers' stories. Some aspects of mothers' experiences continued, particularly feelings of love and connection to their babies. Mothers also reported evolving changes in their thoughts and feelings. Personal changes, such as increased compassion, faith, and strength, were frequently mentioned. Mothers described phases of highs and lows. Drawing personal meanings or life-lessons was the main way mothers connected their past experiences to their present lives. Mothers' descriptions of their experiences enhance nurses' understanding of perinatal loss. Established care practices, such as birth planning and creating mementoes, were supported. Nurses and other health professionals can help mothers experiencing loss by elucidating and reflecting their personal meanings. Optimal care of PH mothers should support the development of maternal identity and contact between mothers and newborns when desired. Professionals who care for PH mothers can affirm their motherhood through their behaviors, statements, and attitudes.
... Although the range included gaining more information in order to lower anxiety and increase confidence, some participants did not use the strategies they learned. In some studies, the potential of the health-care provider's role in aiding women to view their birth experience was a positive one (Davis-Floyd, 1990;Sargent & Bascope, 1996;VandeVusse, 1999). Furthermore, many women do not have access to formalized knowledge such as classes, so researchers do not have an appreciation of what formalized learning would mean to those women. ...
... Some of the participants expressed a need to hear others' stories. Birth storytelling is well documented as an effective way for expectant mothers to learn about birth (Armstrong & Feldman, 1990;Davis-Floyd, 1992;Drake, 2002;Leight, 2002;Livo & Ruitz, 1986;McHugh, 2001;Razak, 1993;Sargent & Stark, 1989;VandeVusse, 1999;Zwelling, 2000). The development of personal knowing through relationality may be facilitated through storytelling to comprehend the storyteller as if the listener were inside her world (White, 1995). ...
Research on knowing in childbirth has largely been a quantitative process. The purpose of this study was to understand the ways first-time mothers learn about birth. A phenomenological approach, using a feminist view, was used to analyze two in-depth interviews and journals to understand
nine first-time expectant mothers' experiences of knowing in childbirth. The findings demonstrated a range of knowledge that contributed to issues of control and conflict. The participants also described an increased dependency on their mothers and a lack of their own intuition contiguous
to the birth process. These findings contribute understanding to how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding the event and may even exacerbate it when not combined with learning skills to manage conflict. Childbirth educators may want
to include instruction on negotiating power differential in relationships encountered during childbirth in order to strengthen a first-time mother's ability to receive the care she wants. Educators may also want to assess the expectant mother's view of birth and her expectations for birth.
Schools of nursing should consider the inclusion of women-centered care curricula at both the undergraduate and graduate levels. The mothers' responses in this study clearly reveal that the politics surrounding birthing remain in place and must be removed in order to provide a supportive environment
for normal birth.
... Midwives have generally attempted to deal with the reductionism of the obstetric paradigm by adding up to 10 other P's, for example psychology, preparation, pain and position (VandeVusse, 1999). This approach, however, leaves the obstetric paradigm intact with midwifery philosophy and knowledge marginalised and too easily ignored. ...
... The three Ps are powers (quality of contractions and ability of expulsion), passenger (fetal size and position of presenting part), and pelvis (size and shape of the pelvis). Dystocia is the most common indication for a Cesarean (Cunningham et al., 2010;Vandevusse, 1999). This objectified view of the pregnant woman's body aligns with the empirical science of Cartesian duality where there is a mind/body split. ...
... Some midwives use this simplistic paradigm too; but usually without calling it the three P's (Pairman et al., 2006). Midwives have generally attempted to deal with the reductionism of the obstetric paradigm by adding up to 10 other P's, for example psychology, preparation, pain and position (VandeVusse, 1999). This approach, however, leaves the obstetric paradigm intact with midwifery philosophy and knowledge marginalised and too easily ignored. ...
... Midwives have generally attempted to deal with the reductionism of the obstetric paradigm by adding up to 10 other P's, for example psychology, preparation, pain and position (VandeVusse, 1999). This approach, however, leaves the obstetric paradigm intact with midwifery philosophy and knowledge marginalised and too easily ignored. ...
... The three Ps are powers (quality of contractions and ability of expulsion), passenger (fetal size and position of presenting part), and pelvis (size and shape of the pelvis). Dystocia is the most common indication for a Cesarean (Cunningham et al., 2010;Vandevusse, 1999). This objectified view of the pregnant woman's body aligns with the empirical science of Cartesian duality where there is a mind/body split. ...
To explore the nature of birthing in United States (U.S.) hospitals from 1973-2007 and to explicate and interpret common, often overlooked, birthing experiences and nursing care.
A Heideggerian phenomenological approach utilizing in-depth interviews.
Participants' homes in Washington, Idaho, and Oregon.
A purposive sample of grand multiparaes (N = 14).
Data were collected via open conversational interviews of 60-90 minutes recorded on digital media and completion of a demographic and birth attribute form. Field notes and interpretive commentary were used as additional data sources and were analyzed using an established Heideggerian approach.
The participants came from diverse religious and ethical backgrounds and experienced 116 births (8.29 births per woman, 79% unmedicated), a Cesarean rate of 6%, and a breastfeeding rate of 99% with a mean duration of 12 months. Two overarching patterns emerged: pursuing the "'good birth": a safe passage for baby and being in-and-out of control: body, technology, others. Each pattern subsumed several overlapping themes. The first pattern revealed that women often desire a good birth in the safety of a hospital by navigating their options prior to and during the birth. The second pattern revealed a common, yet often unachievable, desire by all of those involved in the process to control birth.
Harmonizing an exchange of ideas in a technologically advanced environment prevalent in hospitals today can increase the quality of intrapartum care. Encouraging anchored companions and promoting normal physiological birth will make hospitals places where women can experience a good birth and feel safe.
... Fox and Worts (1999) describe a few of these dimensions within the context of medicalized childbirth. Others use the rubric of " internal " and " external " control to categorize interpretations or expressions of control (Green & Baston, 2003; Lavender et al., 1999; Sargent & Stark, 1989; Simkin, 1991; VandeVusse, 1999 ), though as an analytical distinction rather than a definition. Further, there is evidence of diversity in the salience of both the term and concept of control in birth among social classes (Davis-Floyd, 1994; Lazarus, 1994; Martin, 1990; Nelson, 1983; Zadoroznyj, 1999) and by women's choice of birth location (Cunningham, 1993; Davis-Floyd, 1992; Hodnett, 1989; Martin, 1987; Viisainen, 2001). ...
Childbearing women, healthcare providers, and commentators on birth broadly identify control as an important issue during childbirth; however, control is rarely defined in literature on the topic. Here we seek to deconstruct the term control as used by childbearing women to better understand the issues and concepts underpinning it. Based on qualitative interviews with 101 parous women in the United States, we analyze meanings of control within the context of birth narratives. We find these meanings correspond to five distinct domains: self-determination, respect, personal security, attachment, and knowledge. We also find ambivalence about this term and concept, in that half our sample recognizes "you cannot control birth". Together, these findings call into question the usefulness of the term for measuring quality or improving maternity care and highlight other concepts which may be more fruitfully explored.
An analogy between theater and birth is drawn from analyses of women's birth stories to describe birth from a fresh perspective. Birth and theater are compared using the theatrical production elements: setting, casting, props, set, behind the scenes, script, and roles. Selected examples from women's birth stories highlight each element. Nurses' roles are significant during labor and birth, but nurses' abilities to fulfill these roles are threatened. This analogy promotes rethinking of nursing actions in the theater of birth. Implications for clinical practice are provided, including altering the birth environment, offering choices, and maintaining the woman's role as star.
What is unique and exemplary about the midwifery model of care? Does exemplary midwifery care result in improved outcomes for the recipient(s) of that can? These are the questions that the profession of midwifery grapples with today within the context of a changing health care arena. Exemplary midwives, and women who had received their care, came to consensus about these issues in a Delphi study. A model of exemplary midwifery care is presented based on the identification of essential elements aligned within three dimensions: therapeutics, caring, and the profession of midwifery. Supporting the normalcy of pregnancy and birth, vigilance and attention to detail, and respecting the uniqueness of the woman, were several of many processes of care identified. The critical difference that emerged was the art of doing "nothing" well. By ensuring that normalcy continued through vigilant and attentive care, the midwives were content to foster the normal processes of labor and birth, intervening and using technology only when the individual situation required. Health care, whether in the gynecologic setting or during pregnancy, was geared to help the woman achieve a level of control of the process and outcome. The ultimate outcomes were optimal health in the given situation, and the experience of health care that is both respectful and empowering. The model provides structure for future research on the unique aspects of midwifery care to support its correlation with excellent outcomes and value in health care economics. (C) 2000 by the American College of Nurse-Midwives.
Birth stories are personal narratives grounded in the pivotal life experience of giving birth. Richly descriptive birth narratives from culturally diverse childbearing women document the importance of listening to the voices of women. Benefits of sharing birth stories include the opportunity for integration of a major event into the framework of a mother's life; the opportunity to share a significant life experience; the opportunity to discuss fears, concerns, “missing pieces” or feelings of inadequacy or disappointment; the opportunity for the woman to gain an understanding of her strengths; and the opportunity to connect with other women. Providing women with the opportunity to share their birth stories is an important nursing intervention.
What is unique and exemplary about the midwifery model of care? Does exemplary midwifery care result in improved outcomes for the recipient(s) of that care? These are the questions that the profession of midwifery grapples with today within the context of a changing health care arena. Exemplary midwives, and women who had received their care, came to consensus about these issues in a Delphi study.
A model of exemplary midwifery care is presented based on the identification of essential elements aligned within three dimensions: therapeutics, caring, and the profession of midwifery. Supporting the normalcy of pregnancy and birth, vigilance and attention to detail, and respecting the uniqueness of the woman, were several of many processes of care identified. The critical difference that emerged was the art of doing “nothing” well. By ensuring that normalcy continued through vigilant and attentive care, the midwives were content to foster the normal processes of labor and birth, intervening and using technology only when the individual situation required. Health care, whether in the gynecologic setting or during pregnancy, was geared to help the woman achieve a level of control of the process and outcome. The ultimate outcomes were optimal health in the given situation, and the experience of health care that is both respectful and empowering. The model provides structure for future research on the unique aspects of midwifery care to support its correlation with excellent outcomes and value in health care economics.
This descriptive study replicates and extends the previous work on nursing support during labor. Within 72 hours of giving birth, 88 participants rated 25 selected nursing behaviors on a Likert scale as to their perceived helpfulness, with two open-ended questions for additional comments on helpful nursing behaviors. Nursing behaviors were categorized as emotional, informational, or tangible support. The majority of behaviors considered most helpful were in the emotional support category. Sixteen of the 25 behaviors were considered helpful, with the most helpful behaviors being making the woman feel cared about as an individual, appearing calm and confident, and treating the woman with respect. Findings were consistent with those of a previous study and suggest that, regardless of the pain management used, nurses supporting childbearing women must not only be competent but also use a high degree of interpersonal skills in providing nursing care.
An analogy between theater and birth is drawn from analyses of women's birth stories to describe birth from a fresh perspective. Birth and theater are compared using the theatrical production elements: setting, casting, props, set, behind the scenes, script, and roles. Selected examples from women's birth stories highlight each element. Nurses' roles are significant during labor and birth, but nurses' abilities to fulfill these roles are threatened. This analogy promotes rethinking of nursing actions in the theater of birth. Implications for clinical practice are provided, including altering the birth environment, offering choices, and maintaining the woman's role as star.
The pain experiences of culturally diverse childbearing women are described based on a secondary analysis of narrative data from phenomenologic studies of the meaning of childbirth. Study participants were interviewed in the hospital after giving birth or in their homes within the first weeks after having a baby. Transcripts of interviews with childbearing women who lived in North and Central America, Scandinavia, the Middle East, the People's Republic of China, and Tonga were analyzed. Participants described their attitudes toward, perceptions of, and the meaning of childbirth pain. Culturally bound behavior in response to childbirth pain was also articulated. A variety of coping mechanisms were used by women to deal with the pain. Understanding the meaning of pain, women's perceptions of pain, and culturally bound pain behaviors is fundamental in order for nurses to facilitate satisfying birth experiences for culturally diverse women.
To gain an understanding of the perceptions of childbearing women about the maintenance of dignity while laboring and giving birth.
Descriptive qualitative study.
A university community in the western United States.
Twenty low-risk primiparous women who had recently given birth to healthy term neonates.
Semistructured audio-taped interviews were conducted in the homes of participants using an interview guide.
The following themes were identified: (a) nurses played a pivotal role in preserving dignity during childbirth, (b) women appreciated feeling valued and respected, and (c) dignity was enhanced by nursing care that gave women their preferred level of control.
Nursing behaviors that demonstrate valuing and respect of childbearing women are essential in preserving the quality of the birth experience.
In the past one to two decades, midwifery care has taken a new direction, which encompasses a valuing of women's birth experiences. This move has been contingent upon, and congruent with the adoption of 'woman centred' care and a renewed emphasis on normal birth. In line with these developments, women's stories and anecdotes of birth and midwives stories of experience increasingly form the basis of presentations at midwifery conferences and forums. Overall, this philosophical realignment, which commenced in Australia in the early 1990s, has been applauded by many midwives in terms of a greater valuing of the wishes and experiences of childbearing women and as being consistent with a greater promotion of normal birth. Nonetheless, it also gives rise to several questions, regarding the suitability of this form of research evidence. In a bid to answer some of those questions, this paper aims to evaluate the use of stories and anecdotal evidence within midwifery. First, an overview is presented of the way in which stories of pregnancy and birth appear in the literature. Secondly, the value of stories as evidence is critiqued and, finally, the ratio of story based publications, compared to traditional research methodologies, is reviewed. This review aims to address an area poorly attended in the literature and asks specifically: Are women's birth stories a suitable form of research evidence in midwifery?
Birth stories have a lasting impact on expectant mothers. The purpose of this paper is to recognize the influence of birth stories as a key component of informal communication of knowledge about childbirth for expectant mothers. The review of literature and research is related to childbirth education, anthropological thinking, and applied learning theory with foundational concepts from Vygotsky, Bruner, and Bandura. Implications for childbirth educators are included.
As nurses approach the 21st century questions are being raised regarding the direction in which the profession is moving The majority of leaders and educators in the field of nursing have, to this point, stressed the importance of defining nursing as a science and of developing a scientific knowledge base Recently, however, there has been a move among some researchers and theorists in the field of nursing to question the ability of science and the saentific method to deal with nursing concerns Using a variety of perspectives, including feminist theory, they are cnhqumg many of the basic assumptions about saence, saentific method and saentific knowledge This paper uses soaological and feminist theory to support the idea that nursing, as a discipline, has a distinct knowledge base which is not grounded in empirico-analytic science and its methodology but which stems from the lived experiences of nurses as women and as nurses involved in caring relationships with their clients
To determine which nursing support behaviors new mothers rate as most helpful in assisting them to cope with labor.
A retrospective study using quantitative and qualitative approaches, including a ranking of means and a content analysis.
The postpartum unit of a tertiary-care hospital in eastern Canada.
Eighty postpartum women, most of whom were married, employed, and 20-33 years of age.
Within 72 hours of their labor women rated 25 nursing support behaviors.
The perceived degree of helpfulness of 25 nursing support behaviors.
All 25 behaviors were perceived as helpful. The most helpful behaviors included making the woman feel cared about as an individual, giving praise, appearing calm and confident, assisting with breathing and relaxing, and treating the woman with respect. Behaviors in the emotional support category were the most helpful.
Nurses can assist women to cope with the stress of labor. They must use a high degree of interpersonal skills in the care of laboring women in addition to being technically competent.
Although nurse scholars have become increasingly engaged in feminist research and theory development, only a few have included important feminist thoughts expressed by African American womanist theorists. This article presents an abbreviated review and synthesis of Afrocentric ways of knowing, which includes Black feminist, womanist, and Afrocentric perspectives. A developing methodology for use with African American women is also described.
THE PURPOSE OF this descriptive study was to describe the perceptions of childbearing women regarding the nurse's role during childbirth. A convenience sample of 26 married primiparous mothers experiencing uncomplicated vaginal births participated in interviews conducted within two weeks of childbirth. Descriptive content analyses were completed. Participants expressed satisfaction with nursing care, reporting that they were not aware of how much nurses really do. They described the competence of the nurses, the broad range of skills they possessed, and the high level of responsibility demonstrated. Domains of nursing support identified by these women included: emotional support, informational support, and tangible support. This study will promote sensitive caregiving in order to meet more effectively the needs of the childbearing woman, thus promoting more positive childbirth outcomes.
Complex interactions occur among women and caregivers throughout labor. Analyzing women's birth stories provides a rich data source on these interactions. The purpose of this qualitative study was to clarify how decisions were made in labor by analyzing women's birth stories.
A convenience sample of 15 primiparous and multiparous Midwestern women contributed a total of 33 birth stories. Qualitative methods were used, including analyses of the content and themes of stories.
The primary types of decision making that were identified ranged on a continuum from unilateral to joint (shared), and were associated with various emotions expressed by the women.
A model of decision making was derived from the data that may help caregivers change practices in ways that will benefit women. Caregivers can also benefit by understanding women's critiques of the birth care they received, and can use this knowledge to improve women's experiences of birth and therefore their satisfaction with the process.
The relationships among maternal anxiety, selected stress-related biochemical factors, and progress in three defined phases of labor were determined for 32 married, normal, primigravid women, 20 to 32 years of age. Comparisons of plasma epinephrine, norepinephrine, and cortisol in third-trimester pregnancy, during labor, and after delivery are provided. At the onset of Phase 2 of labor (3 cm. of cervical dilatation), self-reported anxiety and endogenous plasma epinephrine are significantly correlated. With the deletion of subjects to control for the effect of medications, higher epinephrine levels are significantly associated with lower uterine contractile activity at the onset of Phase 2 and with longer labor in Phase 2 (3 to 10 cm. of cervical dilatation). The relationship between epinephrine and progress in labor is explained by an adrenoreceptor theory.
Studies demonstrated that support during labor and birth has a positive impact on childbirth outcomes, and that women reported they received little supportive care from nurses during parturition. This study piloted a work sampling method that was adapted to determine the proportion of time the average intrapartum nurse at a Toronto teaching hospital spends in supportive care activities. Supportive care was operationally defined within four categories of activities: emotional support, physical comfort measures, instruction/information, and advocacy. Work sampling was an effective method of measuring support as a specific aspect of direct intrapartum care. The proportion of time that nurses spent in supportive versus all other activities was 9.9 percent (95% confidence interval 7.5% and 12%), based on a sample of 616 random observations of 18 nurses. Findings are discussed in terms of the social and political factors that affect the meaning and value of the supportive activities of work by obstetric nurses.
This study examined the use of selected medical procedures in low-risk women during childbirth. Data from the 1980 National Natality Survey merged with an American Hospital Association annual survey for the same year were used to assess the frequency with which low-risk women in the United States received certain childbirth procedures and to determine whether their use varied by the hospital setting for birth. Stratified analysis was used to assess the relation of hospital level for delivery with the use of electronic fetal monitoring, labor induction, and primary cesarean delivery in low-risk women, with control for potential confounding factors. As the level of available perinatal technology increased, the use of these procedures increased. Results of the study suggest that low-risk women may have received excess interventions and confirm the need for further examination of care procedures for this group.
The purpose of this study was to determine if women who assumed upright positions during the phase of maximum slope would have a shorter phase of maximum slope in their labor and experience more comfort than women who assumed recumbent positions. Forty laboring women were randomly assigned to either an upright or recumbent position group. Subjects assumed the positions of their assigned group during the phase of maximum slope in their labor (cervical dilatation from 4 cm to 9 cm). Every hour during the phase of maximum slope, each subject was examined vaginally to determine her cervical dilatation and assessed for her level of comfort using the Maternal Comfort Assessment Tool. Women in the upright position group had a significantly shorter phase of maximum slope in labor, but did not significantly differ in comfort level from women in the recumbent group. Newborn Apgar scores were not significantly different between the two groups. Nurses need to be aware that the upright labor positions have the distinct advantages of facilitating efficient uterine contractions and reducing the duration of the phase of maximum slope in labor, with no increase in the discomfort experienced or adverse effect on newborn well-being.
Despite the fact that the profession of nurse-midwifery and feminism are both disciplines concerned with women and issues affecting women's lives, there has been little investigation or acknowledgement of relationships between their two paradigms. The work presented here is an attempt to discover both similarities and differences between nurse-midwifery and feminist thought. Using a historical approach, it is shown that despite the common goal of improving and maintaining women's status in the world, whether in general or more specifically with regard to health, feminist theorists and nurse-midwives, to a large degree, have worked separately from each other, rarely acknowledging in any formal way the importance of the other discipline. Current issues that have an effect on the practice of nurse-midwifery today--lay midwifery, the profession of nursing, and nurse-midwifery research--are presented in relation to contemporary feminist thought.
Birth plans are based on the individual needs of the couple as they prepare for labor, birth, and the integration of a new member into the family. In this paper, it is recommended that birth plans be developed with the family in their home around 28 weeks' gestation. The plan is then used to guide the participants in a structured birth rehearsal as a yardstick with which to review the childbearing experience and as a framework to evaluate the care provided.
An observational study was done on the positions and breathing techniques women will choose for second-stage labor when they are given the freedom and support to choose. In the 50 second stages and births observed, nine different positions were used in conjunction with three variations of expulsive breathing techniques. No adverse outcomes resulted from the nonprescriptive approach to birthing women. All outcome parameters were found to be within the range of normal. These findings support the acceptability of allowing women to respond to their birthing impulses. Further study is recommended to verify the safety of a nondirective approach to birth.
The duration of labor in multigravid subjects in phase 1 labor at term (from 3 to 6 cm of cervical dilatation; mean duration = 2.7 hours) was significantly related to measures of plasma epinephrine and norepinephrine obtained at the onset of the phase (n = 50). Epinephrine was significantly related to observer ratings of subject stress and the scores from the three dimensions of our self-report Labor Anxiety Inventory. The fetal heart rate pattern in phase 2 labor (7 to 10 cm of cervical dilatation; mean duration = 1.2 hours) was significantly related to phase 1 measures of epinephrine, observed stress, and two of the anxiety dimensions (n = 44 to 47). The results provide support for the hypotheses that, under normal clinical conditions, several types of patient anxiety are related to catecholamine levels and that anxiety and epinephrine are related to duration of labor and fetal well-being. The results suggest that medical/nursing evaluation and management of patient anxiety should include a self-report measure of three dimensions of anxiety (coping, safety, and pain), which are relatively independent of observed physical stress and which may relate to maternal labor progress as well as fetal heart rate pattern.
To document women's evaluations of their labor and delivery nurses.
An exploratory, qualitative study using open-ended, intensive, tape-recorded interviews.
Postpartum unit of a 400-bed midwestern hospital, except for two interviews in the women's homes.
Sixty-one Lamaze-prepared, married, multigravidae, aged 21-37 years.
Ninety percent of the women evaluated their nurses favorably, 10% unfavorably. Nurses were evaluated favorably because of their positive participation (80%), acceptance (78%), information giving (75%), encouragement (65%), presence (53%), and competence (7%).
Although technical competence is important, manner, provision of supportive care, and acceptance of each woman as a unique human being may be a nurse's most important characteristics.
Twenty postpartal women were shown videotapes of their second stage labors and simultaneously interviewed. During separate interviews, their 25 caregivers were also shown the videotapes and interviewed. The interviews were analyzed for major themes, one of which was sharing information during labor. Although women and caregivers appeared to agree about what information laboring women require and how it should be given, caregiver perceptions of the quality of their information giving were more positive than mothers' perceptions. Many women wanted more informational support, especially in alleviating unvoiced fears about their baby's health.
The purpose of this descriptive study was to describe the perceptions of childbearing women regarding the nurse's role during childbirth. A convenience sample of 26 married primiparous mothers experiencing uncomplicated vaginal births participated in interviews conducted within two weeks of childbirth. Descriptive content analyses were completed. Participants expressed satisfaction with nursing care, reporting that they were not aware of how much nurses really do. They described the competence of the nurses, the broad range of skills they possessed, and the high level of responsibility demonstrated. Domains of nursing support identified by these women included: emotional support, information support, and tangible support. This study will promote sensitive caregiving in order to meet more effectively the needs of the childbearing woman, thus promoting more positive childbirth outcomes.
Labor support is one of the most important intrapartum nursing functions, with measurable effects on the outcomes of labor and birth. Supportive activities fall within five categories: emotional support, comfort measures, advocacy, supporting the husband/partner, and information/advice. Labor support is a repertoire of techniques the nurse can use to help women during one of the most memorable and personally challenging experiences of their lives.
This work sampling study examined how much time intrapartum unit nurses spend providing supportive care overall and during weekday and weekend shifts, and by patient and staff characteristics at a university hospital with 4000 births per year in Montréal, Québec.
Four-hour observation periods were randomly selected to represent each shift and day of the week. Within each period, eight 15-minute observation times were randomly selected. Observers located each nurse assigned to the unit at that time and recorded her activity. Supportive activities included physical comfort, emotional support, instruction, and advocacy.
The percentage of time spent in supportive care was 6.1 percent (95% confidence interval 5.3%, 6.9%), based on 3367 observations. The time providing supportive care was similar for weekday and weekend shifts. Nurses with less than seven years of intrapartum experience spent 2.7 percent (0.9, 4.5) more time providing supportive care than nurses with seven years of experience or more. Supportive care was 9.2 percent (0.7, 17.7) greater for nulliparous than for parous women, and supportive care of women with epidural anesthesia was similar to those without it.
We concluded that intrapartum unit nurses spent a small amount of time providing supportive care to women in labor. This suggests the need for perinatal caregivers and hospital administrators to reexamine how nurses spend their time, given the evidence from randomized trials showing the beneficial effects of continuous support on labor and birth outcomes.
The childbirth experience is multidimensional, and therefore difficult to describe and explain. Studies of it have produced inconsistent findings, and the phenomenon is often confused with satisfaction with the care provided. This study aimed to clarify different aspects of the birth experience, and to identify factors that could explain the variation in women's overall assessment of it.
All Swedish-speaking women in a large city who gave birth during a two-week period in 1994 were given a questionnaire one day after the birth, and 295 (91%) of the questionnaires were returned. Information about the labor process and medical interventions was collected from hospital records.
Women usually experienced severe pain and various degrees of anxiety, and most were seized with panic for a short time or some part of their labor. Despite these negative feelings, most women felt greatly involved in the birth process, were satisfied with their own achievement, and thought they had coped better than expected. The overall experience was assessed as positive by 77 percent of women and negative by 10 percent. No statistical difference was observed between primiparas and multiparas in total birth experience, and few differences in the specific aspects of the birth. Of the 38 variables tested in regression analysis, the six that contributed to explaining women's overall birth experience were support from the midwife (sensitivity to needs), duration of labor, pain, expectations of the birth, involvement and participation in the birth process, and surgical procedures (emergency cesarean section, vacuum extraction, forceps, episiotomy).
The study showed that negative and positive feelings can coexist, thus confirming the multidimensional character of the birth experience. Women's assessment of their childbirth is influenced by both physical and psychosocial factors, highlighting the importance of a comprehensive approach to care in labor.
Health researchers and provider groups have recommended that women in labor should receive continuous professional support. The objective of our study was to compare the risks and benefits of one-to-one nurse labor support with usual intrapartum nursing care.
A randomized, controlled trial was conducted in a 637-bed university hospital in Montreal, Quebec, with 413 nulliparous women who were at more than 37 weeks' gestation, carrying singletons, and in labor. Women with scheduled cesarean section, scheduled induction, breech presentation, presence of paid labor support, or cervical dilatation over 4 cm were excluded. One-to-one care consisted of the presence of a nurse during labor and birth who provided emotional support, physical comfort, and instruction for relaxation and coping techniques. Usual care consisted of care for two or three laboring women with various types of supportive activities.
A beneficial trend due to one-to-one nurse support was found with a 17 percent reduction in risk of oxytocin stimulation (relative risk of experimental vs control = 0.83; 95% confidence interval = 0.67, 1.04). No significant differences were found in overall labor durations and overall rates of total cesarean section, cesarean section for cephalopelvic disproportion, epidural analgesia, admission to the neonatal intensive care unit, instrumental vaginal delivery, and perineal trauma.
The beneficial trend attributed to one-to-one nursing in reduction of oxytocin stimulation suggests that implementation of recommendations for continuous professional support by intrapartum nursing staff may be appropriate in North America.
Nursing scholars have often called upon the concept of praxis to inspire and inform our work. This article derives from praxis a conceptual framework for participatory nursing research. A praxis model can not only guide research, but it can also provide congruent ways to assess the quality of the project and ensure that researchers are accountable to the needs of the groups they study. The intellectual history of the term provides grounding for activist, collaborative, constructive science. Along with Marx and Freire's definition-in-use, this article presents descriptions of components that are specific to the tasks of participatory research. A review of epistemic considerations makes the argument that it is possible to justify research based on a praxis-oriented framework.