TheoryofHumanBecoming:NursesSupportingLaboringWomen

CarrieSueHalseyDNP(c),CNS-AD,RNC-OB,ACNS-BC

Objectives

• Participantswillbeabletoidentify2waystosupportwomeninlabor• Participantswilldemonstrateincreasedawarenessofthebarrierstolowmedicalinterventioninalowriskbirth• ParticipantswillexaminetheAWHONNpositionstatement:NursingSupportofLaboringWomen

• https://youtu.be/NcHdF1eHhgc

ACOGCommitteeOpinionFebruary2017

ApproachestoLimitInterventionDuringLaborandBirth

InformedRefusal

• Theresponsibilityofthemedicalprovider

• Supportstheprincipleofautonomy• Patientunderstandswhatsheis

consentingto,andthepersonsandproceduretotakeplacearedetailed

• Physician/APRNmustexplainandensureunderstandingoftheprocedure,thebenefitsandrisks,whytheybelievesitisnecessary,alternativesandtheconsequencesofrefusal

• Avalidconsentisnotobtainedthroughfraud,forceorundueinfluence

Dobirthplansmakeadifference?• Womenwhoaremoreconfidentgoingintobirthhavebetterbirthexperiences

• Birthexperienceshaveasignificantinfluenceonamother'sself-esteemandhowsheviewsherbaby

• Asenseofcontrolisimportanttowomeninlabor

• Birthplanssignificantlyincreasebirthexperiencesatisfaction

• Recommendedforawomantobringabirthplanorcreateoneuponadmissiontothehospitalusingastandardtemplate

TheNurse’sRoleinlabor

• Assessmentandmanagementofthephysiologicandpsychologicalprocessesoflabor

• Facilitationofnormalphysiologicprocesses,suchasthewomen’sdesireformovementinlabor

• Provisionofphysicalcomfortmeasures,emotionalandinformationalsupportandadvocacy

• Evaluationoffetalwell-beingduringlabor• Instructionregardingthelaborprocess• Rolemodelingtofacilitatefamily

participationduringlaborandbirth• Directcollaborationwithothermembersof

thehealthcareteamtocoordinatepatientcare

RosemarieParse:HumanBecomingTheory

Co-creatingNewRealities• Meaning

• Rhythmicity

• Transcendence

NursingSupportofWomeninLabor• Shorterlabor

• Decreaseduseofanalgesia/anesthesia

• Decreasedoperativevaginalbirthsorcesareanbirths

• Decreasedneedforoxytocin/uterotonics

• Increasedlikelihoodofbreastfeeding

• Increasedsatisfactionwiththechildbirthexperience

SuspendingJudgement

PeanutBalls

• Shortensfirststageoflaborinprimiparouswomen

• Reducethelengthoflabor by90minduringthefirststageoflaborand22minduringthesecondstageoflabor(withepidural)

• Improvespatientsatisfaction• ReducedCesareanratesby13%inonestudy• Inexpensive• Adjustable

Sizematters

• 70cm• forsittingnotside-lying

• 60cm• Tallorplussizedwomen

• 50cm• Averagesizedwomen

• 40cm• Petiteorshortlegs

PeanutBallPositions• SideLying• TuckPosition• Semi- sittingLunge• FireHydrant• ForwardLeaning• Straddling• Pushing• Increasespelvicoutletcomparedtostirrup• Lessriskofnerveinjurythanwithstirrup

HypnosisforBirth

• Alteredstateofconsciousness• Awareofsurroundings• Usedforpainmanagementinotherspecialties• Usedbynurseseveryday

Hypno-tipsfornurses• Createandmaintaincomfortableenvironment

• Adopthypno-language(pressurewave=contraction)

• Protectmotherduringpressurewavefrominterruptionsorquestions

• Teamupwithbirthpartnerand/ordoula

Adviceforadministrators• Staffonenurseforeverylaboringmother• WritepoliciesthatreflecttheAWHONN

EFMguidelinesforintermittentmonitoring

• Promotetheuseofbirthplans• Providelabortoolssuchaspeanutballs• Createasupportiveenvironmentfor

doulastofeelwelcomeatthebedside• Provideeducationfornursesonlabor

supporttechniques• Sendnursestoconferencessuchas

AWHONNtokeepuponbestpractices• Encouragenursestodevelop

complimentaryskillssuchastherapeutictouchormassagebyprovidingorreimbursingforclasses

Co-creatingabirthexperience• Safe• Comfortable• Mutuallysatisfying• Transcending

References

AWHONN.(2011).NursingSupportofLaboringWomen.JOGINN,40,665-666.DOI:10.111/j.1552-6909.2011.01288.x

Anderson,C.J.,&Kilpatrick,C.(2012).Supportingpatients'birthplans. NursingFor Women'sHealth,16(3),210-218.doi:10.1111/j.1751-486X.2012.01732.x

Attanasio,L.,McPherson,M.,&Kozhimannil,K.(2014).PositivechildbirthexperiencesinUS hospitals:Amixedmethodsanalysis.Maternal&ChildHealthJournal,

18(5),1280-1290.doi:10.1007/s10995-013-1363-1

Budin,W.(2015).ChoosingWiselyforBirth.JPerinatEduc TheJournalofPerinatalEducation,3-5.

Burgess,A.(2014).Anevolutionaryconceptanalysisoflaborsupport.InternationalJournalofChildbirthEducation,29(2),64-72.

Condra,T.,&Hafendorfer,L.(2011).InspiringandLeadingWomentoSucceedatUnmedicated Childbirth.JournalofObstetric,Gynecologic,&NeonatalNursing.

Harris,S.,Janssen,P.,Saxell,L.,Carty,E.,Macrae,G.,&Petersen,K.(2012).Effectofacollaborativeinterdisciplinarymaternitycareprogramonperinataloutcomes.CanadianMedicalAssociationJournal,1885-1892.

Meyer,S.(2013).Controlinchildbirth:aconceptanalysisandsynthesis.Journal

OfAdvancedNursing,69(1),218-228.doi:10.1111/j.1365-2648.2012.06051.x

Reisz,S.,Jacobvitz,D.,&George,C.(2015).Birthandmotherhood:childbirthexperienceandmothers'perceptionsofthemselvesandtheirbabies.InfantMentalHealth

Journal,36(2),167.doi:10.1002/imhj.21500

Xue,Y(2013).InformedConsent:Hospital.JoannaBriggsInstitute. Farahat,A.H.,Mohamed,H.S.,Elkader,S.A.,&El-Nemer,A.(2015).Effectof

implementing abirthplanonwomens'childbirthexperiencesandmaternal&neonataloutcomes.Journal ofEducationAndPractice,6(6),24-31.

WebsiteResources

• www.perinatalempowerment.com• www.premierbirthtools.com• www.spinningbabies.com• www.hypnobabies.com• http://www.babycentre.co.uk/a1038554/aromatherapy-in-pregnancy• http://www.therapeutictouchontario.org/index.php/therapeutic-touch/what-is-therapeutic-touch• http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth