Evidence and Skills for Normal Labour and Birth: A Guide for Midwives [NOOK Book]


Evidence-based care is a well established principle in contemporary healthcare and a worldwide health care movement. However, despite the emphasis on promoting evidence-based or effective care without the unnecessary use of technologies and drugs, intervention rates in childbirth continue to rise rapidly.

This new edition emphasises the importance of translating evidence into skilful practice. It updates the evidence around what works best for...

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Evidence and Skills for Normal Labour and Birth: A Guide for Midwives

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Evidence-based care is a well established principle in contemporary healthcare and a worldwide health care movement. However, despite the emphasis on promoting evidence-based or effective care without the unnecessary use of technologies and drugs, intervention rates in childbirth continue to rise rapidly.

This new edition emphasises the importance of translating evidence into skilful practice. It updates the evidence around what works best for normal birth, aspects of which still remain hidden and ignored by some maternity care professionals. Beginning with the decision about where to have a baby, through all the phases of labour to the immediate post-birth period, it systematically details research and other evidence sources that endorse a low intervention approach. The second edition:

  • has been expanded with new chapters on Preparation for Childbirth and Waterbirth

  • highlights where the evidence is compelling

  • discusses its application where women question its relevance to them and where the practitioner's expertise leads them to challenge it

  • gives background and context before discussing the research to date

  • includes questions for reflection, skills sections and practice recommendations generated from the evidence.

Using evidence drawn from a variety of sources, Evidence and Skills for Normal Labour and Birth critiques institutionalised, scientifically managed birth and endorses a more humane midwifery-led model. Packed with up-to-date and relevant information, this text will help all students, practising midwives and doulas keep abreast of the evidence surrounding normal birth and ensure their practice takes full advantage of it.

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Editorial Reviews

From the Publisher
Praise for the 1st edition:

'A well written and powerful book which is a must for midwives, mothers and the medical profession. Denis Walsh eloquently exposes the faults and failures in our current provision of maternity services and offers alternatives that challenge the orthodoxy of the biomedical model.' - Professor Paul Lewis, Academic Head of Midwifery and Child Health, Bournemouth University, UK

'This scholarly, readable book provides a springboard for practitioners to jump into the deep pool of their own and their client's experiences...Throughout, this book celebrates the dignity of childbearing women, emphasizing their need for kind, respectful, and compassionate care.' - Jane Pincus, Birth, September 2008

'In his multi-faceted book Denis Walsh explores research-based evidence about birth, examining practices in the orthodox medical method and empirically-based and more adventurous midwifery practice. He raises the questions that need to be asked about the medical management of birth, and considers ways in which it might be changed to focus instead on women's needs and spontaneous psycho-physiological processes. Denis Walsh stimulates creative thinking...he is essential reading for all student midwives.' - Sheila Kitzinger, birth activist

Praise for the 2nd edition:'There are several highlights to this book. These include the realistic scenarios used throughout the book, to illustrate points and to argue for reflection. These are not dramatic in content and the reader is left with a sense of calm practicality by the author. The questions for reflection that are included at the end of each chapter bring a greater depth to the chapter summaries, but also carry the reader forward.' - Greta McGough, Nursing Times, 2012

'I believe that this book will be of great help to students and practising midwives, and open the way to deeper awareness of their role in helping women in childbirth with quiet, continuous, personal support without directing, dogmatising, yelling 'Push!' or other potentially harmful interventions... This book points the way to the future.' – Sheila Kitzinger, birth activist.

'Overall, I really enjoyed reading this book. It brings the evidence together beautifully and simultaneously offers a great starting point for readers who are new to the area and a useful updating tool for those who have been around longer. The tone is friendly while incorporating an appropriate level of academic debate, and the book will inform, educate and challenge readers to think about care during labour and birth from a woman-centred and physiologically based perspective rather than a medicalised one.' - Sara Wickham, Editor, Essentially MIDIRS, 2012

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Product Details

  • ISBN-13: 9781136598418
  • Publisher: Taylor & Francis
  • Publication date: 11/11/2011
  • Sold by: Barnes & Noble
  • Format: eBook
  • Edition number: 2
  • Pages: 224
  • File size: 2 MB

Meet the Author

Denis Walsh is Associate Professor in Midwifery at the University of Nottingham, UK. He lectures on evidence and skills for normal birth internationally and is widely published on midwifery issues and normal birth.

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Table of Contents

Foreword     ix
Preface     xi
Acknowledgements     xiii
Evidence-based care: the new orthodoxy for maternity services     1
Critiques of the evidence paradigm     3
Qualitative research     5
Models of childbirth care     7
Conclusion     11
Questions for reflection     11
Birth setting and environment     13
Out-of-hospital birth: home birth     14
Out-of-hospital birth: free-standing birth centres     17
Integrated birth centres     20
Attitudes and beliefs     22
Relational dimensions of care     23
Birth ecology     26
Conclusion     27
Practice recommendations     27
Questions for reflection     28
Rhythms in the first stage of labour     29
Friedman's legacy     30
Organisational factors     31
An emergent critique     32
Rhythms in early labour     35
Rhythms in mid-labour     36
Alternative skills for 'sussing out' labour     38
Prolonged labour     39
'Being with', not 'doing to' labouring women     41
Conclusion     42
Practice recommendations     42
Questions for reflection     43
Pain and Labour     45
Pain, birthing and context     47
Models of labour pain     49
Psychological methods     52
Physical therapies     54
Sensory methods     55
Complementary therapies     56
Spiritual rituals     58
Technologies and drugs     59
Conclusion     64
Practice recommendations     64
Questions for reflection     65
Fetal heart monitoring in labour     67
Current evidence base of electronic fetal monitoring     69
Fetal mortality and morbidity related to birth asphyxia     70
Alternative technologies for assessing fetal well-being     75
Conclusion     75
Practice recommendations     76
Questions for reflection     76
Mobility and posture in labour     79
Mobility in the first stage of labour     82
Posture in the second stage of labour     83
Context, beds and birth rooms     86
Posture and perineal outcomes     87
Occipito-posterior positions      88
Birth position and educational initiatives     89
Conclusion     90
Practice recommendations     91
Questions for reflection     92
Rhythms in the second stage of labour     93
The medicalisation of the second stage     95
Research evidence     96
Definition of the second stage     98
Time and fetal health     101
Early pushing     102
Attitudes and philosophy     103
Practice recommendations     105
Questions for reflection     105
Care of the perineum     107
Episiotomy and its legacy     109
Hands on or hands poised     110
Other protective factors     113
Vaginal birth and the pelvic floor     113
To suture or not to suture     116
Conclusion     119
Practice recommendations     119
Questions for reflection     120
Rhythms in the third stage of labour     121
History of oxytocics     122
Components of active and physiological third stage care     123
The RCTs on active or physiological care     124
Choice of uterotonic      127
Defining a benchmark for PPH     127
Physiological third stage and maternal physiology     128
Physiological third stage and neonatal transition     130
Language games     131
Choice, skills, beliefs and institutional constraints     132
Practice recommendations     133
Questions for reflection     134
Changing midwives' practice     135
Relevant generic strategies     137
Targeting barriers to change     138
Strategies to address barriers     139
Diffusion of innovation     144
Conclusion     145
Practice recommendations     146
Questions for reflection     146
Relevant journals for maternity care     149
References     153
Index     175
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