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JPE 24.4: Epidurals: Do They or Don’t They Increase Cesareans?
JPE 24.4: Epidurals: Do They or Don’t They Increase Cesareans?

Article by: Henci Goer

The controversy over whether epidurals increase the risk of cesarean has raged since the 1970s. This article provides a history of the early observational research designed to answer this question and an in-depth analysis of the most recent randomized control trials. Based on the research, the author concludes that we cannot assure women that epidurals do not increase the risk of cesarean.

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JPE 24.3 Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications
JPE 24.3 Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications

Article by: Sarah J. Buckley, MB, ChB, Dip Obst

This report synthesizes evidence about innate hormonally mediated physiologic processes in women and fetuses/newborns during childbearing, and possible impacts of common maternity care practices and interventions on these processes, focusing on four hormone systems that are consequential for childbearing. Core hormonal physiology principles reveal profound interconnections between mothers and babies, among hormone systems, and from pregnancy through to the postpartum and newborn periods. Overall, consistent and coherent evidence from physiologic understandings and human and animal studies finds that the innate hormonal physiology of childbearing has significant benefits for mothers and babies. Such hormonally-mediated benefits may extend into the future through optimization of breastfeeding and maternal-infant attachment. A growing body of research finds that common maternity care interventions may disturb hormonal processes, reduce their benefits, and create new challenges. Developmental and epigenetic effects are biologically plausible but poorly studied. The perspective of hormonal physiology adds new considerations for benefit-harm assessments in maternity care, and suggests new research priorities, including consistently measuring crucial hormonally mediated outcomes that are frequently overlooked. Current understanding suggests that safely avoiding unneeded maternity care interventions would be wise, as supported by the Precautionary Principle. Promoting, supporting, and protecting physiologic childbearing, as far as safely possible in each situation, is a low-technology health and wellness approach to the care of childbearing women and their fetuses/newborns that is applicable in almost all maternity care settings.

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JPE 24.2 The Broken Thread of Health Promotion and Disease Prevention for Women During Postpartum
JPE 24.2 The Broken Thread of Health Promotion and Disease Prevention for Women During Postpartum

Article by: Lorraine O. Walker, RN, EdD, MPH, Christina L. Murphey, RNC-OB, PhD, and Francine Nichols, RN, PhD, FAIS

Postpartum maternal health affects maternal functional status, future pregnancy outcomes, maternal chronic disease development, and infant health. After pregnancy, however, many mothers may find that they face gaps in care related to their health and caregiving roles. Research shows that they were unprepared, uninformed, and unsupported during the postpartum period as they struggle with physical and emotional symptoms, infant caregiving, breastfeeding concerns, and lifestyle adjustments. Limited follow-up after a diagnosis of gestational hypertension or gestational diabetes and screening for postpartum depression are additional gaps in preventive and supportive care. Integrative reviews revealed modest efficacy and limitations of recent postpartum health promotion and disease prevention interventions. System, clinical, and community strategies are identified to address these gaps in women’s postpartum health services.

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JPE 24.1 How Doula Care Can Advance the Goals of the Affordable Care Act: A Snapshot From NYC
JPE 24.1 How Doula Care Can Advance the Goals of the Affordable Care Act: A Snapshot From NYC

Article by: Nan Strauss, JD, Katie Giessler, MPH, and Elan McAllister, BA

Doula care meets each of the triple aims of the Affordable Care Act: improving health outcomes for all, improving the experience of care, and lowering costs by reducing non-beneficial and unwanted medical interventions. Cost is the greatest barrier to use of doula support. Reimbursement for doula services by private insurance, Medicaid, and Medicaid managed care organizations would significantly increase access to doulas. Widespread availability of doula care could significantly reduce cesarean rates, and increased access to community-based doula programs could reduce entrenched health disparities.

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JPE 23.4 #6 Healthy Birth Practice #6: Keep Mother and Baby Together
JPE 23.4 #6 Healthy Birth Practice #6: Keep Mother and Baby Together

Article by: Jeannette T. Crenshaw, DNP, RN, NEA-BC, IBCLC, FAAN, LCCE, FACCE

Mothers and babies have a physiologic need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and babies together is a safe and healthy birth practice. Evidence supports immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. Unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding,” published in The Journal of Perinatal Education, 16(3), 2007.

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JPE 23.4 #5 Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body
JPE 23.4 #5 Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body

Article by: Joyce T. DiFranco, RN, BSN, LCCE, FACCE and Marilyn Curl, RNC, CNM, LCCE, FACCE

Women in the United States are still giving birth in the supine position and are restricted in how long they can push and encouraged to push forcefully by their caregivers. Research does not support these activities. There is discussion about current research and suggestions on how to improve the quality of the birth experience. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions," published in The Journal of Perinatal Education, 16(3), 2007.

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JPE 23.4 #4 Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary
JPE 23.4 #4 Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary

Article by: Judith A. Lothian, PhD, RN, LCCE, FACCE

Maternity care in the United States is intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive. These interventions disturb the normal physiology of labor and birth and restrict women’s ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #4: No Routine Interventions,” published in The Journal of Perinatal Education, 16(3), 2007.

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JPE 23.4 #3 Healthy Birth Practice #3: Bring a Loved One, Friend, or Doula for Continuous Support
JPE 23.4 #3 Healthy Birth Practice #3: Bring a Loved One, Friend, or Doula for Continuous Support

Article by: Jeanne Green, MT, CD(DONA), LCCE, FACCE and Barbara A. Hotelling, WHNP-BC, CD(DONA), LCCE, IBCLC

All women should be allowed and encouraged to bring a loved one, friend, or doula to their birth without financial or cultural barriers. Continuous labor support offers benefits to mothers and their babies with no known harm. This article is an updated evidence-based review of the “Lamaze International Care Practices that Promote Normal Birth, Care Practice #3: Continuous Labor Support,” published in The Journal of Perinatal Education, 16(3), 2007.

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JPE 23.4.2 Healthy Birth Practice #2: Walk, Move Around, and Change Positions Throughout Labor
JPE 23.4.2 Healthy Birth Practice #2: Walk, Move Around, and Change Positions Throughout Labor

Article by: Michele Ondeck, RN, MEd, IBCLC, LCCE, FACCE

In the United States, obstetric care is intervention intensive, resulting in 1 in 3 women undergoing cesarean surgery wherein mobility is treated as an intervention rather than supporting the natural physiologic process for optimal birth. Women who use upright positions and are mobile during labor have shorter labors, receive less intervention, report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #2: Freedom of Movement Throughout Labor,” published in The Journal of Perinatal Education, 16(3), 2007.

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JPE 23.4.1 Healthy Birth Practice #1: Let Labor Begin on Its Own
JPE 23.4.1 Healthy Birth Practice #1: Let Labor Begin on Its Own

Article by: Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE

As cesarean rates have climbed to almost one-third of all births in the United States, current research and professional organizations have identified letting labor begin on its own as one of the most important strategies for reducing the primary cesarean rate. At least equally important, letting labor begin on its own supports normal physiology, prevents iatrogenic prematurity, and prevents the cascade of interventions caused by labor induction. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #1: Let Labor Begin on Its Own," published in The Journal of Perinatal Education, 16(3), 2007.

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JPE 23.3 Birth, Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth
JPE 23.3 Birth, Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth

Article by: Barbara Harper

The 2014 objection to birth in water voiced by both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) in ACOG Bulletin #594 on immersion in water during labor and birth is nothing new. The Committee on Fetus and Newborn published the very same opinion in 2005, based on a case report that was published in 2002 in the journal Pediatrics. What has changed since 2002 is a growing body of evidence that reports on the safety and efficacy of labor and birth in water. This article reviews the retrospective literature on water birth and explains newborn physiology and the protective mechanisms that prevent babies from breathing during a birth in water.

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JPE 23.2 Knowledge and Skills of Lamaze Certified Childbirth Educators: Results of Job Task Analysis
JPE 23.2 Knowledge and Skills of Lamaze Certified Childbirth Educators: Results of Job Task Analysis

Article by: Wendy C. Budin, PhD, RN-BC, FAAN, LCCE, FACCE, Leon Gross, PhD, Judith A. Lothian, PhD, RN, LCCE, FACCE, and Jeanne Mendelson, BA

Content validity of certification examinations is demonstrated over time with comprehensive job analyses conducted and analyzed by experts, with data gathered from stakeholders. In November 2011, the Lamaze International Certification Council conducted a job analysis update of the 2002 job analysis survey. This article presents the background, methodology, and findings of the job analysis. Changes in the test blueprint based on these findings are presented.

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JPE 23.1 Major Survey Findings of Listening to Mothers III: Pregnancy and Birth
JPE 23.1 Major Survey Findings of Listening to Mothers III: Pregnancy and Birth

Article by: Eugene R. Declercq, PhD, Carol Sakala, PhD, MSPH, Maureen P. Corry, MPH, Sandra Applebaum, MS, and Ariel Herrlich, MA

To understand the experiences and views of childbearing women in the United States and trends over time, Childbirth Connection carried out the third national Listening to Mothers survey among 2,400 women who gave birth in U.S. hospitals to a single baby from mid-2011 to mid-2012 and could participate in English. Harris Interactive conducted the survey using a validated methodology that includes data weighting to ensure that results closely reflect the target population. Results of the initial survey describe experiences from before pregnancy through the early postpartum period, and were reported in Listening to Mothers III: Pregnancy and Birth. A follow-up survey directed to the same participants explored postpartum experiences, attitudes about maternity care, and some additional pregnancy and birth items.

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JPE 22.4 Don’t Rush Me . . . Go the Full 40
JPE 22.4 Don’t Rush Me . . . Go the Full 40

Article by: Debra Bigham, DrPH, RNC, LCCE; Catherine Ruhl, CNM, MS; Carolyn Davis Cockey, MLS

Don’t Rush Me . . . Go the Full 40 is a grassroots public health campaign from the Association of Women’s Health, Obstetric and Neonatal Nursing (AWHONN) that educates women about the physiologic benefits of full-term pregnancy for themselves and their babies. GoTheFull40.com seeks to increase the percentage of women who complete at least 40 weeks of pregnancy, decrease the percentage of women who choose elective induction or elective cesarean surgery, and increase nurses’ and other pregnancy-care providers’ effectiveness in reducing the number of elective inductions and cesarean surgeries. Childbirth educators and other pregnancy providers are asked to share the campaign with women in preconception and prenatal settings to encourage waiting for spontaneous labor leading to full-term births when all is healthy and well with the mother and fetus.

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JPE 22.3 Fetal Monitoring: Creating a Culture of Safety with Informed Choice
JPE 22.3 Fetal Monitoring: Creating a Culture of Safety with Informed Choice

Article by: Lisa Heelan, MSN, FNP-BC

The dominant culture in labor and birth is the medical model, not the midwifery model of woman-centered care. Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM). Barriers impact the laboring woman’s ability to give informed choice regarding fetal monitoring. Lack of informed choice denies a woman her right to be in control of her birth experience, and is in opposition to a woman’s right to autonomy and self-determination

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JPE 22.2: First Do No Harm: Interventions During Childbirth
JPE 22.2: First Do No Harm: Interventions During Childbirth

Article by: Lauren Jansen, PhD, RN; Martha Gibson, PhD, RN, CHES; Betty Carlson Bowles, PhD, RNC, ACCE, IBCLC; Jane Leach, PhD, RN, IBCLC

Although medical and technological advances in maternity care have drastically reduced maternal and infant mortality, these interventions have become commonplace if not routine. Used appropriately, they can be life-saving procedures. Routine use, without valid indications, can transform childbirth from a normal physiologic process and family life event into a medical or surgical procedure. Every intervention presents the possibility of untoward effects and additional risks that engender the need for more interventions with their own inherent risks. Unintended consequences to intrapartum interventions make it imperative that nurse educators work with other professionals to promote natural childbirth processes and advocate for policies that focus on ensuring informed consent and alternative choices. Interdisciplinary collaboration can ensure that intrapartum caregivers “first do no harm.”


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JPE 22.1 Supporting Healthy and Normal Physiologic Childbirth
JPE 22.1 Supporting Healthy and Normal Physiologic Childbirth

Article by: The American College of Nurse-Midwives; originally appeared in Volume 57, Issue 5 of the Journal of Midwifery & Women’s Health.

This consensus statement represents the work of a task force comprised of representatives from three U.S. midwifery organizations whose members are experts on supporting women’s innate capacities to birth, and was externally reviewed by maternity care organizations and leaders. The specific aims of the consensus statement are to

  • Provide a succinct definition of normal physiologic birth;
  • Identify measurable benchmarks to describe optimal processes and outcomes reflective of normal physiologic birth;
  • Identify factors that facilitate or disrupt normal physiologic birth based on the best available evidence;
  • Create a template for system changes through clinical practice, education, research, and health policy; and
  • Ultimately improve the health of mothers and infants, while avoiding unnecessary and costly interventions.


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JPE 21.4 Top 10: Tips on Teaching Lamaze Classes
JPE 21.4 Top 10: Tips on Teaching Lamaze Classes

Article by: Judith A. Lothian, PhD, RN, LCCE, FACCE and Barbara A. Hotelling, WHNP-BC, CD(DONA), LCCE 

Lamaze classes should help women think differently about birth, dispel myths, and ultimately make informed decisions that are right for them. In the current maternity care environment, this is a monumental task. In this column, the authors discuss 10 teaching tips that serve as a guide for teaching childbirth classes and ultimately facilitate learning.

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JPE 21.3 Transforming Maternity Care: Implementing the Blueprint for Action
JPE 21.3 Transforming Maternity Care: Implementing the Blueprint for Action

Article by Amy M. Romano, MSN, CNM 

In January 2010, Women’s Health Issues published two direction-setting reports from the Transforming Maternity Care (TMC) Project: “2020 Vision for a High-Quality, High-Value Maternity Care System” and “Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System.” This guest editorial summarizes highlights of the implementation phase of what is now known as the TMC Partnership. Major progress has been made in elevating maternity care quality to a national policy priority, increasing the availability and use of maternity care performance measures, and developing shared decision making tools for childbearing women

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JPE 21.2 The Courage to Birth
JPE 21.2 The Courage to Birth

Article by: Kathryn McGrath, MSW, CD(DONA), LCCE, FACCE

Childbirth educator Kathryn McGrath reflects on fear and courage and comes to see some levels of fear as a normal part of the process of pregnancy and birth and not something to be brushed aside. In this article, originally presented as a keynote address in 2005 at the Lamaze International Annual Conference, McGrath discusses fear during pregnancy and birth and presents ways in which the childbirth educator can acknowledge and accept women’s fears, and help find the courage they need to give birth.

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JPE 21.1 Styles Vary When Teaching Expectant Parents About Medications
JPE 21.1 Styles Vary When Teaching Expectant Parents About Medications

Article By: Barbara A. Hotelling, WHNP-BC, CD(DONA), LCCE

In this column, the author presents information from prominent Lamaze childbirth educators and from the literature to describe various options that educators can share with expectant parents regarding the use of pain relief medications during labor and birth. Ann Tumblin teaches about epidurals in a hospital class without losing sight of evidence-based practices that support normal birth. Jessica English focuses her classes on the natural processes of giving birth and spends only a little time presenting information about pain medications. Judith Lothian encourages educators to consider a new framework for Lamaze classes that involves letting go of the details and incorporating Lamaze’s six Healthy Birth Practices and storytelling.

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JPE 20.4 Many Women and Providers Are Unprepared for an Evidence-Based, Educated Conversation About
JPE 20.4 Many Women and Providers Are Unprepared for an Evidence-Based, Educated Conversation About

Article By: Michael C. Klein, MD, CCFP, FAAP (Neonatal-Perinatal), FCFP, ABFP, FCPS

Findings from recent Canadian studies on the knowledge and beliefs about birth practices among first-time pregnant women and among obstetricians and other birth providers indicate that many women are inadequately informed and many providers deliver non-evidence-based maternity care. Consequently, informed decision making is problematic for pregnant women and their providers. New strategies are needed to inform pregnant women about key procedures and approaches that might be used in birth so they can have an educated, shared discussion with their provider and successfully advocate for their preferred birth experience. In addition, providers can be encouraged to supplement their knowledge with current, evidence-based maternity care practices. To avoid a lack of informed decision making and to ensure that natural, safe, and healthy birth practices are based on current evidence, pregnant women and providers must work together to inform themselves and to add childbirth to the women’s health agenda.

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JPE 20.3 Pain, Suffering, and Trauma in Labor
JPE 20.3 Pain, Suffering, and Trauma in Labor

Article by: Penny Simkin, PT, CCE, CD(DONA), with commentary by Kimmelin Hull, PA, LCCE 

In this column, Kimmelin Hull, community manager of Science & Sensibility, Lamaze International’s research blog, reprints and discusses a recent blog post series by acclaimed writer, lecturer, doula, and normal birth advocate Penny Simkin. Examined here is the fruitful dialog that ensued—including testimonies from blog readers about their own experiences with traumatic birth and subsequent posttraumatic stress disorder. Hull further highlights the impact traumatic birth has not only on the birthing woman but also on the labor team—including doulas and childbirth educators—and the implied need for debriefing processes for birth workers. Succinct tools for assessing a laboring woman’s experience of pain versus suffering are offered by Simkin, along with Hull’s added suggestions for application during the labor and birth process.


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JPE 20.2 Breathing: What Every Pregnant Woman Needs to Know
JPE 20.2 Breathing: What Every Pregnant Woman Needs to Know

Article by: Judith A. Lothian, PhD, RN, LCCE, FACCE

Lamaze breathing historically is considered the hallmark of Lamaze preparation for childbirth. This column discusses breathing in the larger context of contemporary Lamaze. Controlled breathing enhances relaxation and decreases perception of pain. It is one of many comfort strategies taught in Lamaze classes. Conscious breathing and relaxation, especially in combination with a wide variety of comfort strategies, can help women avoid unnecessary medical intervention and have a safe, healthy birth.

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JPE 20.1 Umbilical Cord Blood: Information for Childbirth Ed
JPE 20.1 Umbilical Cord Blood: Information for Childbirth Ed

Article by: Renece Waller-Wise, MSN, CNS, CLC, CNL, LCCE

Childbirth educators may be one of the main sources that an expectant family depends on to gain more knowledge about cord blood banking in order to make an informed decision. Preserving umbilical cord blood in public banks is advisable for any family; however, it is recommended that expectant families only consider private cord blood banking when they have a relative with a known disorder that is treatable by stem cell transplants. The childbirth educator is encouraged to be well versed on the topic of cord blood banking, so that as questions from class participants arise, the topic can be explored and addressed appropriately.

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