Evidence-Based Practice by Nurses for Nurses: Encouraging Waiting Spontaneous Labor
This article describes an evidence-based patient-centered campaign and clinical resources that were developed by nurses, for nurses. Evidence includes an older AHRQ systematic review combined with current and emerging evidence. The topic (early induction of labor) is a high priority across many disciplines and is a strong example of how evidence can stimulate and inform changes in practice that are entrenched routines (you know the refrain -- "because we've always done it that way."). We hope you enjoy this new posting and explore the embedded links to the evidence-based materials.
Keeping women healthy during pregnancy and childbirth is critical not only to the health of the baby but also for the woman's lifelong health. Complications sustained during childbirth, including complications of cesarean birth, can negatively impact a woman's mental and physical health in the immediate postpartum period and in the long-term. Her newborn can be affected as complications can negatively affect breastfeeding, a woman's energy and her adjustment to parenting. A focus area of heightened attention in maternity care has been elective, or non-medically indicated, induction of labor because evidence shows this practice results in higher rates of cesarean for women who have induction of labor with their first pregnancy and/or with an unripe cervix.
NOTE: Since this article references materials not developed by AHRQ, we must note that the findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Evaluating evidence for obstetric practices is complicated because practices, such as induction of labor without medical indications, began when there was less of an emphasis on an evidence basis for practice therefore the risks were not fully known or understood. The practice of elective inductions became culturally-accepted and widely used in obstetrical care. The practice paradigm is shifting away from elective inductions however many women are still expecting to have a non-medically indicated induction for convenience of family and work life. Women need to know the risks of elective inductions for themselves and their baby so they can make an informed decision about their birth choices.
Explaining the evidence behind culturally-accepted practices can be hard. Nurses are ideally suited to discuss the safety and harms of non-medically indicated induction of labor with their patients and also friends, family and their communities. No other group of professionals has such an intimate knowledge of the effects of induction on mothers and babies because nurses are responsible for the bedside monitoring of the high-alert medication oxytocin, which is used for most inductions. That's why the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) developed their public health campaign, Don't Rush Me--Go the Full 40, which gives women and nurses 40 reasons to wait for labor to start on its own when pregnancy is healthy. The reasons address what emerging evidence demonstrates regarding healthy labor and birth practices, such as:
Reason #3: Let nature take over--there are fewer complications and risks for both you and baby through natural birth
Reason #15: Give baby's development the benefit of time since you may not know exactly when you got pregnant
Reason #21: Ignore people who say an induction is more convenient. Nothing is convenient about a longer labor and increasing your risk of cesarean
The benefits of waiting for spontaneous labor and normal birth are well documented and result in giving mom and her baby the best possible start toward bonding, breastfeeding and recovery from labor and birth. Nurses can use the 40 Reasons article of the campaign (English & Spanish) to lead evidence-based, patient-centric discussions with women about the risks of elective induction of labor. Nurses can download a Go The Full 40 toolkit to share with their colleagues and patients, and engage with the Go The Full 40 Champions group, which advocates waiting for spontaneous labor when all is well in pregnancy.
Evidence has identified the risks and complications of administering exogenous hormones such as synthetic oxytocin to a woman and her baby to induce labor. An equally importance evidence question yet to be answered is what short and long term benefits do women and babies receive from the powerful natural hormones of spontaneous labor and birth?
