Normal Birth

[arabianeyez83]

i am trying to come up with a questionnaire to understand rn opinions on normal birth. i will use it as a pretest, then do some interventions, and then do a post test to see if some attitudes about normal birth has changed.

any opinions or comments ?

[Double-Helix, BSN, RN]

What do you mean by "normal birth"? Normal birth comes in many forms. In general, a normal birth is one without any complications. If you mean "unmedicated childbirth" you need to consider the wording of your survey to make it clear what you are asking.

[arabianeyez83]

A normal birth is one that

1-Labor begins on its own

2- Freedom of movement throughout labor

3- Continuous labor support

4- NO routine interventions

5-Non-supine (eg. upright, side-lying) positions for birth

6- No seperation of mother and baby after birth with unlimited opportunity for breastfeeding

[klone, MSN, RN]

"Normal" is kind of a loaded word. What are you trying to accomplish with the questionnaire?

So my first comment is to call it something besides "normal birth"

[arabianeyez83]

I am a nurse midwife students doing my clinical rotations at a large hospital and busy L&D where most of the women get IV's, restricted movement, no skin to skin, baby gets a bath within 2 hrs of being born..so on. We want to know what the nurses' perceptions are on "normal birth" and what interventions we can do to "return to normal". I know everyone is going to have a different idea on what is normal. So I want to make a questionnaire kind of like a pretest, then do some interventions, then have a post test.

[klone, MSN, RN]

Right, I read your second post, and what I'm saying is that "normal birth" is a loaded phrase and is bound to cause divisiveness and defensiveness. Not to sound snippy, but you said that already, so repeating it doesn't really explain what you mean. I don't understand what you mean by pretest, "do some interventions" and have a post test. What exactly would the pretest be, and what do you mean by "do some interventions"?

[arabianeyez83]

Those were the exact directions given to me by the midwives, I was just looking for some opinions on what I can do.

[ixchel]

The WHO uses the word "normal" for births that occur without the use of any interventions. Lamaze used to throw that word around all the time, but have realized that some people get very offended by it. In this context, "normal" can feel quite judgmental, even though advocates of normal birth understand what is really meant by it.

OP, perhaps change your wording to natural, unintervened birth?

[Elvish, BSN, DNP, RN, NP]

I think you will find that most opposition to normal birth as you describe it does not come from the nursing staff. Most of the L&D nurses I have worked with in a couple different hospitals have no problem with any of that.

Not to turn this into a RN vs. MD debate, but I've only ever had MDs (not all of them, they opposition I have seen comes from MDs) roll their eyes at this list of what constitutes a normal birth. Most L&D nurses I know would love to labor a woman who goes into labor on her own, and desires to do the rest on her own as well.

I hate, hate, HAAAAATE it when doctors say, "Normal labor and delivery is a retrospective diagnosis."

[klone, MSN, RN]

Those were the exact directions given to me by the midwives, I was just looking for some opinions on what I can do.

I would ask for clarification, because I really don't know what you're looking for. Do YOU know what they're asking of you? If so, can you give us an example of what you're looking to do?

And don't get me wrong, I LOVE everything you described. I had it with every single one of my children (two of whom were born with midwives, one at home, all without any kind of augmentation or pain medication of any kind). But "normal" is such a vague word that could mean ANYTHING, and I hate that if it's not normal, then it must be "abnormal" and I don't like that connotation, either.

[rn/writer, RN]

It sounds like you are trying to find out what nurses consider to be a normal birth. So, why not just ask that.

"Please, describe what you consider a normal birth at your hospital, from start to finish."

"What interventions/procedures are considered routine parts of the birthing experience?'

"How does each intervention or procedure contribute positively to the birthing experience? What drawbacks or downsides does each one produce?"

"Of these routine interventions and procedures which ones do you personally consider essential and which one do you think could be deferred if there are no indications to the contrary?

Questions like these would help you to identify where the nursing staff is in their thinking. But more important, they would help you to peg the areas of least resistance where people are more open to change. They would also pinpoint the "sacred cows" that might need previous smaller successes before they are tackled.

I agree with the others that the use of the word "normal" is tricky. Normal can mean healthy, but it can also mean accepted, and in any discussion of this topic, those meanings can bump up against one another. A healthy, non-interventional birth (barring complications, of course) is what I believe you're aiming for.

But I think most people would use the word to mean usual or accepted. "What is the usual course of a birth on this unit?" If the unit routinely places IVs and fetal monitors and doesn't let the mother move around or choose a position that is comfortable for her, your version of normal is actually abnormal, meaning unusual.

If you use the word "normal" to mean natural or not interfered with, you will be confusing the very people you are trying to connect with and educate. You might get further if you use usual or routine or typical to identify what "normally" happens on the unit and natural or non-interventional to refer to a birth process that is not interfered with.

This division avoids semantic confusion and sidesteps any perceived judgment that could derail your project.

I'll be interested to hear about the results.

[PetsToPeople]

Basically exactly the opposite of what happens on a hospital L&D floor...I hated my clinical time in that dept. I was very disappointed by my own 2 hospital birthing experiences and wish to this day that I could have been able to go to a midwife instead.