Saturday, 27 October 2012

Evidence based practice to support a pain free labour - One.

Midwives today have improved the care offered to pregnant women by providing Evidence Based Practice. That is, only offering a plan of care that has been proved to be effective by research. The concept of evidence based practice was developed by Dr. Archie Cochrane in order to encourage all health care professionals to use evidence when making care decisions.
The Cochrane Library are a wealth of information when seeking research to guide our practice. They take the findings of similar research projects and amalgamate them to present an overall picture of what the researchers were hoping to discover. Their aim is to present independent high quality evidence for decision making within health care settings.
Lawrence et al (2009) examined 21 such studies which included the experiences of 3706 women. Their subject matter was Maternal Positions and Mobility During First Stage Labour.  Their findings after examining each piece of research by two independent health care specialist were:
  • The first stage of labour was one hour shorter in the upright groups.
  • There was less use of epidurals in the groups that remained mobile and upright.
They concluded that remaining upright and mobile during the first stage of labour was advantageous to women. They pointed out that lying down in labour should not be encouraged due to the weight of the pregnant uterus putting pressure on the abdominal blood vessels.

This blog supports staying upright during labour. This summer I visited Bonny Scotland and was amazed at how hilly it was. Walking up the hills was hard work, I would arrive at the top of a hill breathless with the muscles in my legs hurting. When women lie down in labour the uterus has to work against gravity and push the baby uphill, no wonder the uterine muscle starts to hurt, just like my legs did in Scotland. However, I had the choice of sitting down and getting my breath back at the top of the hill and so the hurt went away. Labouring women do not have this choice, of stopping the labour to relieve the hurt.

From the research available to guide my practice I can surmise that staying upright in labour will shorten the labour and make it more comfortable. I can therefore be confident that when I advise labouring women to have a little walk or adopt an upright position such as sat on a birthing ball or kneeling on a mat, my practice is evidence based.