Forms of Care in Midwifery:
Evidence-Based Findings Regarding Selected Maternity Care Practices Based on Benefits or Potential for Harm
Table 1: Beneficial Forms of Care
Effectiveness demonstrated by clear evidence from controlled trials:
§ Emotional and psychological support during labor and birth.
§ Maternal mobility and choice of position in labor.
§ Free mobility during labor to augment slow labor.
§ Consistent support for breastfeeding mothers.
§ Unrestricted breastfeeding.
Table 2: Forms of Care Likely to be Beneficial
The evidence in favor of these forms of care is not as firmly established as for those in Table 1:
§ Midwifery care for women with no serious risk factors.
§ Respecting women's choice of companions during labor and birth.
§ Respecting women's choice of place of birth.
§ Giving women as much information as they desire.
§ Change of mother's position for fetal distress in labor.
§ Woman's choice of position for the second stage of labor or giving birth.
§ Maternal movement and position changes to relieve pain in labor.
§ Counter-pressure to relieve pain in labor.
§ Superficial heat or cold to relieve pain in labor.
§ Touch and massage to relieve pain in labor.
§ Attention focusing and distraction to relieve pain in labor.
§ Music and audio-analgesia to relieve pain in labor.
§ Encouraging early mother-infant contact
Table 3: Forms of Care With a Trade-Off Between Beneficial and Adverse Effects
Women and caregivers should weigh these effects according to individual circumstances and priorities:
§ Continuity of care for childbearing women.
§ Routine early ultrasound.
§ Induction of labor for prelabor rupture of membranes at term
§ Continuous EFM plus scalp sampling versus intermittent auscultation during labor.
§ Narcotics to relieve pain in labor.
§ Epidural analgesia to relieve pain in labor.
§ Prophylactic antibiotic eye ointments to prevent eye infection in the newborn
Table 4: Forms of Care of Unknown Effectiveness
There are insufficient or inadequate quality data upon which to base a recommendation for practice:
§ Immersion in water to relieve pain in labor.
§ Acupuncture to relieve pain in labor.
§ Aromatherapy to relieve pain in labor.
§ "Active management" of labor.
Table 5: Forms of Care Unlikely to be Beneficial
The evidence against these forms of care is not as firmly established as for those in Table 6:
§ Routinely involving doctors in the care of all women during pregnancy.
§ Routinely involving obstetricians in the care of all women during pregnancy and child birth.
§ Not involving obstetricians in the care of women with serious risk factors.
§ Routine withholding food and drink from women in labor.
§ Routine intravenous infusion in labor.
§ Face masks during vaginal examinations.
§ Frequent scheduled vaginal examinations during labor.
§ Routine directed pushing during the second stage of labor.
§ Pushing by sustained bearing down during second stage of labor.
§ Breath-holding during the second stage of labor.
§ Early bearing down during the second stage of labor.
§ Arbitrary limitation of the duration of the second stage of labor.
§ "Ironing out" or massaging the perineum during the second stage of labor.
Table 6: Forms of Care Likely to be Ineffective or Harmful
Ineffectiveness or harm demonstrated by clear evidence:
§ Routine pubic shaving in preparation for delivery.
§ Electronic fetal monitoring without access to fetal scalp sample during labor.
§ Rectal examinations to assess labor progress.
§ Requiring a supine (flat on back) position for second stage of labor.
§ Routine use of the lithotomy position for the second stage of labor.
§ Routine restriction of mother-infant contact
§ Routine nursery care for babies in hospital.
§ Samples of formula for breastfeeding mothers.
Excerpted from A Guide to Effective Care in Pregnancy and Childbirth, 2d edition, by Murray Enkin et al., 1995. Reprinted by permission of Oxford University Press.
Note: These findings are not exclusive and are presented as examples only. These tables should not be relied upon alone for clinical practice.