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.