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.