Elsevier

Nursing Outlook

Volume 65, Issue 2, March–April 2017, Pages 240-241
Nursing Outlook

Article
American Academy of Nursing on Policy
Improving maternal and infant outcomes by promoting normal physiologic birth on hospital birthing units

https://doi.org/10.1016/j.outlook.2017.02.007Get rights and content

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Executive Summary

Pregnancy, labor, and birth are normal physiologic processes in women's lives. Women should receive care that supports a physiologic approach, using medical interventions only when needed, and continuing to support normal aspects of pregnancy and birth in more complex situations when possible. The academy supports the normalcy of pregnancy and birth and a woman-centered physiologic approach to providing care on hospital birthing units.

Background

Nearly $70 billion is spent in the United States annually on maternity and newborn care in hospitals where 98% of women give birth. Despite spending more than any other developed country, our outcomes are worse than most. High rates of unnecessary medical interventions such as labor inductions, epidurals, and cesareans add substantially to costs without improving maternal and newborn outcomes. Doing more and getting less was termed the perinatal paradox in 1998 (Rosenblatt, 1989).

An increased

Responses and Policy Options

The American College of Nurse–Midwives (ACNM) along with two other U.S. midwifery associations published a consensus statement related to supporting women to have a physiologic birth when possible, defined as “… one that is powered by the innate human capacity of the woman and fetus” (ACNM, MANA, NACPM, 2012). The same year ACNM along with the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the American College of Obstetricians & Gynecologists (ACOG), the American Academy

The Academy's Position

During the last 20 years, the American Academy of Nursing has expanded its focus on supporting both interdisciplinary and consumer-based collaborative initiatives that can lead to needed health care system changes (American Academy of Nursing, 2014). The Expert Panel on Maternal and Infant Health has determined that the primary focus of system changes in hospital birthing units should be on the use and documentation of physiologic birth care practices. Standardization of quality indicators that

Recommendations

  • 1.

    Build on existing collaborations among the National Quality Forum (NQF), TJC, AWHONN, ACNM, and ACOG with designated hospital teams to develop labor and delivery care guidelines and approaches (American College of Nurse–Midwives, 2016) that make physiologic birth practices the norm.

  • 2.

    The TJC should partner with hospital birthing units across the United States to develop and test education programs addressing physiologic birth practices.

  • 3.

    The NQF and TJC should continue the development and

Acknowledgments

The authors acknowledge the contributions of Nancy K. Lowe, CNM, PhD, FACNM, FAAN and Cindy M. Anderson, PhD, WHNP-BC, FNAP, FAHA, FAAN and the support of the members of the Expert Panel on Maternal and Infant Health.

References (8)

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    Improvement of maternal and newborn health through midwifery

    The Lancet

    (2014)
  • ACNM, MANA, NACPM. Supporting normal and healthy physiologic childbirth: A consensus statement by ACNM, MANA,...
  • Quality patient care in labor and delivery: A call to action

    Journal of Midwifery and Women's Health

    (2012)
  • American Academy of Nursing (2014). Choosing wisely. Retrieved from http://www.aannet.org/choosing-wisely. Accessed...
There are more references available in the full text version of this article.

Cited by (4)

  • ‘I felt like I could do anything!’ Writing the phenomenon of ‘transcendent birth’ through autoethnography

    2019, Midwifery
    Citation Excerpt :

    Negative connotations have risen up around the term natural and its essentialising connotations, the way it implies women are `close to nature’, that birth is `easy’ or that those not experiencing this type of birth are experiencing something `unnatural’ (Frost et al., 2006). Perhaps in an attempt to recognise the term as yet another cultural construction of birth, or to more precisely label what is meant in a birthing culture which remains heavily medicalised, the term `physiologic birth’ appears to be replacing `natural birth’ in the literature, see for example, Saftner et al. (2017) and Mayberry et al. (2017). In the interests of both accuracy and perception, this article will also use the nomenclature, physiologic birth.

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