Paper
Monday, November 5, 2007

363
This presentation is part of : Clinical Initiatives for Families with Newborns
Obstetric Interventions in Normal Labor and Birth: Are They Indicated?
Phyllis L. Brodsky, RNC, MS, The Board of Education of Worcester County, Newark, MD, USA
Learning Objective #1: Discuss obstetric beliefs and methods of practice and the midwifery model of practice through the centuries to the present.
Learning Objective #2: Identify the clinical trials that show that obstetric interventions and technologies are not necessary in normal birth and may have some adverse outcomes.

ABSTRACT

Historically women cared for women during childbirth.  During their confinement, birthing women were in control of their bodies and were surrounded by a cadre of women who knew how to best meet their physical and emotional needs.  Midwives of yesteryear were empiricists, having learned their vocation from those before them and experimented with nature’s bounties.  In ancient times, scholars, such as Hippocrates and Soranus of Ephesus, wrote and taught about pregnancy and birth, but left the management to the midwives, whom they admired. However, such attitudes changed through later centuries.  Following the middle ages in the fifteenth and sixteenth centuries, the guilds formed in Western Europe. Members of the barber-surgeons guild were sometimes called upon by midwives, who, under duress, were unable to deliver an obstructed fetus. Thus these men were able to get their feet in the door of the birth chamber.  By the nineteenth century, medical schools proliferated in Europe and America.  In the struggle to improve medical education and gain access to “clinical material” (poor women), medical men established lying-in hospitals and wards, where childbed fever spread like wildfire, mainly from the contaminated and filthy hands of the male students and practitioners.  During this century, anesthesia in childbirth was also discovered.  When men took the reigns and childbirth took place in hospitals, childbirth became a medical event with interventions performed to this day without scientific rationale.  Clinical trials that have been conducted in the twenty-first century have shown that many obstetric interventions, such as continuous electronic fetal monitoring, routine use of labor induction or augmentation, and others, do not do as previously believed and have potentially adverse effects. This paper will explain why many current interventions are not best practice in normal labor.