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Hot Topics in Intrapartum Care
CLINICAL ISSUES EDITORIAL
Hot Topics in Intrapartum Care
M
any years ago, as a novice nurse, I remember caring for laboring women who received “twilight sleep” and were heavily medicated during labor. One of our main concerns was the mothers’ safety, as many of the women experienced pain in the moment with no memory of the previous moment. They also experienced confusion and hallucinations. Another concern was the safety of the newborn infants, as many were depressed at birth due to the medications the mothers received during labor. When I entered nursing, our empirical knowledge associated with the laboring woman was limited. We had many “sacred cows” in intrapartum nursing care, such as enemas and perineal shaves upon admission, with little evidence to support our practice. Empirical knowledge was evolving at a steady but slower pace than today. Safety is still our main concern, but now there are other hot topics that labor and delivery nurses encounter daily. As evidence continues to emerge on best practices to insure the best outcomes for women, infants, and families, staying abreast of this new knowledge is often challenging, and the translation of this knowledge into practice may be complex. This Clinical Issues series provides a comprehensive review and synthesis of evidence regarding four timely issues that affect patient care. Although nursing practice is responsive to research findings, the timeliness of the translation of research findings into practice varies across practice sites. Hopefully providing these syntheses will speed the process. The first article, a scientific review, explores the management of the laboring patient solely within the domain of nursing practice. Although much work has been done in nursing management of labor, gaps in the evidence behind potentially beneficial practices do still exist. In juxtaposition, the next paper explores the rising rates of cesarean deliveries. The authors provide the most recent evidence on the perinatal
risks of cesarean delivery versus vaginal birth, describe the economic impact of elective cesarean delivery, and outline ethical principles associated with nonmedically indicated cesarean deliveries. The third article addresses the growing number of women who are having their first child after 35 years of age. Interestingly, this age group represents about 23% of all laboring women and experiences increased rates of inductions and cesarean births. As the authors aptly point out, these women have different physical and psychosocial needs during labor and require tailored care during labor and delivery. Importantly, the last paper highlights recent changes in our national cardiopulmonary resuscitation guidelines for both the neonate and the adult patient. The information in this Clinical Issues series has important practice implications. When caring for laboring patients, nurses can implement the evidencebased nursing management measures described in the first article from admission through management of labor and delivery. Valuable evidence is provided concerning the first stage of labor progression, fetal monitoring, and care and comfort practices during labor. Plus, when they care for women who are contemplating the decision to have a nonmedically indicated cesarean delivery, nurses will be able to provide a more informed discussion of the risks and benefits associated with each type of delivery. Nurses must be prepared to use the cardiopulmonary resuscitation guidelines at any delivery. In closing, the body of empirical nursing knowledge related to labor and delivery practices has definitely evolved since my entry into nursing. It promises to continue to grow and will ultimately improve the perinatal outcomes of the patients we serve. Marilyn Stringer is an Associate Professor of Women’s Health Nursing and Clinician Educator at the University of Pennsylvania School of Nursing and the University of Pennsylvania Medical Center.
© 2007, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
JOGNN 597
Hot Topics in Intrapartum Care
M
any years ago, as a novice nurse, I remember caring for laboring women who received “twilight sleep” and were heavily medicated during labor. One of our main concerns was the mothers’ safety, as many of the women experienced pain in the moment with no memory of the previous moment. They also experienced confusion and hallucinations. Another concern was the safety of the newborn infants, as many were depressed at birth due to the medications the mothers received during labor. When I entered nursing, our empirical knowledge associated with the laboring woman was limited. We had many “sacred cows” in intrapartum nursing care, such as enemas and perineal shaves upon admission, with little evidence to support our practice. Empirical knowledge was evolving at a steady but slower pace than today. Safety is still our main concern, but now there are other hot topics that labor and delivery nurses encounter daily. As evidence continues to emerge on best practices to insure the best outcomes for women, infants, and families, staying abreast of this new knowledge is often challenging, and the translation of this knowledge into practice may be complex. This Clinical Issues series provides a comprehensive review and synthesis of evidence regarding four timely issues that affect patient care. Although nursing practice is responsive to research findings, the timeliness of the translation of research findings into practice varies across practice sites. Hopefully providing these syntheses will speed the process. The first article, a scientific review, explores the management of the laboring patient solely within the domain of nursing practice. Although much work has been done in nursing management of labor, gaps in the evidence behind potentially beneficial practices do still exist. In juxtaposition, the next paper explores the rising rates of cesarean deliveries. The authors provide the most recent evidence on the perinatal
risks of cesarean delivery versus vaginal birth, describe the economic impact of elective cesarean delivery, and outline ethical principles associated with nonmedically indicated cesarean deliveries. The third article addresses the growing number of women who are having their first child after 35 years of age. Interestingly, this age group represents about 23% of all laboring women and experiences increased rates of inductions and cesarean births. As the authors aptly point out, these women have different physical and psychosocial needs during labor and require tailored care during labor and delivery. Importantly, the last paper highlights recent changes in our national cardiopulmonary resuscitation guidelines for both the neonate and the adult patient. The information in this Clinical Issues series has important practice implications. When caring for laboring patients, nurses can implement the evidencebased nursing management measures described in the first article from admission through management of labor and delivery. Valuable evidence is provided concerning the first stage of labor progression, fetal monitoring, and care and comfort practices during labor. Plus, when they care for women who are contemplating the decision to have a nonmedically indicated cesarean delivery, nurses will be able to provide a more informed discussion of the risks and benefits associated with each type of delivery. Nurses must be prepared to use the cardiopulmonary resuscitation guidelines at any delivery. In closing, the body of empirical nursing knowledge related to labor and delivery practices has definitely evolved since my entry into nursing. It promises to continue to grow and will ultimately improve the perinatal outcomes of the patients we serve. Marilyn Stringer is an Associate Professor of Women’s Health Nursing and Clinician Educator at the University of Pennsylvania School of Nursing and the University of Pennsylvania Medical Center.
© 2007, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
JOGNN 597