This blog series is based upon an article I wrote, along with my friend, Matt Cline, MD, that appeared in the Primary Care Clinics of North America. In today’s blog I’ll present some introductory comments. I hope you’ll share this series with anyone you know planning or preparing to have a baby.
This is the abstract of the article:

Objectives: The purpose of this paper was to review highlights from the literature concerning those interventions within the control of maternity caregivers, payers, or institutions which might increase the likelihood of keeping normal labor normal.

Method: Articles reviewed for techniques, beliefs, or interventions that might effect the process of labor, and in particular, articles that discussed the avoidance of unnecessary or potentially harmful interventions.  The majority of the articles reviewed that discussed the topic were found in the midwife, nursing and family practice literature.  Summary thoughts were then consolidated into a broad-based approach that could benefit pregnant women in labor, their babies, their families and their caregivers.

Findings: The suggestions in the literature to keep normal labor normal were arranged into ten topical areas and christened “The “10 P’s of Keeping Normal Labor Normal,” namely: (1) Philosophy, (2) Partners, (3) Providers, (4) Pain control, (5) Procedures, (6) Patience, (7) Preparation, (8) Positions, (9) Payment, and (10) Prayer.

Conclusions: There is a considerable and growing literature that suggests that there are both interventions and non-interventions that maternity caregivers, payers and institution could consider, delete and/or provide which would increase their likelihood of keeping normal labor normal.

The purpose of my article was to review and synthesize the medical literature concerning those interventions which could result in keeping normal labor normal and to argue strongly for an academic consideration of family-centered birthing using both evidence-based data and techniques that appeared to have withstood the test of time.
However, I think it will also be helpful for families who are actively developing a birth plan. My belief is that being aware of this information, and partnering with a birth attendant who is comfortable with these 10 P’s will increase the chances of having a shorter labor and a safer birth.
To prepare the article, I also searched for articles in the medical literature that discussed the avoidance of unnecessary intervention. The majority of these articles were found in the midwife, nursing, and family medicine literature.
Because evidence-based medicine is a relatively new tool for most maternity-care authors, a unique noncritical review approach was utilized which involved gathering summary quotes from the articles which discussed inappropriate intervention or appropriate non-intervention in maternity care.
Although the quoted “pearls” are taken out of context, I’ve attempted to “string the pearls” together into an academically defensible apologetic for family-centered birthing.
In effect, the maternity care literature was utilized to provide a “Delphi-type” description of family-centered birthing which was then synthesized into a broad-based approach that could possibly be utilized by future researchers to evaluate any benefit it may give to pregnant women in labor, their babies, their families, their communities, and their care-givers.
In next week’s blog, we’ll look at the costs of “abnormal labor.”
Here’s the entire series:

• Introduction
• The Costs of Abnormal Labor
• THE 10 P’s

1. Philosophy,
2. Partners,
3. Professionals,
4. Pain control,
5. Procedures,
6. Patience,
7. Preparation,
8. Positions,
9. Payment, and
10. Prayer.

• Summary