Outcomes For Women Admitted During Active Versus Early Labor

Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).

The writer explained there could be no concern for fetal or maternal health during the delivery although some obstetricians tended to induce labor in all diabetic mothers to protect babies and mothers. Moreover, labor progress was supposedly assessed by old-fashioned methods, which resulted in performing unnecessary obstetrical practices. Intervention was imposed in cases of inaccurately labeled slow or abnormal labors and failures to progress. It is common practice that a primary cesarean generally produces subsequent surgical deliveries. The author realized that cesareans were performed because of insufficient data on laboring women’s

The conclusion was ultimately reached that medical or elective induction of term women was associated with an increased risk of cesarean delivery and that estimate was determined heavily based on the Bishop Scores attained The study closes by advising that induction of labor, whether it is medical or electively induced, should be avoided because a low Bishop score means that the cervix is unripe and even with cervical ripening agents, the study showed that the risk of cesarean delivery for nulliparous women remained unchanged. Their advice is to allow the mothers to spontaneously go into labor if they have an unfavorable Bishop score because it will lower cesarean delivery rates (Vrouenraets et al. 2005). This rationale directly correlates

The author is a nurse in a level two trauma facility in a community of approximately fifty thousand people in Oregon. The community is a college-town surrounded by a large agricultural area. There is a minimal ethnic diversity within the community. The diversity present occurs mainly from internationally students and faculty from the college. There is a growing population of women who desire low interventional births in the community. The author has worked on the labor and delivery unit of the hospital for the last 14 years. The hospital is the only one in the area to offer trial of labor services to women who have previously undergone a cesarean section. The unit on average experiences around 1000 deliveries annually.

In many cases, a patient increases their odds of a cesarean section if they chose to be induced without causation. A study was conducted between the years of 1999 to 2000 with 3215 nulliparous women. The findings of this study showed that nulliparous women are at a significantly higher risk of needing a cesarean section if they were electively induced (Luthy et al., 2004). Multiple studies have looked at nulliparous versus multiparous women and have found that elective inductions do not look to increase the odds of a woman needing a cesarean section in multiparous women. Researchers have begun to look at other possible relationships between patients who undergo an elective induction that results in a caesarean section and they have found

- maternal requests for induction and/or cesarean delivery vary across hospital patient populations, affecting data

Cesarean section (C/S) births can occur in the hospital for several reasons. Some women choose to have elective C/S birth and others require C/S births out of infant or maternal safety, complications, or by necessity. This paper discusses both elective and emergency C/S deliveries and reviews both National Guideline policy and Carilion Clinic policies on C/S births. The problem statement is: in pregnant women (population), does C/S delivery following National or Carilion policies (IV: exposure vs. none-exposure) differ in terms of patient care and outcomes concerning maternal and neonatal health (DV)?

Elective inductions are becoming increasing popular and the old wait till you go into labor is becoming something of the past. Many woman want to predict when their future offspring will be here and be able to have a plan for when to take off of work. But one thing about having these elective inductions is the fact that they are more of a social event rather than a medical necessity. Studies have shown that the elective induction group makes up more than one third of the pregnant population (Jonsson 2012, pg. 198). This means woman are volunteering to make themselves go into labor before their body is ready. Not only are elective inductions increasing but being induced has been associated with a 3 to 4 fold increase in having a cesarean section (Yogev 2013, pg.1736). A Bishop Score is done before the start of any induction. This score is based off of cervical dilation, cervical effacement and the station of the babies head compared to the ischial spines. The number produced from this score shows whether or not the cervix is favorable or unfavorable. A favorable score is a score above 7. If the score falls below this, the cervix is not favorable. “Women who were closed dilation

According to “Human Sexuality: Diversity in Contemporary America,” women and couples planning the birth of a child have decisions to make in variety of areas: place of birth, birth attendant(s), medication, preparedness classes, circumcision, breast feeding, etc. The “childbirth market” has responded to consumer concerns, so its’ important for prospective consumers to fully understand their options. With that being said, a woman has the choice to birth her child either at a hospital or at home. There are several differences when it comes to hospital births and non-hospital births.

For almost all of the previous 25 years roughly, the knowledge of pregnancy, labor, and delivery has changed little for some women. But change is arriving to the most traditional establishing, the hospital.

The World Health Organisation (WHO) states that Induction of labour should be offered to women when it is considered safer to deliver the baby for either, the baby, the mother, or both, rather than proceed with the pregnancy until spontaneous delivery. WHO specify there should also be an absence of contraindications for vaginal delivery and there should be no indication for a caesarean section (The World Health Organisation, 2011). This is supported by The Royal College of Obstetricians and Gynaecologists (RCOG) and National Institute for Health and Clinical Excellence (NICE) guidelines, (2008) for IOL, which endorse that women should be offered induction after 41 weeks between 41+0 and 42+0 weeks to avoid the risks of post-term pregnancy such as intrauterine fetal death (RCOG,2008; NICE, 2008). Yelikar (2007) suggests that post-term pregnancy is a pregnancy that is greater in length then 294 days from the last menstrual period or where it has progressed passed the expected date of delivery (EDD). It can also be referred to as prolonged pregnancy, post-maturity or post-date pregnancy (Yelikar, 2007)

The nurse must be mindful of each intervention initiated and the possible benefits of the intervention against its potential harmful effects for both mother and fetus. Not providing basic comfort measures for the mother can cause serious physical and emotional problems and could lead to possible fatigue and feelings of failure from the mother. The priority of this nursing intervention is to provide the mother and fetus with the least discomfort as possible and

In many U.S. hospitals today the patient care that women receive during management of labor and delivery doesn’t look very evidenced based. Electronic fetal heart rate monitoring (EFM) is the most common form of intrapartal fetal assessment in the United States. We continue to see widespread use of EFM in low risk pregnancies. Electronic fetal monitoring is standard procedure despite numerous randomized controlled trials that have disproven its validity. It is routinely used, yet does not decrease neonatal morbidity or mortality compared to the use of intermittent auscultation. Intermittent auscultation of the fetal heart rate is an acceptable option for low-risk laboring women, yet it is underutilized in the hospital setting. Several expert organizations have proposed the use of intermittent auscultation as a means of promoting physiologic childbirth. So why do we use continuous EFM in the low risk pregnancy and what does the best evidence support and how can nurses apply the best available evidence to practice? As a patient advocate it is the nurses responsibility to answer these questions and provide the low-risk pregnant woman with current evidence about options for fetal heart rate assessment during labor.

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.

While some women who received no prenatal care had normal, uncomplicated births, others did not. Most of the women who did not receive adequate prenatal care gave birth to an underweight and underdeveloped infant. Among the benefits of early, comprehensive prenatal care are decreased risk of preterm deliveries and low birth weight (LBW)-both major predictors of infant morbidity and mortality. (Dixon, Cobb, Clarke, 2000). Preterm deliveries, deliveries prior to 37 weeks of gestation, have risen. Since the studies in 1987, which showed the rate of preterm deliveries as 6.9% of births, the 1997 rate shows an increase to 7.5%. Low birth weight, defined as an infant weighing less than 2500 grams (5lbs. 5oz) is often preceded by preterm delivery. Low