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When I first began my nursing career in labor and delivery, I quickly realized that physiologic birth was not well understood where I worked.  I was looked at strange, and even told I didn’t know how to push with women in labor (I would sit them up right, even with epidurals, and change positions every half hour).  What I didn’t know at the time, was that nursing support during labor was not taught well, even though we had one of the highest numbers of births in the states.  It was at that time that I decided I was going to train myself to provide labor support for women, and found an organization that I could do on my time.  So it was not surprising to me to read research that supported the idea that one of the biggest barriers for nurses providing labor support was their age (older nurses provided more), and the institution they work at.  In institutions where nurses were not exposed to normal, physiologic labor as often, were less likely to provide labor support. Continuous support was also more likely to show clinical benefits if performed by someone not employed by the institution.

Here are a few tips, then, to help those nurses who want to overcome some of the natural barriers that are present in their institution or culture of birth in their work setting.  You can also find more tips on our youtube station and in our e-books.

  1. Get to know the midwifery model of care.  The midwifery model of care is evidence-based and views birth as a normal event, rather than a disease.  New ACOG guidelines have suggested practices that are much more in line with this model of care.  This is the model of care that values the impact of labor support and will provide you with a framework with which to work with when providing labor support.
  2. Find a peer support network that can help guide you through the process of what labor support can look like, and what physiologic labor looks like.  When I was learning labor support, I often would turn to local midwives when I had questions.  I would suggest becoming a member of Evidence Based Birth.  It was started by a PhD prepared nurse to help provide information on evidence based care during childbirth, and it includes a community of like minded health care professionals.
  3. Take some kind of labor support course that provides information on how to care for woman no matter what choices they make.
  4. Take a lead in embracing culture change within your unit.  If you feel your unit does not support your desire to provide labor support, then find ways you can make small changes to that culture.  One of the things I used to do was leave research articles out that supported the midwifery model of care.
  5. Look into getting magnet status for your hospital.  A big part of doing this, is to allow staff nurses to have a larger role in the leadership and decision making at the organizational level.  Once this is accomplished, there will be a culture of nurse leadership that may be more conducive to the implementation of systems that allow nurses to take a greater role in labor support.
  6. The best outcomes for women have come when the labor support professional is not hired by the hospital.  With this in mind, it may be important to begin bridging the gap between labor support professionals and the medical staff in hospitals.  Be a leader in encouraging collaboration between nurses and doulas or other support professionals a woman chooses.

Download our E-book on Rethinking the Stages of Labor to provide more information on physiologic birth.

Follow Rachel Leavitt:

Rachel has worked as a register nurse (BSN from University of Utah) since 2004 with a work history in Labor and Delivery, NICU and Postpartum Care. She is also the founder of New Beginnings Doula Training which she organized in 2011. When she's not busy being a mother and grandmother, she can be found reading research papers related to some aspect of childbirth.

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