Lisa Kane Low, PhD, CNM, FACNM & Kerri D. Schuiling, PhD, CNM, WHCNP. Physiological aspects of social support and comfort in labor

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1 Comfort and Support in Labor Lisa Kane Low, PhD, CNM, FACNM & Kerri D. Schuiling, PhD, CNM, WHCNP I. Introduction II. Physiological aspects of social support and comfort in labor A. Theories associating positive outcomes associated with comfort and support in labor B. Evidence supporting the bio-psycho-social linkages of social support and physiologic responses III. Setting the Stage: What is comfort? A. Comfort in labor..does it exist? B. Measuring comfort in labor.can it be done? C. Components of comfort in labor is it specific interventions or being there and feeling cared for? D. Review of the evidence about comfort in labor

2 IV. Setting the stage: What is support in labor and who provides it? A. Support in labor B. Defining support 1. Is it continuous or intermittent? 2. How much support is enough? 3. What types of support do women want? V. Women s perspectives on comfort and support in labor A. Help me.until I can get my epidural B. Thank-you doctor, I could not have done it without you C. I am woman, I am strong D. You go girl no drugs that s cool but not for me!

3 E. Just in case, I want to be sure I can get an epidural if I need one VI. Challenges to listening to women A. What are midwives to do? B. New members of the team..a DOULA!!! C. Do we really need new members of the team? D. I do not want to be a dinosaur so I have to do what women want today. E. Advocacy, education, informed consent as extensions of a midwifery model of care VII. Summary and future directions for research and practice

4 References Bowers, B. B. (2002). Mothers experiences of labor support: Exploration of qualitative research. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 31(6), Campero, L., Garcia, C., Diaz, C., Ortiz, O., Reynoso, S., & Langer, A. (1998). Alone, I wouldn t have known what to do : A qualitative study on social support during labor and delivery in Mexico. Social Science Medicine, 47(3), Chalmers, B. & Wolman, W. (1993). Social support in labor: A selective review. Journal of Psychosomatic Obstetrical Gynaecology, 14, Corbett, C. A., & Callister, L. C. (2000). Nursing support during labor. Clinical Nursing Research, 9(1), Davies, B. L., & Hodnett, E. (2002). Labor support: Nurses self-efficacy and views about factors influencing implementation. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 31(1), Doulas of North America. (1998). Position paper: The doula s contribution to modern maternity care. Simkin, P., & Way, K. Gagnon, A. J., & Waghorn, K. (1996). Supportive care by maternity nurses: a work sampling study in an intrapartum unit. Birth, 23(1), 1-6. Gagnon, A. J., Waghorn, K., & Covell, C. (1997). A randomized trial of one-to-one nurse support of women in labor. Birth, 24(2), Hodnett, E. D. (2002). Caregiver support for women during childbirth. Retrieved October 4, 2002, from The Cochrane Database of Systematic Reviews. Hodnett, E. D., Gates, S., Hoymeyr, G. J., & Sakala, C. (2003). Continuous support for women during childbirth. Retrieved July 23, 2003, from The Cochrane Database Hodnett, E. D., Lowe, N. K., Hannah, M. E., Willan, A. R., Stevens, B., Weston, J. A., et al. (2002). Effectiveness of nurses as providers of birth labor support in North American hospitals. Journal of the American Medical Association, 288(11), Hodnett, E., & Osborn, R. W. (1989). Effects of continuous intrapartum professional

5 support on childbirth outcomes. Research in Nursing & Health, 12, Kennell, J., Klaus, M., McGrath, S., Robertson, S., & Hinkley, C. (1991). Continuous emotional support during labor in a U.S. hospital: a randomized controlled trial. Journal of the American Medical Association, 265(17), Kolcaba, K. (1992). A theory of holistic comfort: operationalizing the construct as a nurse sensitive outcome. Advances in Nursing Science, 15, Kolcaba, K. (1994). A theory of holistic comfort. Journal of Advanced Nursing, 19, Kolcaba, K. (2001). Evolution of the mid-range theory of comfort for outcomes research. Nursing Outlook, 49, Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research., New York: Springer Publishing Co. Lowe, N. (2000). The nature of labor pain. American Journal of Obstetrics & Gynecology, 186S, S16-S24. Maternity Center Association. (2002, October). Listening to mothers: Report of the first national U. S. survey of women s childbearing experiences. New York: Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Risher, P. Miltner, R. S. (2002). More than support: Nursing interventions provided to women in labor. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 31(6), Orenstein-Manning, G. (1998). A birth intervention: The therapeutic effects of doula support versus Lamaze preparation on first-time mothers working models of caregiving. Alternative Therapies, 4(4), Rosen, P. (2004). Supporting women in labor: Analysis of different types of caregivers. Journal of Midwifery and Women s Health, 49(1), Schuiling, K. & Sampselle, C. (1999). Comfort in labor and midwifery art. Image: Journal of Nursing Scholarship, 31,

6 Schuiling, K. (2003). Exploring the presence of comfort within the context of childbirth. Unpublished doctoral dissertation,, Michigan. Schuiling, K. (2004). The experience of comfort in a population of healthy, primiparous, laboring women. Manuscript submitted for publication. Scott, K. D., Berkowitz, G., & Klaus, M. (1999). A comparison of intermittent and continuous support during labor: A meta-analysis. American Journal of Obstetrics and Gynecology, 180(5), Sleutel, M. (2000). Intrapartum nursing care: A case study of supportive interventions and ethical conflicts. Birth, 27(1), Sosa, R., Kennell, J., Klaus, M., Robertson, S., & Urrutia, J. (1980). The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction. The New England Journal of Medicine, 303(11), Trueba, G., Contreras, C., Velazco, M. T., & Lara, E. G. (2000). Alternative strategies to decrease cesarean section: support by doulas during labor. Journal of Perinatal Education, 9(2), Tumblin, A., & Simkin, P. (2001). Pregnant women s perceptions of their nurse s role during labor and delivery. Birth, 28(1), Zhang, J., Bernasko, J. W., Leybovich, E., Fahs, M., & Hatch, M. C. (1996). Continuous labor support from labor attendant for primiparous women: a meta-analysis. Obstetrics and Gynecology, 88(4),

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