Women in the United States are still giving birth in the supine position and are restricted in how long they can push and encouraged to push forcefully by their caregivers. Research does not support these activities.There is discussion about current research and suggestions on how to improve the quality of the birth experience.

Childbirth educators who express frustration with the perceived lack of power in their practice may be suffering from moral distress. Although the impact of moral distress has not been thoroughly explored among health-care professionals, the topic is emerging as an important ethical concept. In this article, the concept of moral distress is explored, and suggestions are made for moving from moral distress to moral action.

In this article, a Lamaze Certified Childbirth Educator describes her efforts to change the culture of birth in a community hospital in a small Midwestern town. Her experience highlights the challenges and the frustrations involved in creating change. The authors reflect on ways to enhance the success of change and advocacy strategies.

This collection of commentaries by childbirth educators, doulas, a labor and delivery nurse, and a woman preparing for the birth of her second baby provide an overall response to all six of Lamaze International's care practice papers that promote normal birth: Labor Begins on Its Own; Freedom of Movement throughout Labor; Continuous Labor Support; No Routine Interventions; Non-Supine (e.g., Upright or Side-Lying) Positions for Birth; and No Separation of Mother and Baby with Unlimited Opportunity for Breastfeeding. Strategies for using the position papers to facilitate learning in childbirth classes and for helping expectant parents access and understand research are presented. The commentaries describe the value of the position papers as a catalyst for professional growth, a foundation for creating change, a way to encourage reflection among professionals and women planning for the births of their babies, and an inspiration for everyone who advocates normal birth.

Tradition, not evidence, continues to drive the management of the second stage of labor in most hospitals. This is an overview of current evidence associated with best practices for healthy outcomes for mothers and babies.