First, Do No Harm: How Routine Interventions, Common Restrictions, and the Organization of Our Health-Care System Affect the Health of Mothers and Newborns

Abstract

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the ''First, do no harm'' principle in a different way. New research on the potentially harmful effects of intravenous lines demonstrates that refraining from routine interventions in labor protects the safety of women and babies. A new systematic review of movement and position changes in labor shows that eliminating unfounded restrictions also protects maternal and infant health and well-being. Finally, a study of patterns of use of neonatal intensive care units reveals how the organization of the maternity care system itself can affect the health outcomes of its beneficiaries.

A concept analysis of watchful waiting among providers caring for women in labour

“…Midwives, especially US nurse‐midwives, embrace the term watchful waiting as part of their philosophy of caring for women (Kennedy & Lyndon , McCourt ). ‘Doing nothing’ and ‘non‐intervention’ (Romano , Everly ) were used in midwife‐focused literature as surrogate terms for watchful waiting. Related terms (Rodgers & Knafl ) found in the literature include ‘supportive care’ and ‘therapeutic presence’ (Jordan & Farley , Romano ).…”

“…Literature about midwifery care also expressed the idea that labour progress can usually be accurately tracked through the woman's behaviour, thus making internal examinations unnecessary except in cases of ‘mixed signals’. Foetal monitoring is continued, but it is carried out intermittently to allow for the woman's unrestricted movement in labour (Romano ). Laboratory and imaging tests are not mentioned as part of a period of watchful waiting within a midwifery approach to labour care.…”

“…Importance is placed on normal labour progress, with regular interventions being required in the form of vaginal examinations to track this progress (Simonds ). From a midwifery perspective, periods of watchful waiting have the woman's action at their centre (Jordan & Farley , Romano ). Because the provider practising from this perspective stays nearby during watchful waiting, her entrance and exit is not associated with surveillance.…”

“…() recommend induction of labour when discussing the implications of their clinical study (which showed no difference in immediate outcomes between watchful waiting for labour vs. induction of labour in the mothers of intrauterine growth‐restricted babies), even after pointing out a previous study showing some long‐term neurological protective effect on children whose mothers were allowed to wait for labour. This recommendation is logical in light of the medical view that ‘the normal condition is now the ‘experiment’ and the intervention is the ‘control’ in perinatal care' (Romano ). In contrast, the literature presented midwifery beliefs that childbirth is a natural physiological event and that most pregnant women will require little or no medical intervention to have a normal and safe birth (Oakley ).…”

Global health indicators and maternal health futures: The case of Intrauterine Growth Restriction

“…When maternal and foetal physiological pathologies are detected, how are scarce resources allocated? Concerns in both well-and under-resourced countries that arise about a prenatal 'cascade of intervention' resulting from ultrasound scans are similar to those identified for labour -unnecessary harm (Roberts, Tracy, & Peat, 2000;Romano, 2009) and increased cost (Tracy & Tracy, 2003). Post-diagnostic interventions raise ethical spectres, as well as biomedical and economic conundrums, a brief consideration of which I return to in the conclusion.…”