Inspiring and Leading Women to Succeed at Unmedicated Childbirth

  Purpose for the program:  In this facility delivering over 5000 babies per year, we have seen a shift from most patients desiring a medicated birth with controlled epidural anesthesia to one where many are choosing an un-medicated birth option. This is not surprising since birth has not always been seen as a hospital process and we have seen the pendulum swing medically through the years. 

Proposed change:  Our facility desired to respond to the needs of our community and set forth to create an atmosphere and initiatives to ensure that the women of our community could obtain the delivery they desired within the hospital setting.  Our facility chose to meet this need is by partnering with the Doula’s of our community and our patients to better create ways to ensure that we created such an environment. 

Prior barriers to our success were going to be our anesthesia team and nursing staff which preferred the popular epidural management of labor, lack of available monitoring equipment allowing women to move about freely during labor, and free community education.  One way we overcame these barriers was by having all healthcare providers attend workshops with the Doulas to enhance their knowledge. Through the quarterly workshops with the Doulas the staff was able to stay up to date on the changing needs of this population.  We also added new free prenatal class open to anyone in the community on how to plan your natural childbirth. We already offered Lamaze and a modified Bradley class with contracted instructors with a fee for attendance. To facilitate patient mobility in labor, the unit purchased remote fetal monitors. 

Implementation, outcomes and evaluation:  Since implementation of our initiatives in January 2010, we have seen a modest increase un-medicated delivery.  We only expect to see this number continue to rise as we continue to enhance our environment and continue to build relationships with the community Doulas, physicians, and patients.  Patients as well as Doulas who have delivered or assisted with deliveries at our facility have found that our new initiatives have accomplished our goals and that the environment provides them the support they want.

Implications for nursing practice: The labor and delivery staff nurses have become more confident in caring for an un-medicated laboring patient.  You cannot fail to press forward with such an initiative just because you have staff push back or lack of knowledge.  The knowledge deficit within the staff can be overcome with continued education and support 

Keywords: Un-medicated childbirth,prenatal education ,nursing