Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by the American College of Nurse-Midwives, Midwives Alliance of North America, and the National Association of Certified Professional Midwives

Introduction

In 1996, the World Health Organization called for the elimination of unnecessary intervention in childbirth, yet currently there are few resources to assist maternity care providers in achieving this goal. The purpose of this consensus statement is to explicitly identify key benchmarks of safe, healthy, and normal physiologic childbirth. This statement will assist maternity care providers, women, policymakers, and payers to protect, promote, and support human childbearing physiology and to avoid overuse of interventions, thus achieving better care, better health, and lower costs.

This consensus statement represents the work of a task force comprised of representatives from three U.S. midwifery organizations whose members are experts on supporting women’s innate capacities to birth, and was externally reviewed by maternity care organizations and leaders. The specific aims of the consensus statement are to

• Provide a succinct definition of normal physiologic birth;
• Identify measurable benchmarks to describe optimal processes and outcomes reflective of normal physiologic birth;
• Identify factors that facilitate or disrupt normal physiologic birth based on the best available evidence;
• Create a template for system changes through clinical practice, education, research, and health policy; and
• Ultimately improve the health of mothers and infants, while avoiding unnecessary and costly interventions.

This statement is placed in the context of the current, widespread application of technological interventions that lack scientific evidence to a primarily healthy birthing population. The use of obstetric interventions in labor and birth has become the norm in the United States. More than half of all pregnant women receive synthetic oxytocin to induce or augment labor, which demands additional interventions to monitor, prevent, or treat side effects. Nationally, one third of women deliver their babies via cesarean, a major abdominal surgery with potential for serious short- and long-term health consequences. For the mothers these consequences include, but are not limited to, postoperative infections, chronic pain, future cesarean births, and placental complications that can lead to hemorrhage, hysterectomy, and rarely, death. Infant risks include respiratory distress, and in subsequent pregnancies maternal risks include increased likelihood of preterm birth and associated morbidity and mortality. Regardless of intervention or outcome, childbearing care perceived by the woman as disrespectful or traumatic is more likely to be associated with maternal psychological morbidity and potential for disrupted mother-infant attachment

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Citation

ACNM, MANA, NACPM (2012). Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by the American College of Nurse-Midwives, Midwives Alliance of North America, and the National Association of Certified Professional Midwives. Journal of Midwifery and Women’s Health, 57(5), 529-32.