In the majority of developed countries, more than 70% of childbearing women are healthy, have normal pregnancies and give birth to full-term healthy babies. The role of modern maternity care is to preserve and promote health of these already healthy childbearing women without introducing any unnecessary harm or unproductive expense.
According the World Health Forum: “Pregnancy and childbirth in healthy women are normal physiological processes which, in circumstance of healthy living, can almost always be successfully completed with minimal assistance”. [WHO Forum vol no. 11, 1990] At a policy level this includes not only the birth and health of this particular baby, but the mother’s future reproductive capacity and the well-being babies in subsequent pregnancies.
The working definition for normal childbirth as developed by the Information Centre for the NHS (UK) is one in which the mother’s labor was not induced or sped up with artificial hormones, no anesthesia was administered before or during the birth and the baby was delivered without the use forceps, vacuum extraction or cesarean surgery.
The physiological management of normal pregnancy and childbirth is an evidenced-based model of normal maternity care for a healthy childbearing population. It is always articulated with the healthcare system and includes the use of medical interventions in the event of complications or at the mother’s request.
As a scientific model of maternity care, physiological management is distinct from the surgical specialty of obstetrics. The term “physiological” is generally defined as: “..in accord with, or characteristic of, the normal functioning of a living organism”. [Stedman Medical Dictionary, 1995 edition] As a formal discipline in its own right, it focuses on supporting normal physiological processes in healthy women with normal pregnancies. Appropriate use of interventions is an integral part of physiologically-based care.
In ideal circumstances, the principles of physiological management are integrated with best advances in obstetrical medicine to create a single, evidence-based standard for all healthy women with normal pregnancies. In this integrated model of care, the individual management of pregnancy and childbirth is determined by the health status of the childbearing woman and her unborn baby, in conjunction with the mother’s stated preferences, rather than the occupational status of the care provider.
The knowledge base, precepts and technical skills of physiologic care are specifically matched to biolological norms in a healthy population, while also preparing its practitioners to deal with emergent situations. This includes regular antepartum risk screening for medical problems, and referral to obstetrical or perinatal services for evaluation or necessary treatment.
The training of birth attendants who provide care for physiologically-mangaged childbirth (physicians and midwives) includes a unique set of competencies that promote and preserve maternal-fetal wellbeing though out the process of labor and birth and immediate postpartum care of the new mother and baby. This includes initial and on-going evaluation during labor and a transfer to obstetrical services whenever indicated or if requested by the mother.
Physiological management during normal childbirth is neither passive nor neglectful, nor a matter of simply abstaining from the routine use of medical or surgical interventions. Preservation of maternal-fetal wellbeing during the normally stressful events of spontaneous labor and birth relies on a hands-on, proactive approach and a specific set of behaviors and technical skill for guarding the health of mother and unborn baby while simultaneously addressing the physical, psychological, emotional and social needs that women and their unborn-newly born babies typically face.
Over the course of the 20th Century there has been a loss of diversity in childbirth practices in many developed countries. Care for normal childbirth in healthy populations has become increasingly medicalized and significantly more expensive. For example, 93% of American women have 7 or more medical interventions during labor and 70% of births in the US include one or more surgical intervention or a baby delivered by Cesarean section. [Listening to Mothers surveys, 2002 & 2006] Despite the increased expense associated with routinely medicalizing the care of healthy childbearing women, no comparable improvement in maternal or infant outcomes has been demonstrated.
Countries who provide highly-medicalized care to healthy women would benefit greatly by reintroducing the principles, technical skills and supportive structures of physiologically-based care into the education and practice of maternity care professionals and birth attendants of all backgrounds.
With this expanded pool of more broadly educated practitioners, healthcare systems are able to offer a more sustainable and cost-effective model of maternity care based on ‘best practices’. This integrated model has a much smaller carbon footprint, while being able to provide safe, mother-baby-father friendly care to its childbearing population.
Document References
List ~ Characteristics of Physiological Management
