Intrapartum nursing care: a case study of supportive interventions and ethical conflicts.

Abstract

Studies have shown that one-to-one labor support is associated with a reduced rate of operative births, and with long-term improvements of parenting and breastfeeding rates. Labor support by nurses may reduce the cesarean birth rate, but this has not been adequately studied. No one knows which labor support strategies nurses use, if they are effective, and how they work. This pilot study used the qualitative techniques of observation and an audiotaped interview with an expert intrapartum nurse to describe labor support techniques and strategies to enhance labor progress and prevent cesarean births. The narrative revealed three major themes. The first theme, "the nurse's approaches to labor," included three subcategories: "following the mother's body," "hastening and controlling labor," and "labor support techniques." The second and third major themes, "ethical dilemmas: an unwilling partnership" and "nurse-physician conflict," were unanticipated. Labor support practices were limited by some physician practices. Inappropriate physician practice created ethical dilemmas for the nurse and impeded labor support interventions. Intrapartum nursing care reflected both a medical model of controlling and hastening birth, as well as a supportive, nurturing, and empowering model of practice that used independent clinical judgments and advocacy. Questionable medical care entangled the nurse in these practices and created moral dilemmas and nurse-physician conflicts. The nurse used various strategies to promote the wishes and welfare of the laboring mother.