Evidence Based Practices for Newborns - article

[Julie Doula]

Hi everyone, here is an interesting article. It discusses how many procedures that are accepted practice may not actually have a sound scientific basis. Some are just done out of tradition rather than according to current evidence. This is specifically regarding how we handle new born babies but I think the same applies to many standard procedures used in birth, too.

Here is just the intro an the conclusion but if you want to read the whole article go to Medscape.com (I hope that's OK, mods!? Edit me if not!)

"The truth is out there ....." (insert theme music!)

Evidence-Based Practices for the Fetal to Newborn Transition

Judith S. Mercer, CNM, DNSc; Debra A. Erickson-Owens, CNM, MS, ;
Barbara Graves, CNM, MN, MPH; Mary Mumford Haley, CNM, MS

J Midwifery Womens Health. 2007;52(3):262-272. ©2007 Elsevier Science, Inc.

Posted 06/22/2007

Abstract and Introduction
Abstract
Many common care practices during labor, birth, and the immediate postpartum period impact the fetal to neonatal transition, including medication used during labor, suctioning protocols, strategies to prevent heat loss, umbilical cord clamping, and use of 100% oxygen for resuscitation. Many of the care practices used to assess and manage a newborn immediately after birth have not proven efficacious.
No definitive outcomes have been obtained from studies on maternal analgesia effects on the newborn. Although immediate cord clamping is common practice, recent evidence from large randomized, controlled trials suggests that delayed cord clamping may protect the infant
against anemia. Skin-to-skin care of the newborn after birth is recommended as the mainstay of newborn thermoregulation and care.
Routine suctioning of infants at birth was not been found to be beneficial. Neither amnioinfusion, suctioning of meconium-stained babies after the birth of the head, nor intubation and suctioning of
vigorous infants prevents meconium aspiration syndrome. The use of 100% oxygen at birth to resuscitate a newborn causes increased oxidative stress and does not appear to offer benefits over room air.
This review of evidence on newborn care practices reveals that more often than not, less intervention is better. The recommendations support a gentle, physiologic birth and family-centered care of the newborn.

Introduction
The transition from fetus to newborn is a normal physiologic and developmental process -- one that has occurred since the beginning of the human race. Many hospital routines that are used to assess and manage newborns immediately after birth developed because of convenience, expediency, or habit, and have never been validated.
Some practices are so ingrained that older traditional practices, such as providing skin-to-skin care or delaying cord clamping, must be considered "experimental" in current studies.[1] However, recent research is beginning to identify some older practices that should not have been abandoned and some current practices that should be stopped. In order to achieve a gentle, physiologic birth and family-centered care of the newborn, practices that might interfere with maternal and newborn bonding need to be closely scrutinized. This article examines the evidence about practices related to the newborn transition, including the effects of various drugs used labor, umbilical cord clamping, thermoregulation, suctioning, and resuscitation of the newborn.


Conclusion
An important tenet of practice for all health care personnel is to first do no harm. This idea takes on additional importance when dealing with newborns, as there is almost no long-term data on the
safety of many procedures. No clear conclusions can be drawn from studies on maternal analgesia effects on the newborn; thus, judicious use of medications in labor is recommended with further study of better biobehavioral assessment tools to differentiate outcomes. Delaying clamping of the umbilical cord appears to offer protection from anemia without harmful effects. The practice of immediate clamping, especially with a nuchal cord, should be discontinued. The evidence suggests that skin-to-skin care of the newborn after birth and during the first hour of life should be the mainstay of newborn thermoregulation and care. Routine suctioning of the infant at birth should be abandoned. Meconium-stained babies should not be suctioned on the perineum and vigorous infants should not be intubated and suctioned. There is no evidence that amnioinfusion prevents meconium
aspiration syndrome. The mounting evidence suggests that use of 100% oxygen at birth to resuscitate newborns may cause harmful effects. Room air is permissible for the first 90 seconds with oxygen available if there is not an appropriate response in that time.

Routine interventions, such as suctioning the airway or stomach or using 100% oxygen for resuscitation, or immediate clamping of the umbilical cord, have never based on any clear evidence that they improve newborn care or outcomes. Yet some of these practices are so firmly entrenched that it will take a large body of research to change the standard. We must continue to build a body of knowledge that supports the evidence: more often than not, less intervention is
better.

[August]

Hmm, maybe caregivers these days think the risks are too high not to go by the book but we would not be where we are today without being "experimental".

[becmc]

And that is exactly why I am giving birth at home this time!!
I don't want doctors 'managing' my birth that still know nothing about it, or know nothing about why they do what they do!

[~kaos~]

I think it is just appalling that these practices are not routine. Poor mums and babies are missing out on the best care.

I was lucky to have care providers that strongly believed in immediate skin to skin and only physiological 3rd stage/delayed cord clamping until cord stopped pulsating.

I'm just pregnant with my 3rd and I'll be homebirthing too this time Nice to see other homebirth mums around here becmc

[becmc]

Thanks Kara, and congratulations on your pregnancy!!
I am 34 weeks, and am getting so excited about the birth. I have absolutely no anxiety at all, and even after an awful inducement and emergency c/s with my son I know I am totally doing the best thing for my bub and I by having a homebirth!

[Julie Doula]

It's interesting that this paper was written by 4 Certified Nurse Midwives (in USA). The paper in its entirety is quite compelling as they go into careful detail.

It is amazing that their conclusion: "More often than not, less intervention is better. The recommendations support a gentle, physiologic birth and family-centered care of the newborn" indicates that hard scientific evidence actually supports what many have known intuitively all along.

Some dismiss gentle birth ideals as being "arty-farty" & "airy fairy" (IYKWIM) and therefore by implication, not scientific. But this study indicates the converse is true.

AugustMoon, Bec and Kara, all the very best for wonderful, safe, joyful birth experiences for you!