One-on-one nursing support during childbirth

¶ … Nursing through Stages of Labor and Delivery:

For many women and families, labor and delivery is usually a time of excitement and expectations that is coupled with anxiety, uncertainties, and fear. This is largely because childbirth represents a huge transition in a woman's life that involves becoming a mother and learning and growing in the entire process. Actually, the experiences of labor and delivery remain in the woman's memory for the rest of her life. As a result of the experiences, the care and support that women receive during this period is quite critical and important. The main objective of caring and supporting women during this process is to provide a positive experience for the mother and her family. Moreover, the care and support helps in maintaining the health of these women, responding to emergencies, and preventing the occurrence of complications.

Role of Nursing during Childbirth:

Nurses have the privilege and responsibility of providing care for women during labor and birth in the healthcare facility ("Chapter 5 -- Care During Labor and Birth," n.d.). The main goal of nursing during the period of labor and delivery is to promote and enhance complete physical and emotional well-being of the pregnant woman, the baby, and her family. Nursing continues to be an important aspect during childbirth despite the fact that the role of midwife in caring for women is re-emerging in Canada. Nurses play a critical role during childbirth because they have more contact with the woman and her family as compared to other healthcare professionals. Therefore, in a hospital setting, nurses have a significant influence on shaping the experience of childbirth for both the pregnant woman and her family.

There are various critical aspects that these nurses should consider in order to provide effective care to women during labor and delivery. Some of these aspects are the need to develop rapport, trust, and effective communication with both the woman and her family. Moreover, these professionals should be competent regarding the normal and abnormal processes of childbirth. They need to have mastery of suitable technical skills, communication processes with the healthcare team, necessary judgment, and skills to cope with emergency situations. In addition to this, the nurses should be able to critically assess the needs of the pregnant woman depending on her cultural background, expectations, and wishes. Such knowledge is vital for the establishment of having the most positive experience during labor and delivery.

Nursing practice during childbirth also plays the roles of advocate and provision of informational, physical, and emotional support. According to the findings of research, nurses spend considerably minimal amounts of time in offering supportive care for pregnant during labor and delivery. Therefore, there is a huge need for policies and procedures to be established in facilities with women in labor in order to provide supportive care to the women. One of the measures that have emerged and recommended in the recent past is one-to-one nursing. This concept is not only required but it's also recommended during stages of labor and delivery.

The Concept of One-to-one Support during Childbirth:

The concept of labor support is a term that basically describes the work of social or caring support that is offered to women during childbirth i.e. labor and delivery (Barrett & Stark, 2010). When a trained birth companion such as nurse-midwife and nurses is involved in providing labor support, birth outcomes are usually improved. The probability of positive impacts on birth experiences is enhanced in cases where supportive nursing behaviors and practices are implemented consistently. it's important to note that continuous labor support that starts earlier in labor tends to be more efficient that those that start later in labor. While labor support can be offered by several healthcare professionals in a hospital setting, a labor nurse is usually present during childbirth.

Nursing support through the stages of labor and delivery primarily involves three main components i.e. emotional support, advocacy, and physical comfort. Emotional support focuses on activities like ongoing presence and positive encouragement or reassurance. In certain cases, the emotional support can incorporate various kinds of behaviors like efficient caring attitude, partner care, nursing presence, spirituality, and distraction. On the other hand, physical comfort or support measures increase satisfaction with the experience of childbirth and labor progress. In order to accomplish the goal of physical support measures, nurses may use accurate positioning, partner care, and environmental control. Proper positioning helps in lessening perineal trauma, reducing pain and analgesia use, and promoting more efficient uterine contractions.

The provision of physical comfort includes various activities like therapeutic touch, encouraging intake of fluids and output, warm baths or shower, and massage. The importance of such interventions is that it allows pregnant women to be actively involved in the process of childbirth and giving her strength and confidence. As the last component in labor support, advocacy consists of activities like communicating the wishes of the woman and providing information regarding relaxation mechanisms, coping techniques, and labor progress. In the process of advocating for the woman in labor, nurses must show respect, resolve any conflict, and recognize the expectations of the woman.

One-to-one Nursing Support:

The concept of one-to-one support has been used in various ways in several policy literatures and researches across the medical field (Sosa et. al., 2011). This term has been used in several policy documents and research reports across the globe without an obvious consensus on its definition. This concept has developed to be considered as one of the significant requirement for lessening maternal morbidity and mortality since women need to have skilled care, especially when complications occur. According to the World Health Organization, 90% of births in the entire world should be assisted by competent assistants or healthcare professionals. Despite of the increased use of the concept without clear meaning, there is need for clarity of the concept because of its numerous potential benefits during childbirth.

Generally, the concept of one-to-one nursing through the stages of labor and delivery refers to the ratio of one nurse assistant to one woman. This is unlike the practice of one-nurse-to-many-women in which several nurses are involved in providing help to one woman during the stages of labor and delivery. While the concept of one-to-one nursing during childbirth is recommended, the one-nurse-to-many-women practice is still present and widely used in some countries like Canada. Regardless of the recommendations for one-to-one nursing during childbirth, there are some situations that require more than a single nurse of midwife to attend to the woman based on the complexity of the needed support. Therefore, the practice of one-to-one nursing through labor and delivery stages should be applied to low-risk women.

One-to-one nursing through the stages of labor and delivery is not only described as a numerical allocation but it's also described as a face-to-face relationship between the nurse and the laboring woman. The meaning of one-to-one nursing during childbirth entails the exclusive focus of supporting women during the stages of labor and delivery. In this case, the nurse attendant should stay with the woman without interruption, except for short periods at the woman's request. In some cases, one-to-one nursing during childbirth is defined as the presence of a nurse during labor and delivery attending to both the physical and emotional needs of the woman in labor and her family (Montgomery, 2001).

Reasons for the Recommendation of One-to-one Nursing during Childbirth:

Throughout history, laboring women have continually been supported by other women known as midwives though the stages of labor and delivery. Based on the findings of recent analysis on hospitals worldwide, labor support has largely been the exception instead of the routine. However, one-to-one nursing during childbirth is required and has been recommended through the stages of labor and delivery because of its benefits that include the following reasons

Continuous Labor Support:

One of the major reasons one-to-one nursing is required through the stages of labor and delivery is that is promotes and strengthens continuous support to the laboring women. Based on the outcomes of an analysis, women who receive support through one-to-one nursing are less likely to undergo cesarean birth and other medical interventions unlike those without the care. These women receive continuous support through nursing report satisfaction with their birth experiences (Masciale, n.d.). Women who receive continuous labor support in one-to-one nursing are less likely to experience epidural or other regional analgesia, birth with vacuum extraction, dissatisfaction, and forceps.

Continuous labor support has developed as a significant tool for helping women to avoid risks that are linked with the need and practices for medical interventions in order to promote satisfying birth experiences. Nonetheless, continuous labor support can also be provided by non-hospital caregivers, whose impact on the birth experience are less than those provided by nurses. Consequently, one-to-one nursing in the hospital setting has boosted the provision of continuous labor support with impressive results.

The provision of ongoing support by nurses during labor and delivery provides greater benefits when it starts at an earlier stage during labor, provided in settings with no routine epidural analgesia, and in settings where women are not accompanied with their companions of choice. However, women also receive labor support even when its starts at a later stage in labor, in settings with companions of their choice, and settings with routine epidural. The supportive care provided to women during labor and birth through the one-to-one nursing includes various processes like provision of physical comfort and information and emotional support. The other processes include assisting women to communicate to caregivers and engaging members of their family as desired by the woman.

As an important part of one-to-one nursing during stages of labor and delivery, continuous support during childbirth enhances the normal labor processes while lessening the use of obstetric interventions. Therefore, this kind of support is an exceptional element of maternity care that provides well-established incentives and has no identified disadvantages.

Enhancement of Spontaneous Vaginal Birth:

Since continuous one-to-one nursing support during childbirth enables women to avoid analgesia or anesthesia and cesarean surgery, it's vital in promoting spontaneous vaginal birth. It has been found that one-to-one nursing during childbirth promotes spontaneous childbirth by enabling women to avoid instrumental child delivery. According to research, women who receive continuous labor support through one-to-one nursing tend to experience slightly shorter labor periods. Therefore, this kind of nursing support is not only cost-effective but it's also a safe intervention procedure that is beneficial to women.

One-to-one nursing during childbirth is recommended because it ensures that all the necessary measures are established for birth environments to be non-stressful and empowering (Hodnett et. al., 2007). This kind of support is also required in the birth environments because it promotes privacy, communicate respect to the women, and ensure that routine surgical or medical intervention procedures are not a common characteristic in these environments unless they are necessary and have clearly stated benefits.

Limited Access to Trained Doulas:

In the United States, the responsibility of providing support to childbearing or laboring women left to trained doulas and other professionals. Currently, childbearing women have limited access to these trained doulas in most countries across the globe. In areas where the trained doulas are available, the costs of their services are usually covered by families of the laboring woman resulting in barriers to access their services. Consequently, encouraging women to invite companions to be present during birth to assume the role of the trained doulas has been suggested as a means of increasing one-to-one continuous labor support globally.

However, the promotion of labor companionship through the involvement of family members to support the laboring women is ineffective in promoting positive birth experiences. This is largely because most of these companions are in-competent to handle the support procedures to women during the stages of labor and delivery. Therefore, one-to-one nursing is an effective means of providing support during childbirth since competent caregivers are involved in all the procedures. Childbearing women are able to have positive birth experiences because of the positive relationships they have established with the nurses and the effective support they receive from them.

Helps in Dealing with Reality of the Labor Ward:

As compared to other types of support to childbearing women, one-to-one nursing through the stages of labor and delivery helps women in dealing with the reality of the labor ward. This is mainly because nurses are better equipped to know when to delay or provide epidural analgesia rather than the mere decision to use them. Nurses use slightly less invasive approaches first before settling for an early epidural in order to promote positive birth experiences (Klein, 2011). Consequently, nurses avoid exposing the childbearing woman to other intervention approaches that may eventually result in several negative outcomes and a possible cesarean section. As the nurses help laboring women to avoid such measures that could contribute to extra problems either immediately or at a later stage, they help the women to have positive experiences during childbirth. In situations where the nurses are required to use epidurals, they usually provide information of the direct consequences of epidural analgesia to the childbearing woman. One-to-one nursing in the stages of labor and delivery is vital in Canada because many women approaching the first birth in this country are not aware that epidural analgesia interferes with labor.