We've heard a lot about how the midwifery model supports the birthing person's capacity and avoids unnecessary interventions. But what does it really mean to support biological processes? What is the evidence and how is it incorporated into practice? By the end of this lesson, you will be able to understand what it means to support biological processes, understand the definition of physiologic birth and the short and long-term benefits, describe the challenges of implementing evidence-based practices and getting providers to adopt them. All the way back, in 1996, the World Health Organization called for an elimination of unnecessary interventions in childbirth, and provided a definition of physiologic birth as spontaneous onset, low-risk at the commencement of labor and continuing so for the remainder of labor and birth. The infant is born spontaneously between 37 and 40 weeks of pregnancy with a cephalic or head down first presentation. But it was felt a more concise definition was needed along with the evidence to support it. In 2012, the three different US midwifery organizations, American College of Nurse-Midwives, Midwives Alliance of North America, and the National Association of Certified Professional Midwives, joined together to create a consensus statement on supporting normal physiologic birth. The definition of a normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus. Normal physiologic childbirth is characterized by spontaneous onset and progressional labor. It includes biologic and psychologic conditions that promote effective labor, and it results in the vaginal birth of the infant and placenta, and results in physiologic blood loss and facilitates optimal newborn transition through skin to skin contact and keeping the birthing person and infinite together during the postpartum period. It supports early initiation of breastfeeding. The benefits of physiologic birth are both short and long-term and includes supporting normal endocrine function that promotes normal labor, improved bonding and attachment, and improved newborn transition, which we will hear about in our next segment. Unless need to intervene during labor, when biology is allowed to proceed uninterrupted. Long-term benefits can include improved physical and mental health for the birthing person as well as improved growth, immune function, and less chronic disease for the infant. We know what the evidence says about supporting biologic processes, so why is it not happening more often? Why are practices not changing to reflect the evidence? Let's look at an example to better understand this. Say, the practice of physiologic cord clamping, also referred to as delayed cord clamping. For many decades, the medical practice was to immediately clamp and cut the umbilical cord after a neonate was born. It's unclear how this practice began and with what evidence, but it became the norm globally. Though some midwives continued physiologic cord clamping, many midwives too had adopted this medical intervention. After decades of research and evidence, it is now clear that there are benefits to physiologic cord clamping, which is the process of waiting until the cord stops pulsing or waiting at least 1-3 minutes before clamping and cutting the cord. You can link out to some articles to read about all the benefits of this simple practice if you want to learn more about it. But what I want to focus on here is now that we have had this evidence, how do we get providers to change their practice? Is it enough to change a practice guideline to change behavior? One researcher looked at this very question. What does that dynamic of when providers successfully transition from practicing based on old protocols to practicing based on best evidence? Sagady, Erickson-Owens, and Cseh, in 2015, they found five themes emerged that helped influence a provider taking up the new practice based on evidence. One, trusting colleagues. Two, believing the evidence, honoring mothers and families, knowing personal certainty, and protecting the integrity of the mother and baby. Change was not a momentary decision that was made, but rather an evolution toward change. Simply knowing the evidence is not enough and is almost always combined with other factors. Interestingly, they found that the influence of one's colleagues was the primary driver of change. Yet they also found that professionals were often reluctant to speak to one another about their change to a new evidence-based practice. This graph from that paper, which you can link out to later if you want to read more about this, shows how the adoption of the evidence-based practice took place over time. The domains of influence are important here at the bottom. It is important for providers to feel that the evidence is supported by their professional organizations, but also supported by their institution, and finally, that they themselves personally believe it is the right thing to do. When attempting to change practice, in addition to providing the evidence, it will be important to utilize colleague to colleague exchanges and mentoring to facilitate practice change. Up next, you'll hear from another expert on their experiences and implementing evidence-based change that supports biological processes. Dr. Scovia Nalugo-Mbalinda, a midwife, educator and researcher at Makerere University, Department of Nursing, in Uganda, where she is the chair of the midwifery specialty. Let's listen as she walks us through a project that helped introduce the concept of skin to skin for immediate afterbirth care to support healthy physiology. It is one thing to understand the evidence and the concepts yet an entirely different thing is to put that evidence into practice.
