Really teaching lamaze: evidence-based practice.

In this column, a reader identifies the importance of accurate, up-to-date information in making informed decisions. She is shocked to find that the Lamaze classes she observes are not evidence-based. Evidence-based practice is described, and examples of the use of best evidence in childbirth classes are discussed. The implications for childbirth education are explored.

Questions from Our Readers Commentary on Lamaze International's Statement on Induction.

Lamaze International recommends that "pregnant women neither choose nor agree to be induced unless there is a true medical indication for induction." This commentary discusses the recommendation and its implications for the practice of childbirth education.

Do birthing options really exist?

In this column, the author answers the question, "Is choosing to give birth naturally a realistic option in today's birth environment?" Women's choices of health care provider and place of birth are limited by the general belief that birth is safe only in the hospital and when managed by obstetric medicine. In the typical hospital environment, women rarely have access to the wide variety of comfort measures and the continuous emotional and physical support required to give birth naturally. Routine care practices further limit women's birthing options. The Coalition for Improving Maternity Services' document, the "Mother-Friendly Childbirth Initiative," offers direction for creating birth environments that ensure options for women who choose to give birth naturally.

Back to the future: trusting birth.

Research over the past 30 years provides support for once again trusting birth. This is a paradigm shift in thinking about birth and requires a dramatic change in the practice of nursing. Confidence in a woman's ability to give birth, the freedom to find comfort in response to pain, and the support of family, friends, and professionals facilitate normal, natural birth. Hospital policies and routine care practices that decrease confidence, restrict freedom and support, and separate mothers from their infants sabotage natural birth and breastfeeding. The goal of the perinatal nurse is to promote, protect, and support women's efforts to give birth naturally and breastfeed their children.

The birth plan revisited.

In answer to a reader's question, the author of this column discusses moving birth plans beyond a check list of options to a plan of evolving confidence, support-building, and comfort.

Really teaching lamaze: what about pushing?

A reader is justifiably puzzled when a Lamaze childbirth educator tells her that directed pushing is the Lamaze way. The author of this column discusses second stage in the context of normal, natural birth, guidelines for pushing, evidence-based practice, and strategies to access and incorporate evidence into practice.

Why natural childbirth?

A reader asks for help in answering the question "Why natural childbirth?" Understanding the simple story of normal, natural birth, what helps and what sabotages nature's plan for birth, and the appropriate use of interventions are discussed and form the foundation for coming to the conclusion that nature's plan makes sense. Women are inherently capable of giving birth, have a deep, intuitive instinct about birth, and, when supported and free to find comfort, are able to give birth without interventions and without suffering.

Really teaching lamaze: putting ideas into action.

The column contains concrete suggestions for preparing women to tap into their inner wisdom for their inherent when giving birth.

Really teaching lamaze: the power of pain.

In response to a reader's question, this column discusses the benefits and uses of pain to facilitate childbirth. Childbirth educators are urged to help women understand pain, so that they may work with pain and appreciate the role it plays in providing them with the inner wisdom to give birth.

Does lamaze "work"?

In answer to a reader's question, this column affirms that Lamaze preparation for birth is important and valuable.

Maternal-infant attachment, naturally.

In answer to a reader's question about the necessity of prenatal sonograms, this column asserts that, unl there is a serious medical problem, mothers should depend less on technology and more on their natural abilities to foster the all-important bond with their babies.

Meta-analysis of antisecretory and gastrokinetic compounds in functional dyspepsia.

In view of therapeutic advances, we carried out meta-analysis of results from 18 randomized, controlled clinical studies to update a previous meta-analysis and to provide an overview of clinical trials involving treatment of functional dyspepsia. The studies were included only if they satisfied inclusion and exclusion criteria and assessed treatment of functional dyspepsia with the antisecretory compounds cimetidine and ranitidine and the gastrokinetic compounds cisapride and domperidone. Outcomes of each of these trials were classified in terms of differences in therapeutic success between active treatment and placebo. For antisecretory treatments, the 95% confidence intervals for the difference in therapeutic success between active treatment and placebo were inconsistent for cimetidine, but analysis of both ranitidine trials gave favorable results. For the gastrokinetic compounds cisapride and domperidone, the differences in success rates were generally higher and more in favor of active treatment than placebo. By combining the results from both antisecretory treatments and comparing them with the combined results for gastrokinetic compounds, we observed that gastrokinetic compounds had a greater difference in success rates than did antisecretory agents. Overall, our meta-analysis shows that antisecretory treatment with cimetidine or ranitidine offers little advantage over placebo, whereas gastrokinetic treatment with cisapride or domperidone is significantly better than placebo for treatment of functional dyspepsia.

It takes two to breastfeed. The baby's role in successful breastfeeding.

This article describes the influence of the baby on the process and duration of breastfeeding. A qualitative study of the experience of breastfeeding provided rich, contextual descriptions of breastfeeding in the lives of five families before and after the birth of their first babies. Knowledge, skill, and support of family and friends influenced breastfeeding duration, but only in the presence of baby satisfaction. The characteristics associated with baby satisfaction were competent sucking, "easiness," and stamina. Based on these findings, it appears that, to be successful, "it takes two to breastfeed." Breastfeeding education should include much more information on the contribution of the baby to the process of breastfeeding. Health care providers should be skilled in both infant breastfeeding assessment and interventions to facilitate successful breastfeeding.

Critical dimensions in perinatal education.

A commitment to family-centered care demands that perinatal education include the following critical dimensions: presenting information, enhancing coping strategies, fostering support systems, promoting informed decision making, and integrating consumer advocacy. Families must have accurate, current information about pregnancy, birth, infants, early parenting, and the health care system in which these vents occur. This information is the foundation, not the final product, of perinatal education. Families need appropriate and effective coping skills and a strong support network as they move through this stage of the life cycle. The ultimate goal, and perhaps the most critical dimension of perinatal education, is to promote informed decision making. Families need options and the opportunity to understand the implications and feasibility of alternative decisions in their lives. The perinatal educator acts as an advocate by providing information and support for the client, and in advocating for the client in the health care system.

Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital.

An outbreak with a strain of methicillin-resistant Staphylococcus aureus began in The London Hospital in 1982 and continues to be associated with significant morbidity and mortality. This particular strain, termed epidemic methicillin-resistant S. aureus, is recognized by its characteristic antibiogram, phage-type and plasmid profile. In this outbreak various means of control have been attempted. Sideroom isolation did not curtail spread of the organism and containment was only achieved with the combination of extended screening, mupirocin for treatment of carriage and the use of an isolation ward.