Protocols vs. Guidelines
The term protocols is confusing sometimes because it is used differently from location to location, state to state. In general, protocols have to be very carefully written, or midwives damage themselves legally. The midwife should be certain that the way she practices and interacts with clients fits within her protocols. For example, a protocol in Florida is usually between a CNM and a physician and serves as a contract to limit the midwife's practice. Should she deviate from working within the protocol (in this case as determined by the agreement she has with the physician), she may be liable for damages in a malpractice claim and may be unable to get insurance coverage for her defense. The same is true for a midwife whose practice uses written protocols. Most of the time protocols are decided by a group of practitioners and serve to insulate the group from legal action should one of the members deviate from them.
Midwives need to understand the terms standards, clinical guidelines and protocols so that they can use them in the same way that others in the medical and legal fields do. This is a mechanism by which to protect the midwife, her practice and the midwifery profession.
The terms Guidelines and Standards should NOT be interchanged. Standards provide the midwife with process. Clinical guidelines provide research-based information. Standards are rigid. Clinical guidelines may be flexible to meet client needs and the particular circumstances. Clinical guidelines do not take the place of standards, but rather provide research-based options for decisions.
Clinical Guidelines are:
- Operational tools to assist in clinical decision-making
- Detailed and client-focused
- Based on procedures or clinical conditions
- Recommended courses of action and/or practices for meeting standards of care
- Sources of continuity, quality of care and a range of acceptable practices and options that can be adapted to specific needs
For guidelines used by other professionals, see: www.guideline.gov
— Suzanne Hope Suarez, excerpted from "Protocols vs. Guidelines," Midwifery Today Issue 73
Order Midwifery Today Issue 73.
SPECIAL OFFER TO E-News Readers: Subscribe to Mothering Magazine for only $17.95 or Mothering Digital for $15.00.
Mothering magazine is the premier publication of the natural family living community. Every publication addresses contemporary, evidence-based child birth and parenting issues in an upbeat, intelligent and compassionate manner. To get your discount, go to Mothering.com and enter the code of your choice. For a $17.95 print subscription, enter A7MT. For a $15.00 digital subscription, enter A7MTD.
Research to Remember
A retrospective study in Hong Kong compared outcomes of "post-term" pregnancies that were routinely induced at 42 weeks per hospital protocol with outcomes after the protocol was changed to require routine induction at 41 weeks. Prior to the protocol change, a routine cardiotocogram (non-stress test) was performed at 41 weeks and if normal, induction was scheduled at 42 weeks.
Routine induction of labor at 41 weeks reduced the mean gestational age at delivery by only three days, while it more than doubled the rate of labor induction in women at or beyond 41 weeks of gestation. The average length of labor was significantly longer, and use of epidural analgesia was significantly more common among "post-term" women after the protocol changed. No differences were found in maternal characteristics, mode of birth or newborn.
— Eur J Obstet Gynecol 125: 206–10, 2006
Earn Your Master's Degree Online
Master of Science in Nursing
- Nurse Midwifery
- Women's Health Nurse Practitioner
The University of Cincinnati has launched two new distance learning programs that make it possible for working nursing professionals to earn their Master's degrees in just two years. Coursework is completed online, while clinical experiences are conducted with preceptors in your community. More information here.
Products for Birth Professionals
Watch women reclaim their power as bearers of life…
…when you watch Born in Water: A Sacred Journey. This DVD is a fantastic collection of seven waterbirths, including a home waterbirth, and shows women surrendering to the power of their labor and giving birth without intervention. Anyone with preconceived notions of waterbirth as risky will find that this DVD dispels those fears and misconceptions about this gentle way to give birth.
Buy the DVD.
Be Prepared for Hemorrhage
Order "The Hemorrhage Handbook" and you'll learn the tricks, remedies and philosophy of care involved in hemorrhage and hemorrhage prevention during the childbearing year.
Buy the book.
What do babies want?
They want to be loved and cherished. They want to be given support and understanding that will help them develop into compassionate and empathetic individuals. The DVD What Babies Want will show you how the events during birth and the prenatal period can influence our children for the rest of their lives, and how our society is the result of how we welcome and raise our children. Anyone who is pregnant or planning to be should watch this DVD.
Buy the DVD.
Save with Special Packages!
You'll find packages for beginning and student midwives, audio tape packages, combo book offers and more. Best of all, package prices are always less than the same items bought separately.
Women with asthma now make up 10% of pregnant women. When compared to women without asthma, perinatal risks to women with asthma were only slightly higher than to those without. Women with asthma were shown to have a modest increased risk of miscarriage.
— American Journal of Respiratory and Critical Care Medicine, May 15, 2007
What's so bad about a cesarean?
Find out when you read Cesarean Voices. "This is the most important book ever published about the cesarean experience because it deals, in truth, with the horrendous emotional and spiritual effects on mothers. Be prepared to have your heart broken by these stories of real women; multiply their voices by millions." —Jan Tritten, Midwifery Today. Available only through ICAN at:
Web Site Update
Read these articles recently posted to our Web site:
- Vegan Pregnancy Diet—by Mindy Goorchenko
"Aside from the details of my homebirth of twins, Psalm and Zoya—a vertex son and a footling breech daughter—the questions I get most frequently concern my vegan diet. Many, many women are interested in, even long for, a vegan diet, yet find the idea seemingly impossible to implement."
- Herbs for Postpartum Perineum Care: Part Two—by Demetria Clark
"The author discusses uses of herbs for postpartum perineum care, such as gotu kola, comfrey, horsechestnut, marshmallow and St. John's Wort."
Better Birth Education Opportunities Page
Reach aspiring midwives and others interested in better birth education with this special advertising opportunity. Advertise online from June to November—includes a hotlink to your Web site. Act now to take full advantage of this seasonal page.
[ Learn More ]
Norway Conference 2007
Advertise at our next international conference "The Heart and Science of Midwifery," in Oslo, Norway, September 12–16, 2007. This conference will offer the opportunity for participants to learn from the skilled and talented Norwegian midwives, as well as from presenters from all over the world. There will be a decidedly "international" focus to this conference. Opportunities for program advertising, exhibiting and registration inserts can be found on our Web site. [ Learn More ]
Take advantage of Midwifery Today's popular Forums section, where midwives and other birth professionals meet online! A banner ad across the top of all Midwifery Today Forums pages will be seen over 41,000 times per month. [ Learn More ]
Contact our Advertising Director at email@example.com
Or view advertising options at: http://www.midwiferytoday.com/ads/
Question of the Week
Q: A doula recently told me that a large percentage of clients for whom she had worked in hospital births had decided to have a homebirth upon becoming pregnant with their next child. They were motivated by the belief that what went wrong in the first birth was related to being in the hospital. Have other doulas had similar experiences?
SEND YOUR RESPONSE to firstname.lastname@example.org with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.
Question of the Week Responses
Q: I am the mother of a seven-month-old girl. I live on the Big Island of Hawaii and a cold/cough has been going around for quite some time now; nothing seems to be helping my daughter/family. Strangely, Dad and Grandpa have the cough as well, but I don't. A friend suggested a Chinese Herbal remedy (Plum Flower Brand - Quiet Cough Teapills/ Ning Sou Wan). I can't find any information about this particular remedy so was wondering if any readers have any experience with it.
Any information would be greatly appreciated.
— Kanu Priya Bernal
A: The folks with the coughs should be evaluated for pertussis, or whooping cough. In December 2006, the Centers for Disease Control (CDC) came out with a new recommendation that all adults who will have contact with an infant less than one year be re-vaccinated with the new DTaP vaccine.
Last summer, a newborn from our practice in NYC was hospitalized with pertussis, and the previous winter there were mini-epidemics in the counties outside of NYC. Apparently the old vaccine, which many in the alternative health movement questioned as being unsafe, also did not confer lifelong immunity and, in fact, even having had pertussis itself does not confer lifelong immunity. The new vaccine has includes an acellular rendering of pertussis and thus is felt to be much safer.
— Nancy Kraus, CNM
A: Aloha Kanu. As a neighbor of yours on Maui, we are keenly aware of the "vog" (volcanic fog) that travels over when the Kona winds blow, as it brings on new challenges for most of us. Many experience the cough, along with other ailments such as sore throat, crusty noses, fever, headache and body aches. I also have a friend who grew up there and has commented on the difficulties presented by the vog, and that moving back there isn't an option for her because of it.
Where we live on the island we also have to deal with smoke from burning the sugar cane fields, so when they are not burning those we seem to have the vog to contend with! My son and I are particularly bothered by it and we try to close up the house and use a great air purifier as our number one defense. After that, we use Maui Sun Tea, four cups a day, and Umcka (herbal cold care remedy) religiously until symptoms are relieved. I do use one of the Chinese teapills, but not the particular one you mentioned, and I am using it for prenatal balance. I really like it and would recommend you call one of your local health food stores (Alive and Well here is great) that have certified herbalists or Naturopaths, as they are usually well-versed in those remedies. God bless you and your family.
A: A persistent cough should be assessed medically. Your case rings a bell with me as we had the same thing happen to us years ago. My four-year-old daughter got whooping cough at a birthday party and it lasted for over six months. Because not many doctors see it these days, it was misdiagnosed a number of times and it eventually ran its course. Her father and grandfather also had a cough after exposure to her, but they had a lesser version of it. Her grandfather had one serious episode of coughing while driving where he couldn't get his breath. He was quite distressed after this experience. Her brother did not get it. Both she and her brother had not received vaccinations for pertussis. I didn't get it. I don't know the herbs you mention, but we found that cough syrups (over-the-counter and herbal) didn't work. Homeopathy, however, was very helpful.
— Shawn Gallagher, BA, BCH
Q: My daughter's son is seven days old and she is breastfeeding him. He latches on and sucks well. Despite some soreness and bleeding of the nipples at first she is coping well and the soreness is clearing. She uses nipple shields for alternate feeds to help her breasts heal.
The baby rarely settles after a feed unless he also has some formula either from a cup or a bottle. However, once he has formula he sleeps well.
Does this indicate a shortage of milk? I recall when I was breastfeeding many years ago, my breasts were full and leaky most of the time. My daughter does not seem to feel like this and there is no leakage. Is there something we can do to make sure she has plenty of milk?
— Brenda (Sian's Mum)
A: I had the same problem with my daughter. As much as I hate to say it, your daughter needs to discontinue supplementing with formula and I also would encourage her to stop using the nipple shields. What worked for me was feeding frequently and on demand as well as pumping with a good quality hospital grade pump for 10–15 min. after each feed.
If she feels she needs to supplement, she can give the baby her pumped milk, preferably with a lactation aid so the baby doesn't receive a bottle and mom will still get the additional stimulation. One thing I would say is a "must-have" is gel nursing pads called "soothies." You can put them in the refrigerator and they work really well to soothe sore nipples when used with a good lanolin cream. Definitely get in touch with a lactation consultant - they are worth their weight in gold!
Responses to any Question of the Week may be sent to E-News at any time. Write to email@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Think about It
The UNICEF UK Baby Friendly Initiative and the Department of Health have published a new 18-page color brochure to assist health professionals to implement best practice and to inform parents about breastfeeding.
Called "Off to the best start," the brochure is intended to be used as a teaching aid when health professionals are discussing the benefits and management of breastfeeding with pregnant women and when they are teaching new mothers how to breastfeed.
With beautiful illustrations and clear text, the brochure includes information on the benefits of breastfeeding, as well as on skin-to-skin contact, positioning and attachment, and hand-expressing.
The brochure can be downloaded from either the Department of Health Web site, at www.breastfeeding.nhs.uk or the UNICEF UK Baby Friendly Initiative Web site at www.babyfriendly.org.uk/pdfs/otbs_leaflet.pdf.
The nonprofit Bumi Sehat in Indonesia, a provider of culturally sensitive prenatal, postpartum, birth services and breastfeeding support, reports that they have only enough money in the bank to support the Aceh and the Bali clinics for three more months. As you are probably aware, Aceh is the area that was most heavily affected by the Tsunami. Since the Tsunami is no longer in the news, grant funding has dried up.
Donations to Bumi Sehat are tax-deductible through the Sakthi Foundation (www.sakthifoundation.org/).For every dollar sent to Sakthi that is EARMARKED for Bumi Sehat, the Zimmerman Foundation makes a 25% match, so any donation will automatically increase.
Please help by making a donation!
Send checks EARMARKED FOR BUMI SEHAT to:
1507 Lone Oak Circle
Fairfield, Iowa 52556
Alternatively you can transfer a donation directly to their US$ account in Indonesia:
PT. BANK NEGARA INDONESIA (PERSERO) Tbk
Branch Denpasar, KLN Ubud.
Address: Jl. Cok Oka Sudarsana, No: 45 Ubud, Bali, Indonesia
Account Name: Yayasan Bumi Sehat
Ds. PKR Nyuh Kuning
Account #: 117-766-133
Swift Code: BNINI DJADPS
— Robin Lim
Only letters sent to the E-News official e-mail address,
firstname.lastname@example.org, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.
Remember to share this newsletter
You may forward it to as many friends and colleagues as you wish—it's free!
Want to stop receiving E-News or change your e-mail address? Or would you like to subscribe? Then please visit our easy-to-use subscription management page.
On this page you will be able to:
- start receiving any of our e-mail newsletters
- stop receiving any of our e-mail newsletters
- change the version (text or HTML) that you receive
- change the e-mail address to which newsletters are delivered
If you have difficulty, please send a complete description of the problem, including any
error messages, to our newsletter.
Learn even more about birth!
Midwifery Today Magazine—mention code 940 when you subscribe.
| ||1-Year Subscription||2-Year Subscription|
|Canada / Mexico||$60||$113|
|All other countries||$75||$143|
E-mail email@example.com or call 1-800-743-0974 to learn how to order.
Or subscribe online.
How to order our products mentioned in this issue:
Secure online shopping
We accept Visa and MasterCard at the Midwifery Today Storefront.
Order by postal mail
We accept Visa; MasterCard; and check or money order in U.S. funds.
Midwifery Today, Inc.
PO Box 2672
Eugene, OR 97402, USA
Order by phone or fax
We accept Visa and MasterCard.
Phone (U.S. and Canada; orders only): 1-800-743-0974
Phone (worldwide): +1 541-344-7438
Fax: +1 541-344-1422
E-News subscription questions or problems
Editorial submissions, questions or comments for E-News
Editorial for print magazine
For all other matters
All questions and comments submitted to Midwifery Today E-News become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today Web site.
Midwifery Today E-News is published electronically every other Wednesday. We invite your
questions, comments and submissions. We'd love to hear from you! Write to us at:
firstname.lastname@example.org. Please send submissions in the body of your message and not
This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.
Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.
The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.
© 2007 Midwifery Today, Inc. All Rights Reserved.
Midwifery Today: Each One Teach One!