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CLINICAL DECISION-MAKING REGARDING INTRAVENOUS HYDRATION IN NORMAL LABOR IN A BIRTH CENTER SETTING

Authors

  • Phyllis A. Sommer CNM, WHCNP, MS,

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    • Phyllis Sommer received a bachelor of science degree in nursing from the University of Washington in Seattle. She received a master of science in maternal/child nursing and nurse-midwifery from the University of Illinois at Chicago. She is currently working as a CNM in Illinois.

  • Kathleen Norr PhD,

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    • Kathleen Norr is an Associate Professor at the University of Illinois in Chicago and a medical sociologist who completed a PhD at the University of Michigan. For the past 20 years, she has collaborated with nurse-midwives and nurses in addressing the care practices that accompany childbirth as well as address other aspects of women's work, roles, and health needs. Most recently, she has developed a program of research and intervention strategies to prevent HIV infection of women in the United States as well as Africa.

  • Joyce Roberts CNM, PhD, FACNM, FAAN

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    • Joyce Roberts is a Professor at The Ohio State University, College of Nursing in Columbus, Ohio. She has been involved in nurse-midwifery education since 1972 at the University of Illinois at Chicago and at the University of Colorado. She completed a bachelor of science degree in nursing from the University of Wyoming, a master of science degree in maternal-newborn nursing and nurse-midwifery from the University of Utah, and a PhD in nursing from the University of Illinois. She is currently serving a second term as ACNM President. She has also been Chair of the ACNM Division of Accreditation. Her area of research is care practices that accompany labor and birth.


Phyllis A. Sommer, CNM, WHCNP, MS, 933 Aspen Drive, Buffalo Grove, IL 60089-1316.

ABSTRACT

Intravenous hydration (IVH) in normal labor is used routinely in most hospital settings despite the lack of support from recent research. However, it is not used routinely at one in-hospital, Alternative Birthing Center (ABC), in the Midwest. The purpose of this study was to explore and describe the criteria and perspectives of the certified nurse-midwives (CNMs) and nurses (RNs) in their decision-making process toward nonroutine use of IVH. In-depth interviews with five CNMs and four RNs that work in the ABC provided insight into how they balanced patient preference, research-based knowledge, and clinical judgments, in making decisions about IVH. The RNs were slightly more in favor of IVH than the CNMs, but not because of philosophic differences. Rather, the different roles and responsibilities of CNMs and RNs seemed to be most important. CNMs had a stronger commitment to client preferences, whereas RNs were more concerned about their responsibility for efficiently starting IVs prior to an emergency situation. Understanding professional differences in the decision-making process for IVH can enhance clinical functioning of the caregiving team by helping CNMs anticipate and address potential conflicts.

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