Untethering in Labor: Using the Evidence for Best Practice

Barriers and facilitators to birth without epidural in a tertiary obstetric referral center: Perspectives of health care professionals and patients

“…RNs and midwives with elevated perception of intrapartum risk are more inclined to use medical interventions, including those which often act as barriers to birth without epidural. For example, routine use of continuous electronic fetal monitoring for all birthing patients hinders provision of labor support to patients who prefer birth without epidural . Internationally, obstetric organizations recommend intermittent auscultation in the absence of specific indications for continuous electronic fetal monitoring .…”

“…Oxytocin use may be partially related to decreased efficacy of uterine contractions when hospital protocols restrict ambulation among patients receiving epidural due to fall risk . These patients are also more likely to be on continuous electronic fetal heart monitoring, further restricting mobilization . Epidural is thus part of an intrapartum “cascade of interventions,” where one intervention increases rates of others, magnifying risk of complications for both birthing patients and neonates …”