[Editor's Note: This marks the beginning of our coverage of the 5th International Normal Labour & Birth Research Conference, taking place July 20-23 in Vancouver. Sharon Dalrymple, staff development nurse, prenatal educator, doula, and Lamaze's first Canadian president, will present a session she developed with maternity care quality expert and Lamaze's president-elect, Debra Bingham. They were both part of a research team that investigated how women perceive terms like 'normal birth' and 'natural birth' and what that means for helping them understand evidence-based information to make health and healthcare choices. There are many reasons that women's perceptions and priorities matter in birth. One is that meaningful improvements in maternity care quality and safety are impossible without a strong consumer movement. Dalrymple's and Bingham's findings have major significance for 'normal birth,' however we each define it.

Remember, there's an Open Thread for conference attendees and enthusiasts to post messages. You can follow all of the updates from the conference on Twitter by following the #birthconf hashtag and find more analysis here on the blog - AMR]

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For the past 50 years Lamaze International has been promoting normal birth practices in North America and more recently worldwide. Despite these educational efforts women are being over-treated more now than they have been in over 30 years. For example, 31% of women in the United States give birth by cesarean surgery. The overuse of interventions with harmful side effects when there is little or no expected benefit for mother or baby has led to worsening maternity care outcomes in the United States and many other countries. In addition, women do not get adequate information so they are aware of the excess, unnecessary risks they and their infants are being exposed to.

One of the reasons these educational efforts may not have been as effective as desired is that our conversations may not be persuasive enough or clear enough. For example, it is not universally understood or agreed upon how to define a normal birth, the differences between normal and natural birth, and which behaviors constitute a normal birth.Conversations and language affect how persuaded others are to make changes. In fact, 50 years of diffusion of innovation research tell us that for women to demand safe, high quality maternity care, we must engage in clear conversations that outline specific desirable behavior changes and show that women and babies can expect better health outcomes if these changes are made.

Lamaze International hired a public relations market research firm to conduct research and identify which messages are the most effective for persuading women to adopt normal birth practices. Online surveys were conducted among 811 women aged 16-44 and 408 Lamaze Certified Childbirth Educators.

Indeed, the research showed that the meaning of the words 'normal' and 'natural' was not interpreted by the women and educators the same way. For example, 36% of women felt that ALL vaginal births are 'normal birth', while 63% of Lamaze Certified Childbirth Educators defined 'normal birth' to be a birth without medical intervention. Women and Lamaze childbirth educators are likewise divided when deciding if the terms 'natural birth' and 'normal birth' are generally similar or generally different in meaning.

Lamaze International found that the words safe and healthy are the most effective words for communicating and promoting the birth practices Lamaze has endorsed for years. Everyone wants a safe and healthy birth. Mothers are particularly motivated to keep their baby and themselves safe and healthy. Most importantly, the practices are safe and healthy.

As a result of these and other findings, Lamaze International updated our six evidence-based key practice papers in Fall 2009 to ensure women realize that these practices simplify the birth process with a natural approach that helps alleviate fears and manage pain, with the ultimate goal of keeping labor and birth as safe and healthy as possible for each individual woman. Every woman needs clinicians who promote, support, and protect these six practices:

1. Let labor begin on its own
2. Walk, move around and change positions throughout labor
3. Bring a loved one, friend or doula for continuous support
4. Avoid interventions that are not medically necessary
5. Avoid giving birth on your back and follow your body's urges to push
6. Keep mother and baby together - It's best for mother, baby and breastfeeding

Conflict of Interest Disclosure: The research was funded by Lamaze International.

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