Managing labor--never walk alone

Ambulatory labor analgesia: what does an obstetrician need to know?

A simple statement that describes the degree of the patient's satisfaction with the pain relief from her labor epidural analgesia has often assessed the quality of labor analgesia as perceived by the patient. Many laboring parturients, midwives, obstetricians and anesthesiologists are increasingly concerned by the limitations of traditional epidural labor analgesia. In general, women dislike the inability to void, the often-dense motor block, the feeling of numbness of the lower body, the total lack of the urge to bear down, and the complete perineal anesthesia. Continuous search for balanced labor analgesia that provides relief from pain, while preserving motor function, has led to the development of an ambulatory labor analgesia technique. This article assesses the validity of various strongly advocated opinions as to whether parturients benefit from ambulation in labor and also reviews the current trends in ambulatory labor analgesia.

Towards an understanding of the cultural roots of homophobia in order to provide a better midwifery service for lesbian clients

Research has indicated that homophobia amongst health professionals, including midwives, has negative consequences for the care received by lesbian clients. Social scientists recognise that homophobia is neither inevitable nor universal, rather it is culturally specific and culturally constructed. This recognition is potentially very positive, since it suggests that homophobia in midwifery practice may successfully be theorised and critiqued in order to support the development of better services for lesbian clients. In this paper discourse analysis methodology from the cultural and social sciences is used to interrogate textual evidence of the nature of homophobia in British and North American culture. The analysis results in the identification of five 'themes' underlying cultural expressions of homophobia: anxiety about sexual difference, fear of female sexuality, the sexualisation of lesbianism, the characterisation of lesbianism as 'sick' or 'unnatural', and the inability to identify lesbians with any certainty. In the context of midwifery, these themes emerge as particularly powerful, suggesting that, while the deep-rooted nature of homophobia is resistant to rapid change, midwives may be uniquely well placed to develop appropriate professional services for the growing minority of their clients who are lesbian.