Date of Award

January 2017

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Holly Powell Kennedy



Introduction: Physiologic birth practices support the normal processes of childbirth, are associated with improved outcomes, and can prevent unnecessary intervention. Defensive maternity practice contributes to the overuse of medical interventions and decrease in physiologic birth practices. Team-based maternity care has been studied as a method to improve safety through improved communication and teamwork skills. The purpose of this literature review was to explore whether team-based care can be used as a strategy to promote physiologic birth through decreasing defensive maternity practices.

Methods: The search engines OVID, CINAHL, Pub Med, Google Scholar and the Cochrane Library were used to identify relevant studies for the review. Search terms included, physiologic birth, team-based maternity care, defensive maternity practice, electronic fetal monitoring (EFM), and cesarean delivery. Intermittent auscultation (IA) was considered proxy for physiologic birth practice and was examined in the research comparing IA to EFM. The data were organized according to major content area then synthesized to summarize the state of the science and implications for practice and future research.

Results: EFM in low risk pregnancies was not associated with improved outcomes and is associated with increased cesarean rates. Overuse of EFM was associated with fear of litigation as was increased cesarean rates. Team-based care was associated with improved communication. There was some evidence suggesting that team-based care supports physiologic maternity practices.

Discussion: A team based-care model may provide a forum to discuss and implement practices that support physiologic birth care. Professional organizations should partner to examine how they can encourage maternity professionals to support physiologic birth. Future research is necessary to evaluate the efficacy of these strategies.


This is an Open Access Thesis.

Open Access

This Article is Open Access