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trol professional practices in labor and delivery units. In “ Birth Plans: The Good, The Bad and The Future, ” Lothian discusses the genesis of birth plans and why they often are met with staff resistance. She reframes birth plans as a bridge rather than a barrier to high-quality safe care that is valued both by staff and labor-ing women and their families. Last, Ballen and Fulcher explore the role of the doula, why the role was devel-oped, and how it challenges traditional relationships between laboring women and hospital-based staff. De-spite positive research on the impact of doulas on wom-en ’ s physical and psychological responses to labor, they are often regarded with consternation by labor and de-livery personnel. In their article, the authors explore as-sumptions and misunderstandings about the doula role and explore models for a partnership between the doula and the nurse to improve labor and delivery care.

Knowing that once an innovation reaches the “ tipping point ” ( Gladwell, 2000 ), its dissemination becomes diffi cult to control, these articles were written to promote refl ection on current efforts to alter the care dynamics for pregnant women in this country. I am hopeful that they will stimulate you to examine the current and potential energy in your practice setting to encourage family-centered maternity care.

Merry-K . Moos , RN , FNP , MPH , FAAN Guest Editor Professor, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill. 214 MacNider Building, CB# 7516, University of North Carolina, Chapel Hill, NC 27599. E-mail: mkmoos@med.unc.edu.

REFERENCES

Gladwell , M . ( 2000 ). The tipping point: How little things make a big difference . New York : Little, Brown and Company .

Zwelling , E . , & Phillips , C . R . ( 2001 ). Family-centered maternity care in the new millennium: Is it real or is it imagined? Journal of Perinatal and Neonatal Nursing , 15 , 1 - 12 .

Challenging the Status Quo: Innovations in Obstetric Care

Family-centered maternity care redefi nes the rela-tionships between and among childbearing women, their families, and their maternity-care providers ( Zwelling & Phillips, 2001 ). Each of the four articles in this series is about an innovation in the care of pregnant women that has the potential to redefi ne these relationships. The topics were chosen because they represent changes in the structure of care that are becoming increasingly common and have been known to elicit strong negative reactions from nurses. Negativity may arise from anxiety about challenges to the status quo, negative experiences, or a lack of opportunity to refl ect on the rationale behind the in-novation and the evidence of its impact. To help readers evaluate these innovations, the authors ex-plain the motivation behind the alternative care mod-els, summarize the available evidence on their effects, and call for additional evidence where needed to de-termine the impact on process and outcome for preg-nant women, providers, and institutions.

In the 1st article, Moos explores the limitations of prenatal care as currently offered and explores three promising alternatives to the current standard of care. One of the three models she discusses is Centering-Pregnancy, the fi rst radically new approach to prena-tal care in nearly a century. This model provides the majority of prenatal visits, including physical assess-ment and patient education, in a group setting.

In the next article, “ CenteringPregnancy: Relationship- Centered Care, ” Massey, Rising, and Ickovics ex-plain the philosophy behind this innovation, how it is delivered, and its promise to improve pregnancy outcomes. This model, which has a growing number of proponents among health care professionals and childbearing women, aims to reshape the power dynamic between providers and patients, by helping women develop enough confi dence in their own wisdom to become full partners in their care.

The last two articles in the series explore strategies to decrease tensions that sometimes arise when laboring women are perceived by nursing staff as trying to con-

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