MOTHER FRIENDLY CARE DURING DELIVERY
42-19 WHAT IS “NATURAL CHILDBIRTH”?
A natural childbirth is a delivery where there is minimal medical interference and the women has as much control as possible. Women should be encouraged and allowed to have a natural childbirth whenever possible. However, the labour and delivery should be supervised and monitored by a skilled person to detect and manage any complication which may arise. A natural childbirth is not an unsupervised delivery.
42-20 WHAT ARE THE ADVANTAGES OF NATURAL CHILDBIRTH?
It gives the mother the pride, joy and satisfaction of having been in control of her own labour and delivery. It enables the mother to have a choice in what she wants.
42-21 IS IT BETTER IF A DOCTOR DELIVERS ALL INFANTS?
Most healthy women who are expecting a normal delivery and a healthy infant at term can be safely delivered by a midwife. Delivery by a doctor is only needed if a serious complication is expected in the mother or infant. There is no medical reason why normal deliveries should be conducted by a doctor. In many countries most deliveries are very ably conducted by midwives.
| MOST WOMEN CAN BE SAFELY DELIVERED BY A MIDWIFE |
42-22 SHOULD ALL WOMEN BE DELIVERED IN HOSPITAL?
Many women can be safely delivered at a primary care maternity clinic (midwife obstetric unit). Only where complications are present or are expected, need a woman deliver in hospital.
There are many advantages if a mother can be delivered at a maternity clinic:
- Closer to her home and family.
- More likely to have a normal vaginal delivery without medical intervention.
- Discharged home sooner.
- Cheaper both to mother and health service.
- Often preferred by mother.
- More “homely” and less impersonal.
In a large regionalised maternity service, about half of all pregnant women can be safely delivered at a clinic. The other half are referred to hospital during the antenatal period or during labour.
| WITH CAFEFUL SELECTION, MANY WOMEN CAN BE SAFELY DELIVERED AT A MATERNITY CLINIC |
42-23 CAN WOMEN BE SAFELY DELIVERED AT HOME?
With careful selection, some women can be delivered safely at home. However, excellent transport and communication are needed in case of an emergency. A warm, well lit home with clean water and other basic facilities are also needed. In poor communities, many of these requirements are missing. Instead of home deliveries, it is preferable that women deliver in a clinic close to their home.
42-24 SHOULD EVERY DELIVERY BE CONDUCTED BY A TRAINED BIRTH ASSISTANT?
Every effort must be made to ensure that a trained birth assistant is present at every delivery, i.e. a doctor, professional midwife or well trained traditional birth attendant (TBA). Having a trained birth attendant at every delivery is one of the most important factors in reducing both maternal and perinatal mortality. It is very dangerous for family members or untrained birth assistants to conduct deliveries, especially if they are not experienced.
42-25 SHOULD THE FATHER BE PRESENT AT THE DELIVERY?
If possible, and if the woman wants him there, the father should be present during labour and delivery. It is important that he support his wife or partner and share in the experience of childbirth. Being present is important in strengthening bonds between mother and father and developing bonds between father and infant. Often fathers can attend a caesarean section.
There are times where it may be best if the father leaves the delivery room for a while. Either if the mother wishes it or during a medical procedure. The father should not interfere with the management of the woman.
| THE FATHER SHOULD BE ENCOURAGED TO ATTEND THE LABOUR AND DELIVERY |
42-26 SHOULD CHILDREN BE ALLOWED TO WATCH A DELIVERY?
Although this is usually not allowed during clinic or hospital deliveries, children are often present during home deliveries. Children know that their mother is pregnant and ask questions about the delivery. Being present at a delivery can be either a frightening or exciting experience for a child. It is important to explain to children what to expect, that their mother will have some pain, and that this is normal.
42-27 MUST A WOMAN LIE ON HER BACK DURING DELIVERY?
Many women are still expected to lie on their backs during delivery (supine position). This has been shown to be the worst position for the fetus as the uterus presses down on the mother’s main blood vessels which can cause maternal hypotension and a reduced blood flow to the placenta, resulting in fetal distress. It is also very difficult to bear down effectively in this position. Labour ward staff, however, have tended to prefer the supine position as it provides the best access to the delivering head.
Many women prefer to find their own most comfortable position during delivery. Some want to squat, crouch, kneel or lie on their side. Some women may wish to change their position during delivery. It is important to allow a woman to choose the position that feels best for her. The upright (squatting, crouching or kneeling) and side-lying (lateral) positions results in less pain, better progress of the second stage and less perineal tears.
Often a compromise position can be found. For example, the mother can squat or kneel on the bed, holding onto the top of the bed for support, and then lie down once the head has crowned. Labour ward staff should get used to delivering women in different positions.
| WOMEN SHOULD BE GUIDED AND ENCOURAGED TO FIND THE MOST COMFORTABLE POSITION DURING DELIVERY |
42-28 IS A ROUTINE EPISIOTOMY NEEDED BY ALL PRIMIPAROUS WOMEN?
No. There are no good reasons for performing a routine episiotomy on all primiparous women during labour.
42-29 IS IT BETTER TO DO AN EPISIOTOMY THAN ALLOW THE PERINEUM TO TEAR?
For many years it was believed and taught that is was better to perform an episiotomy than allow the perinuem to tear. This is now known to be incorrect as there are more complications with an episiotomy than with a first or second degree tear. A first or second degree tear is easier to repair and results in less trauma, less suturing, better healing, less dyspareunia (painful sex) and less urinary and bowel incontinence later. An episiotomy does not always prevent a third degree tear.
An episiotomy should only be performed when there is a good medical indication, such as prolonged second stage of labour or fetal distress during the second stage.
| EPISIOTOMIES SHOULD BE AVOIDED WHERE POSSIBLE |
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