|
Results
of a brain storming session with mid colleagues.. The list is by no means
complete, and if you have further points to add, please email them to me so that
I can add them to the list.
Thanks also to Andrea
Robertson's 'Active Birth' literature, easily obtainable on the Internet, in
bookshops and in libraries.
Contents
-
Potential
Interventions in Childbirth.
-
Informed
decision about her care.
- How to achieve
a rapport with the woman.
- Ways of
stimulating oxytocin production.
- Factors that inhibit
oxytocin production.
- Immediate results
of oxytocin inhibition.
- Active labour strategies
- Points to remember
- Internet Connexions -
connect to more resources
Potential
Interventions in Childbirth
Giving birth in hospital and the distractions this situation presents
Labouring and giving birth on a bed seen as unnatural and inhibiting
Wearing other people’s clothes/hospital attire
Internal examinations, constant checking of the baby’s heartbeat seen
as disruptive and invasive
Baseline electronic fetal monitoring inhibiting free movement
Restrictions on companions, food and drinks
Imposition of some limits, especially boundaries of labour wards, volume
of surround and ambient noise levels
Learned relaxation, distraction techniques and imposed breathing patterns
Prolonged eye
contact with the labouring woman perceived as disrupting birth plan
Being left alone in a strange place, lack of privacy
Change of staff in labour ward, interruptions to constancy of care
Alterations to birth plan
Top of Page
When explaining medical interventions or
procedures, remember the woman must make an informed
decision about her care.
Make sure the information is based on scientific evidence, and not
hearsay or personal experience.
Include all the pros and cons of the procedure.
Avoid censoring or filtering the information.
Let the facts speak for themselves.
Giving percentages, for example, may enable a woman to better assess the
risk factors.
Be aware of your own personal views toward the treatment being offered.
Your own bias will show up in the works you choose and the way you speak.
Keep the communication simple. Further
details can always be added in response to questions or to clarify if requested
by the woman.
Note when you have not been able to get your message across (you can tell
from the look on her face and other non-verbal cues), choose a different medium
– try a drawing, use a model, demonstrate on your own body.
Allow time for consideration and further questions before asking for her
decision. Private time without the
presence of caregivers is essential (except in real emergencies) and will ensure
that better decisions are made, without duress.
Top of Page
How to achieve a rapport
with the woman.
Initially, stand back a little and survey the whole scene, look at where
the people are located, what is happening, how they are interacting. Check the mood and general ambience. Note the level of conversation; it’s tone, volume and
amount. Observe where the woman has
positioned herself, her movements and reactions to contractions.
Next, make whatever observations of the labour you can, while maintaining
your distance. If you need to know
about the quality and frequency of the contractions, for example, a few minutes
of quiet observation will give you the answers, without the need to ask the
woman, or the partner directly.
When you approach the woman, position yourself at her level.
Avoid standing over her or in front of her.
It is likely that she will have her eyes closed, as she concentrates on
what is happening inside her body. Standing
beside rather than facing her will reduce the risk of her opening her eyes, when
someone faces you, you are likely to make eye contact and this is a powerful
distraction for a labouring woman. Positioning
yourself shoulder to shoulder will still enable you to observe from the corner
of your eyes, and be less confronting. Give
her personal space.
Imitate some of her behaviours, and take your cues from her. If she is quiet, avoid asking questions.
If she has her head down and is resting, whisper in her ear.
To let her know you are there, place your hand gently on her arm or
shoulder, rather than speaking to announce your presence.
If you need to check the baby’s heartbeat, do so as unobtrusively as
possible, and try to move her as little as possible.
Having to move every half hour for this kind of check can break the
rhythm of her labour.
Top of Page
Ways of stimulating
oxytocin production
Distension of the vagina
Clitoral stimulation
Pressure on the cervix
Distension of the pelvic floor muscles
Stretching of the perineum
Nipple stimulation
Conditioned reflexes
Top of Page
Factors that inhibit
oxytocin production
Fear and anxiety, especially foreign environment
Anaesthetic injections, which numb the receptors needing to initiate
Ferguson reflex
Induction and augmentation, which flood the receptor sites with high
levels of oxytocin
Episiotomy; this reduces the stretching of the perineum, an important
stimulatory mechanism.
Separation of mother and baby at birth for initial resuscitation on resus.
cot, leading to lack of nipple stimulation
Indirect factors include beliefs and attitudes, which may lead to
embarrassment, a powerful inhibitor
Memories of past sexual abuse, which may remain subconscious (leading to
fear)
Embarrassment or anger. especially with inappropriate
or non-supportive comments from partners, significant others and staff.
Top of Page
Immediate results of
oxytocin inhibition
Slowing of labour
Slower dilatation of the cervix due to contractions of reduced strength
Prolonged second stage, due to little or no urge to push
Increased likelihood of post partum haemorrhage
Problems with breastfeeding due to slowed milk ejection reflex
Top of Page
Active Labour strategies
Discourage her from using the bed apart from sleeping
Turn down the lights to create a cosy, intimate atmosphere
Show the support people how to move the furniture in the immediate
vicinity
Get out the beanbags, the floor mats, birth balls and extra pillows
Show the support people where they can heat up hot packs, and full a
bucket with hot water if needed for hot wet towels. Encourage
the husband/partner to have a shower with the labouring woman.
Encourage the woman to stay in her street clothes while she is
comfortable
Keep your initial observations to a minimum.
Discourage her from being seated while you take observations, and, if she
does adopt a seated position, be seated next to her
Explain to others her need for quiet and calm and support. Allocate each person a specific task if mother is agreeable,
for example, one person to supply her with drinks, another to massage her feet
and another to help her to the toilet
Once a comfortable environment is established, leave the couple there to
get settled into the room and unpack their ‘goodies’. Be flexible and allow her to explore all avenues to attain a
degree of comfort.
Top of Page
Points to Remember
Listen
first
Observe
the body language
Avoid
asking questions or distracting her during contractions
Try
not to stand in front of her
but be close by her side
Keep
your voice low and calming
Home Page
Internet Connexions
Top of Page | 
