PREPARED CHILDBIRTH

Before the 1920's, birth took place, for the most part, at home and was attended by doctors or midwives. In the 20's, women flocked to hospitals for the 'new' modern methods of 'painless' childbirth. This consisted of separating Mom from the rest of the family, using drugs to make her oblivious to what was happening, separating Mom, Dad and Baby to keep the environment sterile for the newborn. Breastfeeding was discouraged and replaced with 'modern' infant formulas and baby bottles. Soon, Mom and Dad had absolutely no control over their childbirth experience, everything was orchestrated by the doctor. The natural, normal aspect of pregnancyno longer existed.

Not all doctors saw comatose childbirth as a positive step for Mom and Baby. Dr. Grantley Dick-Read of England saw the beauty in participatory childbirth. He noticed that women who had someone with them to explain events had significantly less pain. In the 1930's he wrote Birth Without Fear. Dr. Dick-Read was ridiculed by his American colleagues.

In the late 40's, the Maternity Center of New York sponsored a grant to study the effect of his methods and to allow babies to 'room in'. Fernande Lamaze, a French obstetrician, studied Russian techniques of conditioned response to reduce childbirth pain. His techniques were readily embraced by French women who felt the American drugs were dangerous and expensive. Again, American doctors rejected his theories. However, an American woman, Marjorie Karmel, who had her first child in Paris, and Elizabeth Bing began a nationwide movement and organization to promote the Lamaze Method. The organization of the LaLeche League gave us the movement to promote breastfeeding. In the 60's, Dr. Robert Bradley introduced the radical concept of fathers in the delivery room.

As women became more and more of a force in the marketplace and the workplace, their voices were heard. They began to demand participation in the childbirth experience.

    Thus, today we have Prepared or 'Natural' Childbirth. Prepared Childbirth means teaching and understanding methods to cope with normal childbirth and understanding the natural sequence of events in labor and delivery. This gives Mom choices as to how to have her baby and along with her partner allows her to make these choices based on information not fear or ignorance. Even if she decides she wants regional anesthesia, she will understand the effects on her body as well as her baby.

    Prepared Childbirth classes can now encompass different aspects of all the Methods available today. My own personal practice uses this eclectic approach as well as incorporating many of my own ideas.

PREPARED CHILDBIRTH METHODS

A. LAMAZE METHOD

Ferdinand Lamaze, a French obstetrician, went to in the early-1950s to develop of method of pain relief based on Pavlov’s training principles. Lamaze classes are structured to help women replace their negative preconceptions regarding pregnancy and the birth process with positive, learned responses and coping skills. At the same time, participants and their Lamaze partners are taught active relaxation techniques and patterned breathing to ease the discomfort of labor and birth. These skills are taught in a six-to-eight week series of classes. A variety of information is covered in each class. The following represents a typical series of Lamaze classes and information presented.

First Class

The initial Lamaze class gives an overview of the anatomical, physiological, and emotional changes that accompany pregnancy, with a focus on the third trimester changes.

Common topics in the first class include:

Coping skills and expectations. You and your partner are encouraged to share your thoughts, fears, and feelings. You are taught to trust each other and to work together to deal with labor.

Normal discomforts of pregnancy. You and your partner are taught to provide counter pressure for low backaches and pains by steadily pushing on your lower back. You are both encouraged to discuss discomforts you are experiencing and the instructor explores different remedies.

The benefits of breast-feeding. Breast-feeding helps your uterus contract after childbirth. These contractions also reduce blood loss after delivery. The mother’s milk immunizes the baby from childhood illnesses. The breast-feeding experience strengthens the mother-baby bond.

Nutritional needs. You continue to require additional nutrient dense calories to build a healthy baby. Brain cells only develop in babies for a short period of time. Brain cell development occurs throughout the last trimester and up until 18 months after birth, during which time proper nutrition is very important.

Third trimester changes:

As your body grows to accommodate the growing fetus, you

Will often feel tired; May cry and laugh easily; Will have an increase in blood volume; May notice generalized swelling; or May need to urinate frequently.

Activities

The activity session for the first class may include progressive relaxation, positive affirmations, and positive imagery. You and your partner can practice progressive relaxation. You first contract and then relax each body part in turn, starting with your feet. This process helps you recognize how your body feels when it is relaxed and to contrast it with the feelings of being tense. During labor, your cervix opens more easily if you are relaxed. You practice positive affirmations, replacing negative thoughts with positive images. One example is welcoming the contraction as you feel the pain begin. You can also visualize the work of the contraction by using positive imagery.

Second Class

During the second class, participants discuss fetal growth and development, fetal movement counting, and waking and sleeping cycles of babies. The discussion of feelings regarding labor and birth builds upon those explored in the first class. Anatomical and physiological changes during labor and birth are reviewed. Some instructors choose the second class as the time to show birthing movies to participants.

Special Place Imagery

A second relaxation sequence is taught during the activity portion of the class, consisting of the use of “special place” imagery for dealing with discomfort. You learn to picture yourself in a pleasant place and to focus on the sights, sounds, and smells of the special place. This technique helps you distract yourself from the pain and focus on positive feelings.

Third Class

You learn more about Lamaze’s theory during the third class. The instructor presents and discusses the perception of pain. You may be encouraged to share what you have been told or believe regarding labor. A concrete discussion regarding the physics of birth can be helpful in demystifying the delivery process. As you understand more about the nature of birth you may begin to see it more and more as a normal event. Childbirth preparation may help you and your partner trust more in your ability to experience the birth of your baby positively and to participate in it more fully.

Another focus of the third class is the developing fetus and its transition to newborn baby:

Amniotic Fluid. The fetus is surrounded by amniotic fluid within the uterus. This fluid acts as a temperature stabilizer and as a protective cushion for the fetus. The developing fetus practices breathing activities beginning in the fourth month of pregnancy. During these fetal breathing exercises, amniotic fluid washes in and out of the fetus’ respiratory tract. Cells from the fetal respiratory system are carried out into the amniotic fluid, which can be analyzed to tell the maturity of the fetus’ lungs if necessary. The fetus drinks the amniotic fluid and urinates back into this fluid. You should drink 2 to 3 quarts of liquid each day to maintain an adequate supply of amniotic fluid. The fetus strengthens and exercises its muscles by moving about in the amniotic fluid. You may

notice periods of activity balanced with quiet periods. Even in the uterus, the fetus has waking and sleeping times.

Sights and Sounds. The fetus begins to hear sound in the second trimester. Some studies have concluded that the fetus grows familiar with the voices and sounds of the external environment during its time in the uterus. Other researchers believe the fetus is able to recognize the voices of his parents and other family members. The pulsing of the mother’s blood flow and the rumblings of intestinal activity are also present in the uterus and are heard by the developing fetus. Visual ability develops at the same time. Fiber optic photography demonstrates a “rosy” glow within the uterus when the mother’s abdomen is exposed to bright light.

Behavioral Adaptations. Most babies are alert and reactive in the first 30 minutes of life. Breast-feeding is ideally initiated while the baby is active. Inactivity alternates with reactivity as the baby again establishes sleeping and waking cycles.

Breathing Techniques

Lamaze breathing techniques teach you to pattern your breathing to decrease the pain you feel. As each contraction begins you take a deep or “cleansing” breath. This deep breath is followed by slow, deep breathing in through the nose and out through pursed lips. The focus on careful breathing distracts you and decreases your perception of discomfort. Another breathing regimen is to pant slowly while repeating “hee, hee, hee.” Your partner assists you, breathing with you and encouraging you. If you feel the urge to push before the cervix is fully dilated, you may be asked to blow out more rapid, short breaths. You are encouraged to learn these breathing techniques, identifying the ones you find most useful during labor.

Fourth ClassActive Labor

Active labor is the focus of the fourth class. As the uterus repeatedly contracts, the cervix progressively dilates. During early labor the contractions are short and occur every 20 to 30 minutes. The cervix softens and thins. Early labor usually progresses slowly. You may feel a heavy tightening in your back and/or lower abdomen and cramping in your upper thighs. The mucous plug may be expelled and you may secrete streaks of blood from your vagina. When the cervix is about 4 cm dilated, active labor begins, with contractions closer together and stronger. Labor usually progresses more rapidly. You may need help in focusing and dealing with the pain at this time. As the cervix dilates to 6 to 8 cm, labor is intense, sometimes called the stage of transition. During this time you and your partner will work very hard to deal with labor. A jetted tub, rocking chair, or birthing ball may help you get more comfortable.

When the cervix is fully dilated the first stage of labor is complete. In the second stage of labor you will usually feel an urge to push as the baby descends into the birth canal. With each contraction you are encouraged to take in a breath and push the baby down and under your pubic bone. As the baby’s head stretches the vaginal opening, and becomes visible, you can reach down and touch the baby’s head to help you focus.

Touch Relaxation

Touch relaxation is a technique to cope with labor pains. You learn to condition yourself to relax each muscle group as your partner touches it. Your partner in turn learns to identify how you look when you are tense and to touch the tense area to help you loosen the muscles.

Fifth ClassPushing Techniques

You may find yourself involuntarily pushing as the baby moves down the birth canal. There are various techniques to assist this natural urge:

Take in a breath at the beginning of the contraction and slowly release the air as you push-the open glottis method.

Take in a deep breath, hold the breath and bear down with all the force you can muster.

Back Labor

Some women feel most of the pain of labor in their back. Pelvic rocking on your hands and knees or squatting can ease this discomfort. A hot pack or an ice pack on the lower back may also be helpful. Firm counter-pressure applied to your lower back by your partner can also provide some comfort.

Postpartum Coping

You and your partner are encouraged to prepare yourselves and your homes for the arrival of a new baby. A supply of easy-to-fix, nutritious foods is helpful during this time. You should learn to accept help from friends and family. You are encouraged to nurture your sense of humor as you learn the skills of parenting and being a couple.

Sixth ClassIn the sixth and final class the instructor reviews previous materials and skills and holds a dress rehearsal for the childbirth. An important aspect of the final class is to help couples understand that the birth process is a normal process.

B. BRADLEY METHOD

In the late-1940s, Dr. Robert Bradley suggested mothers should follow “natural instinctual behavior” when giving birth. Bradley described contractions or labor pains as the “tightening of a large bag of muscles surrounding the baby.” He encouraged women to work with the contractions. The Bradley method of childbirth teaches women to relax completely and breathe deeply, rhythmically with each contraction. Dr. Bradley encouraged couples to focus on the love relationship as they worked together to birth their baby. The woman’s partner is taught to be the “coach.” Bradley viewed the physician’s role as a “lifesaver” who helps only if something goes wrong.

The Bradley method, taught in a series of eight to twelve classes, asserts that the dangers of medication or anesthesia during childbirth far surpass the benefits. Students are taught the importance of a protein-rich diet and adequate calories. Pregnant women are encouraged to practice tailor sitting, squatting, pelvic rocking, and Kegel exercises every day.

Class 1. Introduction to The Bradley Method®

This class deals with Bradley Method® history, philosophy and goals. It is a time to get to know the instructors and the members of the class. During this class, they will begin to study things they can do to keep themselves healthy and low risk during pregnancy. The instructors will introduce important pregnancy exercises and they will lead discussion of how to handle pain and give a lesson in how to avoid unnecessary pain in labor.

Class 2. Nutrition in Pregnancy

The primary focus of this class is on nutrition. They will discuss good nutrition during pregnancy so that they will understand which nutrients are important and what quantities are necessary. They will help you to evaluate your diet and suggest ways to improve it if necessary. They will also review the pregnancy exercises and discuss: sex during pregnancy, breastfeeding and continue studying what they can do to stay healthy and low risk during pregnancy.

Class 3. Pregnancy

During this class, they will discuss the many changes your body goes through during pregnancy. The class will focus on anatomy and physiology as well as common discomforts and how to handle them naturally. This is helpful for the coach as it makes him more aware and therefore more understanding of these changes. We will also begin to discuss some of the many choices you face regarding labor and birth.

Class 4. The Coach’s Role

This is the first of two classes that focus on pregnancy and childbirth from the coach’s point of view. In this session they will discuss: coaching during pregnancy, the importance of natural childbirth, bonding, and the father’s role in breastfeeding. They will conclude the study on staying low risk during pregnancy and discuss drugs, myths and birthing.

Class 5. Introduction to First Stage Labor

This class is on how your body works in first stage labor. The class will cover anatomy and physiology of first stage, stressing the respect for the natural process and examining the built-in safeguards for the mother and the baby. They will teach basic coaching techniques and instruct couples on how to practice together. Standard hospital admitting and prepping procedures will also be covered.

Class 6. Introduction to Second Stage Labor

This class is on how the body works in the second stage of labor. The class will cover the anatomy and physiology of second stage labor stressing our respect for the natural process and examining the built-in safeguards for the mother and the baby.They will discuss the importance of the natural alignment plateau and the fetal Heimlich maneuver. Basic pushing techniques and second stage positions, as well as the coach’s role, will be covered. Third stage will also be discussed briefly.

Class 7. Planning Your Birth

Class seven covers consumer information and how to make a birth plan. They discuss: what your choices are, the importance of evaluating your feelings and listing your priorities, and meeting with your medical team to discuss your choices in a positive way. There is also a first stage labor rehearsal in this class.

Class 8. Variations and Complications / Postpartum Preparation

This class covers two units of information. They cover various complications including cesarean surgery discussing: how to avoid these problems if possible, how to evaluate whether it is necessary to intervene, and how to handle interventions that become necessary. They also cover information on taking care of yourself after your baby is born.

Class 9. Advanced First Stage Techniques

This class is filled with advanced coaching techniques dealing directly with the challenge of handling first stage labor. We will go over the First Stage Study Guide so that you can be sure you are well-prepared. We will also have a labor rehearsal and do some role playing.

Class 10. Advanced Second Stage Techniques

This class begins with an advanced labor rehearsal which helps to pull together all of the information that the couples have learned so far. They will also cover the Second Stage Study Guide to be sure that they fully understand and are prepared to handle the second stage of labor.

Class 11. Being a Great Coach / Are You Ready?

At this point they will go over the techniques for labor and birth as a comprehensive review of the most important points you will use while in labor. This class also covers information for coaches on how to handle the challenges they will face in labor. Emergency childbirth will be discussed, just-in-case the baby comes before you get where you’re going. They will also participate in an intriguing discussion on the theory of “what is labor” and why it is so different for each woman and even for each pregnancy.

Class 12. Preparing for Your New Family

The last of our twelve week series begins with an advanced labor rehearsal. Next they will discuss the concluding chapter in the student workbook which is titled “Your Labor and Birth”. They will also cover: newborn care, mothering, fathering, breastfeeding, how to handle a crying baby, and adjusting to the many changes you will face during this time.

C. DICK-READ METHOD

The Grantly Dick-Read method, which dates back to the 1940’s and 1950’s, is one of the first organized approaches to childbirth education. This theory assumes that lack of knowledge about childbirth, or incorrect knowledge, leads to fear. This fear causes tension, which then contributes to increased pain. Therefore, understanding how labor affects different parts of the B body can help to do away with unnecessary fears.

Classes emphasize understanding what you are experiencing during childbirth. This method was also the first to introduce the father onto the delivery scene. This, as well as the Lamaze and Bradley methods, encourage the woman to experience and accept the contractions during labor and delivery.

• This method is based on the idea that fear and anticipation of pain arouse natural protective tensions in the body, psychic as well as muscular.

• Fear stimulates the sympathetic nervous system and causes the circular muscle of the cervix to contract.

• The longitudinal muscles of the uterus then have to act against increased cervical resistance, causing tension and pain.

• Tension and pain aggravate fear, which produces a vicious cycle of tension, pain, and fear.

• A minor degree of pain, magnified by fear, becomes unbearable.• According to Dick-Read, prenatal courses and training reduce fear, overcome

ignorance,and build a woman’s self-confidence.

Dick-Read Methods• Explanations of fetal development and childbirth.• Descriptions of methods available to relieve pain.• Exercises that strengthen certain muscles and relax others.• Breathing techniques that will enable the woman to relax in the first stage of labor and

work effectively with muscles used during delivery.• Explanations of the value of improved physical health and emotional stability for

childbirth.• The woman is not told that labor and delivery will be painless; analgesia and anesthesia

are available if needed or desired.• The woman is given empathic understanding and support during labor by her partner,

the nurse, and the health care provider.

D. LEBOYER METHOD

LeBoyer Method of Childbirth was introduced by French obstetrician Frédérick LeBoyer in the 1970’s. This method allows the baby to be born in a quiet dim light room amid soft voices trying to minimize the trauma and stress for the newborn. Delivery occurs softly and the baby’s head is not pulled, instead immediate mother-child bonding is encouraged.

Dr. LeBoyer technique was outlined in 1975, when his book “Birth Without Violence” was published. LeBoyer’s believed that babies born in less stressful surroundings were more happy and healthy than those born using traditional methods. Like with other childbirth methods, LeBoyer Method has caused controversy since its creation.

This method allows a completely natural childbirth, giving the newborn a warm water bath before being placed on the mother’s stomach for bonding. They both are handled gently and without making any sudden movement that could startle or jar the baby, but being gently massaged to ease the crying.

LeBoyer recommended doctors do the massaging, but today mothers can do it themselves enhancing the bonding with their babies. Infants delivered using this method, usually open their eyes and breathe without loud, harsh noises, or being slapped on the bottom, as occurs in traditional deliveries.

If you decide on this method of childbirth, your baby’s umbilical cord will not be cut immediately, until it has stopped pulsating. This waiting time before cutting the baby’s cord, allows the baby freedom to take their first breath on their own, until they are ready and not before. The warm bath given to a baby shortly after the birth is to recreate the atmosphere from which the baby came from.

Due to practical reasons, not all the women subscribe to the gentle LeBoyer Method of Childbirth, but it has certain remarkable influences in delivery rooms which try to minimize noise levels, in order to make the atmosphere more peaceful and pleasant for mothers.

The avoidance of slapping or smacking the babies when they are born to make them breathe is no longer used. Instead, babies are massaged gently to encourage their first breathe before their umbilical cord is cut.

LeBoyer Method of Childbirth is a method approved by the National Association of Parents and Professionals for Safe Alternatives in Childbirth (NAPSAC). It is also recognized as a natural alternative by the International Childbirth Education Association (ICEA), and the International Cesarean Awareness Network (ICAN), among the countless other techniques using the right methodology for childbirth without painful stimuli such as spanking the baby.

OTHER PREPARED CHILDBIRTH METHODS

E. KITZINGER

Based on Dick-Read and Lamaze, Kitzinger uses mental imagery to enhance relaxation. The use of touch, massage and visualization helps the woman flow with the contraction rather than ignore or breath it away. She uses "puppet-strings relaxation" in which the partner tells the patient which limbs the strings are pulling, the others remaining relaxed. She uses long, slow, deep chest breathing methods to achieve complete relaxation. Mom is encouraged to labor in any position that is comfortable for her. Pushing is done when the body tells you. Between pushes, short breaths are taken. Kitzinger emphasizes the empowerment of childbirth for women.

F. GAMPER

The key to the Gamper Method is the self-determination and confidence instilled by instructors in the ability of women to work and cooperate with the natural forces of childbirth. The emphasis is ON the contraction, rather than away from the contraction. A normal, natural rate of deep

abdominal breathing is taught to be able to help the woman work with the contraction. Classes begin early in pregnancy so that the fear-tension-pain cycle can be broken and new self-confidence instilled early on.

G. SIMKINS

    The Simkins Approach to childbirth works with the strengths of the couple giving birth. They are encouraged to use whatever means of breathing and style which helps them as individuals. An eclectic mix of techniques is taught.

H. NOBLE

    Elizabeth Noble's technique involves relaxation of the pelvic floor muscles and learning ways to relax them. Her 'gentle pushing' or 'breathing the baby out' technique is now incorporated in many classes. Her approach emphasizes women listening to their body.

I. ODENT

    Michael Odent, another French physician, went a step further than LeBoyer. He put mother and baby both in the water. Odent allowed his laboring mothers to submerse in a pool of water. This appears to help some women ease labor pain. When some of the women were reluctant to leave at the time of delivery, they were delivered submersed, without drowning the baby since the baby has lived in fluid for nine months. The subsequent safety of this procedure has allowed this movement to be embraced in this country and many centers and hospitals now have this option available.

PANPACIFIC UNIVERSITY NORTH PHILIPPINESUrdaneta City, Pangasinan

College of Nursing

PREPARED CHILDBIRTH

Submitted by:GARCIA, Neil

GUILLERMO, AllanGroup 10

Submitted to:Ms. Carolyn Selmo, RN

Clinical Instructor

March 2010