Monday, July 17, 2006

Significance of Birth to the Mother

Significance of Birth to the Mother
by Michelle Schnaars

It is the opinion of this author that woman who prepare for childbirth, receive labor doula support, and participate in the decision making process have a better birth experience than woman who do not receive childbirth education, labor and birth support, and who do not receive emotional support and encouragement.

I will attempt to show that the decision for labor doula support, the place of birth, and preparation for childbirth can greatly improve the childbirth experience and overall satisfaction. Following the history of childbirth we can see the options of today differ greatly than in years past. We have seen many drugs come and go.
The history of obstetrical forceps is long; from approximately 1500 BCE there is evidence of single and paired instruments; Egyptian, Greek, Roman, and Persian writings and pictures refer to forceps. Credit for the invention of the precursor of the modern forceps to be used on live infants goes to Peter Chamberlen (circa 1600) of England. Modifications have led to more than 700 different types and shapes of forceps. In 1745, William Smellie described the accurate application to the occiput, rather than to the pelvis, regardless of the position of the head, which had been performed previously. In 1845, Sir James Simpson developed a forceps that was designed to appropriately fit both cephalic and pelvic curvatures. In 1920, Joseph DeLee further modified that instrument and advocated prophylactic forceps delivery. In an era in which many women labored and delivered under heavy sedation, forceps deliveries became common.

In the past 30 years we have seen the introduction of epidurals, sterile water injections, and a list of drugs that can be overwhelming. Fathers are now more involved in their children’s and their family’s life. They are also a more prominent figure in the birth team. We see father’s presence in the labor and delivery room, in childbirth education classes, at prenatal doctor visits, and father’s participation in the decision making process. With open communication, childbirth education, and labor doula support woman are now able to make decisions for their care and their baby’s care. Women realize they have a responsibility to themselves and their children. They are realizing too that the very place of birth and the people they choose to surround and support them will have an impact on their labor and birth.

The husband’s presence at birth has a significant impact on the birth outcome. Women feel safe, supported and loved when their partner is present at the birth. When a father witnesses the birth of his child he too experiences a stronger, deeper bond with his wife and child. The place of birth also serves to shape the labor and birth experience and ultimately the postpartum experience. A woman’s options are either readily available or she will have to do extensive research to become well educated and ultimately be able to participate in the decision making. Learning about and understanding the process of childbirth will help a woman to cope, help her to adjust, and to make the best decisions for herself and for the baby.

In 1940, Twilight Sleep was introduced. This heavy dose of narcotics and amnesiacs completely incapacitated laboring women and caused women to loose control. Many were literally strapped to their beds to keep them from injuring themselves. Often helmets were placed on the laboring woman to protect her head during ‘wild episodes’ that the drug would bring about; these episodes could lead to severe head trauma. Dads were useless with this kind of labor and delivery, so they were relegated to the waiting room. Most just went home and waited for a phone call that their wife had given birth.

In 1944, Dr. Grantley Dick-Reed wrote Childbirth With-out Fear; Dick-Reed believed that woman could give birth with out being drugged; and as long as they had the support to do so. In 1953, Dr. Fernand Lamaze published his findings about labor and delivery in Russia. Soon women in America wanted Lamaze’s natural childbirth. And in 1970 Dr. Robert Bradley co-founded the Bradley Method of Natural Childbirth. Bradley was significant in bringing the husband into the labor and delivery room. Dr. Bradley realized just how important the husband’s role was (and still is today). He taught couples how to work together to bring about physical and emotional relaxation which he found to be crucial for painless childbirth. He taught couples the process of labor and birth, how to relax physically and emotionally, and how to abdominally breathe. He taught husband’s how to support their wives through labor and birth. He believed that with loving couch-like-support woman would not need drugs, and medical deliveries.

Woman wanted change, they wanted support, and they wanted their husbands with them in the labor and delivery room. Women had finally realized that even though they were expecting a baby, they were indeed consumers; and so they assumed the responsibility of consumers to gain control of their birth experiences.

Natural childbirth methods were popping up all over America, classes were growing by leaps and bounds; and more and more organizations we created to train and certify individuals to keep up with the demand for education, support, and natural –normal childbirth. These individuals, mainly woman, were trained to work with the expectant couples in preparation for the birth event. Organizations such as Lamaze International, The Bradley Method, ALACE, ICEA, DONA, and CAPPA, certified childbirth educators and labor doulas, and still do today. Training people, to support the laboring woman and her companion, to help the mother achieve her wishes for the birth of her child, and to preserve the memory of the birth experience.

There is a definite difference in the management, or appreciation and patience, of labor and birth; and a definite difference in the way women are treated from birth place to birth place and from region to region. Hospital birth is generally a medical procedure and interventions are expected by the medical staff. Birth centers are usually much more “natural birth” friendly and support decisions made by the expectant couple. At a home birth the midwife will encourage the laboring woman to make her own decisions. The woman that chooses to birth at home usually wants an un-medicated labor and birth with little or no monitoring. This woman prefers the “active role” approach to birthing; walking, squatting, hydrotherapy, and birth ball. These same benefits can be found in a birth center; plus birth centers have doctors on call.

Now we see the decision to birth in a hospital, most likely, will lead to some type of “intervention”; (amniotomy, epidural, pitocin, IV, c-section) and most likely the majority of labor will be spent in bed. Hospital medical staff does not easily support the decision for natural birth because they simply do not learn about un-medicated birth in medical school. Mom may find herself bombarded with offers for pain medication. Other hospital interventions include continuous monitoring, IV, and no food or drink in early labor. Because hospitals are under staffed and nurses have many patients, the nurse will not be able to stand by mom’s side during labor. Also labor usually takes several hours or a few days and so the laboring woman will have several nurses throughout the course of her labor; she may find it difficult to “bond” with each nurse, and she may get very little, if any, emotional and physical support.

How a woman is supported through labor and childbirth can change the way she views herself as a laboring women. Is she encouraged to take an active role in her labor? Does her care provider encourage her to make decisions? Is she expected to leave the decisions to her care provider? Some times family members put pressure on mom to comply with hospital or doctors orders because they feel embarrassed if mom speaks her wishes. In any event she is the one who will live with the decisions; whether she chose them directly or indirectly. Now we see the positive effect of labor support, and the negative effect of a lack thereof.

In childbirth education classes parents learn not only changes that occur during labor and birth, they become aware of their options for childbirth and the benefits and risks involved with each procedure; so they may become a more active participant in the decision making process. When the couple attends childbirth education classes together the mother feels supported by her partner, she is encouraged by his participation. Through the classes she gains confidence in her body’s ability to labor and birth in a natural way, and she gains confidence in the decisions that she makes.

Ultimately, the woman’s choices for what types of care she will receive, place of birth, doctor or midwife, labor doula support, natural or medicated birth, or c-section, set the stage for the birth experience and postpartum recovery. Each decision impacts the birth outcome and how she views herself both as a woman and as a mother. These decisions affect her view of relationships; with her husband, children, extended family, and friends. Women remember their birth experiences for the rest of their lives. Yes, there are forgotten details, however some things are remembered with such vivid clarity even years later a woman still remembers and still feels the result of the decisions that were made.

Often a mother feels inadequate if she has had an epidural, or a c-section and these feelings can mount with hormonal changes and lack of sleep. If a woman ended with a birth experience she did not plan on she may feel as though she has missed out on what could have been, and she may experience a type of loss. Postpartum support is very necessary. The new mother needs to be encouraged and her feelings validated; and she needs to talk about the birth experience. Research has shown that a doulas support lowers the chances of a c-section, epidural, and pitocin; research also shows that a doula helps promote family bonding, increases breastfeeding success, and improves the overall birth experience.

The labor doula is an important member of the birth team. Her presence at the birth can give the mother a sense of security. A labor doula provides physical and emotional comfort; she explains medical terminology, and she helps the mother assume various labor positions to bring optimum comfort and facilitate birth. She gives the mother permission to labor and birth in a way that is comfortable and safest for both mom and baby. The labor doula also helps the father to be as active and supportive as he can be to his laboring wife.

Researchers from Case Western Reserve University in 1998 reported the findings of a series of studies designed to examine the effects of labor support by a doula. In six clinical trials, researchers found that providing the support of a doula to women during childbirth decreased caesarian section delivery rates, shortened labor times, and reduced the need for analgesia. In another study at the Department of Pediatrics at the Case Western Reserve University School of Medicine. According to researchers, doula support is an effective, risk-free, non-pharmacologic, and inexpensive pain relief method that may be a viable alternative to epidural analgesia for many women in labor; without the negative side effects and expense of an epidural.

Childbirth education classes and pharmacologic methods of anesthesia and analgesia are not the only variables that have been associated with reduced pain in childbirth. Women with lower levels of anxiety have been found to experience lower levels of pain (Klusman, 1975). Women whose husbands were present at labor and birth reported less pain (Chaney, 1980). Women with lower levels of education (Nettlebladt, Fagerstrom, & Uddenberg, 1976) and younger women (Davenport Slack & Boylan, 1974) reported experiencing more pain in childbirth. Lowe’s (1989, 1991, 1993) significant work confirmed the inverse relationship between a woman’s confidence in her ability to cope with labor and perceived pain during childbirth, the less perceived pain she will have and the better she will cope.

Standley and Nicholson (1980) developed a model for looking at maternal coping during the childbirth experience that depicts the relationship between the psychological, physiologic, and environmental factors that can be tested. The outcome measure were identified as childbirth competence (“a women’s ability to control her behavior and assist in the labor and delivery of her child without showing signs of psychological distress or functional inability”) and postpartum childbirth affect (“how a woman feels physically and emotionally immediately after birth”). The woman’s childbirth competence is influenced by general determinants, such as background and personal characteristics, and factors related to her pregnancy and physical and social environment and her cognitive appraisal of childbirth, which is related to her expectations for childbirth, her phychophysiologic adaptability, and stimuli in the childbirth environment. A woman’s interactions with others in the environment influence her coping ability during childbirth.

A society’s cultural beliefs and values establish the importance of the childbirth experience in that society, what is proper, what should be done, who participates during the childbirth experience, and what their roles should be during childbirth. Cultural beliefs and values significantly influence the woman’s perception of the childbirth experience (Callister et al., 1996; Jordan, 1993; Mead & Newton, 1965)

Whether childbirth can be considered a developmental task for adolescents is questionable and needs to be examined. Mercer (1996) found that as the educational level of the women increased, so did the level of childbirth satisfaction.

Adolescent mothers have a less positive perception of the childbirth experience than older mothers (Mercer, 1986). In addition, Nichols (1992) found that adolescents’ perceptions of the childbirth experience differed markedly from those of adult women. The goal of adolescents was on “survival” in contrast with the adult women’s desire to “master” the experience.

A mother’s personal history helps shape her perception of the childbirth experience. The childbearing woman’s feelings of self, her social support, and the significant life events she has experienced may all affect her childbirth (Areskog et al., 1984; Humenick & Bugen, 1981; Nuckolls, Cassel, & Kaplan, 1972).

Other factors include; a woman’s spiritual beliefs, the personality characteristics of the woman, family influences, society influences.

Finally when a laboring woman is encouraged to become well educated in childbirth, when she has labor doula support, when she is encouraged to assume comfortable birth positions, and when she has had little or no drugs, she feels a sense of success with the birth, and feels empowered by her experience. She relates to her baby, she bonds with her new born, the breastfeeding relationship is improved, and she is more likely to respond in kind to the baby’s needs.

Works Cited

Case Western Reserve University (Researchers John Kennell, M.D., and Susan k. Mcgrath, Ph.D., with Vijay S. Varadaraulu a premedical student at CWRU). 1997-06-04 Source Johns Hopkins Children’s Center.

Case Western Reserve University School of Medicine. The study was presented at the annual meeting of the Pediatric academic Societies in New Orleans, May 1-5, 1998.

Husband Coached Childbirth; Robert A. Bradley, M. D. (Bantam trade paperback edition /February 1996)

Childbirth Education: Practice, Research, and Theory; Francine Nichols and Sharron Smith Humenick (Second EditionW. B. Saunders Company 2000

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