Preparation for Childbirth & Parenting

Preparation for Childbirth  Expectant families are faced with many choices about a childbirth experience and preparation for parenting.  Birth attendant  Setting  Expectant parents need to be prepared for childbirth or cesarean birth.  Physical  Emotional

Childbirth Education  Prepare expectant mother and support person for the childbirth experience.  Create knowledgeable consumers of OB care.  Help clients reduce and manage pain.  Help increase couples’ overall enjoyment with the childbirth experience.  Childbirth Educators and Teaching:  Group format with interaction with peers  Videotapes, slides, lecture, demonstrations

 Efficacy of Childbirth Education Courses:  Increase satisfaction, reduce amount of pain, and increase feelings of control.

 Cultural and Socioeconomic Factors:  Sometimes the advice of family or friends carry more weight than a professionals.  Avoid stereotyping  Consider financial needs

 Perineal and Abdominal Exercises:  Encourage woman to maintain an active exercise program during pregnancy.  Classes teach exercises to strengthen their pelvic and abdominal muscles and make them more supple.  This allows for stretching during birth, reducing discomfort, strengthened muscles return to normal quickly.  Lamaze begins the last 8 to 10 weeks of pregnancy.

 Tailor Sitting:  Stretches perineal muscles without occluding blood supply to the lower legs.  Do not put one ankle on top of the other.  15 minutes per day.

 Squatting:  Also stretches perineal muscles  Useful position for 2nd stage of labor  15 minutes per day  Keep feet flat on floor to be effective.

 Kegel Exercises (Pelvic Floor Contractions):  Tighten muscles of perineum  Helpful in postpartum period, perineal healing, increased sexual responsiveness, and stress incontinence in later life.

 Abdominal Muscle Contractions:  Strengthen abdominal muscles.  Prevents constipation and restores abdominal tone after pregnancy.  Contracts abdominal muscles while standing or lying or hold fingers 6 inches in front of herself as if blowing out a candle.

 Pelvic Rocking:  Helps relieve backache by making lumbar spine more flexible.  Arch back, trying to lengthen or stretch the spine for 1 minute, then hollows her back.  5 times

Methods for Pain Management  1. Discomfort can be minimized if woman is informed about what is happening and prepared with breathing exercises.  2. If abdomen is relaxed and uterus is allowed to rise freely against abdominal wall with contractions.  3. Pain perception can be altered by distraction techniques or gate control theory of pain perception.

 Bradley (Partner-Coached) Method:  Muscle-toning exercises  Limits foods with preservatives, animal fat, or high salt content.  Abdominal breathing to relieve pain.  Walk during labor and use an internal focus point as a disassociation technique.

 Psychosexual Method:  A program of conscientious relaxation and levels of progressive breathing that encourages the woman to “flow with” the contraction.

 Dick-Read Method:  Based on fear leads to tension  Abdominal breathing during contractions.

Lamaze Method  Most often taught in the US today.  Developed in Russia.  Based on theory that thought stimulus-response conditioning, women can learn to use controlled breathing and reduce pain during labor.  Gate control method of pain relief:  Teaches A&P,labor and birth process.  Sensation(contractions) can be inhibited from reaching the brain cortex and registering pain.  Concentrate on breathing patterns  Use imagery or focusing (concentrating) on a specific object to block incoming pain sensations.  Conditioned reflexes-reflexes that automatically occur in response to stimulus. Displace pain during labor.  Woman is conditioned to relax automatically on hearing a command.  Pavlov

 Conscious Relaxation:  Learn to relax body portions deliberately, relaxing one set of muscles then another.  Support person notices symptoms of tension, wrinkled brow, clenched fists …  Cleansing Breath:  To begin and end all breathing exercises: woman breaths in deeply and exhales deeply.  Limits hyperventilation.

 Consciously Controlled Breathing:  Set breathing patterns at specific rates.  Prevents diaphragm from descending fully which prevents pressure on uterus.  Exhalation little stronger then inhalation.  Level 1- slow chest breathing, full respirations, 6 to 12 /min. (early contractions).  Level 2 – breathing lighter, rib cage expands but diaphragm barely moves. Rate 40/min. Use when cervix is 4 to 6 cm.  Level 3- breathing more shallow at sternum. Rate 50 to 70/min. exhalation little stronger than inhalation saying “out” keeping tip of tongue against the roof of the mouth. Transition contractions.  Level 4- “pant-blow”pattern. Take 3to 4 quick deep breaths in and out then forced exhalation. Breath-breath-breath-huff or hee-hee-hee-hoo.  Level 5- Chest panting is continuous very shallow 60/min. used in 2nd stage to prevent pushing before full dilatation.

 Identify contraction by hand on abdomen or observe monitor.  Cleansing breath  Level 1- 3 breaths  Level 2 - 4 to 6 breaths  Level 3 - 10 breaths  Level 2 - 4 to 6 breaths  Level 1 - 3 or 4 breaths  Cleansing breath

 Effleurage:  Light abdominal massage with fingertips at constant pressure and rate.  Distraction technique and decreases sensory stimuli transmission from abdominal wall.  Can be done on thighs. Support person may do.  Focusing or Imagery:  Focusing intently on an object (sensate focus). Keeps sensory input from reaching the cortex of the brain.  Do not break their concentration.

 Second Stage Breathing:  Breath out while pushing.  Avoid holding their breath.  Do not practice pushing because they could rupture membranes.

Expectant Parenting Classes  Cover 4 to 8 hours of content spaced over a 4 to 8 week period.  Tour of maternity unit, nutrition, birth, supplies, childcare and other plans.

 Sibling Education Classes:  Acquaint siblings with what happens during birth at age appropriate levels.

 Childbirth Plan:  Choice of setting and birth attendant.  Meds, family, complications, visitation.

Birth Setting  Setting:  Depends on woman’s health and fetus.  Preferences, economics, hospital, birthing settings, or home.  Physician, Nurse-midwife.  Birth Attendant and Support Person:  Obstetrician, physician, midwife.  Father, doula or person to assist.

 Hospital Birth:  Come to hospital when contractions are 5 min. apart and regular.

 Birthing room:  LDR-labor-delivery-recovery rooms  LDRP-labor-delivery-recovery-postpartum rooms.  Bed converts to birthing bed.  Home like setting, family present.

 Birthing chairs:  Reclining chair with a slide away seat to allow perineal exposure.  Gravity.

 Postpartal Care:  May breast-feed immediately, infant remains with parents, “rooming in”, siblings visit.

 Alternative Birthing Centers: (ABCs)  Wellness oriented childbirth facilities.  Within or near a hospital.  Screened for complications.  Minimal analgesics or anesthesia.  Remain 4 to 24 hours after birth.

 Home Birth:  1% in US  Nurse midwife.  No complications.  Allows for family integrity: not separated.  Children Attending the Birth:  Need supervision.  A pets birth may help prepare. Alternative Methods of Birth  Leboyer Method:  Based on decreasing the shock to the newborn. Moving from a warm, fluid filled intrauterine environment.  Birthing room is darkened, warm, soft music playing or no harsh noises, handle the infant gently, cord is cut late, infant is placed immediately into a warm-water bath.  Late cutting of cord may lead to excess blood viscosity in the newborn.

 Hydrotherapy and Water Birth:  Soothing and relaxing.  Baby is born under water and immediately brought to the surface for a first breath.  Difficulties- feces, aspiration by fetus, and maternal chilling when she leaves the water.