Child Birth Methods
Choosing a method of childbirth is a very important aspect of pregnancy for
a couple, especially the motherto-be to consider. You should be actively
involved in deciding the way it should be carried out. We highlight some
important factors to consider before making your choice.
First and foremost, it must be safe for both mum and baby. In this day and
age, having a baby in the hospital seems the way it should be, with nurses
at your side and a doctor who has probably seen you through the anxious nine
months. For a normal delivery there should not be any problems in you choosing
the type of childbirth that you wish to have.
The Lithotorny Position
The majority of births are carried out in the lithotomy position where the
mother lies on her back with her feet in stirrups, although in the early
part of our human culture, mothers have given birth either sitting, squatting
or standing. However, this type and any type that causes the mother to lie
on her back will, according to Dr Denis Haire, 'decrease the normal intensity
of contractions and inhibits the mother's voluntary efforts to push her baby
out spontaneously'.
This will make it more likely for a need of forceps and an episiotomy because
of the tension on the pelvic floor and the stretching of the perineal tissue.
It is in contrast to the semi-sitting position where the mother can push
more effectively because the force of gravity is with her. Those using this
position also appear to have a lesser need for an episiotomy.
Sitting Position
According to Dr Lee of Gleneagles Hospital, the 'couch' is a kind of smart
bed that can be converted to a chair. In the past ten years, the couch or
sitting position is getting more popular because of the more natural position
and hence more comfortable for the mother.
Indeed so, proud parents of a baby boy, Lillian and Shaun spoke enthusiastically
about the birth of their first child. Lilian says that she found it much
easier to push when she was halfway up instead of lying down. She found it
a very comfortable position as her legs were very well supported.
Get To See Baby's Head
She also got to see her baby's head so she knew exactly what was going on.
All was very safe as Dr Lee was right there to catch the baby as he entered
the world. And the patient can get to control the bed making it at the angle
she feels most comfortable. It is a method they highly recommend.
And as the excited new father says, ' It was so easy for me to assist ...
I can hold her and help her to count!' This is because, in this sitting up
position, the father can easily move between standing behind the mother to
hold her and give moral support to going in front to look at the baby to
see what is going on.
Change Positions
According to research, women tend to change their positions several times
during delivery. But towards the last, they tend to want to sit up for an
easier push. You will be the best judge as to which position feels right according
to your own needs and comfort. However, it is best to consult your doctor
under what conditions different positions might be used.
In recent years, there has been much talk about going back to natural childbirth.
With natural childbirth, as the name implies, no form of medication is used
during the delivery, not even pain-killers. This form relies on the idea
that if the mother is sufficiently relaxed and prepared for the birth, medication
will not be necessary.
Underwater Birth
Thus women are trained to relax, breath as well do exercises such as Yoga.
However, it is important to be open-minded and be ready to take medication
and allow intervention if you or your baby becomes distressed. Another recent
alternative is the underwater birth. For underwater birth, the woman stays
in a tank of warm water to relax herself. The water is also able to lessen
the effects of gravity.
However, this is still only much read about in foreign books and magazines
and not adopted in the hospitals in Singapore. So far none of the people
I spoken to mentioned any special water tank for birthing. In these water
births, some of the babies may be removed after twenty minutes! An alternative
is that the water is used only to ease the mother during the earlier stages
of labour and not for the birth itself.
Casearean
Fathers are now recognised as very important birthing partners and are expected
to take an active part in the process. Only in a Caesarean is his role confined
to before and after the birth because the Caesarean is a major surgery. Caesarean
sections are done only for medical reasons such as foetal distress. Other
reasons for a Caesarean is if the mother has diabetes or pre-eclampsia that
is active during the time of delivery; and other problems with the uterus,
placenta or with the labour. This is when the mother's pelvis is too small
for the baby to be delivered through the birth canal. It is surely not a
choice of childbirth. Your doctor will tell you if you need a Caesarean or
not.
Pain Relief In Labour
There are several ways to reduce the pain of labour. From breathing techniques
to pain-relieving drugs, labour can be made more tolerable so that the mother
can concentrate on the birth itself. Preparing oneself psychologically and
learning the various breathing techniques may enable some women to forgo
the drugs altogether.
Pain Relief - Epidural Block
However, if the labour is too long and exhausting and/or the baby is presented
in the wrong way, the mother may opt for pain relief. The most common method
of pain relief is the epidural block which has been proven to affect the
baby least. However, some women claim that because they don't feel anything
after the epidural, they are unable to push.
So your doctor must know when to time the epidural. Complications which
may occur include a fall in blood pressure which can be easily corrected
by turning the woman on her side. Following labour, there may be loss of
sensation in the legs and lack of control of the bladder hours after the
delivery.
Experience Not As Expected
Mrs M. Lim, who gave birth to a baby boy with the help of an epidural, two
years ago, and who is now expecting her second child, says that her experience
with the epidural was not what she expected.
She felt extreme pain when the needle was inserted into her back. And hours
after the birth, her legs were still so numb that she was unable to stand
up. This time round, she is hoping to go natural all the way as she dreads
having any needle in her back. However, Lillian and another new mother I
spoke to says the epidural came as a relief because they had it only at the
third stage towards the end when the pain was quite unbearable.
Pudendal
Another type of local analgesia is the Pudendal nerve block. It is performed
just before a forceps delivery or when general anaesthetic is best avoided.
An injection into the nerves in the side wall of the pelvis with local anaesthesia
is made so that the vulva, vagina and perineum does not feel pain.
Whatever your form of pain relief, do consult your doctor as to what is
best for you and your baby because he would know best the condition you are
in. Clara, who has three children and is now trying for a fourth, has this
to say to other mothers-to-be, 'Save your energy till the very end. It is
that very last stage that you need it to push the baby out.' Doctors and
nurses also advise that pushing too early may exhaust the mother unnecessarily.
It may also tear tissues that will be sore later.
Positions For Labour
There are several delivery positions. In Helen McKinnon Doan's book entitled
'Every Pregnancy', she explains the advantages and possible disadvantages
as described of the various positions:
Lateral Position - Lying On The Side
Advantages
- Convenient
and comfortable for the woman.
-
Allows for the relaxation of the pelvic muscles, which facilitates the descent
of the foetal head.
-
Permits easy control of the foetal head during delivery.
-
Allow a natural drainage of secretions.
- Less
likely for the mother to develop supine hypotensive syndrome. (During the
late stages of
pregnancy, when a pregnant woman lies on her back, her heavy uterus presses
on some of the
large blood vessels. This pressure results in less blood returning to the
heart and hypotension results. The symptoms include nausea, shortness of
breath, faintness and pallor.)
Disadvantages
-
Tears of the vaginal and cervix are more awkward to repair.
-
Any complications during the third stage of delivery are more difficult to
manage.
Dorsal Position - Lying Flat On Your Back With
Knees Flexed
Advantages
-
Used with women who have had previous deliveries and who do not need an
episiotomy.
Disadvantages
-
Episiotomy not performed easily; forceps more difficult to introduce.
- Supine
hypotensive syndrome may occur.
Lithotomy Position - Lying On Your Back With Your
Feet In Stirrups
Advantages
-
Good position for monitoring the foetus.
-
Anaesthesia can be easily administered.
-
The perineum can be protected and tears prevented.
-
Good position for the use of forceps, an episiotomy, and for the delivery
of the placenta.
Disadvantages
- Use
of the stirrups may lead to sacroiliac or lumbosacral strain, thrombosis
in the veins of the lower limbs, and damage to the nerves as a result of
the prolonged pressure.
Semi-Sitting Position - Using A Delivery Table
With An Adjustable Backrest Or A Birthing Chair
Advantages
-
Makes use of the force of gravity to facilitate the delivery.
Disadvantages
- If
any medical intervention is required, such as an episiotomy or the use of
forceps, this position is inefficient.
Source: Motherhood Magazine