Professional Documents
Culture Documents
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IN SEVERAL ARE.ts oF HoLLAND, mid- bowel movement, and if someonc sug- Midwives arc Ending thar en i.scrcas-
wives urd the women under *reir carc be- gesred thar wc should do so, we wouldnt , ing number of womcn prcfer ro rcmain
gan co erperimcnt with a numbcr of trkc them seriously. Ifit weren't for culy' positioned venically during dclivcry. \r:ar-
spontaneous delircry positiors used pri- tural condirioning, dre idea of dclivering ting, siEting, knecling, and send.ng facfi-
or to drc cightccnrh cennrry dut had been supine-and therc\ hampering a physi- ace rhe binh proccs for both mothcr and
almosr forgotten by Vcstern mcdicine. ological process by going ageinst tbc lerr of child Awarcncs ofthe adranages ofvcr-
During the past rwo deedcs, $cse mid- gravity-rvould saikc us al cqudly absulcl cical birdr is growing arnong doctori. In
wives have gined in'ralu:blc expericnce Pressurc placed on main blood ves- some hospirals, verrcical dclivcry is already
with verriol birth, the most mnrral and sels widrin rbc pclvic caviry is rnothcr me- cusromary
,rncienr method of delivery. flhird Vodd jor disadvrntage of supinc dclivery. Thc It gocs widrout srying thar a birdring
o"nons have contirured m use vertical po- ,babv's weiehc as well as that of the amni- position can bc eEective onlv ifit is sirn-
C, u for childbearing.) Exploretion for otic fluid and glacente f.e.<cr onto the ple ro assume, eesily meiatained, and very
\--prnativcs ro the current conventional vesscls that provide thc blood flow jnto seble. Durilg dcliverier etrcnded by mid-
oiirhing position did nor cooe out ofthe *re phce!.ta. blood f,olv which is vitai fol wivcs, nuny wonen innritircly wcar inro
bluc; tbe disadweaagc ofdelivering while thc childt oxveenerion. the supporrcd squat. The rupponed sguat-
lying on onc's back, in dre supine pori- ln drc scventies, many midwives rc- ring positio+ bccausc of is simplicity and
tion, heve loog bccn known. jccted the supinc posirion.and switchcdfabiliry, is an obvious position to choosc-
, F:sc e loc oftime and coergy is wasr- to thc semisining posirion ic which rhe A partrcr sis on a sof+ chzir, or bed bc-
/ cd on an unnecesary batdc agairut gravi- wom:n half sits and brlf lics, supported hind rbe womeq who squaa bctrcen her
ry. Lying on her back-legs in thc air, by pillows, with her lcgs slighdy bcnt and parmcr! legs. She rcss bcr errns oo tf,eir
knccs pulled up toward the chcst and hcr feer fat on the matqes. A new prob- . thigtu. If drc prshing is prolonged br any
spread aparr, chin on chesc-is cxccmely lem erosc; in this position, the woman! rcason, as it oftcn is with a fist child, the
riring for a woman in labor, In esscnce, weight tcn& co estrict thc birdr opening, woman is supponed by r small birthchair
this is a horizonrel squaning position, lcaving too litde room for drc baby! heed or by e bucket with a widc edgc on
which does opcn up thc pclvi: rnd rele-r and shouldcrs. If a womm wcte co rcmain which shc can rit couforably. Thfu cr-
the rnusclcs ofrhc pelvic floor, though io this posirion, she would expcrience an . ne support is usudly rcmoved thc mo-
nor u much as squ:tdng when onc ! ver- uncomforable countcrplcsur 6om che mcnt thc head pre:cnrs itsclf, becausc
ncal (sec Increased Mobiliry ofdrc Pelvis, rrrttrcss 15 the hcad dcscended end the during vcrrical dclivcries from thet point
gage 5). But 'tquattinC' whilc on one! anrs begur ro bulgc. This position is prr- on, many worncn no longer need ro
back rrn5 cravity inro e hindrance rather ticulady unsuitablc for a finc-timc moch- push.
than using it ro assisc delivcrv. The infcr- e( who musr exert more strcngrh to push Soine womcn shy awav from the
ibiliry of giving birrh in rhe 5upmc po- her baby rhrough rhe unpreplrcd birlh squatring posirioo bccause rhey've heard
f
tsition is rnadc very clerr when onc canal. If she is halfinrry berween sining rnd rhe misconceprion that Westcrn no^rV/
consrders the posicion assunred for defe- lying down, she cannor brrce henclfsuf- have become totally unaccustomed to
qi,r'-o, anorher expulsive funccion of chc ficienrly. Ic is not wichouc rcrson, lfter :quatting rnd chat the,v shor.rld mke spe-
|] We sit upright on rhc toilct, lnd pushing in this ptrsirion for l while with- cial courscs ro le.rrn to squac lintn rhe chinl
no faciliries:rre rvail:rble-on r out succLss. shc is .rdviscd ro lic down frr- monch oI pregn,rncy ou. lvtost wotncn
)in
camprng crip, tbr exlnrplc^_rve
sqult. [t ther ro pruvidc rnore roonl tbr rhc held who have rlelivcred in l squirttirrg posi-
ncvcr occllrs ro us ro lie dorvn to hrrve. :r
<r prsr thnrtrgh. rion hive, irt tlcc, pmcticcd vew lirrlc. E.r-
I
crcis!. durirg prcgr:tncy is helptirl but is on rhe gn>uml": slre krrows clcrcdv what is ofbirth is ful-
cnsu.r. lhirt dre cxpcrience
tilling ro yoLr rnd rhc orhers involvcci.
Abovc rll, keep in nrind rhrt this is your
dclivcry, your chiltl.
shJlelns 6.r.Fio rest bctwcen contr:rc- This is not thc crse whcn a women is in WHo wlr oe at the dclivcry?
rions. Tirgether they watch chc child being che supine posi<ion. Shc lies in a bed as if Do you want only your partncr to be
oorn. ill. rnd people rower lbovc hcr. making prEscnt, or do you want o invisc e friend,
More and morc ofren a woman will her feel smdl aiid dcpendcoc. Whcn thc sistir, rhother, or other rclativc.
invire r girlfriend or someonc with delivcry doci ndt go smoochly, she tends If you hrvc orhcr children, do you
whom rhe couple is very close to attend to surrcnder to dre specialist and gives up feel they should bc there, or wou.ld their
rhe delivery. Their prcsence adds an extra resporsibfiry. prcscnce discact or inhibir you?
dimension to the birth. Childbirth bc- Quitc aa unexpected dcvelopment in
comes morc ofa communal evenr. Flaving rerms of thc mothcr's 6rst conract wirh WHERE AAr You gging to dcliver?
a girlGiend prescnt givcs the woman who thc aewborn cbild was mede possiblc by At home or in a hospital? Ifin a hos-
is delivering e fceling of securiry which thc rrcrtiel delivery: she can see her chilSl pial, visil scleral in advance and ask about
hclps rclax her body, and thc woman at- immediarely and is the fi$t pcrson to hola their rcgulerions. Choose che. onc wirh
cending has a wondcrful oppomrniry to her baby. Whcn a woman- deliven in dre which you feel most con,fortable.
expericnce a binh 6rst-hand, gainilg di- sup+e position, thc midwife must lctive- If you decidc to deliver ar home' in
rccr c'ensfercnce ofknowledgc ra*rer dran V asstst thc hby! btd. Ithasbeenotlr-. what room will you give birth: thc iiving
having to e-xeact all her informarion 6om expcrience fiat such inrc.rcntsal!-lrs4ry. room, thc bedroor+ chc bathrioom? Re-
books. unnecess:lfv rrrlrn \rerucar ocuvcrtes. The membqr to take iq(o consideradon the
A Thc current devclopmcns in vertical cHfd ts born bv tsrtf. duc rc:se c""E "- size of the roorrq thc noisc lcvel, and the
\' ;rh have taken place primarily ia tions and grrvity, and $e midwifc {nctelv hcacing' You will also want to decide if
-circhcs
pmen's hornes. This is undersrandablc; it. The baby slidcs onto en ob- akiug a bach or sbower during labor or
t{r at homq in her own csdrcnmccg sur- sreEic pld on thc floor in &ont of thc dclivcry sounds appeding lo you.
rounded by people of her choicc, a morher. Thcre ale !o dmc prcssures; a
,/woman fcels free to take on her own po- waman cau, adhcc to her own rhythm, WHrcH PosITloNs aPpcal to you?
sition ald to follori thc. signals ofhcr rec6wring her brceth and bccoming at- srrl you squat, sen4 or krrecl? Ouc
body. Not only is thc position altercd but tuncd to hct child at her own pace. of the misconccpcions abou( sqqatting is
the whole amr.osphere around chc binh that one must plectice flom thc third
ch.angcs. Corsequendy, drc idea to which mon& ofpregn:nry. Aldrough uscfirl, ex-
MAKING ARRANGEMENTS ercise is not necessary. Most womcn in-
wc balc bcen conditioned for two ccn-
FOR T!{E DELIVERY tervicwcd in this book who delivered
mries, that a bcd is neccssary for binhing,
is no longer acceptcd as truc. Horpial de- Early ic your prcgnanry, it is wire to vcnicrlly did not do squ:aiag c:<crcises.
Iiwry rooms in which vcrticd deliverics discoss rhc type ofdclivcry envision
are standard praccicc coocain no bcds. wirh pur "ou and to
midwife or obstericien Wr.rAT Do You VANT to happen during
Bedrooms, oftcn small and the cbillicsr comc to firll agrcemcnt with bcr or him. your 6rst conact with your child?
rooms of the house, ztt usurJly less than To 6nd out during dre dclivery thet your Do you want anybody clsc to coqch
ideal locations for homc dclivcries. A opinions abour giving birth don't corrc- &c baby besides you and your parmer?
lwoman should choosc the spor in hcr spond with rheir mucine wou.ld be an un- Do you urant to bathe che babY Your-
J home rhat is most comfortable and warm. plcasanr surprise. If you feel the midwif;7 sclf or would you like your partne! !o do
The di-fercnccs in emorioru between or doctor should stay in rhe backgtound this? Would you like to grr into che rub
u tr wotnln in r horizonca.l posicion and l and lervc you ro iniiiaEe cvcnrs, yqu with rhe baby?
l. should talk rbout this. Both pardes must
F woman in a vcnicd porition arc ptobund.
In rhe vcrricrl positioo, shc h:'< "bgth fe"t be rbsolucely clerr rnd srr.righrforwrrd to
t1
F.t
\'
FiguF I
birthchair was uscd, Thc mid,wifc set in
front of the womrn on a small stool.
Helpcrs, on cithcr sidc or bchind, sup-
portcd the woman giving birrh. Birth-
Figure 1 Figiu$ 4
chairs ranged from hendsomely dcconted
dcliver, Lero had to flee ro rhe island of pieces such as Figure 3 (Moincr, Paul. Figurc 5 shows a Sious delivery, The
Delos bccau:c shc was chased by chejeal- "L'6nigme
de la Papesse Jeanne l' .Emiape woman, supponed by hcr parmer, scandt
ous Hcra. (Lero was expecting ,r baby by
fJanuary 19291: 320.) to simple woodin ro deliwr, and drc midwiG sis bchind her
Zeus, Hera! ,pous. ,rnd rh-c sl'lp..rrre chairs rhat wcte owncd by the commuoi- co carch thc child. (Witkowski, G. Hisain
dciry) Leco could bc dclivercd only ty end lent out for dclivcrics. Figure 4 dq Amrchements dc Tirrt lrr ftrrphs fWodd
,Greek
che hclp ofthe birth goddess Eilci-
n shows:t Rcnaissance delivcry on such r History of Giving Birthl. P.rris, lfitlT.)
is oftcn depictel giving birth irr An lbundance ofbirrh sccncr show-
\ ". *- poririon. birthchuir.
,rKnccling After nine long days The wornun in lrbor sis bolt upright, irtg deliverics in ..r virriery oi vcrticrl po-
lL
Lrbour in Centrrl Africt!' Edi uryh Mad. Over cinre, howcwr, evcn uncompli-
icrrl../orrar,rl [April t884].) carcd detiveries torrk phce in a supine po-
rition. The fccrl srechoscope, used to listgn
to fetal heart toncs, was invcntcd rround
FRoM VERTTcAL To ttls0. Wirh this instrument, che baby\
HoRTzoNTAL hearr roncs can be heard best when che -
[n the scvcntecnth rnd eightccnth mother is lying on hcr back becruse lhere
centurics, opinions rbout how to deliver is less movemenr.-tvlo$..nd.rnoq oftenr/
began to divergs from the spontaneous e"cn durinr normal dcliveries. che ert-
verricrl positiooi that hrd rlways been
used- Europe flourished economically. and born in ordcr to intervene if 4cccssaqr
the incrcascd weahh qlvc e boost to eL Fctal heart toncs were checkcd Ecqucndy
during d:c dclivcry mehing ic esscnrid fot
rhc woman to bc supine. In this way' with
en advance in tcchnology; albeit en in-
vcntion ofincalculable ralue, cven women
whosc h$ors progrcssed wi&out problems
lication of ?rcia dcsMaladies dcs Femmts werc delivcrcd ia a horizonal positioa-
Grcssu et tk ccllzs qui sotrt trouwlle ent e' Thc inveqtion ofdtc 6tal stcthoscoPe
Figur 5 6c change 6om lhc verticd to
expleias
-the
sitions comcs &om Robcrc Fclkin's late supinc+osirion6r dcliverics widrout
nineteenth ccntury rqPort' "Notcs on coriplications much mgrc pleusib.lv thalr
Labour in Centnl A.&ica." ln Figurc 6, a blhcr theoriG conccrning thls obstetrlc
-delelopsrcnt. ofdrc icxu-
woman in hbor sis on 1 trec trunl by the such as *!c cab
ally perversc Louis Xw or dre cxpbna-
A' .idc. Bysqnders maks music to evcn don *nt womcn harrc bcen "put ou *rcir
( \ ,:iris. Figurc 7 strows a deli'rcry in a -!iEii-!nisraA*"..."-.;;;;;;
t"-'fng posirioq a helpcr a'certs consider-
rics mcrely to Eqilitete dr obstecician!
-r1"'p.""t,ro. on dre woman's body 6om
job. The srory about Louis XIV cbirtr
behind. Figucs 8 and 9 prove tha.t stand-
ing duling dcli'/cry wus pncticed in A6ica rhar hc derivqd scxurl gntiEcetion by
as well. (Felkia, Robert Wi."Notes on wat&ing 6om beldnd I curtain rs his mis-
tcsses gzlrc birdr. If drcc women hed dc-
livcred fully dresscd on a
Figurc 8 birthchair, he would have
ouclrccs f!rcatise on thc Disc2ses Affcst- . seenvcry littlc. To
ing Women During and Post Femrm] in cnsure that drc king
1668 by drc French obcrctrician Fnngois would hryc rnorr
Meuriceau in which thc anatoury arrd oPPortuniry ro
physiology of Fmdc Epoductivs organs obscrve,
were dccribcd in detr,il. Solutionr wtrc
sought ro hclp women drrough diEcult
labors rnd to rcducc rraternal end infent
deeth ratcs. At thc cnd ofdre ssvcntcndt
ob-
Wrticul Dcliwry / s
pubic synrphysis. Thc result: the pubic dilrtating slightly more wirh citch con-
lrch is not srretched at l. tr.rction s irr Figure 15.
J Thc supin" position (Figurc '14) is I Ovcr rhc cormc ofcervicrl tlilatarion'
Scccr posirion for deliwry rhrn thc scmi- contnctions lengthen irrrd inctease in in-
sitring poiition bccruse the blck rathcr tensity lnd frequcncy. Thc womb be-
rhirn the coccyx is used rs the push-off corncs nrrrowcr during a contraction'
point. tVhcn I woman lies down rnd which rrises thc intrrurerine pressure. The
oulls her knees owrrd hcr chest' thc coc-
cyx is unobsructed and the uPPer Part
ofthe body is bent in a way that incrtas-
es the size of the pelvic opening' The
major dnwback oithe supine delivcry is
Figue 12 that gravity is not uscd ro the woman!
adwantage.
breeth in coniunctio
Figute 13
@@
lwoman uses rhc cocqrx as a Pusn- The shaPc end Posirion of the
y'off point; thus, the tailbonq is not
uterus during a contracdon-ex-
I able romove ouc of tbc wzy bccause tendcd, tiftcd, end forward-rans-
I of thc councerprersurc produced by forms thc vromb into e continuation
Ithe bcd. In rurn, thi: Pressurc is Figut! 15
of thc pelvic axis so ttrc i.PlO-*'
trurnised o both Pars of 6e Pubic tt" eftctitcty- wfttn
arch, pushiag rhe pubic boncs towzrrd each tlF',d grevity wod<s egirut
a"[*ty, p*ncs
a wom3n
"g"i-a
is in "crvix
thc vcrtical Posluon as
thc ocher forces, but in a vertical dclivery
ot}r"r. Fordrcrmot , whcn sitdng likc dris' graviry docs not
it worls in conjunction with dre rcsr of in
rhown Figure 16,
a woman's thighs usually are noc spread the forward movement ofche
apart far enough to puc tension on che thc birth proces and promoccs thc child! counteract
bir*t. uterus during a contraction'
ln thc semisicing or the suPine Po-
DuRINc CERVICAL DILATATIoN: A con- sition, the uterinc muscles must cxcrt
tracrion moves likc r wave chrough rhe
womb: it incrcascs in srrength' reacnes a
peak, rnd diminishes gndually' While the
ccrvix Lr closed. the force ofconrncdons
is distributcd equ:rlly over the enrire
wrnrb- Durirrg the tint sogc of hboc ccr-
vicll dil:rtetion, cottr.tctions qrusc thc cf-
fecrd ccrvix (Jll PxgEr)) to opelr slowly' Figurc l7
Figu.c 14
rcn to iit'tccn rnirrutr:r-,iitch day is I usc_
or rlr t of lrqr blby. (.5i,c Circulltrr>rr ot,
rut q.\(.rcBe.
Morhcr arrrl Qhild, belows.)
In the verricrl posicion, the tnnsrnorr Irr the supinc posiri()d, tltc lirrll oor_
t'runt rlihnriort contracti<lus to thc lctull
6 ti<lrr of clte birch clnul bcntls upwartl..rr
pushing ruru l nrurc nlnrnl coutrc. Dur-
shown in Figurc ?(). IJecausc the wonuil\
rurg rnaximurn dilatacion. the babylr
) hcld pr.rshes
rylinst gr.rviry when shs lis dorvn,{
pushcs with gn:atcr lirrcc becauc ofgrlv_
the pelvic tloor antl perineurn. th.
iEy. so the wornurr really feels the urge to bctween rnus rnd vaginl, becorne "...,r )
rI
y'ush.. Ttaching thc "pushing cechnique.' "nrounrain" over which she nrusr pushJ
usultlly bccontcs superlluous lince rvQmcn tlre babv
in rhis position almosr rlwrys san to push / Figure 2l illustratcs rhar pushing wirh
Flgure 18
inruidvely during che perk ofa cootrac_ grrvity is the line ofleasc resisurncc.
rhemselves lo drc urnost during each con- tioo, Thcrc is absolutely no necd to rcll r
araction ro lift the womb againsr th force woman who i: in a vertical positroo
S'RcyrArroN_CF MorH
co
,of gnviry (Figure l7). flrs-rakelgflq_ "ukc r dcep breath, close offrhrcrc, pur Nerrly-dl-expeCrancrvomcnGmJEiii-
/_"*"y tfu- ".-i""1 aiUillil six monds ofprcgnancy on have e.rpcri_
1@ cnced fceting lighdrcaded, shon ofbrqaih,
mother and child needlesslv.
and anxious rftcr lying on their backs for
|(, FF;lttti.rrr6that when a u short a pcriod of timc er five mjnutes
woman leans forward as she sits, rhc
to balf rn hour. !n the supine posirion,
womb is r.lready ti.ked slighdy so ao en-
dre hczvy wornb css on thc ioGrior vcna
crgy nccds to be diverted &om the con-
cava, e large rcin dret rcqrms blood to qhc
traction to move the ucerus to this Figue 20 hcarq causing a severe drop of venous
position. In this maruer, graviry ncreascs
blood to thc hean rnd a dccria;e ofoxy-
rhe eFectiveness ofthe contracsioru and chin on chest" prcGrably rhrce timc dur- genaced blood o the aoro- Ukimarely, ar-
acceleraccs cewicd dilatarion. ing a conaection. Uoless coached o oush tcrial blood prcssurc decreases and the
difcreatly, the rendincy ofa women dc- women feels feint, but dicse symp<oms
f.t R.rNG Tt{E PusHrNG STAGE; The sup- livering supinc is ro :ubsritute making disappear whcn she turns onto her side.
\orred squattiag posirion i5 somcri.gres noiscs &om rhc throes for using thc eb- Thc hlporcnsion also affecs rhe blood./
.)nsidcrcd ro bc too &tiguing, if not im- dominal musdcs ro move drc baby. push- fow through rhe placena, which means
7q from the abdomen in r vcrtical the child! orygen supply is insufi.cicnt
posicioa is morc ef,cctive for rwo reasoru: when thc mother is supine.
fusdy, thc abdomind muscles nced uot A: mcndoncd previoudy rhe increz:e
work againsr graviry, and secondly, thc of intrauteriae pressulc tt thc pcak ofa
raoman does nor need o lG up hcr head contncion reduces placenal blooci flow
This means intra-abdominal and in- ro its lowest lcvel. The blood f,ow im-
c'rthoracic prcssure' pressurc betrrecn thc prcvcs betwcen concactions, rnd the childT
rnodrer's neck end rbdomen, will not risc can "rccover iE breath" whcn a woman
as much when she is rrertical so there is is uprighr. Dcliveriug in a rrcrtical posi-
less chance of hindcring hcr circuhtion tion prwens circub,tion problernr 6r bodr
Figqr. 19 modcr and child. [n drc supine posicion,
howencr, thc relaxed uctu5 6llr onro the
possible, for wesrcrn womcn during
the infcrior vene cava during this recovery
pushing scagc. [n our culture, wE slc on
suge. A finrs io prime condition can bcar
chairs rnd arc noc used ro prolonged
quirc a biq u4 in gcnenl. the supine de-
squardng. People in ocher culturcs squar
Iivcy docs nor lerd ro infaots born in no-
whcn at rcsr as wcll as when workins.
ticerbly poor condirion. Nevertheless, ic
During pregnancy, ir is advisable to bJ-
is not inconccivrblc thlc rhe chilu nuy
comc comfortablc wich the posirion,
sutfer unneccrsrrily during ln cxcended
)quacing*fhr foorcd wirh back agarnst
supinc delivcry.
'r (Figure l9), sc.rrring wich
,,.t-'- one to
\:.:- . .mulcs fi a lirnc :rnd building up to
Figure 2l
)
Wrticul Dcliucry / z
helpers turn ittto spcctators around espected rrury ltappen during rhe clelivery
Il*vt:goLo<;lcnL thrt requircr:l wotllan to be tmnsprrrrecl
(1, /ANTA(iES 't v:tgirrlr' which is suddenly Pronounced
to a hospitrl. Lrbor i: interrupted by tlrc
\!-,ff.,. verrictl poririon is the optinul ro be public erritory' Arsisunts nray nor
trip, lnd the wouun rnry tLcl rirsd fronr
,rot only because i! co- sce the whole womln-l
physical rnd
",.,J.r"
*"i,i"lt the contoctiotu and dis.rppointed thlt the
;".;;: ;ld.' " woman'.s physiology and enrotioni bring-when the woman she is sr'rpine'
giv- delivery b-not going ru plarured. A womarr
;:;;;;:; -*;, p".."b".""'"-of th" hr I venicrl delivery
nee& to grthcr her sttngh rt such r 1no-
birth dirccs the process md i5 activc
i.rioJ.ltti,"".:. n hu on her emotiond ing ment. Thc end is in sight' and thre is
i.'.r.'ri r".rr_u"i"g. when i wonirn phvsicdly rnd mentally. "Bystanden" bc-
comforc in knowing that r portion of rhe
jiil ;; i.ri*''-1ii ot r"*r *i*' T"" P.rT* *-!o, asisr hcr in her eEors'
"t '*
J,il":gr"grl''6,1*.".:"":ff:[:ililffi delivery took phce in her own environ-
she is their socnl equal. )ne ren HffiTiltrTffi lln ment. Her contcntmcnt with fie deliv-
cry should not dcpend upon whethcr the
around much les dcpcndcnt on iruauctioru &om
concrcr wich what is happening birth followcd I narural counc, but rarhcr
con- ochcrs' This bqoss hcr sclf-confidencc and
her and crn indicarc her desires, can with hcr unon the knowlcdge that she did cvery-
ne:c enables her.to deliver her child
; ;;"' or can waic quiedy for thc ,hir,g -i hitt htt powcr co bring chc de-
Own Strengtll'
COnFaCllOn' livcry to r hrppy and safc end, whercver
Another prychologicd bencdt sfde- end however rook plecc ln addition'
it
livcring upright is that shc is fa{niliar wi*r thc eadition of homc dclivcry has had r
&.nily she has asked to atrcnd tbc delivery. thcy call for mcdical advice right thar readys tbe body to defcnd itself.
Some womcn may want to call ttrc mid- Adrcneline countcrlcts oxycocin, andrz
wift or doctor imrncdiercly qPon dtc on- A woman should cdl for essis- rhercby rcduccs the effectivenqss of dre
ser of contncdons, while ochen choose . taacc immediately in the following contnclions. Conscquencly, dclivery is
to wait awhile. Most likely, rhc midwife ququttulatc6: prolonged needlessly, posing edditional
' will gcrform a vaginal ocamination wbcn * her arnniotis fluid has a grccu or risk for morhcr and chnd. Di:ru1!arrc6,
she errives. Shc will fccl how soft thc blown iilge; which rt odre! aim6 would bc considctrd
celvix h.s bccomc, to what cxteat the *hcr wrcss brcak ard dc baby's hcad inconscoucntid crrcng.-, wrooc word. a /
r:::::
cewix hes opcned, and how far dre brby! hed not dcsccnded propcdy at lougn bucn. 1_!99!!egglggg!lP:9!_
hcad has desccnded. Ttis procedurc can her previous checkup;
a shc loses e corsider:ble rmount of
@
woman drring contnctioru. An uncom-
be donc easily when the woman sirs on
a birthcheir, dnd in thi5 posirion, thc cx- blood (saurarcs two saniury nap- forable position or a ringing phone can
aminadon is less uncomforEblc becausc kins widrin rcn minutes): or cause irritation when shc is crying co givc
rhe perineum is rchxed and che regina is <shc fcels rnxious. in what is happening in her body' Sim-
co
morc opcn. After scverrl hours of con- ple steps, such u closing the currains rnd
tracrions, a womrn may be buming with Ifnonc ofdre abovc applics, thc unptugging thc phone, cirn Prcvcnc Po-
_.-c'riosicy to know how t'lrr dilatation has crn wait to call hcr midwit'e or ob- tencial disruptions.
(: rcsscd; the rnidwitt nr:ry be cqually sretrician undl the contrecrions in- Most olicrt. r wottutn's hotrte is where
\urious bur rcluctant so chcck v-rsinallv rensif. llnd occur evcrv lhree to hve she'll Gel nro*t corrttirrcablc rvhcn givirrg
' u!dL{h<,&qJil{-ir-urEgs\{f _b9g*Es_glgh_ .-minuces for h:rlf ln hotlr. birch: howcvcr. sottre wortrcn tlcl slti'r
cs;rrnirurtion iocrclscs rhc chlncc ofirt- rrtd ntoni c(nntitfi:rlrlc clclivc'rirrg irt I lros-
rccll()ll. pitll. lt:r worttirtr Prcfi'rs to lt:rvc hcr bxby
bn,rthirg p:rttcrn to wlrich shc cao cling nraking it crsier for her to surrcnde.r t<l
' Vrtical Delioery
duriuq l contnrctiorr, Shc rhould brcrhc
l nunner dut corrcs nlnrmlly to her, as
itr
the linrl, nrost diflicult contractions of
ccrvicll dilirntion. [n r brrhtub. shc cln
at . " I
{ - '
tn a trlosDttal cxrtglrcnting hcr brc:rching by irrhaling or lie full-lcngh on her bitck or on hcr sidc,
,
'H()st'[f l,S H()US|: MANY
...
n:slucnt Uirc-
exhllhrg too rlccply might cluse hsr to letting her rrms lnd legs florr. lrr rhc
lrypervenrihre. shower, r womrn may wrnt to ii! on l
rri:r. llccrusc :r womln is in l frrreigr
srool lnd have her feet rcscing in a fooc-
cnvinrntttent. her body h:rs not hrrl I
Posm<>N.s;_ Ccrtrin posirions, which rrc barh.
chlncc to build up rcsisrance to thcsc
crlled lcrive positions, makc concrrctions
ofinllction. Thc dc-
pgicnd:rl sourccs
crsier :rnd morc effecdve. During ttre ini-
livery room noor E Probably not hy- PUSHTNG
tial contractions, urany women feel in-
gienic becruse so many pcople move
clined to w'rlk. As dilaocion procqeds, we The nexr phasc, thc pushing, begins
in and oltt of thc room during the
rccommend rhit womcn reduce mgvc- wirh chc pushing urge, which women de-
birth. Thercfore, thc hospital floor is
mcnr rnd assumc rn active posicion be- scribe a! en irresistible urge to bcrr down.
ursuitrble for vetical delivcries, and it
is neccsary to use r smdl pladorm to
causc mo much musclc activiry stirnuhtes lVomcn oftert say they 6il they can 6nal-
adrenaline, which can prolong delivry. ly coirtributc acdvely to the birth when
providc a sanitary foundation for dte
The posirions illustrrted herc usist thc pushing bcgins. After hours of dealing
birchchair. Only the woman end hcr
wqomb in ics movements end improvc with cervicd dihation, pwhing comcs as
partrlcr gP onto thc Platrorm, and thc
blood 6ow through rhc pleccnca as wcll a relicf. But pushing also means hard
midwifc or doccor sits in front of
as being soothing for *rc woman during work. A woman may ger discouraged if
chem.
labor. thcre is no visible progrcss aftcr half an
T'beBittbcbair
muscles bceusc thc beby's head slowly
strrtches thcln ald evcnlrally pushcs thcm
qas- A woMAN wHo eusnrs much longcr than rcn minutcs uay find shc requircs
. zsidc. The less tensc musclcs alp, tbe
morc supporr dun tlnt which hcr parmcr can providc' Thc edditional.suppon
of
. i-r thry arc sEctchcd rud dre lcss pain is tbc birthihair is especially helpful foi 'romen dclivering tbeir 6rst child' during
A :. When squetting, the gluteus max- which ttre pushing gencrzlly talscs longer rhan wirh sub'scquect dcliveries'
t..nq r crusclc il dc buoocls, ir smrched .ftttrougtr birGheirs in onc form or :nothcr have bcen uscd drroughout
/e*ay &om the body. Squetting dlows
history (se iistory pege 3), in the recent prg a undl buckct-w1 ycd
to suppon
morc sPacc eround the levator eni, the birdrchrn is eraihble to
rh" ,",om"o ,r,hilc she squamd- Now e specidy dcsigncd
rnosr imporent muscle ofdre pclvic floor, ftom material that cen be
faciliratc *re position. birthchairs are manufactured
which stretches rcadily in this posirion.
c"sily cleancd, and a steinles ircel pan wirh a scalc reading to cerch and
measurc
blood and mniotic Suid slips into ttrc bottom of thc cbeir's base- In ordcr to
preveoc rcstriction ofpelvic dgr,unics, thc chair is loa' rnd sheped likc a horscshoc'
ih. ogp.t .htfu arrd ouccr pordon ofe woman! bottom resc on the lip ofthe
bi!&ci;. Exc-ellent suppon is grovided' which reduccs dre problcm of the lca
getting soc or felling aslecp, while et dte seme time drc trilbore rnd Pcrincun
rc-
i,.ir.irr.oo6o.d. ihc o,oman brs considerablc &eedom of movcmcnt' Thc
ctnir har no beck end no leg- or ermrtss' so no Paltiqqhr Position is imposcd on
hcr' sup-
Pdvic f,oot tn|t!.lc. vicwld &ortt bclc* dre vroman rs shc sis. The 'rdjrstrblc baclsJ' hct percncr who sis bchind
pors hcr ls she wishcs. The prrmct! head is close to thc woman's' rqaking it
casy for talking. This intimacy crc-
As disctrsed prcviously, the birsh cand is at
atcs e sease ofsccuriry. Beni'esn con'
is widcst whcn a womrn is in a squaning
rt oactioru, stre en lern back rnd rrst in
posirion, rhd cvery millirneter couns
her percnerls ar[E o! can ge! uP to
this point A woman may wanr to changg
itrqtch hcr legs or can lower herself
her positic o during rhe pushing, r.ltcrnat-
Eom the chair and kncel. During.che
ing berween
final pushing conroctiors. as drc hsad
Besidcs offering somc
begiru to show the binhchair is usu-
., iery switching positioor improves che a.llv tcmovcd: howevc( r wornan cln
(: rd flow to her lowcr body. Anorhcr
continue to siton thc chair while the
\,6otion is thc birthch;rir.
child is born.
During thc pushing, it is rlso inrpor-
rant for tltc gctittcttttt. thc:rrc:l bclwccn
I
rltcrctinr. tllc pcrirlcunl bccorncs lcs\ vul- contracr stongly so the brokcn verisels irt
ncrrblc. Jltis xhlt! itl-wllght exphins thc: thc wrll arc tighcly constrictcd. The con.
,z'.rcsd-rrttr-t-jb:Lqt+Errtq -t!4s-nod-cpt tractious rhrt follow rhc child'.r birrh are
pruies (rr incision nr:rdc in the pcr-
ft\ 11,u,.,u.1 crlled rftcrpains.{he los of blood jgg3t'-
vagina) with vcrtical births; ...-|--+
rer 1l9llt!4!9ry9ry !Q!y seem_iq_be
h1;wcvcr, snltll labitl tears do occur more .----"i--'r;-----:-
rrtner he ry: duc to gnvity, arnnioEic tlu_
frcoucntly rvhcrFthc wornen is uPright. id and blood leave the bodv dmost rm-
Such relrn lrc oftcn supcrdicial. heal prac- mcdiatcly. This should nor alarn: the
cically rvithouc scarring, lnd d<> not cause woman as it is actuallv advanrageous.
womcn discomtbrc during intercoune tbr Whcn bloo4 lcryrs drc urerus wi*rour dc_
up ro six rnonths :rftcr the dclivery as is try, connzguoru arc morc effectivc, which
often the casc with episiocomies. Whcn enl, r wom.an who listens ro hcr body can dccrcrses fur(her bleeding and causcs che
oerincal rcrrs do occur in"a vertical dc- tell rhat she must rlow rhe delivery tbr if -pl""cnto to bJ?iUG*IE*e, w. r.c_
*livcrv. -!h'erc can be considcrable blood she doesn't, she will have a sringing, burn- -ommcnd rhat rhc wornar, 5l! on a
loss, most likcly due to snviry. nrisl.oL- ing scruadon in hcr ragina. All that s rc- birthchair so drc blood and placena can
lcm is solved temporarilv bv having thc quircd for thc babyt hcad to be born is bc collccted and mea:urcd in the pan ar
for rhe wornan to sigh. Many times, with is base- In the supinc posirion, blood says
onc more gendc pus[ thc resc ofrhe child wirhin rhe urerus unsil thc pleccura is
cmergcs inro chc hands of the midwifc, born, which sometirncs skcr r few rnin-
who hy: the infant on *rc obsretric pad utes longer to occur thzn wirh a yerticd
so mother and child can enjoy chet first delivery.
contact in chcir own way. The woman In addition to helping dccreasc blood
may sink ro hcr knees or sit down on thc loss, aftcrpai-rs rssist rhe womb in is rc-
pad wirh hcr child. Immediarch she sees tum to prprcgnancy size- Women oftcn
*re child's gen&r and whcdrcr hc baby is haw afterpains when they breesdecd be-
all right. Thcn she can adjusc to thc new ceuse brcart stirnuletion rcleates oxytocin,
/1 situation lt her own pace, picking up the whid in Urrr4 causcs uterine conaactiors.
).; scwborn whcn she 6els rcady. The womb ofa multiprrous wotrrn, a
woman who has dclirrcrcd morc rhan one
@ AFTERB IRTT{
child, is less eladc than drat of a first-time
livery to stop th. hlecding- modrer. With cach delivery thc wcmb's
On is way to the ousidc world, rhc Thc uterus will coatrrct after the abiliry to rcturn to ic original size de-
baby ha; to rum t corner underncath rhe child is born, causing rhe placcna and crcascs. This los of elasticiry ecplains why
pubic arch. Duc to geviry this ekes place membnles ro furdrct disengage ftom thc multiperous womcn ofrcn have morc in-
more swiftly and smootbly in e vcrtical uterinc wall end be born. This event is tcnsc afterpains and for a looger period of
dclircry. Whcn thc hcad has pasred thc cdlcd *re aftcrbirth. If a woman 6els anr- tirne-up to duce to 6ur dap aftcr thc
barricr of rhe pubic boncs, rhc prcssurc ious rbout drc placcual rrrive!, her srcss birdr.
on the ragina incrcascs and che head will ruy disturb thc process. Scudies indicate Following thc afterbir*r, rhc midvrife
soon be in sight. Once thc head ir prc- that 6e intque cmodons ofthe 6rst qon- chccks dre pcrineum and wagina for teas
scnrcd in dic vcrticrl dclivery it docs nor tlct bcclt ren nodrcr urd cbild induce sc- thac may have occurrcd during thc deliv-
reEact, disappcari.qg bctrveen conertions crcticn of the horrnone oxytocin, which ery. A sevcrc tclr or ln episiocomy must
a numbcr of timcs, es is usually tbe case incrgascs thc intcnriry ofuterinc concrac- be rcpairtd. Thc rrea is scnsirive now, but
in supinc delivcries- Ar dris sage, follow- tiors. Oftcn whib she is cngaged wirh hcr thc women is givcn r locrl ancsrhecic. A
ing thc midwife's irssuctions is vital for baby a woman will have concactions or e minor tear will herl of is own eccond lnd
gtcvcnting tcars. Aftcr rhc head crowns, slighc pu:hing urge, sigru *rat rhe placcn- does not rcquirc sticchcs. Afer the raginal
pushing acrively is no longer oeccsary; in ta i5 on iE way. argr is checkcd, morhcr and child can con-
facc, women are encouraged co pant, Giving birth to rhc ptaccnra entrils !inue their finc corrcacr.
which slows rhe passage of rhe hcaq, so los ofblood, To prcvenr excessive blced-
the vagina is strcrchcd gradually. tn gcn- ing, ir is cnrcial drrt thc userus continue to