Centered Approach Childbirth Education

Introduction

As humans, we need to learn new skills that will help us to broaden our knowledge and everything we do in life, obviously when it comes to child birth, new mothers have the necessity to learn. Adults learn better in a group as they feel more comfortable that someone is experiencing the same thing, that make adults put more interest, they create a network support. Also, they see the positive side of things. I alleviate their fears and worries, having the support of the fellow group, practitioners and other group along the way will motivate each other specially knowing they will experience it at some point (Landon et al., 2004).

My rationale for the early stages is that if an expectant woman is to understand the changes that take placed in her body during pregnancy and early labour. A practitioner using an expectant mother -centred approach that will give her the opportunity acquire information and will make informed decision also she will have the opportunity to make informed choices. Being a new expectant mother is a major change and challenge like most things in life there is a need to learn to gain knowledge from practitioners and others around you (Cram and Gore, 2014)

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Referring to my signature and breastfeeding observation, I observed. I have used that observation using expectant woman -centred-approach for the group to join in the discussion to empower them for a better understanding. I intended to use this method to motivate as well get the group engaged, creating wider discussion and exploring things in different angles.

My rationale about pain relief is to highlight the group can research about the effect the use of natural things such as warm water and endorphins from human hypothalamus as pain management method with a calm and familiar environment and a companion. also explore simple pain control machines such as tens machine, getting to know how the Tens machine works will give them a better understanding of how it works for future use using this kinaesthetic will we keep the group engage, strengthening the discussion and keep them motivate, it will successfully encourage them to identify ways to distract themselves and use les energy during the early stages of labour.

Thinking about gravity helps the baby keep descending during labour and reducing the time considerable during labour. My rationale behind that is that when you are busy with these different positions you don’t notice the time which is a good way of keeping the mind busy, giving a sense of pride that you are utilising your time well and looking forward to shorten the length of labour ( Cochrane).

Agenda setting and plan sharing

Also breaks are very important although, bearing in mind that to have an effective class run, adult learners need breaks in between classes to stretch, change positions, have refreshments also interact with each other to make friends by the end of the course to keep their network going (Robertson, 2006). Promoting active learning describe how you plan to promote the active learning ad visual aids.

Considering that adult lean better in a group, I have planned to do role play being in mind role play help people to remember it better, were couples will have the opportunity to practice and get a better understanding of the advantage of touching and using our hands, I intend to demonstrate how the Tens machine work among the group, how to use the birthing ball safely, some upright positions making sure the group participate to have a feel of it.

Labour of Pregnancy in Women

If the pregnant woman has been pregnant for less than 37 weeks, her midwife should be called if she is giving contraction and having: A bloody vaginal discharge or watery discharge and/or Cramping or lower back pain The signs like these are the ones that the pregnant woman can be going into premature labour. Following 37 weeks, the midwife or the doctor may be called if: She thinks the movement of her baby is been slowed down She thinks her waters have broken and/or She is having bleeding From 36 weeks, she should be readying for labour (Oxman et al., 1993). What are the signs of early labour? It is exactly unknown what set off labour. The natural hormones control the contractions in the body, which is mainly oxytocin. The external environment and the emotions influence the hormonal activity. For instance, stress of fear experienced by women makes it unlikely to be starting or continuing the labour till she feels more secure and relaxed. The patient’s baby’s stage of maturity, position, and actions may be influencing the progress towards labour. What are Braxton Hicks? The causation of the Braxton Hicks contractions is by the muscle tightening of the womb (uterus) to prepare for labour. This is the reason that they are known as the practice contractions, and have been painless generally. Around the middle of the pregnancies, women start feeling the Braxton Hicks. However, it is in their late pregnancy they have the tendency of becoming more noticeable. However, Braxton Hicks symptoms keep coming and going and at time they are not noticeable. However, women must be aware to have one during or after sex as there is production of hormone oxytocin and with sexual arousal the contraction of uterus is also caused (Guyatt et al., 1993).

The process with which preparation is done by the cervix for delivery is the effacement. After the engagement of the baby in the pelvis, usually it drops closer to the cervix. There will be gradual softening, shortening and thinning of the cervix. The phrases such as “cervical thinning” or “ripens” refer to effacement.

Upright positions

Without doubt encouragement should be given to pregnant women in utilizing positions that will be giving them the benefit, control and greatest comfort during first stage labour. In the western societies, usually, women lie in bed during their labour’s entire duration; the benefits and risks of those positions should be known and understood by them (Jacoby, 1987).

The contractions are mostly potentially painful, and prolonged labour is generally exhausting and overwhelming process that results in augmented need for medical intervention that for women have meaningful outcome. For women, one more key outcome for those who are mobile and upright compared to lying down in bed is inclusive of reduced risk of their babies needing admission to the neonatal unit, fewer use of epidural as pain relief method, and caesarean birth. It is recommended that women must be supported and encouraged in using the mobile and upright positions of their choice in the time of first stage labour. This is because it can enhance their labour progress and may be leading to better outcomes for their babies and for themselves.

The advantages are significant to assume an upright position in birth and labour (Lawrence et al. 2009). However, the most frequently used position continues to be lying down. Midwives have to be proactive to demonstrate and encourage various positions in labour.

The postural coping strategies’ usage during the labour’s first stage has the association with the provision of pain relief and to help a woman coping with pain (Spiby et al. 2003).

For the labour’s second stage, usage of upright positions have many benefits that includes the second stage that is shorter, fewer episiotomies, and fewer instrumental births, although there is greater estimated blood loss (Gupta et al. 2004).

Pain Management

The transcutaneous electrical nerve stimulation is what TENS stand for. The machine sends painless and mild electrical pulses to the pregnant women’s body when they have contractions, via sticky electrode pads having attachment to the pregnant women’s back. There are several women finding this to be helpful in reducing the pain that during the labour is experienced. The way TENS machine provides helping hand in relieving the pain is not exactly known, although it is thought that the nerves are distracted by the pulses that transmits pain. The use of TENS machine boost the endorphin levels of a pregnant woman’s body also.

I have seen TENS machine used at home. It has several settings and digital display and the settings include massage setting having strong pulses or lower-pulse frequency. The machine is lightweight and is equipped with a belt clip so that it can be moved around when used. In my home it was found out that during labour, moving around can help the woman feeling more comfortable (Shea et al., 1998).

According to the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists, the uncomplicated pregnancies of the healthy women must have the water bath option and if they wish they can proceed to a water birth.

Various research studies have shown that labouring in water, for most part, have the advantages as follows.

Women having the usage of water have expressed the feelings of being more in control during their labour and have greater satisfaction with their birth experience. Women using water bath have been found to be more relaxed, having less painful contractions and having used fewer pain killing drugs, such as epidural or pethidine Slightly shorter labour and having less likelihood of speeding up with oxytocin drip (Feldman, 1992).

Additionally, it is also been found out that to have water birth will have the reduction of chance of an episiotomy or the tearing of the vaginal area making it unlikely for needing stitches. It is also evident that special care baby unit is needed to be admitted to fewer babies after a water birth. People often use warm water in helping them relax and unwind. The pains and aches are eased by a bath and at end of a day; a long soak can provide a great deal of relaxation. The pain relief can be provided by the warm water during birth and labour in the same way.

The research is suggestive of sufficient preparation helping reducing pain or modifying the pain perception and reduction of anxiety that will help a pregnant mother coping with labour. The other options of non-drug pain relief are: It is important to have a good physical condition. Exercising regularly and gently throughout the pregnancy, having balanced diet, and eating healthy, and avoiding alcohol and cigarettes The pregnant mothers should know the expectation of reducing anxiety during different stages of labour. It is recommended to have antenatal classes. The techniques of breathing can be a helping hand to the pregnant mothers riding the waves of contractions. Close and constant support from their partners and other loved ones and friends can reduce anxiety during the labour (Votta and Cibils, 1993). The use of distractions such as music can provide help taking their minds off the pain. A warm shower, massage, and cold or hot packs and to keep one active can also help Acupressure, acupuncture and hypnosis are some other areas that can be considered too, although there is little research in these areas

Physical skill close contact building up oxytocin

The use of various positions in staying upright and mobile during labour may be a helping hand in progressing faster. They can also be relieving back pain, encouraging the pregnant women to open her pelvis and helping her coping with pain of contractions. Position 1 To stand forward lean This has the suitability for first and second stage labour. The pregnant mother while being supported by her partner should take full advantage of gravity. There is greater room for her pelvis in this position and the baby has a good likelihood being in good position for rotation, descending and flexing his head for birth. The back and labour pain can be less intense and the pregnant mother sway and rock through the contractions. Position 2 The slow dance This has the suitability for first and second stage labour. The pregnant mother needs cuddling from her partner and a boost of oxytocin. The pregnant mother while being lovingly supported by her partner should take full advantage of gravity. There is wider pelvis in this position compared to lying down or sitting (Olofsson and Saldeen, 1996). The baby has a good likelihood being in good position for rotation, descending and flexing his head for birth. The back and labour pain can be less intense and the pregnant mother slow dance through the labour. This position is good of the labour has slowed and the mother’s cervix has dilated fully for a while although the strong urge of pushing is not there.

This has the suitability for first and second stage labour. There is more space of pelvis in this position compared to lying down or sitting. Therefore, it can be a helping hand when there is slow down of the labour. For backache and rocking gently it is good as the birth partner can provide back massage or putting steady pressure on the mother’s lower back.

Rupture Membrane

Rupture of membranes (ROM) has been a term in the time of pregnancy for describing the rupture of the amniotic sac. The amniotic sac is a fluid bag inside the uterus of a woman where the development and growth of unborn baby takes place. It is often referred to as “membranes” as the sac comprised of 2 membranes known as chorion and amnion. The amniotic sac has the filling of straw coloured, pale, and clear fluid where the unborn baby moves and floats. During or before the labour, the amniotic sac breaks along with the draining of the fluid out of the vagina. This is referred to as water breaking.

The types of rapture membrane include spontaneous rupture of membranes (SCROM). The term describes the spontaneous and normal membrane rapture at full term. Generally, at the bottom of the uterus is the rapture and over the cervix that causes the gush of fluid. The second type is premature rapture of membrane (PROM). The term describes the membrane’s rapture occurring before the starting of labour. The third type is preterm, premature rupture of membranes (PPROM) (Bennett et al., 2008). The term describes the membrane’s rapture occurring before the gestation of 37 weeks. The last type is artificial rupture of membranes (AROM). The term describes the membrane’s rapture by a third party, generally an obstetrician or a midwife for inducing or accelerating labour.

Four of the main active hormonal systems in the time of birth and labour involve adrenaline and noradrenaline, hormones of excitement; endorphins, hormones of transcendence and pleasure; oxytocin, the hormone of love; and prolactin, the hormone of mothering.

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References

  • Bennett, S., Cullen, J., Sherer, D. and Woods Jr, J. (2008) ‘The Ferning and Nitrazine Tests of Amniotic Fluid Between 12 and 41 Weeks Gestation’, American Journal of Perinatology, 10 (2): 101–104.
  • Cram, K. and Gore, S. (2014) ‘The ‘Father’ of adult education: Malcolm Knowles’, International Journal of Birth & Parent Education, 1(3), 47-49.
  • Feldman, G. B. (1992) ‘Prospective risk of stillbirth’, Obstetrics and Gynecology, 79(4):547–53.
  • Guyatt, G. H., Sackett, D. L. and Cook, D. J. (1993) ‘Users’ guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid?’, Evidence-Based Medicine Working Group, JAMA: the Journal of the American Medical Association, 270(21):2598–601.
  • Jacoby, A. (1987) ‘Womens’ preferences for and satisfaction with current procedures in childbirth: findings from a national study’, Midwifery, 3(117):124.
  • Landon, M. B., Hauth, J. C., Leveno, K. J., et al. (2004) ‘Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery’, New England Journal of Medicine, 351(25):2581–9.
  • Lawrence, A., Lewis, L., Hofmeyr, G. J. et al. (2009) Maternal positions and mobility during first stage labour, Cochrane Database of Systematic Reviews, Issue 1. Chichester: John Wiley & Sons.
  • Olofsson, P. and Saldeen, P. (1996) ‘The prospects for vaginal delivery in gestations beyond 43 weeks’, Acta Obstetricia et Gynecologica Scandinavica, 75(7):645–50.
  • Oxman, A. D., Sackett, D. L. and Guyatt, G. H. (1933) ‘Users’ guides to the medical literature. I. How to get started’, The Evidence-Based Medicine Working Group, JAMA: the Journal of the American Medical Association, 270(17):2093–5.
  • Robertson, A. (2006) Empowering Women: Teaching Active Birth (Updated edition), Camperdown, New South Wales, Birth International.
  • Shea, K. M., Wilcox, A. J. and Little, R. E. (1998) ‘Postterm delivery: a challenge for epidemiologic research’, Epidemiology, 9(2):199–204.
  • Spiby, H., Slade, P., Escott, D., Henderson, B. et al. (2003) ‘Selected coping strategies in labour: an investigation of women’s experiences’, Birth, 30: 189-194.
  • Votta, R. A. and Cibils, L. A. (1993) ‘Active management of prolonged pregnancy’, American Journal of Obstetrics and Gynecology, 168(2):557–63.

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