Alternative Methods of Birth

In addition to varied settings, several methods of childbirth are popular. These include alternative birth
methods such as the Leboyer method of birth, birth under water, and unassisted birthing.

THE LEBOYER METHOD

Frederick Leboyer was a French obstetrician who postulated moving from a warm, fluid-filled
intrauterine environment to a noisy, air-filled, brightly lit birth room creates a major shock for a
newborn. With the Leboyer method, the birthing room is darkened so there is no sudden contrast in
light; the environment is kept pleasantly warm, not chilled; soft music is played, or at least harsh noises
are kept to a minimum; the infant is handled gently; the cord is cut late; and the infant is placed
immediately after birth into warm bath water.

Some neonatologists question the wisdom of a warm bath because it could reduce spontaneous
respirations and allow a high level of acidosis to occur. Late cutting of the cord supplies extra white
blood cells to a baby so the newborn can increase resistance to disease but it also could lead to excess
blood viscosity. Certainly, soft music, gentle handling, and a welcoming atmosphere are important
ingredients for all birth attendants to incorporate into birth. Providing dim lights (or at least not bright,
glaring ones) and providing a warm temperature could be given more consideration in most institutions.

HYDROTHERAPY AND WATER BIRTH

Reclining or sitting in warm water during labor can be soothing; the feeling of weightlessness that occurs
under water as well as the relaxation from the warm water both can contribute to reducing discomfort
in labor. Using this principle, many birthing centers allow women to labor in warm showers or give birth
in spa tubs of warm water. The baby is born underwater and then immediately brought to the surface
for a first breath. Most women who choose underwater birth are very pleased that they chose this
method. A potential difficulty is contamination of the bath water with feces expelled with pushing
efforts during the second stage of labor. This could lead to uterine infection in the mother or aspiration
of contaminated bath water by a newborn, which could lead to pneumonia. Maternal chilling when a
woman leaves the water is another factor to consider and prevent.

UNASSISTED BIRTHING
Unassisted birthing, freebirthing, or couples birth refers to women giving birth without healthcare
provider supervision. It differs from home birth because, using this technique, a woman learns
pregnancy care from reading books or articles found on the Internet and then arranges to have her child
birth at home, perhaps accompanied by her family or friends, but without healthcare supervision.

Some women choose this method of birth because they believe birth is such a natural process that no
medical supervision is necessary. Others choose it because they have no health insurance and so can’t
afford either a hospital or alternative birth setting. Unassisted birthing is potentially dangerous because,
if a complication should occur, the woman may not recognize that what is happening is serious until
damage to her child or herself results. Even if she recognizes that a problem is occurring, there is a gap
of time before emergency help can arrive to assist her, which puts her at risk for harm. Educating
women that not all online information is reliable and that supervised birth does not mean they have no
choice in their care decisions, such as whether they want pain relief or to use a special position for birth,
is an effective way to help women make safer choices about birth.

REPRODUCTIVE ISSUES IN MALES

Balanitis (Balanoposthitis)
Balanoposthitis is inflammation of the glans and prepuce of the penis. It tends to occur in uncircumcised
boys, is usually caused by poor hygiene, or may accompany a urethritis or a regional dermatitis

Cryptorchidism
Cryptorchidism is failure of one or both testes to descend from the abdominal cavity into the scrotum.
Normally, testes descend into the scrotal sac during months 7 to 9 of intrauterine life. They may descend
any time up to 6 months after birth, but they rarely descend after that time. The cause of undescended
testes is unclear. Testes apparently descend because of stimulation by testosterone; hence, a lower than
usual level of testosterone production may prevent descent. Fibrous bands at the inguinal ring or
inadequate length of spermatic vessels may prevent descent. The condition is found in about 3 out of
every 1,000 male newborns; it occurs most often in premature or low-birth–weight babies

Testicular Torsion
Testicular torsion (twisting of the spermatic cord) is a surgical emergency. Although it can be present in
newborns, it occurs most frequently during early adolescence. Less than normal testicular support
apparently allows the spermatic cord to twist. The boy experiences immediate severe scrotal pain and
perhaps nausea and vomiting from the extent of the pain. The testis feels tender to palpation, and
edema begins to develop. If the condition is not recognized promptly (within 4 hours), irreversible
change in the testis can occur from lack of circulation to the organ. Boys need to be educated about the
phenomenon so that they report symptoms promptly. Fortunately, the torsion can usually be reduced
manually under ultrasound guidance. Laparoscopic surgery, however, may be necessary to reduce the
torsion and to reestablish circulation.

Testicular Cancer
Testicular cancer is rare (only 1% of all malignancies) but can be an adolescent concern because it tends
to occur between ages 15 and 35 years. Symptoms include painless testicular enlargement and a feeling
of heaviness in the scrotum. The disease metastasizes rapidly, leading to abdominal and back pain due
to retroperitoneal node extension as well as weight loss and general weakness.

Therapy for testicular malignancy is orchiectomy (removal of the testis) followed by radiation or
chemotherapy (Haugnes, Bosl, Boer, et al., 2012). At the time of surgery, a gel-filled prosthesis is
inserted to provide a symmetric appearance to the scrotum. “Sperm banking,” or preserving frozen
sperm before the procedure, can be presented as an option for future family planning (Kelvin, 2015).
Teaching all males to perform testicular self-examination for early cancer detection is important to help
detect signs and symptoms of testicular cancer at an early point when the prognosis will be favorable
(see Chapter 34).
REPRODUCTIVE ISSUES IN FEMALES
Mittelschmerz
Some adolescents experience abdominal pain during ovulation from the release of accompanying
prostaglandins. Pain at this time may also be caused by a drop or two of follicular fl uid or blood spilling
into the abdominal cavity. Called mittelschmerz , the pain can range from a few sharp cramps to several
hours of discomfort. It is typically felt on one side of the abdomen (near an ovary) and may be
accompanied by scant vaginal spotting. An advantage of mittelschmerz is that it clearly marks ovulation.
If pain is felt in the right lower quadrant, it should be differentiated from appendicitis; a lack of
associated appendicitis symptoms such as nausea, vomiting, fever, abdominal guarding, and rebound
tenderness does this. Mittelschmerz can be relieved by a mild analgesic such as acetaminophen.

Dysmenorrhea
Dysmenorrhea is painful menstruation (Munro, 2012). The pain is caused by the release of
prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle, which
leads to smooth muscle contraction and uterine pain. Although dysmenorrhea is exceedingly common, it
needs to be investigated because it can also be a preliminary symptom of an underlying disorder such as
PID, uterine myomas (tumors), or endometriosis (abnormal formation of endometrial tissue).

Menorrhagia
Menorrhagia is an abnormally heavy menstrual flow, usually defined as greater than 80 ml per menses
or a flow that soaks more than one pad or tampon an hour. It tends to occur in girls close to puberty
because, without ovulation and subsequent progesterone secretion, estrogen secretion causes extreme
proliferation of endometrium. There is often also an unusual amount of menstrual flow in girls using
intrauterine devices (IUDs). With oral contraceptives, the flow is often light; for this reason, it may seem
alarmingly heavy once pills are discontinued, when this is just a return of the adolescent’s normal flow.

Metrorrhagia
Metrorrhagia is abnormal uterine bleeding (AUB) between menstrual periods (Matteson, Raker, Clark, et
al., 2013). This is normal in some adolescents who have spotting at the time of ovulation
(“mittelstaining”). It may also occur in teenagers taking oral contraceptives (breakthrough bleeding)
during the first 3 or 4 months of use. It also can occur from vaginal irritation caused by infection or
spotting from a temporarily low level of progesterone production, which leads to endometrial sloughing
(dysfunctional uterine bleeding or a luteal phase defect), although this condition most often occurs near
the end of the reproductive years, not the beginning.

Menstrual Migraine
A menstrual migraine headache refers to a sharp, disabling headache, often accompanied by nausea or
vomiting or vision changes, which occurs at the same time as a menstrual flow. This is probably caused
by the drop in estrogen, which occurs immediately prior to a menstrual flow.
Endometriosis
Endometriosis is the abnormal growth of extrauterine endometrial cells, often in the cul-de-sac of the
peritoneal cavity or on the uterine ligaments or ovaries, and is one of the main causes of dysmenorrhea
in adolescents. This abnormal tissue results from excessive endometrial production and a reflux of blood
and tissue through the fallopian tubes during a menstrual flow. The excessive production of endometrial
tissue can be related to a deficient immunologic response. In many women, it appears to be related to
excess estrogen production or a failed luteal menstrual phase caused by not ovulating or ovulating
irregularly. The resulting proliferation of tissue forces the menstrual flow into the fallopian tubes.

Amenorrhea
Amenorrhea, or absence of a menstrual flow, strongly suggests pregnancy but is by no means definitive,
because it can also result from tension, anxiety, fatigue, chronic illness, extreme dieting, or strenuous
exercise. Amenorrhea also occurs among females who diet excessively, partially as a natural defense
mechanism to limit ovulation and also probably as a means of conserving body fluid. Adolescents with
anorexia nervosa or bulimia often develop amenorrhea after approximately 3 months of excessive
dieting or binging and dieting; as in athletes, this is caused by an increase in prolactin

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) refers to various inflammatory conditions of the genital tract in
females: the uterus, fallopian tubes, ovaries, and their supporting structures. Adolescents, those with
multiple sexual partners, and those who don’t use condoms have a higher incidence of PID than other
groups. PID usually begins with a cervical infection that then spreads by surface invasion along the
uterine endometrium and then out to the fallopian tubes and ovaries. It is most likely to occur at the
end of a menstrual period because menstrual blood provides an excellent growth medium for bacteria
and there is loss of the normal barrier of cervical mucus during this time.

Polycystic Ovary Syndrome (PCOS)

is the most frequent cause of ovulation failure seen today. It is found in about 10% of women of
childbearing age. Adolescents with the syndrome begin to develop an increased androgen (male
hormone) level, which then prevents follicular ovarian cysts from maturing, a situation that leads to
typical symptoms of irregular or missed menstrual cycles, acne, excessive hair growth (hirsutism), being
overweight, male pattern baldness, type 2 diabetes, and most important, an absence of ovulation.
Insulin is a hormone that causes an increase in androgen, so excessive insulin appears to be the root of
the disorder. The condition may have a genetic tendency because the condition is often seen in siblings
or daughters.

Reference Book:
Silbert-Flagg, J., & Pillitteri, A., (2018). Maternal and Child Health Nursing (Vol 1). Wolters Kluwer