NCM 103-COL-SG-WK12

REAL WORLD READY PROGRAM

SUPLEMENTAL STUDY GUIDE

NOVEMBER

NCM 103 CARE OF MOTHER, CHILD,

Subject
ADOLESCENT (WELL CLIENT)
Preparing a Family for Childbirth and Parenting
A. Childbirth Education
B. The Childbirth Plan
C. Preconception Classes
Topic
D. Expectant Parenting Classes
E. The Birth Setting
F. Alternative Methods of Birth

Course/Year BS Nursing – 2nd Year

Week Week 12
School Year 1st Semester/AY 2020-2021

I. Objectives

 Describe common preparations for childbirth and parenting including common

settings for birth.
 Identify National Health Goals related to preparation for parenthood that
nurses can help the nation achieve.
 Assess a couple for readiness for childbirth in regard to choose of birth
attendant, preparation for labor, and setting.
 Plan nursing care such as teaching exercises for strengthening abdominal and
perineal muscles for childbirth.
 Identify areas related to preparation for childbirth that could benefit from
additional nursing research or application of evidence-based practice.

II. Discussion
A. Introduction
As active consumers of health care, expectant families can find
themselves faced with a wide array of choices about a childbirth experience and
preparation for parenting. Three of the most important decisions they need to
make involve the choice of birth attendant and setting and how much or what
type of analgesic they want to use in labor. For example, a woman may elect to
have her family physician, obstetrician, or nurse-midwife attend the birth and to
be supported by her husband, partner, family member, friend, or doula (a

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woman who is experienced in childbirth and provides continuous emotional and

physical support). Most women choose to give birth in a birthing center or a
hospital. Families who are rated as low risk have yet another option or may plan
a home birth (Olsen & Jewell, 2009).
No matter what setting a woman or couple chooses, expectant parents
are well advised to be as prepared as possible for the physical and emotional
aspects of childbirth and nonpharmacologic methods of pain relief during labor
such as aromatherapy (Burns et al., 2007). Also available are classes to help
prepare siblings or grandparents to learn more about their role. Women having a
vaginal birth after cesarean birth (VBAC) or women who know they will
have a cesarean birth also can attend specially designed classes for this.
Most childbirth preparation classes are sponsored by community health
care agencies but some work sites also offer such classes. Classes benefit
employers as much as employees, because prenatal care and guidance correlate
with healthier pregnancy outcomes and fewer lost workdays. National Health
Goals related to preparation for parenting or childbirth are shown in Box 14.1.

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B. Childbirth Education
Assessing whether couples need a preparation for childbirth or parenting
class or encouraging them to take one, therefore, can be extremely important to
make childbirth a satisfying experience, help a family bond with its new member,
and become effective parents (Box 14.2).

As many as 7% of women voice that they are afraid of what will happen
in labor. Those who are young, have a low educational level, low self-rated
health, and lack a social network express this most (Laursen, 2008).

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The overall goals of childbirth education are to prepare expectant parents

emotionally and physically for childbirth while promoting wellness behaviors that
can be used by parents and families for life. Women enjoy such classes because
they offer them a sense of empowerment and confirm that they can have direct
input into their labor experience (Box 14.3).

I. Childbirth Educators and Methods of Teaching

o Childbirth educators are health care providers who usually have
a professional degree in the helping professions as well as a
certificate from a course specifically about childbirth education.
o Although childbirth education is an interdisciplinary field, it has
historically been associated with nursing and nurses play a
major role in designing and teaching such courses.

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o One of the most important aspects of these courses, however,

is group interaction. Women and their partners enjoy the
opportunity to share their fears and hopes about their
pregnancy and upcoming birth with others as they learn
together (Box 14.4).

II. Efficacy of Childbirth Education Courses

o Many studies have been done to determine just how effective
childbirth courses are in reducing the pain of childbirth,

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shortening the length of labor, decreasing the amount of

medication used, and increasing overall enjoyment of the
experience.
o Because of the variability in courses offered, however, it is often
difficult to compare results of attending childbirth classes versus
not attending classes. This is partly because people who
volunteer to attend classes already have a high degree of
positive motivation, which may skew the results.
o Despite these difficulties with measurement, it is generally
accepted that preparation courses can increase satisfaction,
reduce the amount of reported pain, and increase feelings of
control (Lauzon & Hodnett, 2009). It is documented that by
discussion of breastfeeding, classes can increase the proportion
of new mothers who breastfeed (American College of Obstetrics
and Gynecology [ACOG], 2007).

C. The Childbirth Plan

Most classes for expectant parents urge couples to make a written
childbirth plan or spell out their choice of setting, birth attendant, special needs
such as the extent of family participation they wish during labor, birthing
positions, medication options, plans for the immediate postpartum period and
baby care, and family visitation (Simkin, 2007).
A group setting of this kind can be the best way for a couple to sort out
their questions and feelings about what they want to consider in a birth plan as
they share information with others.
Box 14.5 is a sample birth plan.

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D. Preconception Classes
Preconception classes are held for couples who are planning to get
pregnant within a short time and want to know more about what they can expect
a pregnancy to be like and what are birth setting/procedure choices. These
classes stress that pregnancy brings with it psychological as well as physical
changes and include recommended preconception nutrition modifications such as
a good intake of folic acid (green leafy vegetables) and protein (meat, tofu,
beans) during the time waiting to get pregnant, to ensure a healthy fetus (Lu,
2007).

E. Expectant Parenting Classes

Expectant parenting classes are designed for couples who are already
pregnant. They focus on family health during a pregnancy, covering such topics
as the psychological and physical changes of pregnancy, pregnancy nutrition,
routine health care such as dental checkups, and newborn care (Box 14.6).

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A typical course plan for 8 weeks is shown in Box 14.7.

Most preparation-for-parenthood programs last 4 to 8 hours over a 4- to

8-week period. Both women and their support people are invited, and the
curriculum is individualized for the group and its needs such as women in the
military, sibling preparation, refresher classes for grandparents, classes for
expectant adoptive parents, pregnant adolescents, or women with physical
disabilities (Smeltzer, 2007).
If all the women in the group already have children, for example, they
may not need a tour of a maternity unit as part of the program; instead, they
may want to learn what is new in baby food or child care. If all the women in the
class work at least part-time, discussion of “brown bag nutrition” and how to
include rest periods during work hours might be most useful. If all the women
are teenagers, they may be most interested in what is going to happen to their
bodies during pregnancy or what sports are safe to continue during pregnancy.
They also need information on how to care for a newborn.
They probably will want a tour of the maternity unit (Fig. 14.1).

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i. Sibling Education Classes

 Sibling classes are organized to acquaint older brothers and sisters
with what happens during birth and what they can expect a
newborn to look and act like.
 If the classes are held at a hospital, a tour of a newborn nursery is
included so children can see how small their new sibling will be.

ii. Breastfeeding Classes

 Breastfeeding classes are designed to help women learn more
about breastfeeding so they can appreciate the advantages of
breastfeeding over formula feeding. Such classes cover the
physiology of breastfeeding as well as psychological aspects.
 They stress that women should try to breastfeed exclusively for the
first 6 months and ways to fit breastfeeding into busy schedules so
they can continue it for the full first year (American Academy of
Pediatrics [AAP], 2008).
 They are often taught by a certified La Leche League instructor
who is an expert on what problems new mothers are apt to
encounter.

iii. Preparation for Childbirth Classes

 Preparation for childbirth classes focus mainly on explaining the
birth process rather than pregnancy and ways to prevent or reduce
the pain of childbirth. Common goals of preparation are to:
• Prepare an expectant woman and her support person for the
childbirth experience

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• Create clients who are knowledgeable consumers of obstetric

care
• Help women reduce and manage pain with both
pharmacologic and nonpharmacologic methods
• Help increase a couple’s overall enjoyment of and satisfaction
with the childbirth experience

iv. Prenatal Yoga

 Prenatal yoga classes are aimed at helping a woman relax and
manage stress better for all times in her life, not just pregnancy
(Smith et al., 2007).
 Yoga exercises help a woman stay overall fit by their focus on
gentle stretching and deep breathing.
 Yoga can also help a woman feel a high level of self-esteem as she
masters difficult levels or positions.
 Yoga breathing techniques can be used in labor to help both
relaxation and pain management.
 Caution women, as pregnancy progresses, that it will become
difficult to maintain difficult yoga positions. Women should use a
chair or a wall for stabilization. They should avoid twisting exercises
late in pregnancy because when joints soften in preparation for
labor, muscle or joint strain could occur.

v. Perineal and Abdominal Exercises

 In addition to encouraging an overall exercise program, childbirth
preparation classes teach women specific exercises to strengthen
pelvic and abdominal muscles and make these muscles stronger
and more supple. Supple perineal muscles allow for stretching
during birth, reduce discomfort, and help muscles revert more
quickly to their normal condition and function more efficiently after
childbirth (Hay-Smith & Dumoulin, 2009).
 A woman may begin exercises as early in pregnancy as she likes.
Many exercises to strengthen abdominal or perineal muscles can be
incorporated into daily activities so they take little time from a
woman’s day.
 In addition to specific exercises, encourage women to maintain an
overall active exercise program during pregnancy, as being in good
physical condition can help prevent the need for cesarean birth.
 Common safety precautions for preparation for childbirth exercises
in pregnancy are summarized in Box 14.8.

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a. Tailor Sitting
Although many women may be familiar with tailor sitting, they may have
to be re-taught the position so it is done in a way that stretches perineal
muscles without occluding blood supply to the lower legs. A woman
should not put one ankle on top of the other but should place one leg in
front of the other (Fig.14.2).

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b. Squatting
Squatting (Fig. 14.3) also stretches perineal muscles and can be a useful
position for second-stage labor, so a woman should also practice this
position for about 15 minutes a day.

c. Pelvic Floor Contractions (Kegel Exercises)

Pelvic floor contractions can be done easily during daily activities. While
sitting at her desk or working around the house, a woman can tighten the
muscles of her perineum by doing Kegel exercises (Box 12.7). Such
perineal muscle- strengthening exercises are helpful in the postpartum
period to reduce pain and promote perineal healing. They have long term
effects of increasing sexual responsiveness and helping prevent stress
incontinence (Hay-Smith & Dumoulin, 2009).

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d. Abdominal Muscle Contractions

Abdominal muscle contractions help strengthen abdominal muscles during
pregnancy and therefore may help prevent constipation as well as help
restore abdominal tone after pregnancy.
Strong abdominal muscles can also contribute to effective second-stage
pushing during labor.
Abdominal contractions can be done in a standing or lying position along
with pelvic floor contractions. A woman merely tightens her abdominal
muscles, then relaxes them. She can repeat the exercise as often as she
wishes during the day.
Another way to do the same thing is to practice “blowing out a candle.”

e. Pelvic Rocking
Pelvic rocking (Fig. 14.4) helps relieve backache during pregnancy and
early labor by making the lumbar spine more flexible.
It can be done in a variety of positions: on hands and knees, lying down,
sitting, or standing.
A woman arches her back, trying to lengthen or stretch her spine.
She holds the position for 1 minute, then hollows her back.
If a woman does this at the end of the day about five times, it not only
increases flexibility but also helps relieve back pain and make her more
comfortable for the night.

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vi. Methods for Managing Pain in Childbirth

 These included the Lamaze, Dick-Read, and Bradley methods, all
named after the professionals who developed them.
 Most approaches are based on three premises:
1. Discomfort during labor can be minimized if a woman
comes into labor informed about what is happening and
prepared with breathing exercises to use during
contractions. In classes, therefore, a woman learns about
her body’s response in labor, the mechanisms involved in
childbirth, and breathing exercises she can use to aid
relaxation.
2. Discomfort during labor can be minimized if a woman’s
abdomen is relaxed and the uterus is allowed to rise freely
against the abdominal wall with contractions. Childbirth
methods differ only in the manner by which they achieve
this relaxation.
3. Pain perception can be altered by distraction techniques
that effectively move a woman’s concentration to other
things than pain or by the gating control theory of pain
perception (Box 14.9).

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a. The Bradley (Partner-Coached) Method

The Bradley method of childbirth, originated by Robert Bradley, is
based on the premises that pregnancy and childbirth are joyful
natural processes and that a woman’s partner should play an
important role during pregnancy, labor, and the early newborn
period.
During pregnancy, a woman performs muscle-toning exercises and
limits or omits foods that contain preservatives, animal fat, or a
high salt content. She reduces pain in labor by abdominal
breathing.
In addition, she is encouraged to walk during labor and to use an
internal focus point as a disassociation technique.
The method is used widely in some areas of the United States and
at specific centers (Bradley, 1996).
b. The Psychosexual Method
The psychosexual method of childbirth was developed by Sheila
Kitzinger in England during the 1950s.
The method stresses that pregnancy, labor and birth, and the early
newborn period are some of the most important points in a
woman’s life.
It includes a program of conscious relaxation and levels of
progressive breathing that encourage a woman to “flow with”
rather than struggle against contractions (Kitzinger, 1990).
c. The Dick-Read Method
The Dick-Read method is based on an approach proposed by
Grantly Dick-Read, an English physician.
The premise is that fear leads to tension, which leads to pain. If a
woman can prevent fear from occurring, or break the chain
between fear and tension or tension and pain, then she can reduce
the pain of labor contractions.
A woman achieves lack of fear through education about childbirth
and relaxation and reduced pain by focusing on abdominal
breathing during contractions (Dick-Read, 1987).
d. The Lamaze Philosophy
The Lamaze method of prepared childbirth, a philosophy based on
the gating control theory of pain relief, is the one most often
taught in the United States today (Amis & Green, 2007).
The method is based on the theory that through stimulus-response
conditioning, women can learn to use controlled breathing to
reduce pain during labor.
It was originally termed the psychoprophylactic method, as it
focuses on preventing pain in labor (prophylaxis) by use of the
mind (psyche).

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The method was developed in Russia based on Pavlov’s

conditioning studies but was popularized by a French physician,
Ferdinand Lamaze.
Suggestions for supplies that a woman or couple might want to
pack in advance and bring to the hospital for a Lamaze birth are
shown in Table 14.1.

Throughout the program, six major concepts are stressed:

1. Labor should begin on its own, not be artificially induced.
2. Women should be able to move about freely during labor,
not be confined to bed.
3. Women should receive continuous support during labor.
4. No routine interventions such as intravenous fluid are
needed.
5. Women should be allowed to assume a non-supine (e.g.,
upright or side-lying) position for birth.
6. Mother and baby should be housed together following
birth, with unlimited opportunity for breastfeeding (Amis &
Green, 2007).

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Three main premises are taught in the prenatal period related to

the gating control method of pain relief:
1. Women learn in class about reproductive anatomy and
physiology and the process of labor and birth in the belief
that if women are familiar with what will happen in labor and
the nature of contractions, the couple can enter labor with
decreased tension.
2. A woman is taught to concentrate on breathing patterns
and to use imagery or focusing (concentrating) on a
specified object to block incoming pain sensations. The
effectiveness of focusing can be observed in athletes who
hurt themselves in basketball or football games but do not
feel the pain until after the game because they are so
focused on winning.
3. Conditioned reflexes, or reflexes that automatically
occur in response to a stimulus, can also be used to displace
pain during labor. For example, a woman is conditioned to
relax automatically on hearing a command (“contraction
beginning”) or at the feel of a contraction beginning. The
responses to contractions must be recently conditioned to be
effective (because conditioned responses fade if not
reinforced). This is the reason it is generally recommended
that women attend Lamaze classes in the last trimester of
pregnancy. A disadvantage of enrolling so late is that it limits
the total amount of time directed to perineal exercises. If
labor begins early, a woman may have had little or no
practice with this type of exercise.
Lamaze classes are kept small so that there is time for individual
instruction and attention to each couple (Fig. 14.5).

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d.1. Conscious Relaxation

 Conscious relaxation is learning to relax body parts so
that, unknowingly, a woman does not remain tense and
cause unnecessary muscle strain and fatigue during labor.
 By either placing a comforting hand on the tense body area
or telling a woman to relax that area, the support person
helps her to achieve complete relaxation.
d.2. The Cleansing Breath
 To begin all breathing exercises, a woman breathes in
deeply and then exhales deeply (a cleansing breath).
 It is an important step to take because it limits the possibility
of either hyperventilation (blowing off too much carbon
dioxide) or hypoventilation (not exhaling enough carbon
dioxide), both of which could happen with rapid breathing
patterns, and so it helps ensure an adequate fetal oxygen
supply.
d.3. Consciously Controlled Breathing
 Using consciously controlled breathing, or set breathing
patterns at specific rates, provides distraction as well as
prevents the diaphragm from descending fully and putting
pressure on the expanding uterus.
 Various levels of breathing are:
Level 1. Slow chest breathing of comfortable but full
respirations at a rate of 6 to 12 breaths per minute. The level is
used for early contractions.
Level 2. Lighter and more rapid breathing than level 1.
The rib cage should expand but be so light the diaphragm
barely moves. The rate of respirations is up to 40 per minute.
This is a good level of breathing for contractions when cervical
dilation is between 4 and 6 cm.
Level 3. Even more shallow and more rapid breathing.
The rate is 50 to 70 breaths per minute. As the respirations
become faster, the exhalation must be a little stronger than the
inhalation to allow good air exchange and to prevent
hypoventilation. If a woman practices saying “out” with each
exhalation, she almost inevitably will make exhalation stronger
than inhalation. A woman uses this level for transition
contractions. Keeping the tip of her tongue against the roof of
her mouth helps prevent her oral mucosa from drying out
during such rapid breathing.
Level 4. A “pant-blow” pattern, or taking three or four
quick breaths (in and out), then a forceful exhalation. Because
this type of breathing sounds like a train (breath-breath-breath-

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huff ), it is sometimes referred to as “choo-choo” or “hee-hee-

hee-hoo” breathing.
Level 5. Quiet, continuous, very shallow panting at about
60 breaths per minute. This can be used during strong
contractions or during the second stage of labor to prevent a
woman from pushing before full dilatation.
 Figure 14.6 illustrates the use of levels of breathing.

d.4. Effleurage
 One additional technique to encourage relaxation and
displace pain in the Lamaze method is effleurage, which is

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French for “light abdominal massage,” done with just

enough pressure to avoid tickling.
 To do this, a woman traces a pattern on her abdomen with
her fingertips (Fig. 14.7).

 The rate of effleurage should remain constant even though

breathing rates change.
 Effleurage serves as a distraction technique and decreases
sensory stimuli transmission from the abdominal wall,
helping limit local discomfort.

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 Effleurage can also be done by the support person.

d.5. Focusing or Imagery

 Focusing intently on an object (sometimes called “sensate
focus”) is another method of keeping sensory input from
reaching the cortex of the brain. A woman brings into labor a
photograph of her partner or children, a graphic design, or just
something that appeals to her (Fig. 14.8).

 Other women use imagery by imagining they are in a calm

place such as on a beach watching waves rolling in to them or
relaxing on a porch swing (Stein, 2007)

d.6. Second-Stage Breathing

 During the second stage of labor, when the baby will be actually
pushed down the birth canal, the type of breathing that is best
to use is controversial. Based on this, most classes suggest that
women breathe any way that is natural for them, except holding
their breath during this stage of labor.
Women should not practice pushing. The possibility that they could
rupture membranes by doing this is too great. They can practice assuming a
good position for pushing (squatting, sitting upright, leaning on partner) but
should always be cautioned not to actually push during pregnancy.

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vii. Preparation for Cesarean Birth

 The fact that cesarean birth may become necessary during labor to
ensure a safe birth and what a couple can expect if this happens is
covered in most childbirth classes, although as vaginal birth is
encouraged, this may be done to varying degrees (Horey, Weaver,
& Russell, 2009).
 Some women need this information because they know from the
beginning of pregnancy that they will have a cesarean birth as
these are offered in some communities as an alternative to vaginal
birth to help prevent uterine prolapse or urinary incontinence in
later years or to be more convenient for the family, although this
policy is controversial (McCourt et al., 2007).
 Still other women had a cesarean birth for a first pregnancy and
now need information on whether they should have a second birth
vaginally or have a repeat cesarean one (Farnsworth & Pearson,
2007).

F. The Birth Setting

Another important decision that a couple needs to make during pregnancy
is choosing a birth setting.
Fortunately, birthing practices have changed to better meet women’s
needs based on their descriptions of the pain of childbirth. If women choose
physicians or hospitals who subscribe to more progressive birth practices over
the services of more traditional facilities, the overall standard of care in
communities leans toward the more progressive settings. The addition of birthing
rooms to hospitals in the past 20 years is an example of this.
Nurses are in a strong position to advocate for making childbirth a
“natural” process in the least restrictive setting possible. At the same time,
nurses have a strong responsibility to encourage parents to maintain enough
restrictions that birth remains safe.

I. Choosing the Appropriate Setting

 Women having uncomplicated pregnancies may choose hospitals,
birthing centers, or their homes as settings for birth.
 Women with high-risk pregnancies have less choice; women with
potential complications are advised to give birth at hospitals where
immediate emergency care will be available.

II. Choosing a Birth Attendant and Support Person

 In the United States, most births are supervised by an obstetrician,
a physician specializing in labor and birth. As the tendency for
specialized physician practice declines, however, it is becoming
more common for family practitioners to serve as birth attendants.

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 It is also becoming more common for certified nurse-midwives to

attend births, especially at alternative birth centers.
 In addition to selecting who will medically supervise her baby’s
birth, a woman needs to choose who will support her in labor.
 Doulas can be helpful as fathers may find it hard to provide doula-
type support during labor when they are so emotionally involved
themselves in the birth.
 Although research in the subject is not extensive, there are
suggestions that rates of oxytocin augmentation, epidural
anesthesia, and cesarean birth can all be reduced with doula
support (McGrath & Kennell, 2008).

III. Hospital Birth

 Maternity services of hospitals have changed a great deal in recent
years, influenced by the First Consensus Initiative of the Coalition
for Improving Maternity Services (CIMS). This organization rates
hospitals regarding whether they are mother friendly based on,
through its practices, if the hospital respects that birth is a normal,
natural, and healthy process and a woman has the opportunity to:
• Experience a healthy and joyous birth experience,
regardless of her age or circumstances
• Give birth as she wishes in an environment in which she
feels nurtured and secure
• Have access to the full range of options for pregnancy,
birth, and nurturing her baby
• Receive accurate and up-to-date information about the
benefits and risks of all procedures, drugs, and tests
suggested for use during pregnancy, birth, and the
postpartum period, with the rights to informed consent and
informed refusal
• Receive support for making informed choices about what is
best for her and her baby based on her individual values and
beliefs (CIMS, 1996)
 Based on the above criteria, 10 steps to a mother-friendly hospital
climate have been identified (Box 14.10).
 Urge women to ask hospitals in their community if they are rated
as mother-friendly as this should influence their choice of a hospital
or birth attendant.

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 Advantages and disadvantages of hospital birth are summarized in

Box 14.11. The major advantage of a hospital is that equipment
and expert personnel are readily available if the mother or fetus or
newborn should have a complication.

 A woman usually comes to the hospital when her contractions are

approximately 5 minutes apart and regular in pattern. If she has
preregistered at the hospital, she is admitted to a birthing room
without any separation time from her support person.
 Birthing rooms are also called labor-delivery-recovery rooms (LDRs)
or labor-delivery-recovery-postpartum rooms (LDRPs).

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 Such rooms are decorated in a homelike way; couples can bring

favorite music or reading materials with them to use during labor;
and the bed can be used as a labor bed until birth, when it
converts into a birthing bed or a lithotomy position bed (Fig.
14.9).

 Birthing chairs (Fig. 14.10) are comfortable reclining chairs with

a slide-away seat that allows a woman to assume a comfortable
position during labor and also furnishes perineal exposure so a
birth attendant can assist with the birth. The semi-Fowler’s position
acts with gravity and so may speed the second stage of labor.

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IV. Postpartum Care

 Women giving birth in LDRPs remain in the room with their families
for the rest of their hospital stay.
 Women giving birth in birthing rooms may be transferred to a
postpartum unit after birth; they remain there for the length of
their hospital stay.
 Both LDRPs and postpartum units serve as “rooming-in” units in
which the infant remains in the mother’s room for most of the day.
 After birth, encourage mothers to breastfeed immediately.
Breastfeeding on demand for infants should be the rule.
 There should be no restrictions on visiting for the primary support
person; in many institutions, a rollaway bed is provided so he or
she can remain constantly. Siblings of the newborn should be
allowed to visit at least once and touch and become acquainted
with the newborn.

V. Alternative Birthing Centers

 Alternative birthing centers (ABCs) are wellness-oriented
childbirth facilities designed to remove childbirth from the acute
care hospital setting while still providing enough medical resources
for emergency care should a complication of labor or birth arise.
 Such a setting is established within, or at least within an easy
distance of a hospital.
 The birth attendants tend to be nurse-midwives.
 Women who deliver in ABCs are screened for complications before
being admitted.
 Like hospitals, ABCs have LDRP rooms where a woman and her
support person can invite friends and siblings to participate in the
birth.
 ABCs encourage a woman to express her own needs and wishes
during the labor process. A minimum of analgesia and anesthesia is
provided, and she can choose a birth position.
 Advantages and disadvantages of ABCs are summarized in Box
14.12.

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VI. Home Birth

 Home birth is the usual mode of birth in developing countries.
 Home birth may be supervised by a physician, but nurse-midwives
are the more likely choice as birth attendants in this setting
(Vedam, Goff, & Marnin, 2007).
 The main advantage of a home birth is that it encourages family
integrity: a woman and her family are not separated so the baby
can be immediately integrated into the family.
 To be a candidate for a home birth, a woman must be in good
health, must be able to adjust to changing circumstances, and
must have adequate support people who will sustain her during
labor and assist her for the first few days after birth.
 Advantages and disadvantages of home birth are summarized in
Box 14.14.

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a. Freebirthing
o Freebirthing refers to women giving birth without any health care
provider supervision (Cooper & Clarke, 2008).
o Freebirthing is potentially dangerous because if a complication of
birth should occur, the woman may not recognize that the
complication is occurring until damage to her child or herself
results.

VII. Children Attending the Birth

 Most birthing centers and some hospitals allow children to view the
birth of a sibling.
 Attendance at sibling classes designed to prepare children to
witness the birth is often required.
 A child who is without supervision during this time could remember
the experience as a time of rejection rather than an exciting, happy
experience.
 The mother should not be expected to provide such supervision
during labor as she will want to concentrate on distraction or
breathing techniques.

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G. Alternative Methods of Birth

a. Leboyer Method
 Frederick Leboyer was a French obstetrician who postulated
that moving from a warm, fluid-filled intrauterine environment
to a noisy, air-filled, brightly lit birth room creates a major shock
for a newborn (Leboyer, 1975).
 With the Leboyer method, the birthing room is darkened so
there is no sudden contrast in light; it 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 a
warm-water bath.

b. 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 (Maude &
Foureur, 2007).
 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.

Reference:

Pilliteri, A. (2014). Maternal and Child Health Nursing. Los Angeles, California:Lippincott Williams & Wilkins.

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