Care of the Mother and Fetus during the Perinatal

Period (Preparing a Family for Childbirth and Parenting)

Lesson 10
LESSON: 10
DURATION: 8 hours

Care of the Mother and Fetus during the Perinatal Period (Preparing a Family for
Childbirth and Parenting)

SPECIFIC OBJECTIVES:

At the end of the lesson, the students should be able to:

1. Describe common preparations for childbirth and parenting, including common settings
for birth.
2. Describe breathing and relaxation techniques used for each stage of labor.
3. Identify non-pharmacologic strategies to enhance relaxation and decrease discomfort
during labor.
4. Identify alternative birth setting such as freestanding clinic or their home.

LESSON PROPER:

TYPES OF EXERCISES

PERINEAL AND ABDOMINAL EXERCISES

• Help prevent the need for cesarean birth
• Strengthen pelvic and abdominal muscles
• Supple perineal muscles allow for ready stretching during birth, reducing discomforts
• Help revert muscles more quickly to their normal condition after childbirth

PELVIC FLOOR CONTRACTIONS (Kegel Exercises)

• While sitting tighten the muscles of the perineum
• Helpful in the postpartum period to reduce pain and promote perineal healing
• Help prevent stress incontinence

TAILOR SITTING
• To stretch the thighs and perineal muscles without occluding blood vessels of the lower
legs
• Avoid putting one ankle on top of the another
• Sits in this position gently push on her knees towards the floor until she feels perineum
stretch
• Hold this position in increased amount each time performed, 15 minutes everyday
• By the end of pregnancy her knees will almost touch the floor if pushed

SQUATTING
• Stretches perineal muscles and can be used for 2nd stage of labor, for about 15mins/day
• For the pelvic muscles to stretch, keep feet flat on the floor
 • Done 15mins/day
• Ex. Picking up toys on the floor reduces amount of time a woman must devote to daily
exercises

ABDOMINAL MUSCLE CONTRACTIONS

• Strengthen the abdominal muscles during pregnancy to prevent constipation and restore
abdominal tone after pregnancy
• Strong abdominal muscle for effective 2nd stage pushing during labor
• Can be done in standing or lying position with pelvic floor contractions
• Tighten the abdominal muscles, then relax
• Blowing out a candle (deep inspiration, then relaxes normally) using finger 6 inches in
front

PELVIC ROCKING
• Helps relieve backache making the lumbar spine more flexible
• Positions: Hands and knees, lying down, sitting, standing
• Arch the back, trying to lengthen or stretch her spine, holds the position for 1 minute, then
hollows her back, thrust back outward with buttocks tucked under
• Hold 3 secs. and release 5x/day to relieve back pain and make herself more comfortable
for the night

SEXUALITY IN PREGNANCY
• Be aware of the physiologic changes
• Discuss responses to pregnancy with your partner
> Alternative behavior (mutual masturbation, foot massage, cuddling)
> Alternative position (female superior, side-lying)
• Intercourse is safe as long as it is not uncomfortable
Precautions:
 Abstain from intercourse if you have experience uterine cramping/ vaginal bleeding
 Abstain from intercourse if you have history of cervical incompetence (activity that
results in orgasms)
• Continue to use safer sex behaviors. Encourage use of condoms

PAIN PATHWAY
Endings of the small peripheral nerve fibers detect a stimulus

Transmit to the cells in the dorsal horn of the spinal cord

Impulses pass through a dense, interfacing network of cells in the spinal cord (substantia
gelatinosa)

A synapse occurs that returns the transmission to the peripheral sit through motor nerve

Impulse then continues in the spinal cord to reach the hypothalamus and cortex of the brain

Impulse is interpreted and perceived as pain
METHODS FOR PAIN MANAGEMENT

A. GATE CONTROL MECHANISMS – involves halting an impulse at the level of the spinal
cord so the impulse is never perceived at the brain level as pain – a process similar to closing
a gate occurs

THREE (3) TECHNIQUES

 Cutaneous stimulation- ability of the small nerve fibers at the injury site to transmit pain
impulses appears decrease if the large peripheral nerves next to the injury site are
stimulated.
Ex. Rubbing a large area around the injured part; heat/cold; effleurage

 Distraction – if the cells of the brain stem that register an impulses as pain are pre-occupied
with other stimuli, a pain impulse will not register.
Ex. Breathing techniques – increases oxygenation– decreasing pain

 Reduction of anxiety – pain is perceived more quickly if anxiety is also present.

B. BRADLEY METHOD (PARTNER-COACHED) METHOD:

 Pregnancy is a joyful natural process and stresses importance of the husband
 Pain is reduced by: abdominal breathing, walking during labor

C. PSYCHOSEXUAL METHOD (SHEILA KITZINGER):

 Stresses that pregnancy, labor and birth and the early newborn period are important points
in woman’s life cycle
 Program involved conscientious relaxation and levels of progressive breathing that
encourages the woman “to flow with” rather than struggle against contractions of labor.

D. GRANTLY DICK-READ METHOD:

 Fear leads to tension and tension leads to pain
 Achieves relaxation and reduced pain in labor by using abdominal breathing during
contractions

E. LAMAZE METHOD (FERDINAND LAMAZE):

 Based on stimulus-response conditioning. To be effective, full concentration on breathing
exercises during labor should be observed.
 Psychoprophylactic method: preventing pain during labor (prophylaxis) by the use of mind
(psyche)

Six (6) major concepts:

1. Labor should begin on its own
2. Woman should move freely throughout the labor
3. Woman should continuously receive support during labor
 4. No routine interventions such as IVF
5. Allow woman to assume a non-supine position
6. Mother and baby should be housed together following birth

Relaxation Techniques
1. Conscious relaxation – relax the body so woman does not remain tense and unnecessary muscle
strain and fatigue during labor.
2. Cleansing breath – woman breathes deeply and then exhales deeply
3. Consciously controlled breathing
Level 1: slow chest breathing (comfortable but full respirations 6 -12 bpm)
Level 2: breathing lighter than level 1. rib cage expands lightly the diaphragm barely
moves. RR up to 40 – good for contractions when cervical dilation is 4 & 6 cm.
Level 3: Breathing is shallow mostly at the sternum, rate 50 – 70 bpm. Keep the tip of
the tongue against the roof of her mouth.
Level 4: uses “pant-blow pattern”- 3-4 quick breaths then a forceful exhalation. “choo-
choo” “hee-hee-hee-hoo”
Level 5: chest panting is continuous, very shallow 60 bpm. Prevents pushing before
dilation
4. Focusing/Imagery – sensate focus like photograph of her husband/children, a graphic design, or
something appeals to them

Second-stage breathing – do not hold breath on the second stage of labor. Teaching woman to
breathe out while pushing may be helpful.

TYPES OF BIRTH SETTING:

1. Hospital birth:

 Birthing bed – woman assumes supine recumbent position, which reduces tension on
the perineum and may result in fewer perineal tears than with a lithotomy position.

2. Birthing Chair

 Comfortable reclining chairs with a slide away seat that allows a woman to assume a
comfortable position during labor and also furnish perineal exposure so as birth
attendant can assist with the birth

3. Alternative Birthing Centers (ABCs):

 Are wellness-oriented childbirth facilities designed to removed childbirth from the

acute care hospital setting while providing enough medical resources for emergency
care should complication of labor and birth arises.

 Woman is encouraged to express her own needs and wishes during labor, she can
choose a birth position, bring her own music or distraction objects and partner can
perform such tasks such as cutting the cord, woman remains 4 to 24 hours after birth.
 4. Home Birth:

 It allows for family integrity, puts the responsibility on the woman to prepare the
house and take of the infant after birth.

5. Alternative Methods of Birth:

A. Leboyer – (from a warm, fluid filled intrauterine environment to a noisy, air filled
brightly lit birth room creates major shock.) The birthing room is darkened so there
is no sudden contrast in light, keep pleasantly warm-water birth.

B. Hydrotherapy and Warm Birth:

- reclining or sitting in warm water labor can be soothing, feeling of weightless and
relaxation can reduce discomforts.

REFERENCES/ADDITIONAL RESOURCES/READINGS:

Pillitteri, Adele (2018). Maternal and Child Health Nursing, Care of the Childbearing and
Childrearing Family, 8th edition.

Ricci, Susan (2007). Essentials of Maternity, Newborn and Women’s Health Nursing, Lippincott
Williams & Wilkins

Seeley, Rod R. (2005). Essentials of Anatomy and Physiology, 5th Edition

Wong, Donna, et.al.(2009). Maternal Child Nursing Care, 3rd edition, Elsevier (Singapore) Pte Ltd.