TRIPURA INSTITUTE OF PARAMEDICAL SCIENCE

NURSING SECTION

SUBJECT: - CLINICAL SPECIALITY-I (OBG)

SEMINAR ON: - 4th STAGE OF LABOUR VARIOUS CHILD BIRTH

PRACTICE, WATER BIRTH,
POSITION CHANGE etc
EVIDENCE BASED PRACTICE
IN RELATION TO LABOUR
INTERVENTION.

Submitted To Submitted By
MS PIANKHI SAHA SUJIT KUMAR NATH
ASSOCIATE PROFESSOR M.Sc Nursing 1st Year

TIPS ROLL NO -13, TIPS

 VARIOUS CHILD BIRTHING TECHNIQUES

INTRODUCTION:
The experience of giving birth is both universal and unique all at once. Although
women have been doing it since the starting of humanity, the process, social norms
around pregnancy and birth have evolved as medical practitioners and mothers become
more experienced in birthing methods.
DEFINITION
Childbirth, also known as labor and delivery, is the ending of a pregnancy by one or
more babies leaving a woman's uterus by vaginal passage or Caesarean section.
1. THE BRADLEY METHOD OF DELIVERY OR "HUSBAND-COACHED
CHILDBIRTH"
A coach may be any significant other such as a friend, mother, - sister, aunt,
grandmother, or husband Involves the concepts of leading, guiding, supporting, caring,
and to gain the confidence.
The Bradley Method focuses on preparing the mother for a natural childbirth coached
by her partner. The emphasis is on being prepared
for an unassisted vaginal birth without medication
Benefits of The Bradley Method: -
• The Bradley method is beneficial to prepare parents for unassisted births.
• It helps the couple be prepared with techniques to reduce the perception of pain and
stay relaxed through a natural unmedicated
childbirth.
• It also teaches the couple about things they need to know to take care of themselves
as new parents and what to expect when the
infant arrives.
 Disadvantages of The Bradley Method: -

For couples who are uncertain if they want to try for an unassisted vaginal birth
without medication, the Bradley Method might not be
best. The course and training take quite a long time. Couples need to begin classes in
the second trimester.

2. PSYCHO PROPHYLACTIC OR LAMAZE METHOD-

This is a relaxed way of giving birth. This involves voluntary relaxation of the
abdominal muscles through proper breathing in order
to increase oxygen intake and distract the mother from labor pains.
• The woman is taught to replace responses of restlessness, fear etc.
• The mother-to-be is taught exercises that strengthen the abdominal muscles and
relax the perineum.
Benefits of the Lamaze Method: -
•Lamaze training prepares the mother and her partner to cope with symptoms of labor
and delivery naturally.
• The breathing and relaxation techniques reduce the perception of pain and keep
labor moving smoothly.
Disadvantages of the Lamaze Method: -
Learning the Lamaze method takes time. The couple must plan ahead and attend
classes starting in the second trimester of pregnancy
3. VAGINAL CHILD BIRTH: -
Vaginal birth without medication benefit for both mother and baby. Childbirth is the
most common way of childbirth is a vaginal
delivery. It involves three stages of labor: - the shortening and opening of the cervix,
descent and birth of the baby, and the delivery
of the placenta.
Benefits of Vaginal child birth:

• Infants born vaginally tend to have fewer respiratory problems.

• Other benefits of vaginal delivery include a quicker recovery for the mother, and
avoidance of abdominal surgery.
• Vaginal childbirth has a lower rate of infection and a shorter hospital stay.
Disadvantages of vaginal child birth:
• The disadvantages of a vaginal birth may include risk of tearing of the perineum.
• Bleeding from vagina due to tearing of perineum.
Complication of Vaginal Child Birth: -
• The perineum is the soft tissue between the vulva and the anus. This soft tissue
stretches to accommodate giving birth, but small and
even severe tears can occur
• In some situations, the pelvic floor (a group of muscles attached to the pelvis), can
become damaged while giving birth. For women
who experience pelvic floor damage, the result can be temporary or chronic pelvic
pain.
• Persistent Perineal or Vulvar Pain, This can be the result of pelvic floor damage or
perineal tears, but sometimes it can occur without
any visible trauma to the area.
4. HOME BIRTH: -
It can be a safe and relaxing natural childbirth delivery method for women with a
normal, low risk pregnancy. Home births are
vaginal deliveries with no medication. Home births are attended by a certified
professional midwife, a licensed nurse. Sometimes a
midwife support professional called a doula attends home births. These birth
professionals also work in birth centers.
 Benefits of Home Birth

• Many women find it relaxing and comforting to be in their own home environment.
Other advantages include:
• Not having to worry about being transported to the hospital while in labor or being
transported home after the baby's birth
• Having a baby at home means having all of the comforts of home, including snacks
and changes of clothing readily available.
• The recovery and transition to breastfeeding can be easy because the environment is
comfortable and familiar.
• The mother can invite whomever she wants to attend the birth.
Disadvantages of Home Birth: -
• If the home is very remote or weather is bad, it may be difficult for the midwife to
reach the home in time.
• If the birth plan does not progress normally, it may require transport to a hospital.
• Some womens are comfortable with a home birth, and it is not a good option unless
it is a low-risk pregnancy, and the mother prefers it.
Complication of Home Birth: -
• Post-partum hemorrhage (excessive blood loss after having your baby) after a home
birth.
• Chances of infection
5. HOSPITAL BIRTH: -
Women giving birth in the hospital have most of the same options as home births,
she has quicker access to surgical interventions
if an emergency occurs. Women giving birth in a hospital or birth center have the
option to attempt a vaginal delivery with or
without medication
 Benefits of Hospital Birth: -

The benefits of a hospital birth include ready access to emergency interventions such
as a Cesarean section, advanced monitoring for high- risk pregnancies, and more pain
management options including epidural anesthesia.
Disadvantages of Hospital Birth: -
The risks of a hospital delivery can include a higher chance of unwanted intervention.
Other risks of hospital childbirth (and any stay in the hospital) include a higher chance
of infection.
Complication of Hospital Birth: -
• An epidural may lower the mother's blood pressure the baby is at an increased risk
of not getting enough oxygen through the placenta, and this could lead to fetal
distress.
• Chances of getting hospital acquired infection.
6. ASSISTED BIRTHS: -
Natural births are not always an option, and if a complication develops, women
now have a number of options to assist them
with a safe birth. Sometimes C-sections are planned in advance. The other assisted
options discussed here.

I. C-Section: - A cesarean section is a surgical procedure in which incisions

are made through a woman's abdomen and uterus to deliver her baby.
Benefits of C-Section: -
In some cases, doctor may offer patient the choice between being induced and having a
caesarean. Having an induced labor can lead to more interventions, such as an assisted
birth with ventouse or forceps, and these carry risks too. So patient and doctor will
need to weigh these risks against the risks of having a caesarean.
Disadvantage of C-Section: -
 • Fever.
• Worsening pain.

• Increased vaginal bleeding.

• Increased redness at the incision site.
• Drainage or swelling of the surgical incision.
• Breast pain with redness or fever.
• Foul-smelling vaginal discharge.
• Pain when urinating.
Complication of C-Section: -
 Bleeding from vagina
 Breathing problems for the child, especially if done before 39 weeks of
pregnancy
 Increased risks for future pregnancies
 Infection in the incision site
 Injury to the child during surgery
 Longer recovery time compared with vaginal birth
 Surgical injury to other or
II) Vacuum extraction: - A vacuum-assisted delivery involves attaching a soft cup to
the head of the infant while it is in the birth canal to facilitate delivery.
Benefits of Vacuum Extraction:-
The advantage is that this assisted birth option has a lower risk than a C- section of
prolonged fetal distress.
Complication of Vacuum Extraction: -
The risks of this method include minor scalp injuries or more serious trauma or
bleeding of the head.
III) Forceps delivery: - A forceps-assisted delivery means that curved instruments
are used to facilitate the progress of the infant in the birth canal. Forceps cannot be
used if the infant is breech, but it can be an option if the mother is too exhausted or if

the infant has to be delivered more quickly than is naturally occurring.

Benefits of Forceps Delivery: -
 Delivery can be achieved faster
 Rate of successful vaginal delivery is higher
 Used to rotate the fetal head into the right position and so facilitate normal
delivery.
Disadvantage of Forcep Delivery: -
Fetal scalp injuries such as cephalhematoma by the following use of forceps.
Complication of Forcep Delivery: -
The risk of a serious birth injury during a forceps delivery is incredibly low but it can
happen. In very rare cases, the baby may suffer a permanent birth injury or die shortly
after birth as a result of their injuries.

WATER BIRTH/HYDROTHERAPY

INTRODUCTION
Hydrotherapy is the use of water for physical or psychological benefits.
The value of hydrotherapy for labour has been known and used around
the world for many years. There are two options for hydrotherapy during
labour - Showering or Immersion Hydrotherapy
DEFINITION
Water birth is labour and sometimes delivery that occurs in water, usually a
birthing pool. birth proponents believe childbirth in water result in a more
relaxed, less painful experience that promotes a midwife-led model of care
Objectives
General objectives
At the end of the class students will be able to know about water birth
and position changing.
Specific objectives

▶
To know about definition of water birth
▶
To know about showering and immersion hydrotherapy
▶
To know about benefits of hydrotherapy
▶
To know about various position during labour

WATER BIRTH:-
The baby can be delivered underwater or the mother can get out of the water and
deliver in a different position. Women chose water births because it can be more
relaxing, and less painful to be in the water. Birthing tubs can be brought into the home
for a home birth, and they are often found in birthing centers. Some hospitals may have
birthing tubs as well.
Benefits of Water Birth: -
• A water birth is thought to be less painful and more relaxed for many women. It
allows the woman to move into a variety of positions that can feel more natural and
less painful.
• The partner can also get into the tub with the mother to support the delivery.
Disadvantages of Water Birth: -
Some critics say a water birth can increase the risk of infection, but as long as the
water is fresh and clean, water births are not any more risky than non-water births.
• If the birth plan at home does not progress normally, it may require transport to a
hospital.
Complication of Water Birth: -
Water birth means sitting, pushing, and delivering in a tub -which often includes feces
in the tub. A baby born in that environment could possibly swallow the contaminated
water, increasing his risk of infection.
• There is a risk of drowning.

.
Showering
All labour rooms are equipped with a seated shower and removable
shower head.
Immersion Hydrotherapy
Soaking in warm water sufficient to cover the mother’s belly is available upon

request and by provider order.

Foetal heart monitoring may be done intermittently while in the water or a mobile

foetal heart monitoring device may use.

 Physiological and psychological benefits include:
▶
Ease of movement with greater mobility due to buoyancy
▶
Relaxation during and between contractions
▶
Safe and effective pain management
▶
Reduction of blood pressure
▶
A sense of control as mother occupies her warm, private space
▶
Facilitation of cervical dilation

When the Tub Can Be Used

After an assessment of labour is performed, your obstetrician is notified and there is a

provider order to determine appropriateness of the tub Immersion hydrotherapy may be used
any time during labour. In some cases it is best to wait until labour is well-established. For a
first-time mom, this is usually 4-5 centimetres of cervical dilation with good, regular
contractions

When the Tub Shouldn’t Be Used

If there are any signs of maternal or foetal distress during labour

Epidural anaesthesia
IV infusion of medicines
Medications for pain or induction of labour
Continuous foetal monitoring or if gestational age is less than 37 weeks
 Delivering in the water

We do not allow delivery of the baby in the water. When delivery is near, you will be
assisted back to bed for delivery.
Variety of positions offer choice and comfort

Women can choose from a variety of positions that take advantage of gravity,
enlarge the pelvis diameter, relieve back pressure, or simply make them feel more
comfortable
Standing and walking

Standing and walking both provide a sense of control, and can reduce backache.
During difficult contractions, the woman can lean against the wall or her partner.
Some women also like to sway in rhythm to their breathing, or stand in a supported
Kneeling

Some women choose to kneel while leaning on a chair. Kneeling on all fours may
offer relief from back pain and can help shift the baby’s position.
 Leaning
Leaning takes advantage of gravity while also supporting the woman’s body. She can lean
against a wall, a bed, a partner, or even place one foot on a chair or footstool and lean into a
lunge during contractions.
 Squatting

Squatting encourages foetal descent, allows the woman to shift her weight comfortably,
and may increase pelvis diameter by up to 2 centimetres, making it easier for the baby to
move through the pelvis.
In water

Many women find labouring in water to be relaxing. In addition, it creates buoyancy that
can make changing positions easier
Massage/soft touch during labour

Massage and touch can be a powerful and effective tool for helping women
during childbirth.Modern and scientific evidence supports the use of massage
during labour. A 2016 study on the effect massage therapy on the duration of
labour found that those who received massage therapy during the first and
second stages of labour had a significant decrease in labour duration as
compared to the control group.
 Massage technique

The use of tennis balls on the lower back or hips or using a rolling pin (hollow)
filled with ice can provide pain relief. Massaging in between contractions, using
long strokes down the mid back to the sacrum, stroking up the back and
massaging the shoulders and neck, applying counter-pressure during
contractions at sites of pain, and hip squeezes to help with relief of back pain
are helpful Massage Techniques for Early labour.

Effleurage is a massage technique that involves a light pressure over the body.
During labour, a doula can use a flat hand to stroke the client’s back, arms, and
legs. Feathering, a sub-category of Effleurage is performed solely with your
fingertips. A labouring person might find this helpful during contractions over
their abdomen (Birthing Naturally.).
SUMMARY:-

Childbirth, also known as labor and delivery, is the ending of a pregnancy by one or more babies
leaving a woman's uterus by vaginal passage or Caesarean section. The experience of giving birth is
both universal and unique all at once. Although women have been doing it since the dawn of
humanity, the process, politics and social norms around pregnancy and birth have evolved as medical
practitioners and mothers become more experienced in birthing methods. As we discussed there are
many child birth practices like Bradley method, Lamaze method, Vaginal child birth, home birth,
Water birth, and assisted child birth etc.

REFERENCE:-

1. Janssen PA, Lee SK, Ryan EM, Etches DJ, Farquharson DF, Peacock D, Klein MC. Outcomes of
planned home births versus planned hospital births after regulation of midwifery in British
Columbia. Canadian Medical Association Journal. 2002 Feb 5:166(3):315-2, seen on - 22 Jan

2. https://www.medicinenet.com/childbirthand_delivery_methods/
article.htm#what_natural_childbirth _methods_are_available_at_home.seen on- 12 Jan

3. https://www.medicinenet.com/parenting_principles_pictures_slideshow/article.htm,seen on - 12
Jan

4. http://blog.johnsonmemorial.org/blog/what-type-of-birth-is-right-for-you-and-your-baby,seen 12
Jan on-