Elloise Richards, S00117666.

MIDW 216
There are many suggestions through evidence and observation that the birthing environment can influence the progress of a normal labour. The sights, smells, sounds, layout and woman’s perception of her security all play a role in promoting a state of relaxation needed for a normal labour. This essay will explore the benefits of a relaxed emotional state on labour and how to protect it with a positive birth environment, as well as explore the physiological advantages of an environment that facilitates mobility during labour. It is important midwives consider these factors to encourage women in actively taking part in their births and, therefore, be empowered. The Australian Nursing and Midwifery Council Competency standards (ANMC, 2008) state the responsibility of midwives to provide an optimal birth experience for women through understanding of the normality and physiological process of childbirth. Through the use of evidence-based practice, midwives can facilitate this experience and provide the best possible outcome to each individual through current research on the optimal birth environment. Further, there is much evidence to support the influence of the birth environment on labour and how to maximise the hospital setting to the woman’s needs. Additionally, there are observations coming out of both clinical and home birth settings surrounding the profound effects of the environment on labour. This essay will focus on creating positive birth environments in standard, hospital settings.

A woman’s emotional response to the birth environment is shown to impact the normal progression and physiology of labour. There are a number of reasons as to why a woman might feel fear, anxiety or stress in a standard, hospital setting. For example, regardless of the setting, parity can influence the emotional response to labour as some women enter their births with fear of the unknown (Dahlen et al., 2008), so sensitivity to this current evidence is important. Specific to this topic, women being cared for in an environment with unfamiliar people can create

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2 . particularly stress. and protect a normal labour. studies have investigated the effects of hormones from stress or fear on labour. tension or fear are shown to increase the level of stress hormones (catecholamines) above what is normal for labour. maintain maternal and fetal wellbeing. 2005). Grantly Dick-Read (2004) and Ina May Gaskin (2003) have both explored theories surrounding the physiological impacts of fear and anxiety on labour. an independent midwife. This can mean that the muscle contractility needed for labour is slowed or stopped.. A study of women’s desires from their carers in maternity settings discovered that women would like to enter one that brings calm and is without stress (Huber and Sandall.Elloise Richards. noted the neuromuscular tension created by fear which. Anxiety. which counteracts oxytocin levels needed for rhythmic uterine contractions. leaves the body reducing uterine blood flow as a form of protection. who worked in obstetrics. Dick-Read (2004). explored the effects of emotions on labour. 2004). She notes that stress increases adrenalin. These physiological reactions are crucial to understand when caring for women. Stress or fear can occur for a woman as soon as she enters the hospital. so it is important to create an environment that is relaxed and comfortable. It is therefore important to try and create peace and relaxation as soon as she enters the hospital to empower the woman with control over her birth and continue with normal labour. MIDW 216 vulnerability and anxiety for her (Walsh. which decrease the frequency or intensity of uterine contractions (Alehagen et al. delays labour through decreased uterine contractions. Buckley (2004) also states that the rise in catecholamine’s (adrenaline. Walsh (2007). Gaskin (2003). noradrenaline and cortisol) can stimulate the ‘fight or flight’ response. 2007). in turn. Whilst the normal physiology of labour and birth rely on hormones. S00117666. which if it occurs in the in the early stages of labour. as environmental changes can be undertaken to try and prevent the stress or fear and help women avoid intervention.

Elloise Richards. These all make an attempt at creating a peaceful environment that is safe. Carlsson (2010) noted that this state of calm will help the woman to focus on her body’s natural rhythm and maintain power over her choices and therefore empower her. Midwives should allow room for these childbirth supports and involve them 3 . partner or doula. and how with physical activity.‘’natures opiates’’. Eddy (2006) suggests maximising the labour environment by lowering the lighting. removing or minimizing these emotions as soon as a woman enters the hospital is vital. Surrounding the woman with a birth support. Continuous support was also stated to reduce the need for intervention and increases the chances of a normal labour and birth. to provide continuous support has been found to have positive effects on a woman’s labour. These endorphins block the reception of pain. This specific physiological response protects a normal labour as it can reduce pain experienced by the woman. S00117666. which is quiet and comfortable and filled with support and encouragement. 2004). The warmth and encouragement that comes from birth supports is described as more effective than drugs. Therefore. feeling support. She explores endorphins. protecting privacy at all times. Dick-Read (2004) was fascinated by the positive effect the soothing presence of a midwife had on a woman upon admission. MIDW 216 explains the slowing of contractions upon entering the hospital as a normal response to the change of environment. Interestingly. calm and the woman’s own. Hodnett et al. no fear. therefore allowing relaxation (Gaskin. facilitating the woman’s ability to feel safe to communicate her needs and vocalize as needed. this is just one of the many things that can be provided for a woman upon admission to create a positive birth environment. love and most importantly. Leap (2006) explored the notion of creating a ‘homely’ environment for birth. the continuous support can remind the woman of the normality of what is happening to build the woman’s confidence and self-belief. (2011) describes emotional support as most effective if provided early in labour and is reassuring and full of praise. endorphins are released. Ina May Gaskin (2004) makes further sense of this research through her own observations of companionship during labour. Additionally.

Lawrence et al. Zwelling (2010) states that mobility facilitates maternal-fetal circulation for both fetal and maternal wellbeing. S00117666. as well as fetal and maternal wellbeing. as well as attempt to create an environment that is calm. homely. Walsh (2007) states this being due to gravity aiding the descent of the fetal head. Maternal hypotension can also occur from the heavy uterus compressing the inferior vena cava from lying flat (Zwelling. so an environment that facilitates upright positioning and movement in labour is a 4 . If there is decreased utero-placental blood flow from a woman lying on her back. physiological labour. Studies have explored the relationship between movement and labour and birth outcomes. It is important for midwives to create an environment that promotes and facilitates mobility during labour. (2009) reviewed the literature on the effects of upright positions and mobility during the first stage of labour to see if there was any impact on the woman. supportive faces. This response interrupts a normal labour. These are fundamental processes that need to be protected for a normal labour. is the need for maternal mobility during labour. 2007).Elloise Richards. as the physiological benefits are fundamental in protecting a normal. This is because being able to change positions or sit upright creates higher comfort for women and helps them manage contractions more easily. Remaining though. suggesting less intensity in pain. and comfortable and with familiar. there was a decrease in the total length of labour for women who were upright instead of flat or in the semi-recumbent position. MIDW 216 when appropriate. Further. There was much evidence that upright positions and movement reduce the use of epidural analgesia. The Coalition for Improving Maternity services (CIMS) have formed 10 evidence-based steps of mother-friendly care which state the freedom of movement during labour as number four on the list as there is much evidence surrounding this step of mother-friendly care (Hotelling. there is less blood to the fetus meaning oxygenation is reduced and late decelerations can occur.. 2010).

most importantly. Midwives that work to protect a normal. and promoting relaxation through comfort and calm. It was found that the advice and support given by midwives was the most powerful tool in helping women find the best position or movement. so midwives should be actively reassuring women. this can work towards empowering the woman with her choices and providing guidance in achieving a normal labour. and promoting the woman’s autonomy in choosing labour positions. 5 .Elloise Richards. Fear is an emotional response that can heavily interfere with a normal labour at a hormonal level. Midwives should allow a woman to autonomously choose what position is most comfortable for her and empower her with that choice. 2004). S00117666. empowerment. however. protecting their environments from stress or fear. If the environment promotes freedom of movement by offering suggestions and removing physical obstructions. women valued this guidance and support (De Jonge & Lagro-Janssen. will also maintain the woman’s control over her labour and reach a positive birth outcome and. MIDW 216 necessity. Accommodating birth supports present at the birth. if the position is supine or semi-recumbent it is important that this choice is also respected. A quantitative studied investigated women’s experiences of mobility in labour and what best facilitated it. physiological birth will consider the factors explored in this essay.

Wijma.L. (2006). (2004). gentle mothering. DOI: 10. Ziegert..au/ Buckley. S.. L.01. New York: Random House. DOI:10. MIDW 216 References Alehagen.).anmc. (2012) Maintaining power: Women’s experiences from labour onset before admittance to maternity ward.E. Retrieved from: http://www.J.G.. Nissen.1080/01674820410001737432 Dick-Read. Obstetricians and Gynaecologists 8(4).. (2009). B..M (2004) Birthing positions: A qualitative study into the views of women about various birthing positions. Journal of Psychosomatic Obstetrics & Gynecology 26(3). E. U. Childbirth without fear. Homer. Barclary. pain and stress hormones during childbirth. 14-15. Fear.org. DOI: 10. London: Pinter & Martin Ltd. (ANMC).midw. Gentle birth. (2008) The novice birthing: theorizing first-time mothers’ experiences of birth at home and in hospital in Australia. (2005). A. National competency standards for the midwife. I-M. & Lagro-Janssen. 28. Canberra: ANMC.1080/01443610400023072 Australian Nursing and Midwifery Council. (6th ed. Sahlberg-Blom. & Wijma. 86-92 Dahlen. K. G. E.012 De Jonge.Elloise Richards. Midwifery. A. Midwifery. Midwifery interventions for the promotion of physiological birth.. Journal of Psychosomatic Obstetrics & Gynecology. H. S. 153-165 DOI: 10. K. Lundberg.1080/01674820410001737432 6 .2008. C. 5363.M. Inc Carlsson. 26.. Eddy.S. (2006). A. 47-55.1016/j. 25(1). S00117666.

Walsh. 38-43. Weston.pub2.pub3. Lewis. (2007).midw. (2007).1016/j.. Midwifery 25.. (2009) Maternal positions and mobility during first stage labour. 2. Hofmeyr. C. Leap.CD003766.A.. Sakala. Cochrane Database of Systematic Reviews. C. 2. 613-621 DOI:10. (2003).). The Journal of Perinatal Education. 46. U. G. C. DOI: 10. In Macdonald. D.J. Styles. The coalItion for improving maternity services: Evidence basis for the ten steps of mother-friendly care. & Henderson. Retrieved from CINAHL Plus with Full Text Walsh. Edinburgh: Bailliere Tindall.011 Lawrence. DOI: 10. S. (2004). (2006).J.1624/105812407X197744 Huber.1002/14651858. & Sandall. (13th ed. N.M. A. Care in the first stage of labour. DOI: 10.2007. (Eds. J. Ina May’s guide to childbirth. A qualitative exploration of the creation of calm in a continuity of carer model of maternity care in London.CD003934. New York: Routledge 7 .16(2). J. Hofmeyr. E... G. S00117666.. L.). D. S. Dowswell. B.. New York: Bantam Dell Hodnett. I.. (2007).D. An ideal birth environment? The right facilities and support for women. Gates.S.1002/14651858. Continuous support for women during childbirth (review). British Journal of Midwifery. T. 14(1). Evidence-based care for normal labour and birth: A guide for midwives. Cochrane Database of Systematic Reviews. MIDW 216 Gaskin.Elloise Richards. Mayes’ midwifery (pp 428-457).10.. (2011). Hotelling.

Elloise Richards.35(2):72-8 8 . S00117666. MIDW 216 Zwelling E. Overcoming the challenges: Maternal movement and positioning to facilitate labor progress. 2010. Am J Maternal Child Nurs.

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