women s health issues
Delivery
Introduction
Delivery is the passage of the fetus and placenta (afterbirth) from the uterus to the outside world. (See also Overview of Labor and Delivery .) For delivery in a hospital, a woman may be moved from a labor room to a birthing or delivery room, a room used only for deliveries. Usually, the father, partner, or another support person is encouraged to accompany her. Or she may already be in a private room where she stays from labor through delivery until discharge—a labor, delivery, recovery, and postpartum (LDRP) room. The intravenous line remains in place. When a woman is about to give birth, she may be placed in a semi-upright position, between lying down and sitting up. Her back can be supported by pillows or a backrest. The semi-upright position uses gravity: The downward pressure of the fetus helps the vagina and surrounding area stretch gradually, decreasing the risk of tearing. This position also puts less strain on the woman’s back and pelvis. Some women prefer to deliver lying down. However, with this position, delivery may take longer. Women in maternities around the world most often give birth lying flat on their backs. This is a familiar position and convenient for the birth attendant, however there are alternative positions that are more effective for birthing women. This video shows a variety of birthing positions to give women choices. These positions help the normal natural process of birth and support a woman’s pushing efforts. Lying on her back can hinder the woman’s pushing efforts, reduce oxygen to the baby, and slow down the birth. Encourage different positions for giving birth, but if the woman prefers to lie on her back, suggest she raise her head to help her pushing efforts; or, better, help her to raise her upper body. Women who choose other birthing positions may give birth more quickly and easily. Let’s see some examples. Here the woman is sitting up in the bed, supported by her partner behind her. This position is comfortable for many women, and makes it easy to see the progress of the birth. Support the perineum as you keep the head flexed, then guide the slow birth of the baby’s head. Once the baby rotates, assist the birth of the shoulders. In this next example, the woman is lying on her side. This position is restful yet allows contractions to remain strong and powerful. It relaxes the perineum and may help prevent tears. The woman can have her companion help support her leg or she may hold her leg by herself. In a side lying position, as in all other positions, support the perineum as you keep the baby’s head flexed; then let the head slowly birth. As the baby rotates, the shoulders come on their own. Upright positions, such as squatting, are very effective in bringing the baby down. The uterus often contracts more effectively plus gravity helps the baby move more easily through the pelvis. The pelvic opening also becomes wider in upright positions. Here the midwife keeps her hand on the baby’s head to monitor progress. Just as the head comes, the woman chooses to lie back. A woman’s legs may tire quickly if she’s not used to squatting. Here the woman supports herself with bars that are attached to the birthing bed. The baby’s head slowly emerges, then the top shoulder; and the bottom shoulder. The baby is born. This woman is in a squatting position supported by the back of the bed. With a few effective pushes, the baby is born. Hands and knees, another upright position, is a favorite position of many women and is helpful when the woman feels her labor in her back. The perineum will often naturally stretch which can prevent tears. The woman cannot see your face – so talk to her often to let her know her progress. Checking the baby’s heart rate is easiest with a doppler or a stethoscope. Wipe away any fecal material that may appear while she’s pushing. Support the perineum and apply light pressure on the back of the baby’s head to keep it flexed. Remember, the birth movements will be the opposite of the way they appear when the woman is on her back. The baby’s face will be looking at the ceiling when it appears. The next contraction brings the baby. Support her as she’s born, then dry her on the blanket at the feet of the mother. Pass the baby through the mother’s legs with her cord intact. The mother then turns over and rests with her baby skin to skin. Keep in mind that the hands and knees position increases the room in the pelvis and is one of the maneuvers to try if a baby’s shoulders are tight. This woman is pushing very effectively in this half kneeling position. As with the hands and knees position, you’ll need to be behind the woman to catch the baby. After the baby rotates, assist the shoulders to deliver, one and then the other. Encourage women in your care to try different positions. You will gain confidence in your ability to support a woman’s choice in how she’ll give birth. Often she will find the most comfortable position for herself, which is also the one that helps her push most effectively. Remember, active upright positions help the natural process of birth. Upright positions can help bring the baby out when the birth is slow. Demonstrate and encourage different positions during birth. Copyright Global Health Media 