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Birthing
Alternatives: Toward
a rewarding birthing experience.
| Course Number |
LWN102 |
| Objectives |
At the end of this course, you will
have several "tools" that will help her guide her laboring
patient to a positive and rewarding birth experience. These tools
include:
1. Assessing your own beliefs and especially your own level of fear
about
birth.
2. The importance of "creating a connection" with the laboring woman
and her
support people.
3. Recognizing and validating the emotional milestones associated with the
different stages of birth.
4. Reinforcing and supporting a woman's "birth plan" goals.
5. Learning several techniques that can help the laboring woman manage pain
during labor.
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| Credit Hours and Fee |
3.0 CE Credit Hours with a fee of $24.00 |
| Instructor/developer |
Rudolf Klimes, PhD (Indiana U), MPH
(Johns Hopkins U);
Adjunct Professor at Folsom Lake
College, Folsom CA.
Kristi Cargill,
RN, BSc. |
Welcome to an accredited continuing education
course in health for nurses, counselors and others with 24/7
certification. Study this three-hour course, take the 12-question
multiple-choice
TEST, register and pay online. If
you score 75% or above, you may print your CE certificate on your printer as
soon as you finish.
If you have difficulty printing your certificate,
click here.
You may retake the test once.
Nurses can help laboring women and their families have more rewarding birth
experiences in the hospital setting. Others may take this course to obtain
general background information.
Take
this course for free. Or study this web-site for an
approved (RN-CEP 11430, MFT- PCE 39) 3-hours Continuing Education Certificate (0.3
CEUs) and take the
12-question multiple-choice test that is linked to the bottom of this page.
Disclaimer: This module assumes that the nurse is proficient in her field
and is well informed on the process, physiology and pharmacology related to
hospital birth. This module is intended to broaden the nurse's knowledge
base, and allow her to use the information herein to help families and
laboring women have more positive, rewarding birth experiences. Within the
available time, limit yourself to persuing the course links, so that you do not
get lost. Always return to this page, www.learnwell.org/birthing.htm
.
1. Assessing your own beliefs and especially your own level of fear about
birth.
Being a good labor and delivery nurses requires that we be flexible in our
own approach so that we can accommodate and support the myriad of different
beliefs and attitudes that come in when women come to have their babies.
As
is necessary in all types of nursing, we sometimes need to put our personal
beliefs and judgments on a back shelf in order to care for our patients.
But, the nurse helping a woman have her baby may have to look at her own
beliefs a little more closely.
Many women come in to have their babies completely unprepared. They bring
themselves and their preconceived ideas about what their baby's birth will
be like. Others come in "totally prepared", having read all the
books,
created birth plans about how they want their birth to be, and may have
brought support people. www.birthpartners.com/doulas_USA.HTM
They too, have brought
preconceived ideas. Both groups need your help to adjust to the "real
work"
of labor as opposed to all the preconceptions. Your job then, is to know
if
you can accept the woman as she is, with whatever ideas she has, and work
with her to gently bring her to the place where she can succeed, and have
the most gratifying birth process possible. This does not mean talking her
out of her ideals, but rather helping her make choices that are consistent
with her ideals when unanticipated questions arise.
Fear is one of the biggest obstacles to successful birthing. Fear of the
unknown, fear of "not being able to do it", fear of pain. Fear
is also very
contagious. If the nurse begins to feel or sense fear or anxiety, that is
probably a good indication that the laboring woman, or one of her support
people is experiencing fear or anxiety. If there is an opportunity to
discuss these fears with the laboring woman and her support people, do it.
Communicating and educating can eliminate many of the emotional barriers to
smooth laboring.
The nurse may have her own fears about birth, or how some physicians work,
or they may even operate in fear of lawsuits. Whatever your fears are as a
nurse, work to dispel them. Again, fear is contagious, and it will impinge
upon and detract from the miracle of birth.
Remember that birth is a spiritual event, so a nurse that can be at peace
with herself and in tune with the "energy levels" at a birth, can be a
very
valuable. If the nurse can sense tension, fear and anxiety and work to
dispel it, the laboring woman will have a greatly improved perception of her
birth experience. www.birthpsychology.com/birthscene/initiative.html
If the nurse is
intolerant of the laboring woman's ideas and perceptions, there will be a
less favorable perception of the birth experience. In her classic book,
"Spiritual Midwifery", Ina May Gaskin writes about attitudes of the
caregiver:
"Your own attitude is a factor which you can't afford to ignore. If
your
own heart/mind are at peace, you can inspire the heart of the lady so that
she knows that she can do it."
Reference:
Gaskin, I. M., (1990). Spiritual Midwifery. Summertown, TN: The Book
Publishing Company.
2. The importance of "creating a connection" with the laboring woman
and her
support people.
Talk early on
with the woman, get an idea of what she wants for her labor experience, and
keep the woman and her support people informed about how the woman is
progressing and of any concerns the medical or nursing staff have. Win her
trust by not challenging or dismissing her wishes, but by discussing them
with her and coming to an agreement early on about how to deal with possible
deviations from her "ideal". For example, if a woman expresses
an interest
in having a natural childbirth, www.hypnobirthing.com
with no pain medication, discuss with her her
plan for coping with her contractions, and discuss the possibility that she
may later request pain medication. Ask her early on how she would like you
to handle that request if it does come up at a later time. She may want
you
to validate her progress, remind her that she is doing a great job, or ask
her to try a couple more contractions, then make a decision about pain
medications. If the woman has a professional labor companion, or a doula,
this person can be of great help in helping the woman work through her
contractions, and ultimately reach her goal of natural birth. A doula is a
supportive companion (other than a friend or loved one) who is professionally
trained to provide labor support. She performs no clinical tasks. The
important
key here is to not give up too quickly on the woman or her "original
plan".
3. Recognizing and validating the emotional milestones associated with the
different stages of birth.
The First Stage of Labor:
www.childbirth.org/articles/really.html
The Latent Phase: In this phase the woman may be excited, anxious, scared,
or any of a broad spectrum of emotions. It may comfort her to tell her
that
any emotional state that she finds herself in is normal.
Many times, a woman in this phase of labor will get ahead of herself and try
to anticipate her ability to cope with and manage the rest of her labor.
This puts her into the future and into the unknown and can make her doubt
her ability to labor successfully, according to her plan. This is a good
time to introduce the idea of "present time". "Present
time" is now. If
you can work with the woman to keep her attention in present time, letting
go of past contractions and not looking past the next, she will be better
able to manage her contractions without getting herself into the "no-woman'
s-land" of how she will manage stronger contractions in the future.
Try to
help the laboring woman settle into a routine to manage her contractions.
The Active Phase: As contractions increase in intensity during this phase,
the woman may try to mentally compare how she has handled contractions until
now, and how she will handle them if they continue to become more intense.
If you have already worked with her on the concept of "present time"
you
will probably be able to work with her to let go of past contractions
completely, and rest and relax until the next contraction begins. Work
with
her to bring all of her attention out of the past and out of the future and
remind her that she is doing a great job. During this phase of labor a
woman's attention will focus more inward, soothing touch and affirming that
she is doing well will help her manage her contractions.
Transition: Transition can be very emotional for a laboring woman.
She may
become angry or weepy; she may feel exhausted and think she cannot go on.
Remind her that she is progressing, and that now, in present time she is
managing very well. Tell her that this emotional stage means that she is
in
transition, which means she is closer to having her baby. Remind her that
her emotions are normal, be calm as you encourage and praise her. If,
before labor, the woman wanted to have her baby without pain medications,
work with her through her contractions, and don't suggest pain medication
now. If she feels she simply cannot go on, she will request medication
herself. Then, you might ask her if she'd like to try just a few more
contractions without pain medication, if she agrees, continue to work with
her, if she is adamant, help her get pain relief.
The Second Stage of Labor:
The Resting Phase: Some women do not experience a resting phase, if the
woman you are caring for has a resting phase, use this time to validate her
efforts so far, and help her get ready for the pushing phase.
Pushing: The laboring woman may have renewed energy at this point, she may
begin to see the light at the end of the tunnel. Many women at this stage,
especially if this is their first child, need to "learn" how to push.
Help
her relax her legs and perineum by encouraging her and telling her when she
is pushing effectively. Let her know she is doing a good job and remind
her
to "open up" to let her baby out. If she is progressing slowly
and had
expected this part of her labor to go quickly, reassure her and tell her
that sometimes it take a while to learn to push. Help her relax and help
her dispel her fears of letting the baby come out.
Delivery: Delivery brings a rush of excitement for everyone present, but
sometimes the mother is so exhausted that she has a hard time being excited.
She may feel guilty about this so reassure her that it is normal to be "too
tired", and that she can cuddle and hold her baby in a few minutes when she
has had a little time to "recover". http://homearts.com/depts/health/fetal/childbirth/html#stage_2
The Third Stage of Labor:
Delivery of the Placenta: Many women seem to forget about this stage of
their labor in the excitement of having and holding their new baby. She
may
be surprised when she feels another contraction. You may need to remind
her
that she still needs to deliver the placenta. http://homearts.com/depts/health/fetal/childbirth/html#stage_3
References:
Gaskin, I. M., (1990). Spiritual midwifery. (pp. 336-366). Summertown, TN:The Book Publishing Company.
Jones, C., (1991). Alternative birth: the complete guide. (pp. 27-43). New
York, NY: St. Martin's Press.
Simkin, P., (1989). The birth partner: everything you need to know to help
a woman through childbirth. (pp. 47-72). Boston, MA: The Harvard Common
Press.
http://www.childbirth.org/articles/support.html
4. Reinforcing and supporting a woman's "birth plan" goals.
If a woman comes in with a birth plan,
www.childbirth.org/articles/birthplans.html
take the time to read
it. This does a lot to help you establish the trust necessary for the
woman
to have a good birth experience. If there are ideas in her birth plan that
will just not work at your facility address them in an open, nonjudgmental
manner and try to reach compromises that work for your facility and for her
needs. If you sense that the birth plan is very idealistic and you
anticipate deviations from the plan, talk about that too. Talk with her to
assess her knowledge of the birth process and talk with her about what she
can reasonably expect. A valuable tool to use with women is to help them
let go of their expectations. This doesn't mean letting go of her birth
plan, it just means allowing for flexibility if the birth does not go
according to the birth plan. Many times a woman has expectations she didn't
know she had until something happens during her birth and she says, "I didn't expect this!"
<http://homearts.com/depts/health/fetal/childbirth.html#unexpected>
If
this happens, help her "go to plan B" and help her let go of the
"ideal" by
encouraging her and, if possible, allowing her time to adjust to any
changes. Remind her that changes are just changes, not failures.
Even though support people are very valuable, remember to address the
laboring woman when decisions need to be made. She may be focused inward,
but the decisions are ultimately hers to make. Don't talk about her as if
she weren't there!
5. Learning about several techniques that can help the laboring woman manage
pain during labor.
www.babyzone.com/dileo/painrelief.htm
6.
References:
Gaskin, I. M., (1990). Spiritual midwifery. Summertown, TN: The Book
Publishing Company.
Jones, C., (1991). Alternative birth: the complete guide. (pp. 66-74). New
York, NY: St. Martin's Press.
Simkin, P., (1989). The birth partner: everything you need to know to help
a woman through childbirth. (pp.73-92). Boston, MA: The Harvard Common
Press.
Links:
Labor of
Love......childbirth resource
Study this web-site for
3 hours for an
approved (RN-CEP 11430, MFT- PCE 39) 3-hours Continuing Education Certificate (0.3
CEUs).
Click
here for the self-correcting test & online payment, and 2) receive your
certificate immediately online. All is online, nothing by post-mail.
Course developed by California State University of California Nursing
Student Kristi Cargill, RN, BSc. Instructor: R. E.
Klimes, PhD, MPH.
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