Preparation for Parenthood Peggy Korman MA CNM Assistant Professor
Handouts • Medication to Know Before Going to Maternity Clinical • Terminology and Abbreviations • Practice Medication Quiz • break into small groups lead by someone who has been to clinical and do your best!
“There comes a turning point in intense physical struggle where one abandons oneself to a profligate usage of strength and bodily resource, ignoring the costs until the struggle is over. Women find this point in childbirth, men in battle. Past that certain point, you lose all fear of pain and injury. Life becomes very simple at that point, you will do what you are trying to do, or die in the attempt, and it does not really matter much which.” -Diana Gabaldon The Outlander
Possibilities • Women can give birth 85-90% of the time without complication and without unreasonable bravery
Penny Armstrong • >1200 Births • Meds: Pitocin, methergine, valium, epinephrine, IBU/Tylenol/Percocet, Abx, • Amnihooks, syringes, IV fluids, ring forcep, clamps, scissors suture kit, needles, suction, O2, larygoscope, ET tubes, ambu
Primip Birth Challenging for several reasons: • Women don’t have any personal experience of birth. Likely frightened. • Muscles are tight and baby has to travel against resistance • Hormonal systems are inexperienced at birth and may be slow to blend All combine to create the major challenge: the long labor
Goal • Preserve the woman’s energy so that she will have enough strength at the end to push the baby out Strategies: • Labor in any position the woman feels comfortable • Do few vaginal checks • Encourage the woman to walk the halls, inhabit the shower • Speak kindly • Eat
The Friedman Curve • Designed to describe the average length of labor, many practitioners and hospital review committees use it the other way around – to prescribe how long a labor might be. Friedman's
Michael Odent • French physician-surgeon • Pithivers • Interested in avoiding unnecessary sx with medical mgmt techniques • Odent’s gifts: boundless curiosity, excellent creative mind, superb capacity for observation, knowledge of medicine and physiology, an appreciation of women & enthusiasm for life..
Odent’s conclusions • Birth goes best if it takes place in a small, dimmed, quiet, well-protected room • Birth goes best if it is not intruded upon by strange people and strange events • Birth goes best when a woman feels safe enough & free enough to abandon herself to the process
Physiological Language • A “fetus ejection reflex” • Spontaneous natural process • At best managed not by our thinking minds, the neocortex, but by the body brain, the hypothalmus, which directs the interplay of hormones
Hypothalmus • Makes and stores oxytocin, which is released (the trigger mechanism is not understood) by the pituitary gland. • Oxytocin causes uterine contractions, which find a rhythm and increase in strength.
Endorphins • With the pain of the UC come endorphins, which both diminish pain and make us feel good. • They also flow when breast milk does • The allies of the laboring woman • Fear and stress can inhibit them
The 3 P’s • The body is malleable and birth is dynamic. • Contractions (powers) like hands kneading close on the baby (passenger), whose moving mass then pressures the pelvis (passage) causing it to spread; presses on the cervix which gives way.
FNS • Good outcomes from caregivers who defer to birth. • Since 1955, not one maternal death • Since 1971 their perinatal mortality rate has averaged 6 per 1,000 or less than half the national average
CPM c/s hazards for the mother: Maternal mortality rates are 5-10 times higher c/s disadvantages for the baby: Higher mortality…resp cx
Our History • Turn of the century one woman died for every 154 births • If a woman had 5 babies, which was common, her chance of surviving her reproductive life was one in 30. .
1880’s • Stethoscope, laryngoscope, opthalmoscope • Organisms responsible for TB, cholera, typhoid and diptheria were isolated • Later we had x-ray, spirometer, ECG