|Care in Normal Birth (WHO, 1996, 60 p.)|
|2. GENERAL ASPECTS OF CARE IN LABOUR|
The preparation for birth on admission to a hospital or health centre often includes several routine procedures such as the measuring of temperature, pulse and blood pressure, and an enema, followed by shaving of all or some of the pubic hair.
The first three procedures, taking and recording temperature, pulse and blood pressure, can have implications for the final outcome of birth, and could therefore influence the management of labour. These routine procedures should not be dismissed, although they should be introduced and explained to the woman and her partner. Measuring the temperature every 4 hours, according to the WHO partograph, is important, because a rise in temperature may be a first sign of infection, and thus may lead to early treatment, especially in case of prolonged labour and ruptured membranes; this may prevent sepsis. Sometimes it may be a sign of dehydration. Taking the blood pressure at the same intervals, is an important check on maternal well-being. A sudden rise in blood pressure can indicate the need to expedite delivery or transfer the woman to a higher level of care.
Enemas are still widely used because they supposedly stimulate uterine contractions and because an empty bowel allows the head to descend. They are also believed to reduce contamination and thereby infection of mother and child. However, they are uncomfortable and carry a certain risk of damage to the bowel. Even though some women ask for an enema, many women find them an embarrassment. Two randomized controlled trials (Romney and Gordon 1981, Drayton and Rees 1984) found that, with use of an enema, the rate of faecal soiling is unaffected during the first stage of labour, but reduced during delivery. Without an enema soiling is mainly slight, and easier to remove than soiling after an enema. No effects on the duration of labour or on neonatal infection or perineal wound infection were detected.
Pubic shaving (Johnston and Sidall 1922, Kantor et al 1965) is presumed to reduce infection and facilitate suturing but there is no evidence to support this. Women experience discomfort as the hair grows back and the risk of infection is not reduced. The routine use could even increase the risk of infection by the HIV and hepatitis virus, either to the care provider or the woman.
In conclusion, measuring temperature, pulse and blood pressure are observations rather than interventions and are part of ongoing assessment in labour. They have a clear place in care, since they can indicate the need to change the course of action in any particular birth. However, they are only feasible in some settings. The last two procedures, enemas and pubic shaving, have long been considered unnecessary and should not be done except at the womans request. There is no documentation on the above mentioned routine procedures in the case of home birth, let alone research. Neither is there evidence that at home the need for them is different from the need in hospital.