| Preparation for childbirth - A health workers manual |
|Part V - Labor and delivery: Information for health workers|
Ideally, every mother would have a trained, caring person with her throughout labor, delivery, and the immediate postpartum period. However, since this is usually impossible in a hospital or clinic setting, we hope that a mother will be able to use the skills learned during the prenatal classes for her own comfort with only a moderate amount of attention on the part of the nursing staff. However, it goes without saying that the time you spend with the laboring mother should be used to maximum effect.
On the verbal level, it is important to explain hospital procedures and the progress of labor in terms the mother has learned in classes. For example, after a check for cervical dilitation, tell her that the cervix has dilated to a certain number of centimeters (or fingers) and how much further it has to go. Answer any questions she may have in an unhurried manner.
Remind her to breath deeply and slowly with each contraction as she has practiced in classes; you may need to breath with her through several contractions to help her establish a comfortable rhythm. Between contraction, remind her to relax completely to allow her body to work naturally to deliver her baby and to conserve her own energy. Gentle massage accompanied by soothing talk is a sure way of helping her relax. Now she should be rested and ready to handle the next contraction with confidence.
Although a mother may have learned how to control a premature urge to push during class, you may have to remind her to breath rapidly with the urge to keep from pushing against an incompletely dilated cervix. The same is true during delivery when a woman will sometimes need help panting so that she doesn't push while the health worker performs some obstetric maneuver. When a mother knows that she is less apt to tear or need an episiotomy if she can control her pushing, she will probably be quite cooperative .
Even a prepared mother may forget how to push effectively once she gets into the delivery room. Therefore, make sure she gets two deep breaths before beginning to push and instruct her to bear down steadily, getting catch breaths as she needs them.
How a mother performs in labor and delivery and how well she responds to your coaching is one measure of how effective the prenatal classes have been and also of how much trust you have been able to generate in her. Watch the laboring mother, listen to what she says, and be willing to modify you behavior to help her. Your mothers are also your teachers!