Cover Image
close this bookCare in Normal Birth (WHO, 1996, 60 p.)
View the document(introduction...)
View the documentACKNOWLEDGEMENTS
close this folder1. INTRODUCTION
View the document1.1 Preamble
View the document1.2 Background
View the document1.3 Risk Approach in Maternity Care
View the document1.4 Definition of Normal Birth
View the document1.5 Aim of the Care in Normal Birth, Tasks of the Caregiver
View the document1.6 The Caregiver in Normal Birth
close this folder2. GENERAL ASPECTS OF CARE IN LABOUR
View the document2.1 Assessing the Well-being of the Woman during Labour
View the document2.2 Routine Procedures
View the document2.3 Nutrition
View the document2.4 Place of Birth
View the document2.5 Support in Childbirth
close this folder2.6 Labour Pain
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View the document2.6.1 Non-pharmacological methods of pain relief
View the document2.6.2 Pharmacological pain relief in labour
close this folder2.7 Monitoring the Fetus during Labour
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View the document2.7.1 Assessment of amniotic fluid
View the document2.7.2 Monitoring the fetal heart rate
View the document2.7.3 Fetal scalp blood examination
View the document2.7.4 Comparison of auscultation and electronic fetal monitoring
View the document2.8 Cleanliness
close this folder3. CARE DURING THE FIRST STAGE OF LABOUR
View the document3.1 Assessing the Start of Labour
View the document3.2 Position and Movement during the First Stage of Labour
View the document3.3 Vaginal Examination
View the document3.4 Monitoring the Progress of Labour
close this folder3.5 Prevention of Prolonged Labour
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View the document3.5.1 Early amniotomy
View the document3.5.2 Intravenous infusion of oxytocin
View the document3.5.3 Intramuscular oxytocin administration
close this folder4. CARE DURING THE SECOND STAGE OF LABOUR
View the document4.1 Physiological Background
View the document4.2 The Onset of the Second Stage
View the document4.3 The Onset of Pushing during the Second Stage
View the document4.4 The Procedure of Pushing during the Second Stage
View the document4.5 Duration of the Second Stage
View the document4.6 Maternal Position during the Second Stage
close this folder4.7 Care of the Perineum
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View the document4.7.1 “Guarding the perineum” during delivery
View the document4.7.2 Perineal tear and episiotomy
close this folder5. CARE DURING THE THIRD STAGE OF LABOUR
View the document5.1 Background
View the document5.2 Prophylactic use of Oxytocics
View the document5.3 Controlled Cord Traction
View the document5.4 Active Versus Expectant Management of the Third Stage
View the document5.5 Timing of Cord Clamping
View the document5.6 Immediate Care of the Newborn
View the document5.7 Care of the Mother Immediately after Delivery of the Placenta
close this folder6. CLASSIFICATION OF PRACTICES IN NORMAL BIRTH
View the document(introduction...)
View the document6.1 Practices which are Demonstrably Useful and Should be Encouraged
View the document6.2 Practices which are Clearly Harmful or Ineffective and Should be Eliminated
View the document6.3 Practices for which Insufficient Evidence Exists to Support a Clear Recommendation and which Should be Used with Caution while Further Research Clarifies the Issue
View the document6.4 Practices which are Frequently Used Inappropriately
View the document7. REFERENCES
View the document8. LIST OF PARTICIPANTS
View the documentSAFE MOTHERHOOD RESOURCE LIST
View the documentBACK COVER

2.5 Support in Childbirth

Reports and randomized controlled trials on support in labour by one single person, a “doula”, midwife or a nurse, showed that continuous empathetic and physical support during labour resulted in many benefits, including shorter labour, significantly less medication and epidural analgesia, fewer Apgar scores of <7 and fewer operative deliveries (Klaus et al 1986, Hodnett and Osborn 1989, Hemminki et al 1990, Hofmeyr et al 1991).

This report identifies a doula as a female caregiver, who has had a basic training in labour and delivery and who is familiar with a wide variety of care procedures. She provides emotional support consisting of praise, reassurance, measures to improve the comfort of the mother, physical contact such as rubbing the mother’s back and holding her hands, explanation of what is going on during labour and delivery and a constant friendly presence. Such tasks can also be fulfilled by a nurse or midwife, but they often need to perform technical/medical procedures that can distract their attention from the mother. However, the constant comforting support of a female caregiver significantly reduced the anxiety and the feeling of having had a difficult birth in mothers 24 hours postpartum. It also had a positive effect on the number of mothers who were still breast-feeding 6 weeks postpartum.

A woman in labour should be accompanied by the people she trusts and feels comfortable with; her partner, best friend, doula or midwife. In some developing countries this could also include the TBA. Generally these will be people she has become acquainted with during the course of her pregnancy. Professional birth attendants need to be familiar with both the supportive and the medical tasks they have and be able to perform both with competence and sensitivity. One of the supportive tasks of the caregiver is to give women as much information and explanation as they desire and need. Women’s privacy in the birthing setting should be respected. A labouring woman needs her own room, where the number of attendants should be limited to the essential minimum.

However, in actual practice conditions often differ considerably from the ideal situation described above. In developed countries women in labour often feel isolated in labour rooms of large hospitals, surrounded by technical equipment and without friendly support of caregivers. In developing countries some large hospitals are so overcrowded with low-risk deliveries that personal support and privacy are impossible. Home deliveries in developing countries are often attended by untrained or insufficiently trained caregivers. Under these circumstances support of the labouring woman is deficient or even absent, for a significant number of women deliver with no attendant at all.

The implications of the above statements for the location of birth and the provision of support can be far reaching, because they suggest that caregivers in childbirth should work on a much smaller scale. Skilled care in childbirth should be provided at or near to the place where women live, rather than bringing all women to a large obstetric unit. Large units that perform 50 to 60 deliveries a day would need to restructure their services to be able to cater to women’s specific needs. Caregivers would need to reorganise work schedules in order to meet women’s need for continuity of care and support. This also has cost implications and thus becomes a political issue. Both developing and developed countries need to address and resolve these issues in their own specific ways.

In conclusion, normal birth, provided it is low-risk, only needs close observation by a trained and skilled birth attendant in order to detect early signs of complications. It needs no intervention but encouragement, support and a little tender loving care. General guidelines can be given as to what needs to be in place to protect and sustain normal birth. However, each country willing to invest in these services needs to adapt these guidelines to its own specific situation and the needs of the women as well as to ensure that the basics are in place in order to adequately serve women at low, medium and high risk and those who develop complications.