Lithotomy Observation Report

“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of survival and political warfare.” ~Audra Lorde. The first 40 days after giving birth is traditionally viewed as a sacred time in which the village, tribe, or clan would care for a new mother so that she could optimally care for her new baby. Many of us in the West are unknowingly desperate for this “lying in”period of postpartum bed rest, where we could deeply surrender to the needs of our newborn, while knowing that our needs, and the needs of our household are being taken care of by others. This approach is what we are physiologically designed for, and this interconnected motherhood remains the norm in most non-western cultures today. The term “Postpartum”

Mothers and newborns have a physiologic need to be together during the first moment of birth. Interrupted skin-to-skin attachment between mothers and babies can be harmful and can negatively impact short and long term health outcomes and breastfeeding success. Evidence supports instant skin-to-skin care after the birth, vaginally and C-section, during and after cesarean surgery for all stable mothers and newborns will enhance limitless opportunities for care and breastfeeding. Skin-to-skin contact after delivery is golden opportunity. Many studies validate that mothers and babies should be skin-to-skin promptly after birth. Not only promotes healthier baby and successful breastfeeding outcome, it is also

Skin to skin contact immediately after birth provides comfort and stability for both mother and infant. Doing skin to skin contact immediately after birth in the

The National Institute for Health and Clinical Excellence (NICE, 2007) Intrapartum guidelines state that during the first stage of labour women should be encouraged to adopt the position they feel most comfortable in. This is what the student was trying to encourage even though her mentor did not.There are various positions the woman can adopt in labour which are generally grouped into upright and recumbent. The positions classed as upright are; standing, walking, kneeling, squatting, on all fours and sitting, and the recumbent position could include; supine, lithotomy, semi-recumbent or side lying (Johnson and Taylor, 2011). The upright position appeared to be more beneficial in Sarah’s case and the author wants to determine if this is always the case. It is evident that sometimes there will be constraints such as continuous fetal monitoring but it is important that the midwife does

physics of birth; moving from sitting and squatting, which was used historically by midwives and

In 1976 Marshall H. Klaus and John H. Kennell came out with a book called “Parent Infant Bonding”. It discussed their hypothesis that like other animals, there is a brief moment directly following the birth of a child where skin-to-skin contact between mother and offspring creates a strong bond. Although this theory continues to be

The article “A Quality Improvement Project Focused on Women’s Perceptions of Skin-to-Skin Contact after Cesarean Birth” was written by Judith Moran-Peters, Cheryl Zauderer, Susan Goldman, Jennifer Baierlein, and April Smith. The purpose of this quality improvement project was to evaluate the implications of the unavailability of skin-to-skin contact following a cesarean birth and to identify perceptions of women who performed skin-to-skin contact after their second cesarean birth. The study also sought to compare cesarean birthing experiences, particularly in relation to the facilitation of breast-feeding, in which skin-to-skin contact was and was not present.

This hospital-based, prospective cohort study investigates how mother-infant-skin-to-skin contact after 3 hours of singleton births may result in exclusive breastfeeding success during the mother and baby’s hospital stay compared to those mother-infants who do not receive skin-to-skin contact three hours after birth. The title is appropriate and accurately portrays the study’s purpose and content. However, the title is quite lengthy. The reader can easily recognize from the title that the article investigates how early skin-to-skin mother-infant contact influences exclusive breastfeeding success during the mother and infant’s hospital stay. The key terms “exclusive breastfeeding”, “early skin-to-skin contact”, and “intrapartum variables” allows readers to easily access this article and similar articles in a library data base.

The postpartum period is a time of huge physiologic and psychological adjustment. The nurse plays an important role during this time, offering support and encouragement to the family, which fosters a healthy and loving relationship with the newborn. In addition to the emotional support, the nurse also must be vigilant in her assessment skills to detect any variation from normal, so that prompt intervention can be provided to thwart complications.

Skin-to-skin contact has not become standard practice in the case of women undergoing a cesarean section. Ideally, skin-to-skin should begin within five minutes of birth, meaning that the infant should be placed directly on the mother’s chest in the operating room. Not only is this not being done routinely, but also in some areas, infants and mothers are separated for the duration of the C-section recovery period (up to 3 hours). This deficit in care is seen in all areas of the world where cesarean sections are

The implementation of this routine tradition has been linked to a lack of education of the nurses of the various benefits of upright birthing positions and thus deficient knowledge of the mothers on their different options for positioning during delivery. Furthermore, research has determined that upright positions for delivery, such as squatting and sitting, yield more positive outcomes physically and psychologically for the mother and the baby than gravity-neutral supine positions. Nurses and other obstetric medical professionals are reluctant to “change their ways” of practice because of barriers to obtaining such knowledge related to their scope of practice. It is the job of the nursing managers on the unit to educate their floor nurses on the benefits of upright delivery positions and the more detrimental effects of supine delivery positions so their patients can have full knowledge and control of the birthing process when deciding on a birthing position as to achieve the most optimal delivery experience as possible.

Some barriers to breastfeeding include the stressful nature of the NICU, the physical separation from the infant, fatigue, the anxiety that comes with having an ill child, the lack of privacy, and the limited supply of milk (Boucher et al., 2011). Not only does the baby benefit from breastfeeding, but women who experience positive early breastfeeding experiences have shown to have a decreased incidence of postpartum depression (Mangan & Mosher, 2012). There are many positive implications for breastfeeding for mother and baby and there are significant barriers in the clinical setting that need to be addressed to alleviate the effects of many of these

In the United States, the most common birthing position is the lithotomy position, which allows the obstetrician to have a better vantage point of the perineal area should a complication occur during delivery. Often times, the preference of delivery position is placed on the obstetrician rather than the pregnant woman herself. The woman 's choice not being taken into consideration is one issue, however another important issue is that some birthing positions may increase the chance of sustaining perineal lacerations. A perineal

Providing continuous physical and emotional support during labour can reducing maternal fear, stress, and anxiety and protect physiological birth (Steen, 2012). Research shows that fear and anxiety during labour and birth can be detrimental to physiological birth. An environment that women feel unsafe in may stimulate a surge of neuro-hormones that can influence both fetal and maternal physiology, causing irregularity of contractions, fetal distress and subsequent medical inteverntions (Fahy & Parratt, 2006). Conversly, maintaining an environment where women feel safe, protected and supported can facilitate favourable physiological performance (Fahy & Parratt, 2006). Midwives can do this by giving women one-on-one continuous support and placing her at the centre of care throughout childbirth (Steen, 2012). As observed in practice, by constantly reassuring the woman about her progress, her baby’s health and addressing any of her concerns, the midwife can provide a calm and relaxing environment that is conducive to the labouring woman (Buckley, 2015; Steen, 2012). The midwife worked with the woman, encouraging her throughout labour and birth by telling her that she was doing extremely well. The midwife also breathed in-tune with the woman while giving her a back massage, inducing a sense of comfort. The atmosphere was calm and this contributed to the woman garnering confidence in her ability to avoid medical pain relief. Downe (2008) noted that the positive impact of

The upright position which is mostly emphasized by most authors to be adapted by laboring women has more advantages to the woman, foetus, and labor. The women who adopted upright position during labour reported to experience less pain and felt more comfortable had short first and second stage of labour. The gravity when a woman adopts upright position facilitates the quicker progress of labour. Women who assumed upright position during delivery were reported to have lesser assisted vaginal deliveries or caesarean section, were less likely get ascending infections and it has good fetal outcome facilitated by good oxygen supply as the mother will be free from aortocaval compression (Mary Steen and Jo Anker, 2008; Munro & Macdonald, 2010)