The Effects Of Laboring Down After Complete Cervical Dilatation

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

Randomization was used to generate what patient went to which group. The way the patients were chosen eliminated bias because “Randomization was performed according to a computer-generated list by means of sequentially numbered, opaque, sealed envelopes which revealed the allocation of the subject to either induction or expectant management”(Nielsen et al. p. 60). This secure randomization added a great strength to the study. The sample size seemed fairly large, 226 patients were split into 116 for elective induction and 110 to expectant management, although the power analysis was disclosed in this study and determined that 600 patients were required. Only 226 patients were used and because it would take 4 years to reach the required amount of patients, the study was discontinued. This was both a strength and weakness because disclosing this information made the study more honest but the quota needed to reach the best answers was not attained. The study for the 226 patients was pretty standard with the 80% power and alpha at 0.05. T-test and chi square tests were used to compare the proportions between the groups of people. The women were chosen based on the inclusion criteria of being 39 weeks gestation or older, maternal age of more than 17, fetal cephalic presentation, singleton gestation, a candidate for vaginal delivery, and a Bishop score of 5 or greater in nulliparous women and 4 or greater for multiparous women. This inclusion criterion was a concern because both nulliparous women and multiparous women were being tested together. This was a weakness because the labor patterns of a nulliparous woman compared to a multiparous woman are very variable and sure to distort study data. It was also disclosed how gestational age was achieved which included the crown rump test measured in 6-12

A concern that many women have who have undergone cesarean birth, is whether or not they can have a vaginal birth after. The answer is yes; they can have a vaginal birth, but only if the incision made was a horizontal one. The benefits are the woman ass’d with fewer blood transfusions, fewer post-partum infections and shorter hospital stays (Rose, 1). On the other hand there are many risks: the uterine may rupture, it could result in maternal and

Many woman give up in labor and beg the doctor to perform a cesarean section or many times the doctor does not want to wait for the laboring patient to progress on their terms and will call for a cesarean section. A cesarean section is a major abdominal surgery. Many woman are not educated in the short and long term effects of having one to be able to stay as far away from them. Maternal complications can be both physical and emotional due to the fact that the woman will not be able to care for her infant exclusively on her own during the recovery period. The first and most common complication with a cesarean section is surgical site infections. This could be caused by many things. It could be a cause of not cleaning the skin properly, a break in sterile technique, or personal hygiene of the wound during the recovery period. It can also be caused by the way the incision is closed. “ The use of staples for skin closure was associated with a marginally statistically significant increase in surgical site infections” (Corcoran 2013, pg. 1262). Infections can also be seen as urinary tract infections, endometritis, and pneumonia. Another complication that can occur from a cesarean section is a thrombus which can lead to pulmonary embolism. When a person has a cesarean section, they are bed bond more than a vaginal delivery. This causes the blood to not circulate in their legs

Healthy childbirth is defined as a safe, natural process that rarely requires medical intervention (Goer & Romano, 2012). The medical model of care, however, often includes interventions that are not supported by the evidence and can increase a woman’s risk of having a cesarean section. These intrusions into labor and birth often lead to what has been called the “cascade of interventions” (DeClercq, Sakala, Corry,

Women often feel unprepared for the degree of perineal pain that they experience postnatally and its impact on activities of daily living, reporting feelings of isolation and lack of support throughout the postnatal period (Herron-Marx, Williams and Hicks, 2007a), therefore, encompassing community and hospital based midwifery care. Enduring perineal pain has long-term implications including depression (Pairman et al., 2011), with evidence supporting that the delivery of postnatal care is too short, as some women experience pain up until three months postnatally suffering in silence as there is no appropriate professional input (Whapples, 2014).

A cesarean section is when the baby is surgically removed from the placenta. Since 1996, cesarean section rates rose to 46 percent. In 2005, 1 out of every 3 babies were delivered through a cesarean section (New Line Home Entertainment). Cesarean sections are considered major surgeries, but they are not depicted as such. They can lead to a variety of complications such as infection and damage to the bladder, intestines and appendix. Hospitals are in favor of cesarean sections because they can reduce the labor time from 12 hours to about 20 minutes. This is beneficial because it shortens the doctor’s busy schedule, but the time shortage is not worth the possible risks that a cesarean section brings. The cesarean section is also beneficial for the hospital because it is a major operation, so it will bring in money. Money paid by the parents of the child, who, more than likely, did not need the cesarean section to begin

Critique of Borders et al.’s Study (2013) “Midwives’ Verbal Support of Nulliparous Women in Second-Stage Labor”

As most people know, giving birth can be extremely painful. During the first stage of labor, pain is caused by dilation of the mother cervix, stretching of the lower uterine segment, and pressure on structures surrounding the uterus. The second stage of labor is characterized by a lack of oxygen to the tissues in the uterus, distension of the vagina, while pain during the third stage of labor is caused by uterine contractions, and dilation of the cervix as the mother expels the placenta (Ladewig et al., 2014). Overall, giving birth requires expending an enormous amount of energy and is exhausting on the body and mind with its association with

This was an observational cohort study among 19,151 women who gave birth vaginally in South Hospital in Stockholm, Sweden. It took place from April 2002 to December 2005, with the purpose of determining the role of birth positions and occurrence of severe perineal lacerations (Gottval, Allebeck, & Ekéus, 2007).

The research question ‘For women in the active second stage of labour is spontaneous pushing method more effective than the Valsalva pushing method in reducing perineal trauma?’ has not been answered due to the limited evidence regarding these two methods of pushing found. After conducting a literature review, it is evident that further studies need to be conducted comparing the valsalva pushing and spontaneous pushing on perineal trauma for women in the active second stage of labour. A randomised control trial, which provides high-level evidence as every birthing woman in victoria has an equal chance of participating and thus reducing selection bias, should be used (Queensland Government Health, 2017). The sample of women participating should

Pharmacological comfort measures can provide partial or complete pain relief. The epidural is the most efficient way of reducing labor pain. Opioids can be given continuously or in intermittent doses at the patient 's request or through the patient controlled pump. There is the potential for these drugs to have some effect on the fetus, such as breathing difficulties that may require assistance through the use of Narcan. Providing pain relief during the labor process is solely the patient’s choice, and as the nurse only support and encouragement should be given for however she chooses to handle the pain. (Jansen, Gibson, Bowles, & Leach, 2013)

In many U.S. hospitals today the patient care that women receive during management of labor and delivery doesn’t look very evidenced based. Electronic fetal heart rate monitoring (EFM) is the most common form of intrapartal fetal assessment in the United States. We continue to see widespread use of EFM in low risk pregnancies. Electronic fetal monitoring is standard procedure despite numerous randomized controlled trials that have disproven its validity. It is routinely used, yet does not decrease neonatal morbidity or mortality compared to the use of intermittent auscultation. Intermittent auscultation of the fetal heart rate is an acceptable option for low-risk laboring women, yet it is underutilized in the hospital setting. Several expert organizations have proposed the use of intermittent auscultation as a means of promoting physiologic childbirth. So why do we use continuous EFM in the low risk pregnancy and what does the best evidence support and how can nurses apply the best available evidence to practice? As a patient advocate it is the nurses responsibility to answer these questions and provide the low-risk pregnant woman with current evidence about options for fetal heart rate assessment during labor.

Childbirth can be described as one of the most rewarding and also painful experiences in a woman’s life. Most women choose some type of method to ease pain, however, there has been a lot of controversy over with pain management method is the most effective. According to the CDC (Center for Disease Control), In 2013, there were 3,932,181 births recorded in the United States, 32.7% of those births were surgical procedures. In 2012, 1.36% of recorded births occurred out-of-hospital, meaning these births took place mostly in homes or birthing centers. Without the option of medicine that a hospital provides, how were these women able to manage their pain during labor and delivery. There are many different methods for easing pain during childbirth, some methods involve the use of medicine and surgery, and others include natural techniques, such as hypnosis, Lamaze, and many others. It is a personal preference of the parents over which method is right for the needs of the mother and child. This can be an overwhelming decision for new parents to make because they have to take into consideration the safety of the mother and child, pain management for the mother and desire for medical involvement.

To determine the safest delivery method for the mother and newborn, the authors of this Cochrane review searched for randomized controlled trials comparing methods of assisted vaginal delivery at term. The authors found 32 studies including 6,597 women. Seventeen of the studies