Michelle C.

Politado August 08, 2010

BSN-3A

Journal on Labor & Delivery

This is a classic article from the Journal of Nurse-Midwifery by Elizabeth Noble,
RPT, urges a holistic view of labor and delivery that observes and follows the natural
process. Attending practitioners too often try to control labor by giving orders on
position, how to breathe, where to focus, when and how to push. The result is
unnecessary pain and stress for mother and child.

Although women who choose to be attended by midwives are encouraged to

work with gravity by squatting or sitting upright, women who give birth in the hospital
usually do so on their backs. Remaining on her back throughout labor and delivery
compresses major blood vessels, straining the circulatory system. Labor also tends to
be longer as contractions are less efficient, increasing the need for oxytocin drugs.
Walking during labor, in contrast to lying in bed, shortens labor time and decreases the
need for painkillers. Babies born to women who walk during labor also have higher
Apgar scores. The Apgar index evaluates a newborn's condition by rating color, heart
rate, response to stimulation of the sole of the foot, muscle tone, and respiration.

The author says that the breathing techniques that have become so popularized
are primarily used for distraction. The techniques actually keep the woman from being
aware of what is going on in the pelvic area. Ms. Noble says that trying to control breath
actually increases, rather than decreases, tension: "Slow deep breathing does not
impair physiology, but any control of respiration expends energy, disrupts body rhythms,
and diminishes relaxation." It takes effort to control the involuntary process of breathing.

Practitioners also tend to encourage women to push before the uterus is ready
and with more force than is necessary. Rather than having attendants tell the pregnant
woman when to push, Ms. Noble says that women should listen to their bodies and
push only "when it is irresistible," in order to avoid wasting effort. When the fetus's head
descends and stimulates stretch receptors in pelvic floor muscles, natural oxytocin
levels rise (Ferguson's reflex) and the urge to push becomes unmistakable. Anesthesia
that affects the pelvic floor disrupts this sequence. Elizabeth Noble says that "...without
the natural expulsive effort of the uterus, mothers often have to force the pushing even
harder in compensation and may also require instrumental delivery." Staff usually
directs women to push longer than they would naturally and to hold their breath while
pushing. Excessive pushing while holding the breath is very stressful for mother and
fetus as indicated by a marked drop in maternal blood pressure and in fetal heart rate.
Vocalization (grunting, groaning, moaning, etc.), on the other hand, is beneficial and
facilitates muscle contraction.
 As Elizabeth Noble points out, "Exertion, whether in exercise, karate, weight-
lifting or childbirth, is performed on the outward breath. This allows the muscles to
contract efficiently."

Ms. Noble encourages practitioners to avoid the tendency to take control and
manage births. Rather, she sees the role of the attendant as someone who encourages
mothers to trust their bodies and to follow their urges and instincts, "Permitting mothers
to birth with ease and dignity can be simple," she writes. "The key is letting go, the
opposite of control. After all, in a normal unmedicated unanesthetized birth, the uterus
knows best." (Vol. 26, No.2, March/April 1981).
 Journal on Labor
And
Delivery

Michelle C. Politado
BSN-3A

Group IV

Ma’m Perla L .Simbulan

Clinical Instructor

Area: Delivery Room

Time: Thursday & Friday ( 7pm-7am)