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• Historically, the term natural childbirth has evolved to mean:1) delivery outside in nature2) home birth3) nonhospital birth (birthing center)4) facility birth-no medical intervention(ie, no IV, meds)5) facility birth without analgesia oranesthesia
PREPARED CHILDBIRTH• Preparation through education and training prior to labor gives the pregnant woman a method of coping with the discomforts of labor and delivery• This method incorporates analgesia and anesthesia into the process• Dominates current culture in the United States
Psychoprophylactic or LamazeMethod• Psychoprophylactic childbirth has a rationale based on Pavlovs concept of pain perception and his theory of conditioned reflexes (the substitution of favorable conditioned reflexes for unfavorable ones)• The Lamaze method is an example of this technique.
• The woman is taught to replace responses of restlessness, fear, and the loss of control with more controlled measures, which can excite the cerebral cortex efficiently to inhibit other stimuli such as pain in labor.• The mother-to-be is taught exercises that strengthen the abdominal muscles and relax the perineum.
• Various breathing techniques to help the process of labor are practiced• The woman is conditioned to respond with respiratory measures and disassociation or relaxation of the uninvolved muscles, while controlling her perception of the stimuli associated with labor
The Bradley Method of Delivery• “husband-coached childbirth”• A coach may be any significant other such as a friend, mother, sister, boyfriend, aunt, grandmother, or husband• Involves the concepts of leading, guiding, supporting, caring, and fostering specific skills and confidence
• Coaches attend classes and learn to help the woman prior to initiation of labor• The coach serves as a conditioned stimulus using the sound of his voice, use of particular words, and repetition of practice.
• Medications are not encouraged for pain relief• Relaxation is the core component• Increased tolerance to pain is accomplished by decreased mental anxiety and fear, which ultimately decreases the awareness of the pain stimulus• This occurs through cognitive and physical rehearsal
Motivations for home delivery:• Increases patient choices and flexibility during the birth process while decreasing patient separation and fear of intrusive intervention• Rising costs of hospitalization
• Desire to avoid such practices as routine cesarean delivery for breech presentation, episiotomy, forceps delivery, oxytocin stimulation, routine monitoring of the fetal heart tones, and other practices associated with facilities• Risk of in-hospital infections; belief that infant is immune to own-home bacteria.
Contraindications:• High-risk pregnancy• History of: • premature or postdate delivery in previous or current pregnancy or previous cesarean delivery • Preeclampsia • gestational diabetes
• Woman with medical, surgical, or emotional complications• Fetal complications • cardiac anomalies • placental abnormalities
Alternatives to home delivery:• Family-centered hospital setting• Birthing centers with adequate facilities for emergency care for low- risk women
Home Delivery is highlydiscouraged by the DOH in the Philippines due toincreased risk for maternal and neonatal deaths.