VARIOUS BIRTHING METHODS

INTRODUCTION

Bringing a baby into this world is one of the most natural and instinctive acts that a woman's

body is programmed to do. Though childbirth is the most fantastic adventure a mother can have,

with all the pressures of the modern world, it's a challenge for women to develop confidence, trust

their intuition and allow their maternal instincts to take over.

TRADITIONAL BIRTHING METHODS

Traditional birthing methods, which involve an attending physician and hospitalization are

currently the norm in India and across the world. Though most urban women gain confidence in

being taken care of by a professional obstetrician, the clinical approach has its downsides too. A

hospital birth most often means being herded into a labour room, being drugged and strapped to the

table and delivering the baby with legs in stirrups.

In the mid-1900s, Dr. Michael Odent, a French Obstetrician, pointed out the errors in this

position for the first time. He expressed the view that when the legs are held in stirrups, a woman

has to push her baby upward, against the force of gravity. This leads to stronger contractions,

greater pain and extended labor. To make childbirth more natural, Dr. Odent devised his own

method based on traditional midwifery. Thus the concept of natural birthing, which includes the use

of birthing pools and birthing rooms designed to offer a gentler, less clinical atmosphere came into

existence. Today, natural childbirth practitioners advocate no, or minimal, drug use and minimal

intervention.

NATURAL CHILD BIRTH METHODS

LAMAZE TECHNIQUE (Psycho prophylactic method)

The Lamaze Technique is a prepared childbirth technique developed in the 1940s by French

obstetrician Dr. Fernand Lamaze as an alternative to the use of medical intervention during

childbirth. The goal of Lamaze is to increase a mother's confidence in her ability to give birth; 1

classes help them understand how to cope with pain in ways that both facilitate labour and promote

comfort, including focused breathing, movement and massage.

The rise of the epidural by 1980 and the widespread use of continuous electronic fetal

monitoring as standard care practices changed the nature and purpose of the Lamaze method.

Today, Lamaze International is an organisation which promotes a philosophy of personal

empowerment while providing general childbirth education.

Modern Lamaze childbirth classes teach expectant mothers many ways to work with the

labour process to reduce the pain associated with childbirth, and to promote normal (physiological)

birth and the first moments after birth. Techniques include allowing labour to begin on its own,

movement and positions, massage, aromatherapy, hot and cold packs, informed consent and

informed refusal, breathing techniques, the use of a "birth ball" (yoga or exercise ball), spontaneous

pushing, upright positions for labour and birth, breastfeeding techniques, and keeping mother and

baby together after childbirth.

Child birth education classes

The child birth educating classes starts from sixth week of pregnancy. Classes are given on

breathing and relaxation techniques and techniques in how to respond to the pain including walking,

using a birth ball, changing positions and massage.

READ METHOD (Child birth without fear method)

The Read method, named for Dick Read, is a technique of breathing that originated in the

1930s to help mothers deal with apprehension and tension associated with childbirth. This natural

childbirth method uses different breathing for the different stages of childbirth.

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Read’s theory

Dr. Dick-Read postulated that fear felt by women during delivery causes the blood to be

carried away from the uterus to be used by the muscles needing it due to perceived pain. This

results to an unoxygenated uterus which would be unable to perform its function well leading to

pain, a phenomenon called “the fear-tension-pain syndrome.” Dick-Read believed that presence of

fear and tension result to labor pains. Thus, eliminating fear would increase blood supply to the

uterus and alleviating labor pains. He also identified that laboring women needed constant

emotional support to help them cope.

Read’s breathing technique

The woman is helped to manage labor and delivery by using the Read method in the

following way:

During the early and middle first stage of labor: Before cervical dilation has reached 7 cm,

contractions are 2 to 5 minutes apart and last for 30 to 40 seconds. The mother lies on her back with

her knees bent. Abdominal breathing is used during contractions. Her hands are placed over her

lower abdomen, fingers touching. She breathes deeply and slowly-in through her nose and out

through her mouth. The abdominal wall rises with each inhalation, which she can feel with her

hands. The rate of breathing is not more than six breaths in 30 seconds, or 12 to 18 in one

contraction.

During the late part of the first stage of labor: After 7 cm of cervical dilation, the contractions

are 1½ to 2 minutes apart and last for 40 to 60 seconds, costal or diaphragmatic breathing is used

during contractions. The mother's hands are placed on her sides, over the ribs. She breathes in more

shallowly, feeling her ribs move sideways against her hands. Each breath is drawn in through her

nose and exhaled through her mouth. The abdominal wall does not rise and fall with this kind of

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breathing. The rate of breathing is no more than six breaths in 30 seconds, or 12 to 18 in one

contraction.

At the end of the first stage of labor: Near full dilation, contractions may be very strong,

occurring every 1½ to 2 minutes and lasting 60 to 90 seconds. The mother lies on her back with her

knees bent. Panting respirations are used during the contractions. The mother holds one of her

hands on her sternum, which rises and falls as she pants lightly and rapidly through her mouth.

Panting continues through the end of the first stage to full dilation as the urge to push grows.

Panting helps the woman avoid pushing.

During the second, or expulsive, stage of labor: After full dilation of the cervix, the contractions

occur every 1½ to 2 minutes, last 60 to 90 seconds, and are accompanied by an urge to bear down

and push. The woman lies back, head and shoulders supported in a semisitting position. She is

helped to draw her legs up and hold them, with her hands behind the lower thighs and thighs on her

abdomen, spread apart. As each contraction begins, she raises her head, takes a deep breath, tucks

her chin on her chest, blocks the escape of air from her lungs, and bears down. During each

contraction she may need to blow the air out, refill her lungs, and push again two or three times.

Throughout labor she is helped to understand what is occurring and to participate and accept the

experience in anticipation of the birth of the baby.

Currently many authorities who advocate use of other aspects of the Read method strongly

recommend that a woman in labor not lie on her back. Maternal hypotension follows, resulting in

decreased placental perfusion and an inadequate supply of oxygen to the fetus. Today the woman

using the Read method spends most of labor lying on her side or in a semisitting position with her

knees, back, and head well supported.

LEBOYER METHOD (Birth without violence method)

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The LeBoyer method stresses a relaxed delivery in a quiet, dim room. It attempts to avoid

over-stimulation of the baby and to foster mother-child bonding by placing the baby on the mother's

abdomen and having the mother massage him or her immediately after the birth. Then the father

washes the baby in a warm bath. This method is also known as ‘birth with out violence’

History of LeBoyer method

LeBoyer childbirth method was introduced by Frederick Leboyer. He is a French

obstetrician who believed that the traditional hospital births of the time (1975) were traumatic for

the infant. In 1975, he published a book entitled “Birth without Violence,” where depth of a

newborn’s sensitivity and the importance of how the baby is handled by the people around him

were emphasized

LeBoyer postulated that moving from a warm, fluid-filled intrauterine environment to a

noisy, air-filled, brightly lit extrauterine environment creates a major distress to the newborn. He

believed that holding a newborn upside down at birth and cutting his/her cord immediately from the

mother is not beneficial to the baby.In his view, the newborns’ senses are intact at birth and intense

sensations at birth such as by slapping the baby’s buttocks are vividly perceived. He emphasized

that a sensitive, unobtrusive technique of care, respecting the natural process and promoting a

peaceful atmosphere at birth will help the baby to be born with a minimum stress.

LeBoyer Techniques

Leboyer childhood method or “birth without violence,” creates an environment of peacefulness. To

decrease the trauma at birth this technique is an advocate of the following:

The birthing room is darkened or dimmed. Doing so prevents sudden contrast of light that

might distress the newborn. Leboyer thought that this is less shocking for the neonate’s eyes

that have been in semi-darkness for several months.

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A soft music is played or at least harsh noises are kept to a minimum. All the talking inside

the delivery room is done by whispering.

The room is kept pleasantly warm, not chilled, to help the newborn be comfortable with the

new environment and adapt to extrauterine life more easily.

Newborns are handled gently and carefully. Leboyer recommends not pulling the baby’s

head to completely allow a natural childbirth.

The umbilical cord is cut late (It is cut after it has stopped pulsating). According to Leboyer,

this allows the newborn to continue receiving the maternal hormones and oxygen carrying

red blood cells. This is also done to allow the baby to breathe when he is ready and not have

to be rushed.

The infant receives a warm bath immediately after birth for relaxation.

Before maternal and newborn bonding is done, the infant is massage to ease crying.

Nowadays, mothers do this massaging to encourage immediate bonding.

Placing the infant in the mother’s abdomen is done for maternal-neonate bonding.

Since fewer drugs are given to the mother during delivery with this method babies are typically

more alert and need less invasive measures to help them breathe.

Opponents to Leboyer Method

Some neonatologists are questioning the principle of warm bath because doing so can

reduce spontaneous respiration and allows a high level of acidosis can occur.

Cutting of the cord until it stops pulsating can lead to excess RBC in the neonate’s

circulatory system that could lead to extra blood viscosity and increased risk of jaundice.

BRADLEY METHOD (Husband-coached child birth method)

The Bradley Method of natural childbirth (also known as "husband-coached childbirth")

is a method of natural childbirth developed in 1947 by Robert A. Bradley, and popularized by his

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book ‘Husband-Coached Childbirth’. The Bradley Method emphasizes that birth is a natural

process: mothers are encouraged to trust their body and focus on diet and exercise throughout

pregnancy; and it teaches couples to manage labor through deep breathing and the support of a

partner or labor coach.

Teachers of The Bradley Method believe that - with adequate preparation, education and

help from a loving, supportive coach - most women can give birth naturally, without drugs or

surgery. The classes teach nutrition, relaxation and natural breathing as pain management

techniques along with active participation of the husband as coach

The "Method" itself is first of all an application of what Dr. Bradley termed "the six needs of

the laboring woman," most notably deep and complete relaxation and abdominal breathing, but also

including quiet, darkness and solitude, physical comfort, and closed eyes and the appearance of

sleep.

The Bradley Method relies heavily on training fathers to be labor "coaches," or partners. The

Bradley Method teachers usually supplement these primary techniques with training in different

labor positions and comfort measures. In order to master the ability to relax completely as a pain

relief tool, couples are taught several different relaxation techniques and encouraged to practice

relaxation daily, so that the mother can rely on a conditioned relaxation response to her partner's

voice and touch.

How Bradley method is applied:

Bradley method classes are offered to the couples for a 12 week period.

Classes are given by trained instructors who have undergone an extensive training program

with the ‘American Academy of Husband-Coached Childbirth’ and are required to complete

continuing education requirements and reaffiliate every year.

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Classes are always kept small in size (6-8 couples) so that they may get individual attention.

The course will address:

Nutrition and how it affects a growing fetus

The importance of exercise (when appropriate) during pregnancy

Common pregnancy symptoms and complaints, and how to cope with them

Techniques for relaxation during labor and birth, with an emphasis on breathing methods

to help you "tune-in" and manage your pain rather than distract you from it

Methods to help your partner be an active participant and a skilled coach on labor day

The stages of labor and how to cope with the changes your body experiences during each

one

Medical interventions and how to avoid unnecessary ones

How to reduce your risk of having a c-section and what to do if it becomes medically

necessary

Making a birth plan and how to communicate effectively with your medical team

Breastfeeding

KITZINGER METHOD (Psychosexual method)

“Our bodies know how to give birth, just as we know how to swallow food, breathe and make

love... An exultant experience of birth comes from self-confidence and a good relationship with

those supporting us."- Sheila Kitzinger

In Kitzinger method the client focuses on internal sensory experiences so that she can respond

to her body signals. Body awareness enhances the sensuality of child birth .

Techniques

Techniques including touch relaxation, during which the birthing woman learns to

respond to her partner's massaging touch.

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Communication skills for working with birth attendants.

Visual imagery

Birth dance -- movement during labor to reduce pain and help contractions

Information and techniques for labor support givers

Relaxation based on imagery and an inward focus to promote comfort during the labor.

Breathing as an relaxed response to contraction.

No predetermined breathing pattern.

No forces pushing until the client feels the urge to push.

NOBLE METHOD (Gentle push method)

This method was put forward by Elizabeth Noble. According to her labour is a normal

physiological process. The client should maintain awareness of body feelings and rely on her

ability to cope with labour.

Physical and self awareness exercise

Spontaneous pushing during exhalation, typically with a grunt or groan and partial closure

of the glottis

No forceful pushing or structured breathing.

Take a position that encourages the baby to move down through the birth canal without

needing to push very hard for the second stage of labor, such as standing, squatting or

kneeling.

ODENT METHOD (Instinctive birth method)

Women can be self reliant during child birth because they have an instinct for and an innate

knowledge of the process. Child birth is a sexual experience that should be experienced with

spontaneity and freedom

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Use of pool of warm water, music and dim light for relaxation

Use of any comfortable position during labor and birth.

Immediate contact with the mother , father and neonate, possibly including a warm bath

for the neonate.

ALTERNATIVE BIRTHING METHODS

WATER BIRTH

Water birth is a method of giving birth, which involves immersion in warm water. The

immersion can mean giving birth to the infant in the water or using it as a tool during the labor

process. Proponents believe that this method is safe and provides many benefits for both mother and

infant, including pain relief and a less traumatic birth experience for the baby.

Water birth has gained popularity in recent times, due to it's many obvious benefits. It is

based on the premise that as babies spend their first nine months in water, a water-birth makes the

right of passage into the world easier on the infant. During a water-birth, the mother-to-be sits in a

tub of lukewarm water and the midwife holds the baby as soon as it is born. It results in lesser pain

and smoother contractions as there is no fight against gravity.

History of water birth:

The first recorded water birth occurred in France in 1803 and in Germany in 1805. In the

1960s, self-educated Soviet researcher Igor Charkovsky explored the safety and possible benefits of

water birth in the Soviet Union. In 1974, French obstetrician Frederick Leboyer published a book

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advocating the immersion of newly born infants in warm water for the purpose of easing the

transition from the womb to the outside world, and to mitigate the effects of any possible birth

trauma.Another French obstetrician, Michel Odent, took Leboyer's work further, using the warm-

water birth pool for pain relief for the mother, and as a way to normalize the birth process.

Benefits of water birth:

For the baby

Properly heated water] is claimed by proponents to help ease the transition from the birth

canal to the outside world because the warm liquid is thought to resemble the intrauterine

environment.

For the mother

Relaxation

Warm water reduces tension and stress for the mother. According to the American Pregnancy

Association, the reduction of anxiety, allows the mother to focus on the laboring process. Warm

water helps in muscle relaxation and reduces pain by releasing pain inhibitors. Thus the mother will

be able to cope with the pain and have a positive birthing experience.

Pain management

Harper reports that water birth is an effective form of pain management during labor and

delivery (Harper 2000). Water birth is a form of hydrotherapy which, in studies, has been shown to

be an effective form of pain management for a variety of conditions. In an appraisal of 17

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randomized trials, two controlled studies, 12 cohort studies, and two case reports, it was concluded

that there was a definite "benefit from hydrotherapy in pain, function, self-efficacy and affect, joint

mobility, strength, and balance, particularly among older adults, subjects with rheumatic conditions

and chronic low back pain," (Geytenbeek 2002). Full immersion in water promotes physiological

responses in the mother that reduce pain including a redistribution of blood volume, which

stimulates the release of oxytocin and vasopressin (Katz 1990), the latter which also increases

oxytocin blood levels (Odent 1998).

Intact perineum/decreased episiotomy

Water birth is believed to aid stretching of the perineum and decrease the risk of skin tears.

Support from the water slows crowning of the infant's head and offers perineal support, which

decreases the risk of tearing and reduces the use of episiotomy, a surgical procedure which can

cause a number of complications. Indeed, there is a zero episiotomy rate in the waterbirth literature

(Harper 2000).

Risks and concerns:

Infection

In a randomized controlled trial of the effects of water labor in Canada, no difference was

noted in the low rates of maternal and newborn signs of infection in women with ruptured

membranes In a 1999 study of bacterial cultures carried out at the Oregon Health Sciences

University Hospital, there were no instances of bacteria cultured from the birth pool itself. In a 2004

study, of the water of a birth pool following birth after filtration and more rigorous cleaning

procedures were instituted, high concentrations of E. coli and coliform contamination were found,

along with staph and P. aeruginosa.

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Slowed labor

Because of the documented relaxing effects of water, laboring in water is sometimes associated

with a decrease in the intensity of contractions, and is thus thought to slow labor. Some hospitals

have adopted a "5 centimeter" rule, allowing women to enter the tub only once the cervix has

already dilated to 5 centimeters (Harper 2000).

Maternal blood loss

For care providers who are inexperienced in delivery in water, it may be difficult to assess the

amount of maternal blood loss. While well-developed methods of determining maternal blood loss

in water do exist, many providers prefer to deliver the placenta "on land" for this reason .On the

other hand, some doctors and midwives see that water births have been known to reduce the amount

of blood loss. The water surrounding the mother lowers the mother's blood pressure and heart rate.

Mothers still lose significant amounts of blood through the passing of the placenta.

Pros and cons of water birth:

pros

Relaxation

The warm water will give relaxing effect and reduces the tension on the perineal muscles.

This may make the birth more easier.

Privacy and control

Usually water birth pools will provide privacy. The area will be quiet and as preferred dim

lights will be provided. It may help you feel having more control over the body.

Buoyancy

Buoyancy force will help to feel lighter and comfortable

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Coping with pain

Being in warm water can make it easier to cope with the pain of contractions (Cluett and

Burns 2009). It's just the same as having a bath to soothe a tummy ache or backache. If the mother

want strong pain relief, such as pethidine or an epidural, they will have to leave the pool. Inhalation

analgesia , which is a mild pain reliever, can be used in the water.

Having a birth supporter

The mother will not be left alone while in a birth pool. Either the midwife or partner will be

with the mother throughout the water birth

Satisfaction

Using a birth pool for labour is often such a positive experience that many women want to

use one again when they have their next baby (Cluett and Burns 2009).

Peaceful birth for the baby

The transition to the outside world is less traumatic for babies who are born in water.

Cons

Infection

The birthing pools water and accidental opening of mothers bowel in water may act as

sources for infection for the babies. But research hasn't found any difference in rates of infection

between women who give birth in water or in air (Cluett and Burns 2009). Hospitals have strict

rules about cleaning pools after each water birth. They do regular checks to ensure that the pools are

kept hygienic.

Unpleasant environment

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The mother may feel uncomfortable about accidental opening of their bowels as she

delivers. The idea of the midwife having to remove debris out of the water to keep it clean may be

unpleasant to the mother.

Disappointment with relief of pain

The mother may have disappointment that being in birthing pool does not make contractions

less painful.

Monitoring of emergencies

The mother may have to stay out of the pool if the labour develops complications. Having to

get out of the water and change the course of your labour may be upsetting for the mother.

Baby may start breath under water

Healthy babies have way of protecting themselves, called a "dive reflex". They instinctively

close their airway, stopping them from breathing in water (Harper 2000; Johnson 1996 cited Cluett

and Burns 2009).

Risk to the umbilical cord

After water birth the baby will be brought quickly to the surface, head first. Because of this

swift movement, there have been a few cases where the umbilical cord has snapped (Gilbert and

Tookey 1999; Cro and Preston 2002).

A snapped cord is not a life-threatening emergency for a properly trained midwife. But midwives

and mothers are now advised to take care not to pull on the cord as they gently lift the baby from

the water.

HYPNO BIRTHING

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Hypno Birthing is designed to teach women to trust in Nature's way of birth and to relax and

let their bodies do what is needed. By practicing a few key techniques, mothers program their minds

and condition their bodies to birth easily.

Hypnosis is a long-used technique of speaking directly to the subconscious mind. When

used in childbirth and labour, it has been found that it allows the deepest relaxation possible, along

with elimination of pain and fear, thus effecting a quicker and easier birth process for both mother

and child, with less bleeding, fewer complications and quicker recovery. Hypnobirthing uses the

technique of guided imagery, affirmation, and special breathing technique. This relaxation, deep

breathing and guided imagery techniques are taught to the mother during antenatal period by special

video assisted training classes in hypnobirthing centers.

HISTORY OF HYPNOBIRTHING

The movement started by English obstetrician Grantly Dick-Read . The work was further

developed in 1987 by Marie Mongan in America. In 2011, the UK's National Health Service (NHS)

began an 18-month trial study on the effectiveness of hypnobirthing and now it is practicing in

many NHS hospitals.

HOW HYPNOBIRTHING DIFFER FROM TRADITIONAL CHILD BIRTH METHODS

Unlike other childbirth methods that teach how to cope with and manage pain, Hypno

Birthing is based on the premise that childbirth does not necessarily need to be painful if the mother

is properly prepared and relaxed. The pain is caused by constrictor hormones, created by fear.

Calming down and reduction in fear produces body’s natural relaxant endorphins which will cause

reduction in pain. Rather than exhausting, shallow breathing and the distraction techniques of

typical “prepared childbirth” programs, Hypno Birthing parents learn deep abdominal breathing and

total relaxation, enabling the laboring mother to work in harmony with her body and her baby. This

allows her to achieve a shorter and more comfortable labor for herself and baby.

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PROS AND CONS OF HYPNOBIRTHING

Pros

Allows relaxation for the mother.

Reduces fear

Relax perineal muscles.

Allows a birth companion

Helps mother to develop a confidence that she could control her body.

Cons

Dissatisfaction for mother if she is expecting complete absence of pain.

In obstetric emergencies, the course of hypno birthing has to be stopped to start with

emergency interventions.

HOME BIRTH

Traditional home birth, with a midwife in attendance, has always been the norm in rural

India. In many western countries, home birth is once again gaining popularity, as it is seen as a

more 'dignified' way of giving birth, in the privacy of home. It could lead to complications if there

is already an underlying risk like placenta previa or a multiple pregnancy.

Home birth in developed countries is an attended or an unattended childbirth in a non-

clinical setting, typically using natural childbirth methods, that takes place in a residence rather than

in a hospital or a birth centre, and usually attended by a midwife or lay attendant with expertise in

managing home births. Professionals attending home births can be obstetricians, certified nurse

midwives and doulas

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Many midwives are prepared with oxygen, if needed, to assist the mother or newborn.

Midwives are usually trained to provide neonatal resuscitation, start intravenous solutions, and can

administer oxytocin and other medications as needed to halt postpartum hemorrhaging. They carry

the supplies needed and are trained to suture. Births necessitating other interventions must be

transferred to a hospital. Home births do not offer access to pharmaceutical pain relief or

pharmaceutical labor induction. They do not provide ready access to the equipment and supplies

required for emergency cesarean section. Most midwives develop working relationships with

obstetricians and hospitals in case these options become necessary. Depending on the midwifery

practice, transfer rates range from 5% to 40%, with most studies citing a transfer rate of about 16%.

PROS AND CONS OF HOME BIRTH

PROS

Gets the privacy and security of home environment.

Safety from hospital –borne pathogens

Gets more natural and less stressful birth in more comfortable and familiar environment.

Can avoid strangers during the birth, thus gets reduction in stress.

More satisfaction after the birthing process.

CONS

In case if emergency occur mother have to be transferred to hospital setting.

This causes stress, financial problems and threats to both mother’s and infant’s safety.

Interventions like induction of labour and analgesia are not practiced in home birth.

Finds difficulty in managing emergency neonatal resuscitation

Nurses responsibilities:

Make sure that the home birth setting is clean and safe.

Make sure that the family is well informed and educated about the home birth.

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The family must be counseled that the mother will be shifted to hospital if any emergency

intervention is needed.

Be prepared for the management of emergencies.

Have collaboration with hospitals and transport facilities for any emergency transfer to

hospitals.

CONCLUSION

There are several different birthing methods. Each style offers advantages and disadvantages as

well as unique coping strategies. A midwife should be familiar with many different birthing

methods and will be able to guide the woman in a choice that fits both her personality and her

desired level of intervention/pain relief.

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