Preparation for labor and childbirth
- Judith A Lothian, RN, PhD, LCCE
Judith A Lothian, RN, PhD, LCCE
- Associate Professor
- Seton Hall University College of Nursing
A woman's experience of birth is vitally important, and her birth memories endure [1,2]. Four factors are particularly important in determining a woman's childbirth experience: personal expectations, the amount of support she receives, the quality of the caregiver-patient relationship, and her involvement in decision-making .
This topic will review goals and educational methods that help prepare women for labor and childbirth. Other topics relating to pregnancy are discussed separately (See "Initial prenatal assessment and first-trimester prenatal care" and "Prenatal care (second and third trimesters)" and "Group prenatal care".)
Women have always prepared for the birth of their babies. Mothers from all cultures traditionally passed their knowledge about labor and birth to their daughters. These cultural and family rituals guided women through pregnancy, labor, birth, and the early days of mothering. Much of women's wisdom about birth was lost when birth moved from home to hospital. Mothers, sisters, and other women knowledgeable about birth no longer attended the woman. Birth became a medical event and cultural and family rituals took a back seat, eventually all but disappearing . The development of structured educational programs in preparation for childbirth came about as the traditional methods of information sharing declined [4,5]. Nurses and physical therapists who knew a great deal about the mechanics and medical management of pregnancy, labor, and birth, began to educate women about childbirth, largely outside of the health care system. Eventually these professionals became formally trained as childbirth educators . Childbirth education focused on two things in those early years: the basic anatomy and physiology of labor and birth and simple strategies (typically relaxation and breathing) to cope with the pain of contractions.
We now know a great deal now about the role of pain in labor , the wide and ever increasing number of ways that women find comfort during labor and birth , and the importance of continuous emotional and physical support during parturition [8-10]. In addition, some traditional birth practices, such as movement during labor, physiologic pushing [11,12], and the upright position for second stage have been shown to be effective practices in controlled studies [13,14]. Women now prepare for labor and birth with much more knowledge than women did forty years ago.
GOALS OF PREPARATION FOR LABOR AND BIRTH
The major goals of childbirth education are to provide women with the ability to be [15,16]:
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- Kennell J, Klaus M, McGrath S, et al. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991; 265:2197.
- Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. Am J Obstet Gynecol 1999; 180:1054.
- Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev 2013; 7:CD003766.
- Bloom SL, Casey BM, Schaffer JI, et al. A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol 2006; 194:10.
- Lothian JA. Making the case for a physiologic approach to childbirth. J Perinat Educ 2012; 21:186.
- Roberts JE, Mendez-Bauer C, Wodell DA. The effects of maternal position on uterine contractility and efficiency. Birth 1983; 10:243.
- Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2012; :CD002006.
- Lothian J. Birth plans: the good, the bad, and the future. J Obstet Gynecol Neonatal Nurs 2006; 35:295.
- Lothian J, DeVries C. The Official Lamaze Guide: giving birth with confidence, Meadowbrook Press, Minneapolis 2010.
- Lowe NK. The nature of labor pain. Am J Obstet Gynecol 2002; 186:S16.
- Buckley S. Hormonal physiology of childbearing: Evidence and implications for mothers, babies, and maternity care. 2014. Washington, DC: Childbirth Connection. http://www.childbirthconnection.org/ (Accessed on October 05, 2015).
- Special issue: Safe, healthy birth practices. J Perinat Educ 2014; 23.
- Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs 2008; 37:94.
- Bonovich L. Recognizing the onset of labor. J Obstet Gynecol Neonatal Nurs 1990; 19:141.
- Maimburg RD, Vaeth M, Dürr J, et al. Randomised trial of structured antenatal training sessions to improve the birth process. BJOG 2010; 117:921.
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- Gagnon AJ, Sandall J. Individual or group antenatal education for childbirth or parenthood, or both. Cochrane Database Syst Rev 2007; :CD002869.
- Bergström M, Kieler H, Waldenström U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG 2009; 116:1167.
- Hodnett ED, Downe S, Walsh D, Weston J. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev 2010; :CD000012.
- Savage JS. Birth stories: a way of knowing in childbirth education. J Perinat Educ 2001; 10:3.
- Everyday Miracles. Injoy Videos, Boulder, CO 2000. http://www.lamaze.org/p/cm/ld/fid=49 (Accessed on October 05, 2015).
- Gaskin IM. Ina May's Guide to Childbirth, Bantam Books, New York 2003.
- Boston Women's Health Collective and Judy Norsegian, 2008.
- Simkin P. The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Labor Companions, 4th, Harvard Common Press, Boston 2013.
- Simkin P, Ancheta R. The labor progress handbook, 3rd, Wiley-Blackwell, Malden, MA 2011.
- Adams SS, Eberhard-Gran M, Eskild A. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG 2012; 119:1238.
- Dick-Read, G. Natural childbirth. Heinemann, 1933.
- Lamaze, F. Painless childbirth. Psychoprophylactic method. Burke, London, 1958.
- Lothian JA. Safe, healthy birth: what every pregnant woman needs to know. J Perinat Educ 2009; 18:48.
- Lothian JA. Lamaze breathing: what every pregnant woman needs to know. J Perinat Educ 2011; 20:118.
- Balaskas J. Active birth: The new approach to giving birth naturally, Harvard Common Press, 1992.
- Mongan, M. Hypnobirthing: The breakthrough natural approach to safer, easier, more comfortable birthing. Health Communications Inc 2005.
- Lothian, J. Why become certified? J Perinat Educ 1996; 5:4.
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- Lothian JA. Childbirth education at the crossroads. J Perinat Educ 2008; 17:45.
- GOALS OF PREPARATION FOR LABOR AND BIRTH
- Coping with pain
- WHAT WOMEN NEED TO KNOW
- Support during labor and delivery
- WHAT TO DO TO PREPARE
- Childbirth education
- Birth plans
- WHAT TO LOOK FOR IN A PREPARATION FOR CHILDBIRTH CLASS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS