Education: Key To A Satisfying Birth Experience

Caesarean births and the use of anesthetics to cope with the pains of labor are on an upward trend across the US (Wong & Perry, 2006). They are becoming more prevalent daily. The RN plays an integral role in educating a pregnant woman toward her best labor and birthing experience because in many instances the RN may be the primary source of information during prenatal care. The pregnant mother should be very well informed on what her body will be going through. The nurse can be detrimental in assessing her fears of labor and childbirth and in turn do something to calm and ease those fears. The pregnant woman should also be educated by the RN on all her choices ranging from when and where the birth is going to take place, birth support systems, options for pain and discomfort management, prenatal, birthing and parenting classes, and also options to include spirituality as part of her birthing experience. The mother should know that this is her experience and she has the right and influence to make it what she wants it to be.
The first nursing strategy is to assess the pregnant woman’s knowledge and fears of pregnancy, labor and delivery. The RN’s education of the client as to the process of a normal pregnancy and birth can be started early in the months before the baby is born giving her increased confidence. “A study by Nancy Lowe, associate professor of nursing, Ohio State University, Columbus, found that, among first-time mothers, less-confident women had a greater fear of labor and birth than did those who scored high on confidence and self-esteem tests,” (Unknown, 2001). By teaching and educating an expectant mother what her body will be undergoing in the following months you are empowering her to make decisions based on fact rather than based on horror stories or myths that may have been told to her throughout her years as a woman. Lowe maintains, “Western women are bombarded with messages that undermine their beliefs in the ability of their bodies to give birth successfully, as well as their beliefs in their personal ability to exercise control over their birth experience,” (Unknown, 2001). Pregnancy and birth are natural processes with which women have been blessed to be the partakers of. In an uncomplicated pregnancy there should be no need for fear or anxiety. In order to help a woman overcome any possible fears or anxieties the RN can use this opportunity to completely and truthfully inform the mother about the process of birth. She can also inform her on what complications can happen because preparedness in both situations is a necessity. “The goals for all childbearing women are safe, esteem-building, satisfying birth experiences that launch them into motherhood with a sense of competence and self-confidence,” (Ballen & Fulcher, 2006, p. 305). The expectant mother should be encouraged to enroll in classes on the birthing process as well as classes on care for a newborn after birth. The RN should also encourage the mother to ask any necessary questions that she may have. Books, websites, magazine articles, and any other information can be suggested, and if needed, support services should be put into place.
One of the most effective ways to have a great outcome in the birthing experience is to have the right support. Midwives and/or doulas are alternatives to a doctor and may be more apt to understand and handle this in a satisfying way. The midwife is trained for delivery in low risk situations and refers to a physician for high-risk deliveries. In contrast a doula would be one who is supportive in the hospital environment. She is not trained to handle the birth on her own but rather to be the main support for the laboring woman. In this type of situation the RN and the doula can work together. “The goal of the nurse is to ensure a safe outcome. The goal of the doula is to ensure that the woman feels safe and confident,” (Ballen & Fulcher, 2006, p.305). The doula knows beforehand the woman's wishes and is prepared to carry them out as an advocate when the woman may not be thinking straight in the heat of the moment. "A woman's satisfaction with childbirth is influenced more by the quality of support she receives, feeling in control of herself, and feeling that she was actively involved in decisions than by her degree of pain, the number of interventions she experiences, or even the medical outcomes," (Ballen & Fulcher, 2006, p. 304-305). By working as a team, a doula and an RN can help produce an environment where the laboring woman and her needs are the number one priority. In order for this to be effective the roles of the RN and doula need to be strictly followed as to not cause tension or confusion between the caregivers. Where an RN cannot be involved a doula can. "The hallmark of doula care is her continuous, rather than intermittent presence." At times when the RN is doing paperwork or out in other rooms, the doula can stay at the woman's side. "The doula's care includes direct hand-on physical care and comfort . . . She keeps the laboring woman informed about her progress in labor . . . She helps explain medical terminology used by healthcare staff. If the plan of care changes, the doula facilitates the mother's adjustment to the new plan." (Ballen & Fulcher, 2006, p.305) By working together and understanding the woman's needs this can be a great time for empowerment and satisfaction for the woman and her long-term self-esteem.
If a woman decides it would be best to include pain relief into her birthing experience, the nurse can educate beforehand on what, when and how each option is used. She should be informed on both the positive and negative outcomes of different pain relief choices including affects on herself and the yet unborn baby. Pain relief comes in many different forms, from narcotics, parenteral opioids and analgesics, to hydrotherapy, breathing techniques, and spiritual components like prayer or just belief. The most common pain relief choice for women right now is the epidural. “More than half of women giving birth choose to have an epidural and some labor and delivery units report 85-90% epidural rate,” (Wong & Perry, 2006). For some women the epidural is a lifesaver. The unfortunate thing about epidurals though is that they can cause the woman to have a fever, which in turn can be potentially harmful to the fetus. “The need for oxygen therapy in the nursery was 6 times higher among infants whose mothers had a temperature,” and “most fever during term labor is not, in fact, related to infection but rather to the use of epidural,” (Lieberman, et al, 2000) “In a study of 1,218 women in labor, 123 developed a fever. Ninety-seven percent of these women had received epidural anesthesia for pain relief. Babies born to these women were more likely to have a low Apgar score, to be inactive after delivery, and to require resuscitation and oxygen therapy. They were also more likely to have a seizure,” (Lieberman, et al, 2000). Other drugs, such as opioid drugs like meperedine (Demerol) and fentanyl (Sublimaze) are commonly used but researchers have found that they “are associated with neonatal respiratory depression, decreased alertness, inhibition of sucking, lower neurobehavioral scores, and a delay in effective feeding,” (Leeman, 2003).
However, there are many options of pain relief that are not drug related. These options are more along the lines of relaxation and focus techniques, as well as the woman’s knowledge of what her body is going through, giving her increased self-confidence. Many women when looking for a place to give birth look for a hospital or birth center that includes a tub for hydrotherapy. Other options include acupuncture, breathing techniques such as Lamaze or Bradley methods, continuous labor support, maternal positioning and touch and massage techniques. Some women use spirituality to help them through the birth experience because they may feel that women’s bodies are supposed to carry and bear children, they may believe that is what women were specifically created for. In the Bible the first woman’s name is “Eve” which means “life” or “life producer,” which may give the pregnant woman added self-confidence if that is her belief. The woman should be told of all the options available to her and make the choice which best fits her view of what the labor, delivery and birth experience should entail.
Overall, being fully informed of any decision to be made in life causes the best outcome to be brought forth. The RN’s role is to assess the knowledge and fear/anxiety levels of the expecting woman and then determine the best method to overcome this. She also has a responsibility to communicate with and educate the pregnant woman on a variety of issues like what pregnancy and labor are, possible birthplace, support of mom, pain relief, etc. Of course there will be times when things outside of the plan may happen, but in the event that were to happen the RN can help the mother to be prepared. The RN is a critical component in advocating for mother and making one of the most important events in a woman’s or families life something to be looked back upon and only think of it as a wonderful experience and cherished memories. Overall the experience includes many facets, which when working together can create a beautiful outcome for mother, baby and family.



Intervention 1 – Having Labor Support That Is In The Best Interest Of The Mother & Baby

Disadvantage 1 – RN & doula not understanding each other’s role and not working together toward the best outcome and same goal.
- It is critical that an RN and doula understand which role each other serves as to not become a hinderance for the mother and baby outcome. Some RN’s see the doula as a threat but it does not need to be seen this way because the two professions serve different purposes. If an RN understands the doula’s role she can be more relaxed in her role as a nurse and less stressed and more able to give competent patient care.(Ballen & Fulcher, 2006)


Disadvantage 2 – Having a midwife who is not properly trained! Make sure to check them out!
- State suspends midwife for unprofessional conduct, she was suspected of “putting a patient’s fetus at risk by failing to provide prenatal attention, not adequately managing her labor and failing to transport the patient during an emergency, the child was stillborn.” The midwife is also suspected of not consulting with a doctor when it appeared another baby’s condition was “significantly abnormal, the child ended up on life support for four days and died after being removed from a respirator.” There is always a bad one out there. (Esposito, 2003)






Intervention 2 – Pain Relief Options For Example The Epidural

Disadvantage 1 – Loss of bodily control
- Although epidural analgesia is the most effective form of pain relief during labor it is associated with increased rates of instrumental vaginal delivery, prolonged labor and oxytocin augmentation. This results from dense paralysis of motor function from the epidural. Some of the adverse events might be related to this motor paralysis because it affects the mothers pelvic floor tone, mobility, and ability to push during labor. (MacArthur, 2001)


Disadvantage 2 – Harmful effects on baby
- Intrapartum maternal fever is a great concern to doctors because it may indicate negative effects on the newborn. Recent studies have demonstrated that for women of term pregnancy, much of fever developing during labor may not be infectious in origin but a consequence of the use of epidural analgesia. Even when the fever is not infectious in origin it is still a cause for concern in regard to the fetus. In primate studies it has been directly associated with the development of fetal hypoxia, metabolic acidosis, and hypotension. (Lieberman, 2000)


References

Ballen, L.E., & Fulcher, A.J. (2006). Nurses and doulas: Complementary roles to provide optimal maternity care. Journal of Obstetric, Gynecologic, and Neo-Natal Nursing, 35(2), 304-311.

Esposito, S. (2003) “State suspends midwife for unprofessional conduct.” The News Tribune. B02. Retrieved February 6, 2008 from ProQuest. Tacoma Community College.

Florence, D.J., & Palmer, D.G. (2003). Therapeutic choices for the discomforts of labor. Journal of Perinatal & Neonatal Nursing. 17(4), 238-252.

Leeman, L., Fontaine, P., King, V., Klein, M.C., & Ratcliffe, S. (2003). The nature and management of labor pain: Part II. Pharmacologic pain relief. American Family Physician 68 (6), 1115. Retrieved January 22, 2007 from Expanded Academic ASAP database. A108993892

Lieberman, E., Lang, J., Richardson, D.K., Frigoletto, F.D., Heffner, L.J., & Cohen, A. (2000). "Intrapartum Maternal Fever and Neonatal Outcome." Pediatrics 105(1). Retrieved January, 22, 2007 from Expanded Academic ASAP. Thomson Gale. Tacoma Community College.

MacArthur, C., Shennan, A., May, A., Whyte, J., et al. (2001) “Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: A randomized controlled trial.” The Lancet. 358(9275). Retrieved February 6, 2008 from ProQuest. Tacoma Community College

Unknown Author. (2001). Self-confidence key to easier childbirth. USA Today Magazine. 10. Retrieved 22 Jan. 2007 Expanded Academic ASAP. A79340037

Wong, D.L., Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., & Wilson, D. (2006) Maternal Child Nursing Care. 3rd. ed. (pp.455).China: Mosby.


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