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Archive for December, 2007

How the gynaecologist became God

Quite a strong statement, I know but with the recent trend it can almost ring true. I’m all in favour of gynaecologists because they do have so much expertise and knowledge. They are trained and educated in high risk obstetrics and therefore see disasters lurking behind every door. When a women needs the care of a specialised obstetrician then I am 100% supportive but I’m not for all the proposed routine interventions they wish to offer low risk women and I cannot fathom how they expect women to just lie back and take whatever the almighty doctor decides is convenient for him or herself.

I’ve heard many times a nurse saying to a labouring mother…

“There dear, we need to
– shave you / give you an enema /have you lie flat on your back /give you an epidural – (take your pick)
 because the doctor really doesn’t like it when
– he cannot see down there / you make a mess / he’s not comfortable delivering / when you are screaming and making a noise.”
The gynaecologistis the new God, never to be questioned or inconvenienced. Woman have foolishly handed over their power to their doctors and in the process they are losing a most valuable part of the process of become parents – looking out for themselves and their families. Many women are mistakenly led to believe that they have very little choice in regards to how and where they birth.

It is a sad reality that women give birth on their backs not because this is how it is done but because the doctor won’t have it any other way. Midwives are regularly on their hands and knees with mothers. They are the greatest contortionists I’ve ever seen. They deliver babies in any position the mother chooses. Ever seen a gynaecologist bend down and look from the floor up to see the progress a mom has made. Never!

More education needs to be given to the new family with regards to informed choices and basic rights. There are basic rights that each labouring woman can undeniably expect, all she needs is to know what they are. All woman have the power to take back what is theirs and make choices based on what they need and want.

The WHO (World Health Organisation) states the following:

SUPPORTIVE CARE DURING LABOUR AND CHILDBIRTH

  • Encourage the woman to have personal support from a person of her choice throughout labour and birth:

– Encourage support from the chosen birth companion;

– Arrange seating for the companion next to the woman;

– Encourage the companion to give adequate support to the woman during labour and childbirth (rub her back, wipe her brow with wet cloth, assist her to move about).

  • Ensure good communication and support by staff:

– Explain all procedures, seek permission and discuss findings with the woman;

– Provide a supportive, encouraging atmosphere for birth, respectful of the woman’s wishes;

– Ensure privacy and confidentiality.

  • Maintain cleanliness of the woman and her environment:

– Encourage the woman to wash herself or bathe or shower at the onset of labour;

– Wash the vulval and perineal areas before each examination;

– Wash your hands with soap before and after each examination;

– Ensure cleanliness of labouring and birthing area(s);

– Clean up all spills immediately.

  • Ensure mobility:

– Encourage the woman to move about freely;

Support the woman’s choice of position for birth.

  • Encourage the woman to empty her bladder regularly.

Note: Do not routinely give an enema to women in labour.

  • Encourage the woman to eat and drink as she wishes.

– If the woman has visible severe wasting or tires during labour, make sure she is fed. Nutritious liquid drinks are important, even in late labour.

  • Teach breathing techniques for labour and delivery.

– Encourage the woman to breathe out more slowly than usual and relax with each expiration.

  • Help the woman in labour who is anxious, fearful or in pain:

– Give her praise, encouragement and reassurance;

– Give her information on the process and progress of her labour;

– Listen to the woman and be sensitive to her feelings.

  • If the woman is distressed by pain:

– Suggest changes of position (Fig C-2);

– Encourage mobility;

– Encourage her companion to massage her back or hold her hand and sponge her face between contractions;

– Encourage breathing techniques;

– Encourage warm bath or shower;

– If necessary, give pethidine 1 mg/kg body weight (but not more than 100 mg) IM or IV slowly or give morphine 0.1 mg/kg body weight IM.

Figure C-2  

Positions that a woman adopt during labour 

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