On “latest fashion“? Alternative childbirth of
the Concept “alternative childbirth“ becomes more and more popular recently. What is meant these words and to what modern future mother looks for alternative?
the popular belief in backwardness and excessive conservatism of classical obstetrics Exists. Stories of “skilled“ mothers about strict orders of a maternity hospital, the hospital atmosphere, white walls and dressing gowns of personnel, lack of an individual approach, a smell of drugs, medical tools and the equipment in chamber, prospect of medicamentous correction of patrimonial activity and strictly horizontal position during all process, certainly, do not add optimism. And all know what important role during and the result of childbirth the positive emotional spirit of the woman in labor, feeling of psychological comfort during the process plays, contact and trust to those people who help mother and the kid.
to understand the reason of such “stern face“ of classical obstetrics, we will make small digression to history.
History of povivalny art
Medicine - one of the most ancient and conservative sciences. Despite continuous emergence of new techniques of research and treatment, opening of new microorganisms and the invention of new medicines, the main positions and postulates of medicine are indestructible. Many of them did not undergo essential changes since Avicenna and Hippocrates - the most great doctors of antiquity.
Obstetric aid at all people and was considered at all times as very responsible and honourable business, Povivalny art usually was family tradition and passed from father to son. Long time, even after emergence of the first medical schools and institutes, there were no written managements in the field of obstetric aid. It is interesting that at the same time, despite a considerable ethnic and class difference of the patients, midwives of different people of the world at various times applied the same receptions, followed identical rules of precaution and a measure of the help to future mother and kid.
To the middle of the 19th century in our country. Obstetric services even to eminent patients were rendered by the midwives who adopted the art from parents. The obstetrics was not taught at the higher medical school where future doctors were trained. Povivalny art was considered as the craft which does not have relations to medicine on that simple basis that pregnancy and childbirth are not an illness, and natural physiological process.
because of such organization of system of obstetric aid in Russia. Female mortality, according to that time, almost by one and a half times exceeded man`s. Among the reasons of female death the first place belonged to death of young healthy women in labor and the early postnatal period. And immediate causes of death was two: bleeding and maternity fever. Or, speaking the modern language, sepsis - blood poisoning. Average “age“ of female mortality of that time horrifies - 25 - 35 years! With babies the situation was also not in the best way: from 10 being born children 3 died in childbed (that is were born deadborn), and 2 more perished in the first week after the decision - generally also from sepsis.by
In connection with these unfavourable data on a measure of development of medicine created understanding of need of competent medical care to the woman and the child at the time of delivery. For this purpose under the decree of the government and on the basis of the European experience founded the schools of povivalny art which were letting out more competent, “diplomaed“ midwives, and shelters for women in labor at city hospitals (before such shelters existed only at monasteries). Then began to train in obstetrics at medical institutes, however, at first within other disciplines - surgeries and therapies. Thanks to it the doctors possessing more high standard of knowledge and understanding of physiological processes had an opportunity to take part in obstetric aid. At last at medical faculty of MSU the department of obstetrics opened, and the first doctors with mainly “female“ practice appeared.
Apparently from this historical information, the medical obstetric care is rather young system - she is less than 150 years old. The classical obstetrics incorporated the knowledge of a current, features and “reefs“ of patrimonial process accumulated for centuries which midwives used. Along with it in science of obstetrics introduced knowledge of an asepsis and antiseptics (science how to prevent hit of an infection in a wound and to struggle with already got infection), the reasons of development of uterine bleeding and methods of fight against them, sharply reduced maternal and child mortality. Emergence of an anesthesia gave the chance to perform operation of Cesarean section, keeping life of mother and kid at difficult delivery. Supervision over health of a young family the first days after the delivery, application of measures of prevention of complications of the postnatal period also considerably reduced incidence and mortality in obstetrics.
the Separate role in the history of domestic obstetric aid belongs to organization of maternity hospitals - the separate obstetric hospitals supplied with all necessary for the help to mother and a fruit and at the same time isolated from other offices of hospital. Thus doctors managed to protect as much as possible future mothers and kids from risk of infection in the course of childbirth.to
Alternative - what is it?to
Along with conservatism and addiction to century traditions of doctoring medicine more all other sciences were subject to emergence of new doctrines, currents and trends at all times. Doctors among themselves call such deviations from “basic course“ of traditional medicine medical fashion. At various times there were fashionable tendencies in the field of dietology (healthy nutrition), remedial gymnastics and massage, a hardening, nonconventional methods of treatment of diseases. Possibly, there is no branch of medicine which fashionable hobbies would never concern. Also the obstetrics, or obstetric aid art is not an exception. In process of development of the stationary obstetric care in the middle and the second half of the 20th century organized at the state level so-called alternative methods of obstetric aid began to arise. Mean the measures of the help to the woman in labor and a fruit, a technique, and at times and a venue of childbirth other than traditions of classical obstetrics by this concept.
Alternative methods of obstetric aid arose in process of accumulation of discontent with a technique of conducting childbirth by doctors of maternity hospitals. Carried a “line“ method of medical care of women in labor which reason a small amount of maternity hospitals and doctors of rather total number of childbirth was to shortcomings of traditional obstetrics. In 1950 - e years from 40 to 60 childbirth were the share per day of obstetric crew of the Moscow maternity hospital on duty! Now this figure averages 10 - 20 childbirth. In prenatal chamber there could be at the same time about 8 women at different stages of the first period of childbirth, the delivery room was also designed for several women in labor. At receipt in delivery room future mother was stacked on a bed and did not allow to rise before the childbirth. The limited provision, lack of an opportunity to move and accept convenient poses also caused negative reaction from patients.
abuse of medicamentous correction of patrimonial activity, was side effects and low efficiency of the applied anesthesia methods, frequent preventive application of antibiotics Other reason of discontent of young mothers. Special indignation of future mothers was aroused by impossibility of joint stay with the kid right after childbirth. Separate stay of mother and child deprived the woman of an opportunity to learn to look after the baby, to look after constantly it and early to adjust breastfeeding. There is a wish to emphasize that, of course, such system of obstetric aid had certain shortcomings, but nevertheless this system at that time provided due supervision over the woman during pregnancy and childbirth, allowed to avoid many and many complications, kept lives to women and children. Besides, many future and young mothers just did not know what can be somehow in a different way: all events were perceived as norm.
B 19b0 - 70 - e years began to arise informal courses on which pregnant prepared for nonconventional methods of obstetric aid. The greatest popularity was gained by “childbirth in water“, “vertical childbirth“ and “active childbirth“. Midwifes (the nurse of delivery rooms), hereditary midwives and mothers having many children became founders of such courses of preparation and assistants in labor generally. As the state did not support such innovations, childbirth on alternative system was carried out at the patient or at the midwife at home. Nothing is known of participation of doctors in such type of obstetric aid (as it is not surprising: the doctor bears criminal liability for conscious refusal in hospitalization of the woman in childbirth).
the Alternative house childbirth which at first sight have a number of advantages before line medical care in a hospital as it appeared, concealed in themselves huge danger. Insufficient qualification of “assistants“, non-compliance with measures of an asepsis and antiseptics, and, above all - impossibility of rendering the emergency operational and resuscitation help in house conditions practically returned participants of alternative obstetric aid in the 19th century - with all that it implies.
Despite obvious shortcomings, the idea which is the cornerstone of alternative childbirth, certainly, has the right for existence. This idea is very simple: childbirth - the natural process which in lack of complications is not demanding medical intervention or the compelled situation. At the time of delivery the woman has to feel comfortable, have a possibility of continuous confidential contact with assistants, at desire - presence of the loved one. At natural uncomplicated childbirth the woman in labor can freely move on the room, accepting convenient poses during fights, using physiological methods of anesthesia (respiratory technicians, the weakening massage, an akvaterapiya) or receiving adequate medicamentous anesthesia. whetherAlways walls of the house help
Despite considerable modernization of modern obstetric aid, still remains a significant amount of the people propagandizing house conducting childbirth. The main slogan of supporters of “domestication“ of patrimonial process - “houses and walls help“.
It is valid, a quiet house situation, a familiar interior, a favourite cozy sofa, a bathtub with warm water, pleasant music, and also a possibility of presence of relatives and lack of frightening medical attributes allow the woman in labor to relax and be adjusted as much as possible on the necessary harmony. And at the time of the beginning of fights, as we know, depends on a condition of nervous system much.
Followers of idea of house childbirth refer to the available foreign experience of obstetric aid at home. Holland (Netherlands) in which all system of obstetric care is focused on house childbirth is most often mentioned.Let`s learn
how medical care is provided to future mother in the Netherlands. During pregnancy the woman is examined and observed in that clinic which will render services of obstetric aid subsequently. The pregnant woman is observed by the midwife under control of the doctor. It is necessary to make a reservation at once that education of the Dutch midwife considerably differs from our compatriot; she studies and more than 6 get practice (!) years before starting independent medical activity. Besides, the midwife in Holland bears legal responsibility for life and health of the patient, has the right to independently appoint medicines. In Russia the nurse is an intermediate link between the patient and the doctor, performance of medical appointments, care of the patient and control of her state belongs to her duties; in labor the midwife does not make independent decisions, does not do appointments.
If during supervision at the pregnant woman problems with health come to light, hospitalize her in clinic where treatment is carried out by the doctor. In a case when the revealed complications allow to assume possible problems in labor or future mother the operational rodorazresheniye (Cesarean section) is shown, childbirth is carried out in clinic, and the doctor observing the patient during pregnancy accepts them.by
If during pregnancy revealed no contraindications to physiological (natural) childbirth, at desire of the patient and existence of the corresponding living conditions childbirth is spent at home. Previously future parents have theoretical training under control of the midwife watching the pregnant woman before childbirth. At emergence of the first symptoms of the beginning of patrimonial activity future mother calls “the“ midwife who immediately leaves to the patient on “ambulans“ - to the resuscitation car supplied with all necessary on an emergency (up to a possibility of transformation to the mobile operating room), This car it is necessary to be on duty under windows of a young family up to the end of childbirth. If childbirth proceeds naturally, without complications, care of mother and help to the kid at the time of the birth are given by the midwife with assistance of the woman in labor relatives. At emergence at least of suspicion on development of any complication the midwife contacts the doctor. The doctor, depending on a situation, or prepares in clinic chamber or the operating room for the patient (it the car “will deliver to ambulance), or (if transportation is life-threatening mother and a fruit) comes out to the house to the woman in labor for rendering the emergency medical care.
Holland - the small country; its population is less, than the number of inhabitants of our capital. This country consists of small towns which residents generally live in certain houses. In each town there is a clinic with out-patient clinic (policlinic), the operating room and chambers for stationary supervision supplied with the modern medical equipment. In Holland good roads and automobile jams are improbable here. Thus, “the fast help“ to the woman in labor always has to keep up in time. And despite it, and also on the qualified obstetric care at home, in Holland to this day the highest maternal and child mortality in Europe.does not have
In our country institute of rendering obstetric services at home. In Russia it is impossible to organize watch of the reanimobile under the woman in labor windows - because of populousness of our cities. Cars will not be enough for all and they can not arrive in time (on city traffic jams or provincial ruts on roads) without saying that the machines which are at the disposal of service of “ambulance“ in the majority strongly are inferior in equipment to the Dutch analogs. But the main negative factor, certainly, are assistants to the woman in labor. The domestic experts rendering services at home generally have no corresponding education and qualification; their work is based on the personal experience gained by trial and error. And, unlike the Dutch midwifes, they do not bear legal responsibility for the medical care.
If childbirth proceeds without complications, mother and the kid, in fact, do not need assistants at all - it is physiological process. Medical care in labor means initially only creation optimum safe (from the epidemiological point of view) conditions for childbirth and supervision over dynamics of patrimonial activity. At emergence of “failures“ in natural process of childbirth the complications posing real threat for life of mother and a fruit can develop. In this case it is possible to prevent the tragedy, having immediately given specialized obstetric care. Unfortunately, it is impossible in house conditions; that is why house “alternative“ to childbirth in a hospital, so attractive at first sight, can turn back tragedy. And walls in this case, alas, will not help.
And, leaves, without water...
Alternative conducting childbirth at which the woman in labor at all stages of patrimonial activity is in water is called “sorts in water“. This idea is based on the weakening and analgeziruyushchy (anesthetics) properties of water. In warm water of fight are felt softer, blood circulation improves, the woman in labor has an opportunity to relax and accept a comfortable position of a body, is tired less. Water excludes emergence of such collateral factors of discomfort in labor as dryness of skin, the increased sweating, a fever or feeling of heat.
However stay in water at the time of delivery without risk for health of mother and the kid perhaps only under control of the qualified medical expert and at observance of some essential restrictions. So, water temperature should not exceed the normal body temperature (36,0 °C) and should not fall below 30,0 °C, the tank and water have to be pure (disinfected). The woman in labor has to be located in the tank entirely, having an opportunity to turn and change position of a body. At the same time the observing expert has to be constantly nearby, having a possibility of convenient access for assistance to the patient, and if necessary - for fast extraction of the woman in labor from water.Stay in the tank at the time of delivery can reckon as
safe with water only until the kid and a cavity of a uterus are protected by a wall of a fetal bubble, After a rupture of fetal covers the last barrier between a sterile uterus and an unsterile vagina disappears. At immersion in water the last fills a vagina, can get into a cavity of a uterus and cause its infection. By the way, the izlitiya of waters in this case can pass the moment unnoticed (the rupture of a fetal bubble is not connected with special feelings - the only symptom is the transparent liquid following from a genital tract).
Now maternity hospitals where use of special bathtubs with shower water at these stages of childbirth when it is safe practices are, it is useful for mother and the kid.the Patrimonial vertical
is meant by
the term “vertical childbirth“ mainly vertical position of the woman in labor at all stages of childbirth, including the moment of the birth of the kid. The main idea consists that at vertical position of a body in disclosure of a neck of a uterus, advance of a fruit on patrimonial ways and the birth gravity participates. Such arrangement of the woman in labor accelerates process of childbirth, facilitates pain during fights, helps to make an effort effectively. Shortcomings of this technique of conducting childbirth is increasing (owing to process acceleration) the risk of development of ruptures of a neck of a uterus, walls of a vagina, tissues of a crotch, a premature otsloyka of a placenta and patrimonial injuries of a fruit. Vertical position of a body in labor is contraindicated with a high arterial pressure, diseases is warm - vascular system of future mother, a prompt and rapid current of childbirth, at premature birth, a hypoxia (oxygen insufficiency) of a fruit during pregnancy. Conducting childbirth in vertical position of a body in the absence of contraindications is possible
, however demands the special equipment and preparation of personnel (are delivered in other plane of rather traditional option). Some maternity hospitals specialize in vertical childbirth. Such hospitals are equipped with chairs for vertical childbirth (on such chairs during the child`s birth the woman costs on cards or on a lap a back to the obstetrician).
Active behavior... in maternity hospital
the Last option - active behavior in labor - ceased to be considered long ago as alternative and is widely applied in the majority of modern maternity hospitals. This technique means for the woman in labor a possibility of the movement, movement on chamber, continuous change of poses, use of massage of problem zones (a waist, area of a sacrum and bottom of a stomach) and respiratory anesthetics of techniques. In the absence of contraindications (premature birth, prompt childbirth, oxygen insufficiency of a fruit at the time of delivery - situations when it is necessary to avoid fast passing of a fruit on patrimonial ways) at such technique of conducting childbirth the woman lays down only in need of carrying out medical manipulation (vaginal survey, control of heartbeat of a fruit, etc.) and just before the birth of the kid.the Idea of “active childbirth“ is based by
on a combination of vertical position (gravity on a fruit and patrimonial ways) and the active movement. The movements of the woman in labor (movement on chamber, change of poses, a pereminaniye from a leg on a leg, rocking, rotation by a basin, inclinations) promote improvement of blood supply of a uterus and a blood-groove in a placenta. Activation of a blood-groove increases sokratitelny activity of a uterus, guarantees uninterrupted supply of oxygen and food to the kid during all childbirth, and also reduces pain during fights. The movement, breath and massage help future mother to distract and relax.
the Modern system of stationary obstetric aid left far forward. And it concerns not only the difficult equipment and the latest drugs. Changes concerned also views of traditional obstetrics, the individual attitude towards future mothers, understanding of importance of preservation of physiology (natural course) of childbirth. New maternity hospitals are equipped with separate chambers - the “boxes“ calculated on one woman in labor.Interiors of chambers remind
of stay in walls of medical institution less. In chamber with the woman in labor at will there can be a loved one, the psychologist or the personal obstetrician.
Today practically in any Russian maternity hospital perhaps individual conducting childbirth. In the majority of maternity hospitals early applying of the newborn to a breast and joint stay of mother with the kid practices in postnatal chamber. Relatives can visit a young family in postnatal office. In the absence of complications mother and the kid are written out home on 3 - 4 - e days, including day of childbirth.the Only unacceptable alternative option remain
house childbirth to this day. Also it is connected not with conservatism of domestic obstetrics and not with stagnancy of the medical legislation, and with the objective reasons doing such option of childbirth under our conditions dangerous to mother and the kid. So it is worth thinking seriously before agreeing to so dangerous replacement of traditional obstetric aid.