Analysis of the Childbirth Stories - Case Study Example

Abstract Pregnancy and child birth are important milestones in women’s lives. For them, child birth is considered as their own second birth. Mortality rates during pregnancy and labour used to be very high before the advent of modern medicine. The birth stories chosen for the study reveal the women’s experience of child birth as pleasant and at the same time an unforgettable experience and important milestones in their lives. Their choices have also proved to be appropriate in respect of safety unique to their preferences. Presence of family members and husbands has also played crucial roles in the outcomes. Describe the sequence of events that leads up to the birth of a baby. The events leading to the birth of a baby are known as labour. Hormones in the body cause labour comprised of several events. It begins with contractions in the uterus. The contractions are prevented by the hormone progesterone, level of which falls as the birth nears. Another hormone called oxytocin produced by the mother’s pituitary gland causes stimulation of the contraction of the uterus muscle. Yet another hormone oestrogen rises in level as the birth approaches and enables uterus to be more sensitive to oxytocin which stimulates the uterus muscle. Contractions of the uterus occur almost every 20 minutes and their frequency increases as the birth approaches. As the amniotic membrane gets ruptured due to contractions, the resultant release of amniotic fluid known as braking of waters, causes dilation of the cervix further. As the cervix widens, the first stage of labour emerges enabling the baby’s head to pass through the widened cervix. The process of labour continues while the baby’s head comes out of the cervix and enters vagina serving as a birth canal. By this time, the labour becomes rapid in that the mother only needs to make gentle contractions by herself assisted by the midwife or the obstetrician. At this stage, it becomes traumatic for the baby due to possible shortage of oxygen supply as the umbilical cord is compressed by the walls of the birth canal. Baby’s heartbeat is also monitored during the birth. When the baby begins to breathe, blood gets oxygen again. If the baby is found to be breathing properly, the umbilical is cut after being clamped to prevent bleeding. After the baby is out, placenta is ejected from the uterus wall and in turn vagina. (Pickering, 2000, p 142) How do the births you have chosen compare to the text’s description of a normal delivery? Joshua’s birth story is different from normal delivery described in text books. The delivery was already late by 17 days. It was going to be a water birth for the baby which was the second one for the mother. The first one which was 22 months old had already been making the mother restless “ripping out walls, ripping up carpet and polishing floors”. The mother was originally planned to be put on induction on the 12th day (Wednesday), yet it did not happen. It was only on the next Wednesday, the birth centre where the mother had been had been waiting for 17 days, informed the induction would have to be postponed as the midwife was not available after her busy schedules until the previous night. The mother’s mother and aunt had already taken leave that day to attend to her delivery and the Joshua’s mother was infuriated. Because of her restlessness, instead of being taken to birth centre for the water birth, the mother was taken to labour ward first so that she could be taken to birth centre when the midwife came in. She was told not to worry as she had a big sized pelvis. Instead of letting amniotic membrane rupturing itself, the doctor came and broke the waters. She was asked to walk for half an hour and it was only after one hour of the breaking of waters, the mother started experiencing contractions. The first few contractions were in five minutes intervals and later they came in 2 minutes intervals. The mother was leaning on the table responding to contractions. Family members had all come and been having lunch in a corner. As the contractions became more frequent, the mother started crying due to pain and her aunt and mother also joined her. One hour after that, midwife was called to deliver the baby. The midwife took her to the showers where they poured hot water on her. Finally after pushing three times by the mother, the baby came out weighing 9 lbs 11 oz (4.4 kg) landing on her hands while she was in kneeling position on the shower floor. This delivery was quite different from a regular normal delivery in that it took two hours from the time of mild contractions and without any drugs. She just positioned herself kneeling instead of traditional lying down along with huge amount of encouragement from her husband, mom, aunt and cousins. Though she wanted to go home immediately, she was allowed to go only the next morning. The experience was so awesome for her that she felt like having the third baby without waiting any longer. The only worry was, the next baby would weigh 12 lbs and that she would literally sneeze the baby out. (Joshua’s birth story, 2003) Next comes, the account of Amanda from Perth, WA. Her delivery of Palmer, a girl baby was in May 2008. She was already 40 weeks pregnant without any signs of labour. She suddenly started experiencing contractions once in six minutes at the end of the 41st week and they lasted the whole day in the same frequency. Strangely, she had an insatiable hunger that she had to eat whatever she could lay her hands on including chicken in spite of being a vegetarian. While about to finish eating, she had sudden gushing of waters out of her which she could not make out if it was urine or amniotic fluid. By 9 pm, she realised it was amniotic fluid that broke like flood sprayed all over from her kitchen to computer table as she walked. She did not forget to post the message in the Belly Belly website. Now the contractions repeated every two minutes. She nearly exhausted all her towels at home and changed six pairs of undies. Only at this stage, she decided to go to the hospital and reached there by 10.30 pm. She even declined to use a wheel chair. Now the contractions occurred every two minutes. She could reach the maternal assessment ward in just two minutes. The medical ward staff tried to confirm what Amanda was having was labour pain by questions which Amanda answered by informing that he amniotic membrane broke and that she had her contractions every two minutes with her cervix dilated to 4 cm. As the assessment ward was fully occupied, Amanda was given a separate room for taking shower. They also arranged for bath at the labour ward when she would be shifted. By 12 pm, she was taken to the labour ward and was made to sit in the bath for three hours. She stood in the shower in the birth suite even afterwards not wanting to keep sitting down. She had a severe backache too. Finally she was checked for dilation and it was ten cm. Hence the staff started preparing her for the delivery by making her kneel on the bed with her head resting on her arms. But then, the contractions stopped and she was asked to lie down on her back which she just could not do due to back pain. Syno trip stimulated contractions again. But her blood pressure was so high at 245 that they found her having Pre-eclampsia. She was given magnesium drip to lower her blood pressure and some bloods clotting agents she was deficient of. It was nearly after 10.30 hours, Amanda started pushing her baby out when a doctor intervened saying she needed surgery which her husband explained to her as C-section. But since she refused, another doctor cam into perform episiotomy to take the baby out who was in the side ways. On episiotomy procedure, Palmer came out finally with Amanda’s pushing at the same time. She had profuse bleeding due to the procedure. After the delivery, doctor started stitching her vagina which was quite agonising. She was given gas to inhale. The stitching took about 45 minutes. She was told by the nurse that had a bay girl but later on that she had baby boy. She was in the intensive care for three days only after which her baby girl was handed over to her. Amanda was 22 and her husband 47. It appears the story was entered very late and the couple were already on amicable divorce process. (Palmer’s birth story, 2008) This also was not perfectly normal delivery because of episiotomy procedure. But it did not differ much from the labour of this kind described in text books. What kind of emotions might a pregnant woman experience in the days before her baby is due to be born? Joshua’s mother feelings were pleasant though there were anxious moments as the baby’s birth was delayed by seventeen days. (Joshua’s birth story, 2003) In Amanda’s case it was quite a trying time for her. Her will-power endured through agonising labour. It seems to be her first baby and she is proud of having a baby girl. How did the women in the stories you chose feel before they gave birth? Explain the role of the birth partner. For Joshua’s mother it was the second delivery and she had not mentioned how she had her first delivery which was just 22 months old. Her husband had already been on leave for two weeks just to attend to her delivery. He was all the while her at the time of labour and she did feel at home when delivering. (Joshua’s birth story, 2003) In Amanda’s case, there appeared to be family members or friends with her at the time of delivery. Her husband alone was there both at home before her leaving for the hospital and it was apparent that he was there with her throughout her labour as he explained to her about the C-section surgery propose. She had her will-power to sustain the labour pain which was quite long for more than 12 hours. (Palmer’s birth story, 2008) Who was with the women in your stories when they gave birth, what role did they play and how effective were they in their support? Both in Joshua’s and Palmer’s cases husbands were there with their mums. While Joshua’s mother who had a water birth was full of praise for her husband who had already taken leave and for her aunt and mother who were also with her throughout the labour. In Palmer’s case, the mother Amanda does not say much about her husband and any thing at all about her family or friends. From the narrative, the husband appears to have played a constructive role. (Joshua’s birth story, 2003 & Palmer’s birth story, 2008) What choices are available for pain relief during labour? While Joshua’s mother had no medications for pain relief and her water bath gave her some relief. So also for Amanda who was standing in the shower for more than three hours. She was not given any apparent pain killer through she had excruciating back pain and pain due to contractions. In fact, there were no choices for pain relief except the presence of family members that gave them moral support to endure pain they had. Evaluate how well the pain of labour was managed in these stories. In the case of Joshua’s birth, the mother had labour pain for a little while. She was having an unconventional water birth which is supposed to keep the pain subsided. In water the pain will be at a minimum or there will be no pain at all and the mother can altogether avoid analgesics. (Manning) In the case of Palmer’s birth, Amanda, the mother had her excruciating labour pain besides back pain for more than 12 hours. Episiotomy and suturing only added to the pain. But her pain was well managed by herself without her having to be put on anaesthesia. (Palmer’s birth story, 2008) Why and in what ways may a baby’s condition be monitored during labour? Monitoring of the baby during labour is as important as right from beginning of the pregnancy. If it is a low risk pregnancy, baby’s heart will be observed with 15-30 minutes intervals with the use of a handheld Doppler Ultrasound or foetal stethoscope. The monitoring will become more frequent in the second stage of labour almost at every contraction and pushing of the baby by the mother. Continuous monitoring will be required only if the patient develops complications during pregnancy or during labour. Electronic fetal monitoring gadget known as cardiotocograph (CTG) will be used instead. The receivers of the gadget attached to the machine are kept on the patient’s abdomen thus limiting her moments. Yet, the machine can accommodate the patient to sit, lie down or stand. With the use of telemetry, another machine, the patient can move about freely while the baby is being monitored. Doctors generally recommend electronic fetal monitoring for 20-30 minutes on admission and intermittent monitoring while in labour. (Planning for birth) However there is no scientific evidence to show that electronic fetal monitor would prevent babies’ death or their brain damage even after twenty five years of its use in intrapartum care. Serious errors are made by care providers by assuming that abnormal fetal heart rate is an indication of the babies being at grave risk necessitating intervention to save them. According Henci Goer, theory of fetal distress during labour will result in brain damage to the baby due to insufficient oxygen supply is not always correct. He says that baby’s heart rate during labour does not correlate with the condition of baby at birth. Baby’s condition at birth does not correlate with the long-term results. Electronic fetal monitoring or intermittent monitoring when compared, the former has no significant advantage for the long-term though short-term benefits will be apparent especially with the use of oxytocin during labour. In fact, EFM induces caesarean, vaginal instrumental delivery, infections and cerebral palsy in premature babies. The remedy for fetal distress such caesarean, forceps or vacuum delivery may themselves cause asphyxiation or trauma. Further infant neurological morbidity is not at all associated with labour incidents. Fetal monitoring actually interferes with labour process and can cause undue distress to the patient. Fetal heart rate during labour is 120 to 160 beats per minute. As contractions peak high, heart beats to the lowest level. It can drop to 60 beats per minute without any risk for the baby but it will be unusual if it happens in a series of contractions. 90 beats per minute is considered as a reasonable drop. (Purebirth-australia) How were the babies in your stories monitored and why were these choices made? In the stories of Joshua’s and Palmer’s birth, monitoring of the babies, while there is no mention of fetal monitoring in Joshua’s water birth, Palmer’s birth appears to have been monitored by intermittent methods as the patient had pre-eclampsia and episiotomy procedure. (Joshua’s birth story, 2003 & Palmer’s birth story, 2008) What choices do Australian families have when considering where to give birth? While Australians prefer midwifery model rather than doctor monitored model unlike in the U.S. where they have medical monopoly. Australians prefer midwifery model because midwifery guidelines are strict and fear-based model. But as far as places of choice of birth are concerned, it is mixed. Some prefer home based though it is going to be banned soon and some prefer hospitals. Logically hospitals should be the better choice as they are equipped to meet any emergency. In a home setting, choices of treatment are limited and last minute shifting of patients to the hospital will only aggravate complications. Yet another choice is the mixture of hospital and resort setting wherein the patients will have the benefits of both provided the place i.e the birth centre is well equipped. Already 95 % of the births in Australia are conducted in hospitals only. 2.5 % of them are in birth centres. (Huggies, Australia) Where did the women in your stories give birth and how do you think this impacted on their experience of childbirth. The women in the stories above gave birth to their babies Joshua and Palmer outside their homes reflecting the majority preference. While Joshua’s mother had her birthing by water birth which gave her no medication as pain killers during her labour, Amanda, Palmer’s mother who had all possible complications during labour fortunately had preferred the birthing at the hospital. Both are satisfied with the outcomes and had no regrets about their choices. It was second baby in Joshua’s case and presumably first baby in the case of Amanda going by her age of 22 years. Joshua’s mother had her aunt, mother and friends with her at the time of birth provided all moral support and it was almost like a home birth. Her water birth has given her pleasant feeling and throughout it was painless except during contractions in the second stage. In the case of Palmer’s birth, her mother started having problems at home itself with her amniotic membrane’s rupturing. It was already late. She was not getting contractions. Even after going to the hospital, contractions which began stopped. She was pre-eclampsia and was recommended for C-Section but the doctor settled down for episiotomy on Amanda’s insistence. Though she had no family members or friends except her husband with her, the hospital setting must have filled the deficit. Hence both the choices of birth places as well as birth models they had, became logical enough to justify the outcomes. Their opinions about their experiences in their own accounts do not mention any thing unpleasant. They appear to have been satisfied with their choices and outcomes. References Huggies, Australia, Your antenatal care - Your birth choice, < http://www.huggies.com.au/BecomingAParent/YourAntenatalCare/YourBirthCho ice.asp > accessed 25 August 2009 Joshua’s birth, October 2003, < http://www.bellybelly.com.au/general/birth-of-joshua-2003> accessed 25 August 2009 Manning Brenda, Preparing for a water birth, accessed 25 August 2009 Palmer’s Birth Story, March 2008, < http://forums.bellybelly.com.au/forums/birth-stories/108988-palmers-birth-story-very-late.html>accessed 25 August 2009 Pickering Ron W, 2000, Complete Biology, Oxford, p 142 Planning for birth, Having a baby in Victoria, Monitoring of your baby during your labour, http://www.health.vic.gov.au/maternity/yourpregnancy/planning.htm#mon >accessed 25 August 2009 Purebirth-australia, Fetal Distress and Fetal Heart Rates, < http://www.purebirth-australia.com/childbirth/variations/fetal-distress-fhr.html > accessed 25 August 2009 Read More