Dr. Areefa Albahri Chapter 1 Introduction to normal childbirth

How Has Childbirth Changed in This Century? Childbirth itself has not changed at all! Babies are still born today in the same way that that they have been born for generations. But many things associated with childbirth have changed, including:  Women's expectations of childbirth  Pain management options  The economics of childbirth and the system of healthcare  The technology used during pregnancy and birth. These factors have greatly changed women's childbirth experiences.

How have women's expectations of childbirth changed? Today, a woman having a baby in an industrialized nation can reasonably expect that both she and her baby will have a healthy journey through pregnancy and birth. Childbearing is generally safe and does not represent illness or disability. A hundred years ago, many women faced childbirth with some fear because they knew of a mother or baby who had died. Dr. Areefa Albahri

How have the economics of childbirth changed? During the 20th century, childbirth shifted to the hospital for several reasons:  The availability of pain medications in the hospital.  The belief that physicians were the most qualified to attend births.  Women's and physician's beliefs that hospital births were safer.

Men were not allowed anywhere near childbirth situations for hundreds of years. There is a story of one Doctor, Dr. Wertt of Hamburg, in 1522, who had the idea to dress up in women’s clothes to gain entry to a labor room. He was discovered and was burned at the stake for his effort! It was not really until the 1970’s that fathers were allowed into birthing rooms, and at that time it was not so that they could help, they had to stand in the corner and just watch! Dr. Areefa Albahri

Throughout time, midwives have provided the majority of maternity care around the world, however, the late 1800s and early 1900s represented a time of change. The development of forceps in the mid 1700s, which were only used by physicians, introduced the doctor to maternity care. Physicians were called to births when progress was slow or there were other problems, and thus their introduction to childbirth was in problem situations where the outcome was often poor.

How has birth technology changed? The past century has brought numerous advances in childbirth technology, including how the baby's wellbeing is monitored, tests and procedures during pregnancy, and birth practices. The baby's wellbeing can be assessed by several methods: A century ago, the baby could only be monitored by using a stethoscope, or a specially designed fetal stethoscope, and a baby can still be monitored in this way today. Dr. Areefa Albahri

In the 1960s, the electronic fetal monitor was introduced, that provided the physician or midwife with a paper record of the baby's heartbeat. Providers can monitor electronically by either using an external device placed on the mother's abdomen, which uses Doppler ultrasound to detect the baby's heartbeats

Tests and procedures Let's consider some tests and procedures physicians and midwives use to promote the health of the mother and baby. Providers generally offer women an array of screening and diagnostic tests during their pregnancy. (A screening test identifies an increased risk of a problem. For example, the prenatal screening may identify a woman as having an increased risk of having an infant with Down Syndrome, but does not provide a diagnosis. The diagnosis can only be made with an amniocentesis).

Changes in birth practices Several birth practices have also changed in the past 100 years. Although cesarean sections and forceps were used early in the 20th century, their frequency was low. Today, the cesarean section rate is approaching about 30% in the United States. A very recent trend is the elective cesarean section, that is, a cesarean section done without a current medical indication but that might potentially prevent future problems such as incontinence.

The Invention of Anesthesia Perhaps one of the other greatest “inventions” for childbirth was the invention of anesthesia. It was in 1853 that Queen Victoria of England gave birth to her 7th baby. Her doctor gave her chloroform to ease the pain. This was a great success and the Queen quickly spread the ‘word’ about how wonderful it was to have relief from the pain! So it is really only in the last 150 years that pain relief has been available to women. Before that time there was no anesthesia available and childbirth pains were greatly feared by women. Young girls were encouraged to witness and hear women birth their babies so that they could “mentally prepare” for their turn to give birth to their own baby! ! Dr. Areefa Albahri

The last 30 years has the greatest advances in childbirth technology! The modern world really “woke up” to the realization that ‘childbirth education’ for women and their partners. ! It is also trendy today for couples who are expecting their first baby to attend Prenatal, or Lamaze classes, in order to prepare for baby delivery day! Modern prenatal classes also offer valuable advice on what types of diapers, strollers, cribs, change tables, baby clothes, baby bedding and other product to buy. The classes also teach new parents how to change a diaper, how to bathe and dress a new baby. Dr. Areefa Albahri

Modern conveniences and the child birth experience Today we are very lucky to have the modern conveniences of doctors (your choice of male or female!), trained midwives, clean hospitals, efficient drugs and effective medical interventions, and a woman can have her husband attend the birth of their baby! In fact in most hospitals today it is possible to have your mother, brother, sister, children, best friend or whoever you wish attend the birth of your baby! We also have, if you so choose, the convenience of disposable diapers. And aren't you glad to have the ever so amazing washing machine and dryer that your great grandmother did not have to wash their “mountains” of laundry that a new baby creates! Dr. Areefa Albahri

Models of childbirth care Chalmers had an acute sensitivity to the ancient Hippocratic injunction, ‘First, do no harm’,. In other words, it is a position of humility before the physiology that respects it, believes in it and affirms it unless pathology manifests. If childbirth professionals had adopted this position, we would not have set about ‘managing’ labour and birth as though it cannot be trusted. The management approach is indicative of the values and beliefs sustaining the biomedical model, and a social model (Walsh and Newburn 2002). The following table contrasts these two approaches: Social model Biomedical model Dr. Areefa Albahri

Biomedical modelSocial model, Reductionism – powersWhole person – physiology passages, passengerpsychosocial, spiritual Control and manageRespect and empower Expertise/objectiveRelational/subjective Environment peripheralEnvironment central Anticipate pathologyAnticipate normality

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