Transcript BIRTHING ENVIRONMENTS & LABOUR CHOICES

BIRTHING ENVIRONMENT
& LABOUR CHOICES
AC 1.1
Aim of the lesson:
Explain with examples how
different birthing environments
might suit different labour choices.
(1.1)
Objectives
By the end of the lesson you will be able to:
• Recognise different birthing environments
• State different labour choices
• Identify positive and negative aspects of
birthing environments based on different
labour choices made
Choosing a place to have a baby
• Watch the following video:
Where to give birth: the options
http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/where-can-i-give-birth.aspx#close
Note the different types of births and any relevant points
the the midwife mentions.
Choosing a birth location
• birth at home
• in a unit run by midwives (a midwifery unit or birth centre)
or
• in hospital. Some hospitals have a separate midwifery
unit. The choice mothers to be have about where to have
their baby will depend on their needs and risks and, to
some extent, on where they live.
Safety of home versus hospital birth
• Giving birth is generally safe wherever mothers choose to have
their baby. However, for women having their first baby, home
birth slightly increases the risk of a poor outcome for the baby
(from five in 1,000 for a hospital birth to nine in 1,000 - almost
1% - for a home birth).
• For women having their second or subsequent baby, a planned
home birth is as safe as having your baby in hospital or a
midwife-led unit.
• If they are healthy and considered to be 'low risk' they should
be offered a choice of birth setting. If the mother chooses to
give birth at home or in a unit run by midwives, they need to be
given information by their midwife or GP about what would
happen if they have to be transferred to hospital during labour,
and how long this would take. If something goes seriously
wrong during the labour – which is rare – it could be worse for
the mother or the baby than if they were in hospital with access
to specialised care.
• Women who give birth in a unit run by midwives or at
home are less likely to need assistance, such as through
the use of forceps or ventouse (sometimes called
instrumental delivery).
• For women with some medical conditions, it is safest to
give birth in hospital because specialists are available if
they need extra help during labour.
• Sometimes the maternity unit mothers choose may not be
available if many women are in labour at the same time
and the unit is full.
Home births
In England, around one in every 50 babies is born at home.
The advantages of giving birth at home include:
• being in familiar surroundings where the mother may feel
more relaxed and able to cope
• no interruption in labour to go into hospital
• No need to leave other children, if they have any
• Do not have to be separated from partner after the birth
• more likely to be looked after by a midwife the mother has
got to know during the pregnancy
• less likely to have intervention such as forceps or
ventouse than women giving birth in hospital
Question
• What do you think the pregnant
woman should think about in terms of
giving birth at home?
Things to think about if mothers to be are considering a home
birth:
• They may need to transfer to a hospital if there are complications –
the Birthplace study found that 45 out of 100 women having their first
baby were transferred to hospital, compared with only 12 out of 100
women having their second or subsequent baby.
• For women having their second or subsequent baby, a planned home
birth is as safe as having a baby in hospital or a midwife-led unit.
However, for women having their first baby, home birth slightly
increases the risk of a poor outcome for the baby (from five in 1,000
for a hospital birth to nine in 1,000 – almost 1% – for a home birth).
Poor outcomes included death of the baby and problems that might
affect the baby's quality of life.
• Epidurals are not available at home.
• The doctor or midwife may recommend that a mother give birth in
hospital. For example if they are expecting twins, or if the baby is
breech, the midwife or doctor will explain why they think a hospital
birth is safer for the mother and the baby.
Midwifery units or birth centres
• Midwifery units or birth centres are more comfortable and
homely than a maternity unit in a hospital. Midwifery units
can be part of a general hospital maternity unit, in a
smaller community hospital or completely separate from a
hospital.
• An Adjacent Midwifery Unit (AMU) is attached to a
hospital where obstetric, neonatal and anaesthetic care
are available should they be needed in the same building
or on a separate building on the same site.
• A Freestanding Midwifery Unit (FMU) is usually where a
unit is on a separate site or some distance away from a
hospital without immediate obstetric, neonatal and
anaesthetic care.
The advantages of giving birth at a
midwifery unit include:
• being in surroundings where the mother may feel more
relaxed and able to cope with labour
• more likely to be looked after by a midwife the mother has
got to know during the pregnancy
• the unit may be much nearer their home, so it is easier for
the partner and friends/relatives to visit
• less likely to have intervention such as forceps or
ventouse than women giving birth in hospital
Question
• What do you think the pregnant
woman should think about in terms of
giving birth in a midwifery unit or a
birth centre?
Things to think about for mothers considering giving
birth in a midwifery unit or birth centre:
• may need to transfer to a hospital if there are any
complications – the Birthplace study found that
approximately four in 10 women having their first baby in
a midwifery unit or birth centre were transferred to
hospital, compared with approximately one in 10 women
having their second or subsequent baby
• in a unit that's completely separate from a hospital (FMU),
no need to have certain kinds of pain relief, such as an
epidural
• the doctor or midwife may feel that it's safer for the mother
to give birth in hospital
Hospital births
Most women give birth in an NHS hospital maternity unit.
• Discuss in pairs and make notes about the advantages
and disadvantages of hospital births.
The advantages of giving birth in hospital
include:
• having direct access to obstetricians if your labour
becomes complicated
• having direct access to anaesthetists (who give epidurals
and general anaesthetics)
• there will be neonatologists (specialists in newborn care)
and a special care baby unit if there are any problems
with the baby
Things a mother should think about if
considering a hospital birth:
• may go home directly from the labour ward or may be
moved to a postnatal ward
• in hospital, the mother may be looked after by a different
midwife from the one who looked after them during the
pregnancy
Home work- find out the meaning of the
following words:
• Word Bank
• episiotomy
• APGAR
• doula
• dilation
• incisions
• chest
• natural
• pushing
• nurse midwife
• contractions
• method
• expulsion
• Caesarean
• frequent
• anaesthesia
• synthetic
• vaccinations
• birth plan
• pain medications
• Braxton-Hicks
References
Where to give birth: the options available on
http://www.nhs.uk accessed 2.12.13