BIRTH

     

Delivery / Natural birthing :Women should not miss the joy of experience of natural birthing.

Straightforward uncomplicated birth comprises three distinct stages.

                            "Physical, mental and spiritual preparation days before day of delivery." Creating awareness among all about health hygiene nutrition and being prepared for the day of delivery is essential to save both  mother and baby.

Mentally and spiritually the mother to be , must be prepared for child birth, by adopting prayers. Prayers are essential or meditation to keep calm, blissful, which ensures easy and safe delivery.

Care of newborn :  Neem, mango, tulsi,  are extensively and judiciously used after birth .
Massage play a great role in child care.

First forty days after child birth as a period of rest, rejuvenation, and bonding.
Puerperium refers to the 6 weeks following childbirth during which the pelvic organs return to the pre- pregnant state and the physiological changes of pregnancy are all reversed. It is divided into three phases:
Immediate Puerperium within 24 hours of delivery
Early Puerperium up to 7 days
Remote Puerperium Up to 6 weeks

False Labor

False labour is when there is contractions (tightening of belly) but they are not painful). Also False contraction stops, if you change your position from sleeping to standing or sitting or vice versa.

Yoga

Not to forget the yoga, which is a critical practice that can help both mother and child and , and enhance the metabolism and mental health of mother and new born.

Early Labor 

In the first stage of labor the mouth of the womb opens up and dilates to make way for the baby's head to pass through. First stage is the longest ranging from twelve hours to more or less than twelve hours. In the first first stage, the lips of the womb or cervix thinned out and stretch apart over the baby's head, while the body of the uterus shrinks on the baby and pushes it towards the cervix. This is what happens during the contraction or pain of labour. Sometimes before contractions are felt, a harmless, thick mucus discharge may be noticed. On the other hand, a water leak may herald the onset of labour.

Labour Pain

According to Ayurveda, labour pain can be reduced if the downward movement of vata (Apana Vayu) is strong so that the mother can push the fetus. If from the eighth month the mother consumes rice gruel with added ghee or medicated gruel's, cooked in milk, she will not be constipated and delivery can be smooth and easy.

Active Labor 

In the second stage of labour baby passes through the vagina and is born. The second stage could be from thirty minutes to an hour and a half. Onset of actual labour is also indicated by contractions, but they get stronger in intensity with time. The key here is to check , how often the contractions are coming and how long does each one last. If they come every ten minutes and go on for more tan thirty seconds, go to the hospital.

Transition Labor

    

In the third stage of labour , the placenta is delivered, having completed its function of nourishing the baby. The third stage could take about ten minutes. At a first delivery, the first stage is usually longer than in subsequent births.

Early Labor 

• When you go to the hospital, your husband or relative will be taken to a room where you will be told to change out of your clothes and wear a hospital gown.
• Then your pubic hair will be shaved.
• It will be followed by an enema. An enema is a process whereby a tube is inserted in the anus and a fluid solution is infused into the rectum. It will cause you to empty your bowels thoroughly. This avoids the passing of a stool during birth. Often after an enema, contractions becomes stronger. Remember an empty rectum will aid the progress of labour, so in labour pass a stool when ever you desire to, and keep drinking fluids and pass urine every 60 to 90 minutes. A full bladder can cause discomfort and pain, and inhibit uterine contractions. Later it can lead to diminished bladder tone and infection. Do not limit your fluid intake. You will specially get thirsty if you perspire a lot.
• After enema your husband or relative will be permitted to join you, and can be with you until when your are ready for birth, and taken into the delivery room. If you have booked in a government hospital, you may not be permitted to have your husband or relative with you.
• During labour your blood pressure could be taken now and then. The nurse would take your pulse and temperature and listen to the baby,s heart beat. The position of a baby would be ascertained by palpating your abdomen or by an internal examination.
• An internal examination could also be carried out  to check how many centimetres  the cervix has dilated. The strength or frequency of the contractions might also be noted. A note would be made of whether the membranes have ruptured and whether  there is any bleeding, you will be asked when and what you ate last and whether you have taken any medication.
• Labour can become quite gently and build up to powerful sensations. Between contractions, you must make an effort to practice quick relaxation. If labour start during the day, move about the house at leisure. If labour starts in the evening or night try and get some sleep.
•  Do not tire your self out by being physically over active. Conserve your energy for the other half of labour, but do try and remain upright. When you are upright the pressure of the baby's head on the cervix will stimulate your uterus to contract. If you lie down for a while, remember lying on your side is better than lying on your back, since it relieves pressure on the vena cava, a major blood vessel, so that the oxygen content of your blood is enhanced, much to your and the baby's advantage.
• The labour can be handled quite comfortably with breathing, various positions and relaxations techniques.
• However there are some drugs that are used for pain relief in labour. Their use will depend on the discretion of your obstetrician. You may or may not need them through labour.
• Castor oil 30 ml with milk on night on due date.
• Aparmar twig tied over umbilicus.

Drugs , analgesics and anesthetics are sometimes administered, although they are often unnecessary and can have harmful side effects. Refrain from asking for them. Family members accompanying the women in labour should avoid becoming unnecessarily anxious, constantly requesting the doctor to do something.

Some women may have an unnatural or difficult birth. Complications sometimes occur, in which case you must leave the decisions to your doctor.Some complication could arise in labour, whereas in some cases risk factors are already present, for instance,

A women with a previous Cesarean delivery.

A previous still birth.

Kidney problems

Diabetes

In such cases a large well equipped hospital, or a good public hospital, if situated between reachable distance, is a good choice. A big public hospital will have a highly experienced and qualified staff, blood bank facilities, a pediatric unit to take care of emergencies in the new born and there would be no commercial pressure.

Prepared Childbirth

If labour progresses without drugs, while a women uses prepared child birth techniques or naturally handles labour in a relaxed way, the body produces endorphin hormones. Endorphins are natural pain killers and are secreted by the body during hard physical exercise and labour. Some prepared childbirth methods concentrate only on psychologically training a women for birth, while other methods equip a women to deal with labour by using certain breathing rhythms.

Prepared childbirth is ideal for a women who would prefer to avoid medication in labour either completely or as long as possible. Just moving about in labour from one position to another as one desires, reduces the discomfort of labour greatly. So does the practice of breathing and relaxation.

Pain killers are often freely offered and accepted in labour because in our civilized society nobody likes to lose emotional control. It is not socially acceptable for a women to make a show of her feelings in labour. She is expected to be a patient who lies down quietly in her bed making a little noise as possible. Women often do not realize they have another option.

It is best to avoid any kind of drug in labour, since whatever you inhale or receive intra-muscularly or through the drip while in labour, passes to the baby through the placenta in a matter of minutes. What you receive will be given to you in accordance with your body weight and it immediately passes to the baby who is only a fraction of your weight . So a drug that will make you sleepy or knock you out , will do the same, manifold, to the baby.

Most sedatives and painkillers given to the mother would depress her breathing and lower her blood pressure, doing the same to the baby. As a result the baby would be born sluggish, so that the baby's respiration may be jeopardized in the few precious moments after birth. Lack of oxygen at birth can have a serious effect on the child's brain, even if mild, it can effect its ability to learn in later years.

Drug must be used with great caution, if the baby is premature or small, because the baby's liver will be immature and will find it difficult to break down the drugs and eliminate them from the body. In labour , a drug , in order to be of use , should not be given in so large a dose that it results in dangerous side effects. At the same time the dose should be large enough to give the desired effect, that is, the dose should not be too small and therefore ineffective.

The more medication a mother receives in labour, the longer and more difficult will be the baby's adjustment to life after birth. Medication can also affect the breast feeding negatively in the first five days.

A women should learn to flow with her body and experience the birth of a baby as a basic function of her body. Each contraction should be considered an effort of her body to give birth to a baby. handled positively and naturally, many women speak of a delight of feeling the baby's body slip through, of feeling a warmness and a wetness followed by the baby's cry. Whereas many drugged or anesthetized women may feel they missed out in all.

Active Labor

The second stage of labour is recognized by a strong contractions coming every one or two minutes apart and lasting a whole minute. After a while the contraction will slow down. Typical of this stage is also the desire on your part to bear down and push the baby out. Some women feel nauseous at this stage of labour. The second stage of labour begins when the cervix has dilated to its full ten centimetres and end with the delivery of the baby. At this stage you are taken into delivery room and made to lie down on your back with legs bent at the knees and feet resting flat on the bed. Alternatively, you will be made to lie down on you back and your legs will be supported by a set of stirrups on either side of the delivery table, so that your legs after being bent at the knee would be supported wide apart on either side. The stirrup would support the back of your bent knee and ankles.

This is often referred to as the working stage of labour, you have to work along with the uterine contractions to expel the baby and deliver it, by adding your efforts to physically push the baby out.

At this stage the folds in the vagina unfold to accommodate the baby's head on the pelvic floor gives a feeling of fullness in the rectum, which many women describe as a desire to pass a stool. Finally the baby's head comes in contact with the perineum or the muscular outlet of the pelvis which is stretched until the baby's head appears through it, just as your head would appear out of the top of a polo neck sweater when you are putting it on. The baby's head is normally delivered face down and the back of the head towards ceiling. After the head is delivered, the baby's shoulders appear, followed quickly by the rest of the body. You may hear you baby's cry or whimper. The absence of a loud cry does not mean that something is wrong.

Transition Labor

This stage begins with the birth of the baby and ends with the expulsion of the placenta, which peels away from the walls of the uterus and is delivered after the baby.

After the birth of a baby the umbilical chord continues to pulsate and supply the baby with oxygen through the placenta, while simultaneously, the baby's own breathing get established. The chord is clamped a few inches away from the baby's navel and a few inches away from this site, and then it is incised between the two clamps. A stump of the cord will be left on the baby's abdomen. After few days the stump will dry up and fall off, leaving the baby's navel as a permanent mark of its past existence.

The baby is born with the mucous or fluid in its nose, mouth and throat. Some of it is wiped away when the head is delivered. After birth the baby is kept head down to encourage further draining of mucous.. If the mucous seems to be interfering with the baby's first breath and there is chances of it being inhaled, it will be removed by a suction device. A little mucus remaining in baby's lungs gets absorbed into the bloodstream when the baby's breathing is well established. At birth the baby's lungs are in a collapsed state like deflated balloons, stickily held together by mucus.The first breath fills them with air. The filling of the lungs with air causes blood to rush to them, and the oxygen from the air is absorbed by the baby's bloodstream. When this happens the baby's blood circulation switches from receiving oxygen from the placenta to receiving oxygen from baby's lungs. The baby's heart starts to function. The artery that fed the baby's heart blood from the placenta stops functioning when the cord is incised, and the baby's heart begins to function independently.

The delivery of the placenta is not unpleasant or painful. The last few contractions cause the placenta to detach from the wall of the uterus and it is delivered through the birth canal. Sometimes an injection of syntocinon is given to make the uterus contract and hasten this stage. Sometimes the doctor tugs at the cord and at the same time the abdomen may be massaged to help free the placenta from the uterus. On the other hand, after ten to fifteen minutes of the birth, uterine contractions simultaneously start again. They take another ten to fifteen minutes to become strong enough to separate the placenta from the uterus wall and expel it.

The doctor checks the placenta to see that it has come out whole. Bits of it left inside can create problems later, of heavy bleeding and passing of clots.

After Delivery

Episiotomy

According to Ayurveda : Episiotomy (surgical process to aid a difficult delivery), can be avoided by the mother to undergo simple measures like medicated enema (yoni pichhu) n nine month can strengthen the vaginal muscles and prevent the need for cutting and stitching.

The Baby At Birth

At birth a baby looks wet with plastered down hair. The body is covered with cheesy substance called vernix which gives waterproof protection to the baby in the uterus. The baby might also be streaked with a little blood. At first the baby may look blue, but will change to a pink shade as its circulation gets established.. At first the baby breathes around 110 breaths per minutes and may cough and splutter or gasp.

Occasionally the baby's head might be a little oddly shaped as a result of its molding during birth. The baby's breast might also be enlarged in either sex. A male baby's testes may seem blue and enlarged. A female baby's labia may be red and swollen. The baby may be covered with the fine hair. After a few days the oddities of appearance will disappear.

After Normal Delivery

Ajwain + Dry ginger in boiled water. Ajwain should be proplerly chewed. Regular menstrual period will start. Good for backache

Post Delivery bath

Nirgundi Leaves should be boiled in bath water. It is good for bodyache.

Keep the record of :

Birth details

Birth date

Time

Weight

Results of any test done like

Blood group

Bilirubin

Hb

G 6 PD deficiency

Menorragia : Post Abortion or Post Delivery Tan Ethamsylate QDS. Tab K Stat QDS. Tab Methargin TDS. Tab Gyne CVP TDS. Tab Daflon 500 mg BD.

Episiotomy

The doctor may make a small cut near the vagina to widen an opening of the birth canal at the time of delivery.Post delivery the cut is stitched up. This cut is known as episiotomy.

Caesarean Section

When the baby has to be delivered by surgical intervention it is known as caesarean or C-Section delivery. Here a cut is made just above the bikini line from which the baby is lifted out.

Forceps and Vacuum Delivery

If the mother gets too tired during delivery and is unable to push anymore, or if there is any other unforeseeable delay and the baby is in distress, the doctor can place a forceps on baby's head and help to ease the baby out.. Similarly a vacuum pump may also be used.

Breech Delivery

The normal position of birth is when the baby is born head first.. When the baby is born bottom first, it is called a breech delivery. Such children are more prone to have congenital dislocation of hip.

Drugs in Labour

Do discuss the subject of pain management with your doctor. In general, I encourage the process of normal delivery. I also believe that a drug to relieve a woman from pain during labour is not a good substitute for emotional support from a sympathetic doctor or midwife or even a husband, mother or mother in law educated in the process of labour. The pain relieving drugs in delivery may result in less cooperation from the mother. They may also depress the baby and cause problem with the breathing and nursing.

However, if required, pain killer can be given during delivery. They are given through a vein and injected into the blood stream

Epidural

This is pain killer administered through the spine. It dulls the pain in the lower part of the body, but the patient remains fully conscious.

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