Search

Uselful Tips for fathers during delivery

Fathers’ contribution to the process of delivery and their support is the healthy begin-ning to a lifelong responsibility. Fathers have quite a lot to do when mothers go into la-bor but are still far away from the moment of birth.

 

The First Stage

When the contractions begin at home, give your spouse a massage, help her with sitting positions and breath control, track the time between each contraction and take care of any last minute additions to the hospital bag.

· The mother can forget about everything when the contractions start, stay by her side, remain calm and support her.

· Take charge of anything that needs to be done, but be sensitive to the mother’s expectations and do your best to meet her expectations.

· Encourage her to walk in order to make use of gravity and assist her for other vertical positions.

· If she had an epidural, she won’t know when her bladder is full, so remind her to go pee with short intervals.

· Make sure she changes positions frequently (Kneeling, squatting, standing up and extending the body forward walking, exercises on a pilates ball, positions on her back, etc.).

· Keep an eye on her breathing and help her to breathe in and out more slowly. Make sure she doesn’t hold her breath, remind her about the breathing exercis-es and try to do them together.

· Keep your voice calm and your speech rhythmic when you talk to her and make positive suggestions.

· Make sure she rests between the waves. The shoulders and the chin should be particularly relaxed. Encourage her to lie on her left side.

· She can sleep, use relaxation techniques, do visualization, imagine that the process of birth flows easily and she holds her baby in her arms… Inspire her with your words!

· You can massage her back and her legs. Keep offering to massage her, small touches could provide great relief.

· When she gets uncomfortable and begins to sweat, apply cold compresses on her neck and face to provide relief.

· Massage and hot compress can alleviate back pain.

· Make sure she gets enough water or wets her mouth to avoid dryness. You can also give her some candy for energy.

· When you get to the hospital, make sure the room is quiet and not too bright. If there are any songs that you have agreed upon beforehand, play them for the mother during her more stressful moments.

· Decide on the people you want around you beforehand and prevent anyone else from entering the room as much as possible.

· There might be changes in the mother’s temperament during this time, so be prepared. Humor her and show her love.

· Support her during the transition period, remind her that the birth is going to happen very soon and motivate her.

· Keep communicating with your baby. 

The Second Stage (Labor)

· Be right by your wife’s side during delivery. Give her your support as she push-es. Support her head and use positive words.

· Try to not go over to the birthing bed early.

· Remain calm and keep communicating with the doctor.

· Encourage the mother to trust herself and her body with positive guidance.

· Repeat the instructions from the doctor or the midwife together.

· Make sure she gets rest between each wave (labor pains).

· If she’ll need stitches after delivery, stay by her side.

· Help her with any discomfort she might experience after the delivery.

· She might be shivering, thirsty, fatigued, hungry, sleepy and low on energy.

Research

Before writing this book, I did quite a lot of research to see how much the rate of natural births have decreased as the rate of cesarean sections increased, to understand whether this was due to local anatomical features, lack of information or outright misin-formation. Certain reports and historical developmental details were particularly inter-esting, and I finally realized that these changes had nothing to do with the health of mothers and babies.

In the Research chapter, I want to share with you some findings without com-ment. These include an official report by the World Health Organization on cesarean sections and natural births. I hope that you take a look at all these.

I also wanted to learn more about the history of midwifery. And when we look at information, we also understand under what conditions the concept of birth has changed.

If we use our right to become informed, apart from what is right or wrong and good or bad, we can find out where we stand on these issues, what we are expected to be a part of, and what kind of choices we can make between the feelings of FEAR and LOVE that are inside of us. Enjoy reading!

Today, many births around the world happen in hospitals under the supervision of ob-stetricians. Data shows that 98.6% of births in 2012 took place in a hospital environ-ment. In many other industrialized countries (England, Japan, Switzerland, etc.) births are often supervised by midwives. The fact that midwives are more prominent in these countries has historical roots.

In colonial times in America, midwives attended every birth. Women usually gave birth at home and midwifery was learned on the job, with a master-apprentice re-lationship. After African women started coming to America as slaves, they began to at-tend the births of both white and black women. After slavery was abolished, African-American midwives continued to attend the births of both black and white women who were poor, especially in the southern regions. They even had a special title: Granny Midwives.

Unlike Europe and England, the legislation on midwifery in America was subject to regional approaches instead of national ones. Due to the small number of midwifery schools, there was no compulsory education for midwifery. However, because of the doctors who didn’t want to treat the poor, midwifery remained an active profession. Un-til 1920, midwifery existed in many states without being subjected to any sort of control. Even today, the system of midwifery is subject to regional regulations.

Medicine did not become professionalized until the end of the 1800s, and when it finally began to, competition began to increase. By the beginning of the 20th century, midwives attended only half of all births. A series of events between 1910 and 1920 laid the foundation for doctors to begin to discipline the traditional role of the midwife and approach childbirth as a pathological phenomenon. 

 Two reports published between 1910 and 1912 emphasized that obstetricians were lacking in experience. With the aim of improving obstetricians’ practical experi-ence, the powers that be recommended that all deliveries should be done at hospitals and midwifery should gradually be wiped out. Women whose financial conditions were below average were encouraged to go to voluntary hospitals instead of working with midwives. Doctors then used these women to increase their experience. Then, in 1914, “twilight sleep” was discovered. Twilight sleep was induced by using a combination of morphine, for pain relief, and scopolamine, a hallucinogenic chemical that prevented women from remembering the moment of giving birth. Upper class women took this as a medical development and while this medicine was administered under strict condi-tions in Germany, it was not subjected to a lot of control and supervision in the US. Even though seriously damaging side effects later came to light, the chemicals were administered to women for nearly 70 years.

In 1915, Dr. Joseph DeLee, author of the most important obstetric articles of that period, described childbirth as a pathologic process (sickness) that caused harm to mothers and babies “often and much.” According to him, childbirth was not a normal process but a destructive one, where even the existence of midwives should be ab-surd. 

In an article that was published in American Journal Of Obstetrics and Gynecol-ogy, DeLee proposed a series of interventions to save women from the “evils of labor.” These included routine use of sedatives, ether, episiotomies and forceps. DeLee was a very influential obstetrician at the time as the head of obstetrics at Northwestern Uni-versity and chairman of obstetrics and gynecology at the University of Chicago. Child-birth changed from a procedure where only problematic situations required interven-tion into a systematic practice where every pregnant woman saw intervention.

 The model of obstetrics in the American medicine still carries the impact of DeLee’s system. Whereas in other, industrialized countries, the social health services approach has already abandoned any practices that aren’t really necessary. However, both in the US and Turkey, the healthcare industry functions on the belief that more intervention means more money, therefore unnecessary treatment and care expenses are still very much a reality. To be fair, these conditions are slowly changing in the US and there is now a standardized natural birth trend in place.

As childbirth became more medicalized due to DeLee’s efforts, midwifery began to diminish. Midwives attended half of all births in 1900, this rate went down to less than 15% by 1935. Interestingly enough, as midwifery declined, the number of deaths or injuries that occurred during delivery generally increased. A study conducted be-tween 1915 and 1929 showed that most infant mortalities occurred due to obstetrical interference.

Around the same time, Mary Breckinridge, who worked for the Red Cross in World War I, founded the Frontier Nursing Service (FNS) and the “nurse-midwifery” system in a rural county in Kentucky, so midwifery slowly began to resurface. Although small in numbers, these nurse-midwives helped improve the concept of childbirth in society and they brought about a family-oriented, holistic approach with regards to hav-ing fathers be present during childbirth, improving birthing knowledge, having mothers and babies stay in the same room, talking about the importance of breastfeeding, etc. In the same period, doctors at many hospitals encouraged formula and baby bottles. When studies conducted at the same confirmed that nurse-midwifery was economical-ly more beneficial, the system became popular again in the 1960s and 70s.

I’ve shared below the chronological development of the midwifery system in Turkey, as stated on the website of the Midwives Association of Turkey. However, the reason why I wanted to talk about certain developments that had an impact on midwife-ry and birth protocols in the world is that the procedures practiced in our country are usually adopted from global platforms. Medical advancements are not always linear. There are many ups and downs, drawbacks and mistakes from some of which there is no chance of recovery. Therefore, sometimes we can benefit from life-saving medicine when it is necessary and at other times we can make decisions regarding our bodies by using our rational minds and the information we have.

You can find the chronological development of midwifery in Turkey below. In addition to that, I think it would be fair to say that while there are many midwives in our country, they are usually not employed as midwives by obstetrics departments but ra-ther as nurses in other departments.

History of Midwifery in turkey

Midwifery has existed in every era and culture of Turkey. Midwives who served women giving birth were revered and respected in Turkish culture and the pro-fession was very much admired.

· Midwifery was learned through a master and apprentice relationship.

· Central Asian Turks attached importance to delivery and women had the mid-wives they trusted with them while giving birth. A midwife who helped women during birth was like a goddess. (Umay Ana)

· There were three types of midwives in the Ottomans;

               Court midwives

               Elite midwives 

               Common midwives

· In the Ottomans, every midwife had a birthing chair (öreke).

· Midwife would go to the pregnant woman and she would say, “As I have arrived here so shall the baby, God willing.”

· If an embryotomy was required, people would call the “bloody midwives.”

· Doctors did not usually perform deliveries but they were required to have knowledge of childbirth. They would convey their knowledge to midwives and teach them what to do in challenging cases.

· In 1840, an assembly was formed in the Ottoman School of Medicine and the school began to accept midwives through an exam.

· 2-year midwifery courses were introduced in 1842. Doctors taught theoretical classes while master midwives taught practical information.

· At first, master midwives were the ones who came from Europe and had a spe-cial training there. Later midwives who graduated from this school also taught classes.

· Haseki Sultan Hospital for women was established in 1843. A department dedi-cated to women was opened up in Gureba Hospital in 1847.

· In 1880, conditions of registration were amended with the changes made by Doctor Besim Ömer Pasha.

· Besim Ömer Pasha founded the first maternity house (Viladethane) in 1892.

· In 1905, a more advanced and bigger maternity house, Kadırga Viladethanesi, opened its doors.

· In 1909, women under the age of 30 from the military and civilian medical schools were enrolled in the midwife school. However, the graduates did not go to practice outside of Istanbul.

· In 1920, the Ministry of Health was founded and the first appointed minister was Dr. Adnan Adıvar.

· 1920: In order to raise midwives for cities other than Istanbul, girls who graduat-ed from primary school were given midwifery training for two years in the Red Crescent barracks.

· 1924: Midwife Education Dormitory provided free boarding training for two years at Şişli Children’s Hospital.

· The graduates were subjected to conscription.

· In 1928, the institute of midwifery in the Haydarpaşa Faculty of Medicine started to register middle school graduate girls for midwifery education.

· In 1928, Law 1291 on the Performance of the Arts of Medicine and Rehabilita-tion banned midwives without a diploma to perform deliveries. The need for midwives increased.

· In 1933, when the Faculty of Medicine moved from Haydarpaşa to Beyazıt, the maternity clinic was moved to Haseki Hospital, where the midwifery training was resumed.

· 1937: Village midwifery schools were opened inside of maternity houses.

· 1943: The law regulating the employment of village midwives was passed. Ac-cording to this law, midwives would be able to come back to the city centers after working for 6 years in rural countries.

· A building, construction of which began in 1953 at Cerrahpaşa Hospital, was finished in 1966 and was put into use (Gynecology Clinic and Midwife School).

· 1961-1962: Village midwife schools were separated from maternity houses. A three-year regular education system was introduced in which institutional clas-ses was taught at schools and practical experience was gained in maternity houses.

· 1963: Law on the socialization of health services was passed. The directive numbered 154 on the execution of the service, conducted a job analysis regard-ing midwifery for the first time in the regions where health services were social-ized.

· 1975: Nurse-midwife programs were prepared.

· 1978: Village midwife schools were closed.

· 1978: The departments of Midwifery in vocational health high schools continued to provide 4-year education programs.

· 1985-1986: With a protocol by the Council of Higher Education and the Ministry 2-year vocational health high schools began to offer midwife education pro-grams.

· In the 1997-98 academic year, midwifery programs in vocational health high schools were increased to 4-year undergraduate level.

· Şişli Health High School was founded in 2000.

The Importance Of Multivitamin Supplements In Pregnancy

In a bulletin published in 1989, the Food and Nutrition Board of the National Research Council in the US reported on the recommended daily allowances (RDA) of energy, protein, vitamins and minerals for non-pregnant women, pregnant women and lactat-ing women between the ages of 19-50. The RDAs should be used for community guidance, not for personal cases as nutritional requirements can vary amongst indi-viduals. Taking prenatal vitamin-mineral preparations may cause individuals to con-sume some nutrients above the RDAs. Large amounts of iron, zinc, selenium, vitamin A, B6, C and D intake in particular, may cause some toxic effects. In a study Rothman et al., conducted on 20.000 pregnant women, they showed that daily vitamin A intake of more than 15.000 IU is closely related to congenital defects. Additionally, failure to adjust blood glucose levels in diabetic patients and blood phenylalanine levels in women with phenylketonuria in the periconceptional period leads to poor gestational outcomes.

American Academy of Pediatrics and ACOG do not recommend taking more than twice the recommended RDA during pregnancy and they do not recommend rou-tine multivitamin supplementation. In 1990, the Institute of Medicine stated that all vit-amin and mineral requirements except iron can be met by a balanced diet during preg-nancy and that routine vitamin supplements other than iron are unnecessary. Later, the U.S. Centers for Disease Control and Prevention recommended that all women of childbearing age with a potential to become pregnant should use 0.4 mg folic acid per day, following the assertion of the fact that periconceptional folic acid supplement re-duced the occurrence of neural tube defects by half. Additionally, it has been suggest-ed that the supplement should be 4 gr for women who have previously given birth to an infant with a neural tube defect. Further studies are needed to reveal if the pericon-ceptional use of other vitamins is effective in reducing other birth defects. Evidence from observational studies indicates that multivitamin-mineral supplement use before conception and during pregnancy reduces birth defects and poor gestational out-comes. Several observational studies show that vitamin-mineral supplements intro-duced during the first or second trimester significantly reduced the risk for preterm de-livery and possibility of lower birth weight. Although the amount of scientific evidence proving that routine use of vitamin supplements improves gestational outcomes is in-sufficient, multivitamin-mineral supplements have significantly reduced the number of preterm deliveries and lower birth weight infants in adolescent pregnancies with se-vere insufficient nutrition.

The Institute of Medicine and ACOG declared that routine vitamin supplementa-tion during pregnancy is unnecessary. However, both institutions stated that daily die-tary habits of each pregnant woman should be evaluated, and a multivitamin supple-ment should be given at the beginning of the second trimester in case of insufficient food intake and inclusion in the high-risk category. 

In 2002, a study conducted by Siega-Riz on pregnant women in North Carolina, data revealed that through diet only, RDA of iron was consumed by 30% of pregnant women while RDA of folate was consumed by 60%. These results indicate that even high-income American women have difficulty meeting their nutritional requirements only through diet, and a significant portion of pregnant women need to use multivita-min supplements. However, compliance studies showed that approximately 1/3 of pregnant women didn’t take their prescribed multivitamins. Younger women with low education levels seem to use fewer multivitamins.

In conclusion, even when pregnant women are prescribed multivitamin supple-ments, multivitamins meet only a fraction of the required nutrients and not all of them, and they can never replace a healthy diet. Pregnant women should be educated on balanced eating and diverse nutrition and their eating habits should be reviewed. All pregnant women should be prescribed folate supplements in the periconception-al/early pregnancy period. Apart from iron and folate, nutrients that are needed more during pregnancy can be consumed through diet (unless the patient has a nutritional risk factor) with awareness about balanced nutrition.

 

Instructor

Burcu Kutluk

Instructor

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.