"Odmori se i budi zahvalna" faza poroda
Iz dnevnika Andree Robertson (http://birthinternational.com.au/dia...s/2005_10.html):
Citiraj:
The "rest and be thankful" stage of labour
There was an interesting discussion today’s workshop about the “rest and be thankful” (as Sheila Kitzinger named it so long ago) stage of labour. This is the lull, the quiet time between the end of the first stage and the beginning of the second stage of labour.
So often this natural phenomenon (more common in first time mothers) is misinterpreted either deliberately, to keep labour moving, or accidentally, because of a lack of understanding of the physiology underlying this condition.
After a turbulent transition, the woman and her unborn baby need time to rest and recuperate. The baby may have been feeling the effects of the long, hard contractions that come very close together in transition. The mother may feel exhausted by the effort of dealing with these fast and furious contractions - there is no doubt this is the most difficult part of the labour for her to handle.
The group today had rarely seen this pause for more than five minutes. They believed that if the contractions stopped it was necessary to put up a drip and use syntocinon to make the uterus continue its work without delay. They were very surprised when I explained that this lull, with no contractions at all, can last on average 20 or so minutes. On some occasions, it may last several hours. When the pause comes, the midwife needs to check that the mother is well, the baby is fine and then be patient.
It also helps if the midwife refrains from doing an internal examination of the cervix during transition. Many practitioners assume that once the cervix is fully dilated, the second stage has begun, and become anxious if there are no pushing contractions to start the baby on its journey into the world. Full dilatation just means that the first part of labour is complete. Second stage cannot be said to be underway until the classic signs of descent are visible and the mother has an urge to push.
Midwives generally know that this is the case, and can buy time for the women if they avoid discovering that the cervix is fully open. The canny midwife waits to observe the woman’s behaviour to tell her that she is ready to give birth, she doesn’t meddle with her fingers to find out what is going on.
All this was news to this group, who were mostly students. Unfortunately they are unlikely to see these normal physiological signs of labour progress because of the prevailing active management strategy and the high rate of induction/epidurals that occur here. I hope they remember some of what we discussed in this workshop, so that when they graduate and can work in less medicalised settings, they’ll have a chance to discover the wonders of women’s bodies and how well they are designed to get babies born safely, without the need for routine interventions.
