Supervision Of The Birth Process

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Supervision Of The Birth Process
Supervision Of The Birth Process
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Video: Stages of labor - physiology 2023, February
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Supervision of the birth process

There are different options for care during a natural birth: Either the expectant mother is optimally cared for by a midwife and a doctor or exclusively by a midwife; this depends, among other things, on the place of delivery. In principle, a midwife must always be present at a birth. If complications arise, the midwife is obliged to consult a doctor.

The birth itself takes place in three phases. A distinction is made between the opening, expulsion and postpartum period.

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  • Who will be there for the birth?
  • How is the care provided at the start of the birth?
  • How is support provided during the opening phase?
  • How is support provided during the expulsion phase?
  • ">How is the care provided during the postpartum phase?

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  • Whom can I ask?
  • How are the costs going to be covered?

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Who will be there for the birth?

The Austrian Midwifery Act states that a midwife must be present at every birth. She is a very close reference person to the woman during the delivery, so a trusting relationship is important. Some women want to choose their midwife themselves and get to know her during pregnancy. In some - rather smaller - hospitals it is possible to be accompanied by private midwives (attending midwives, midwives by choice) during the birth. But even without a private midwife, care by a midwife is guaranteed for a hospital birth.

Most of the births also have an accompanying person present. This does not always have to be done by the future father or be the woman's partner. The accompanying person can be chosen freely depending on the woman's circumstances and wishes. So that the delivery can take place as possible according to your own ideas, you should talk to the midwife about it during pregnancy.

The presence of a helper during childbirth is very important for the expectant mother as a whole. Emotional support, advice, encouragement and other help measures have a positive effect on both the course of the birth and the experience of the birth. The accompanying person should be chosen carefully by the woman.

How is the care provided at the start of the birth?

The majority of all births (98 to 99 percent) take place in a hospital in which doctors and midwives work closely together. Other options for deliveries are home births and births in midwifery practices or in birthing centers (1–2 percent).

In most cases, the midwife will perform the initial examination at the start of the birth. This usually includes the following steps:

  • General examination: The general examination of the pregnant woman includes the measurement of body temperature, pulse and blood pressure.
  • Vaginal examination: The gynecological examination is used to identify the start of labor and the progress of labor. The midwife or doctor examines how far the cervix has opened.
  • External examination: The midwife or doctor palpates the pregnant woman's stomach to determine the position of the child.
  • Monitoring the child's heartbeat: When giving birth at home, the midwife uses a small ultrasound device (Dopton) to monitor the child's heartbeat. A CTG (heart rate and contractions recorder) is used for this in the hospital.

During the admission interview, open questions can usually be clarified, uncertainties discussed and wishes for the birth can be expressed (e.g. the wish for aids such as wall bars, bath tub, etc.). More on the topic: Birth: Special Measures

Depending on the wishes of the pregnant woman, the accompanying person can also be present at the initial examination and during the conversation.

How is support provided during the opening phase?

The opening period is the longest phase of childbirth. It takes an average of ten to twelve hours for first-time women to fully open the cervix.

The midwife is present or close to the call during the entire period; she monitors and controls the birth process at regular intervals. If the birth takes place in a hospital, a doctor is always available.

Repeated tests are performed to assess the consistency of the cervix or the opening of the cervix. The position of the child (which part of the body goes first? How has the child's head turned? How far is it in the birth canal?) Is checked regularly. The strength and regularity of labor (labor quality) are monitored using CTG. If the contractions are too weak or too irregular (inefficient labor), labor support may be necessary to ensure a natural birth process. Labor support measures include medication, acupuncture, and massage. Sometimes additional tests, such as blood pressure measurements, are necessary.

In many cases the amniotic sac bursts towards the end of the opening phase, but this does not always have to be the case. Sometimes the amniotic sac can only burst in the expulsion phase. As soon as the amniotic sac becomes an obstacle for the child, it must be opened by a doctor or a midwife. The amniotic fluid is then assessed for color and quantity. If everything is okay, the amniotic fluid is clear.

In addition to the examinations, the midwife is always on hand to provide support. It shows relaxation exercises, massage techniques, breathing exercises and movements that can make childbirth easier. Depending on the progress and course of the birth, the pregnant woman can take short walks if she wants to. Aids may also be made available in this phase of childbirth, as well as medicated pain relievers, if this is desired. More on the subject of labor and delivery

How is support provided during the expulsion phase?

The expulsion phase describes the period from the full opening of the cervix to the birth of the child. Many women are already very exhausted at this point and feel that they have reached their limits. The right support is particularly important in this phase. Due to the strength of the labor, the woman giving birth is particularly dependent on the guidance of the midwife and doctor during this phase of labor.

The following obstetric measures are used in the expulsion phase:

  • Correct positioning of the woman in labor : The position in which the woman giving birth would like to press during labor is decided according to the course of the labor and the woman's personal wishes. More on the topic: Birth methods and birthing positions.
  • Instructions for pressing along: If the child's head is deep in the pelvis, a reflexively triggered urge to press begins. Pressing actively too early can lead to exhaustion of the parturient. The midwife or doctor therefore supports the woman in pressing by checking the breathing technique and specifying the time to press.
  • Perineal protection: When the child's head is born, the midwife helps the woman giving birth by using what is known as perineal protection. The midwife supports the perineum from the outside and tries to regulate the speed at which the head penetrates and to reduce the pressure on the thin tissue of the perineum. In order to give the child enough space at the end of the birth, a perineal incision (episiotomy) can be made by the midwife or a doctor in rare cases.
  • First aid for the child: After the birth, the midwife removes blood and mucus from the child's face so that breathing is not impeded. The child can now be placed on the mother's breast. Then the umbilical cord is tied off and can be cut, for example by the father.

How is the care provided during the postpartum phase?

Postpartum labor begins within an hour of the birth - but usually for a shorter period of time. These lead to the detachment of the placenta. The midwife and doctor also monitor this phase and check that the placenta has been expelled completely. No placenta residues should remain in the uterus, as this can lead to bleeding, growths or infections of the uterus. If the entire placenta or larger parts do not detach, the doctor or midwife will manually loosen the placenta. It may be necessary to have a complete removal procedure under anesthesia, which can only be performed in the hospital.

Note It is recommended that you always administer labor-inducing hormones (oxytocin) during the postpartum period. This can reduce complications and blood loss.

As soon as the placenta is expelled, any birth injuries (e.g. perineal tear, perineal incision) are treated. The newborn is examined, measured and weighed. If everything is in order, it can immediately go back to the mother. It is usually placed on the breast and the first attempts at breastfeeding are made, with the midwife helping.

After the birth, mother and child (or parent and child) usually stay in the delivery room for around two hours and can get to know each other in peace. The midwife checks the bleeding a few more times. If mother and child are doing well, they can switch to the maternity ward.

Note If the placenta does not detach on its own and the mother suffers from weakness in the postpartum phase, hormones that trigger labor (oxytocin) may have to be administered.

Whom can I ask?

For childbirth in a hospital, you can turn to hospitals with maternity wards. Registration for birth in a hospital of your choice should be made early in the pregnancy. You can find hospitals in your area under Services (hospital search).

You can find free practicing midwives in your area on the homepage of the Austrian Midwives Committee. The search can be restricted to the desired criteria (e.g. midwife with a health insurance contract, midwife offers home birth, etc.).

How are the costs going to be covered?

The costs of childbirth in a hospital are covered by the social security agencies. All necessary medical services and obstetric offers can be used. The costs for caring for a home birth or a birth in a midwifery practice are also covered by the health insurance company, provided that it is a midwife with a health insurance contract.

The birth accompaniment by a midwife of choice (midwife without a health insurance contract) is a private service and must therefore be paid for yourself. This applies to birth in a hospital as well as to birth at home or in a midwifery practice. For certain services, part of the costs can be reimbursed by the health insurance company. More on the subject: midwife

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