Anesthesiology related topics. About pain management during labor. The pharmaological and non pharmacological strategies to reduce pain during childbirth.
Pharmacological includes anesthesia and analgesia. Non pharmacological includes support therapy, alternative medicine like acupuncture..
2. Objectives
At the end of this presentation student will be able
to :
Identify the etiology of pain during labor and birth
Identify types of labor support and advanced
nursing roles in normal labor and delivery care
Define Of Second Stage Of Labor.
Discuss The Mechanism Of Labor
Discuss Cultural and social aspects of labor and
delivery.
Analyze labor and delivery care in Jordan.
3. Etiology of pain during
labor
Basic factors for pain in childbirth: physical and
emotiona
l
.
1. physical pain in labor is caused by:
Muscle cramps/ uterine contraction.
Stretching of cervix and perineum .
Medical tests and procedures (pelvic exams,IVs, catheterization,
and so forth)
Position of the baby and pressure of presenting part on tissue like
bladder,urethra,back,lower colon
4. Etiology of pain during labor
2. Emotional Factors
Many negative emotions can actually increase your perception of
pain
:
Fear of pain
Fear of the unknown
Anxiety
Self-
doubt
Lack of
education
Exhaustio
n
Dehydration
Hunger
6. Endorphin
Natural pain killer produced from pituitary gland released
during stressful events or in moment of grate pain it is
responsible for euphoric feelings known as “runner’s high” and
“adrenaline rush “ .
It secretion triggered by consumption of certain food
“chochlate,chili peppers” also triggered by massage therapy or
acupuncture .
7. 1. Nonpharmacologic strategies
1. Support from a Doula or coach
Is a women who experienced in childbirth but without
professional credentials , who guides and assist women in labor .
Having a doula can increase women self-esteem as well as
decrease rate of oxytocin augmentation ,epidural anesthesia and
cesarean birth .
Doula can be women husband,mother,father..etc
8. 2. Water therapy(hydrotherapy )
Standing under warm shower or soaking in tube of warm water ,
the temperature of water used should be between 35-37c .
Several study have investigated the risk of using hydrotherapy with
rupture membrane findings have shown no increase in
chorioamnionitis , post partum indometraitis,neonatal infection or
antibiotic
use ( tournaire & theau-yonneau,2007,zwelling et al ,2006)
No limit to the time women can stay in bath and often they are
encouraged to stay in it as long as desired
1. Nonpharmacologic strategies
10. In randomized controlled trial (RCT) to determine the efficacy of warm
showers on parturition pain and the birth experiences of women during the
first stage of labor
participants in the experimental group received warm shower bath
interventions full body or lower back shower, participants could spend 5
minute complete bath 15 minutes directing shower water toward any body
region that felt most comfortable. Facilities allowed participants to stand and
sit as desired. Water was constantly monitored and maintained at a
temperature of 37◦C. Participants in the control group received standard
care.
women who participated in warm showers reported significantly lower VAS
pain scores at 4-cm and 7-cm cervical dilations, and higher birth experiences
than the control group.
warm showers are a cost-effective, convenient, easy to perform ,non-
pharmacological approach to pain reduction. This intervention helps women
in labor to participate fully in the birthing process, earn continuous caregiver
support, feel cared for and comforted, and have a more positive overall
experience.
(Lee, Liu, Lu, & Gau, 2013)
11. 3. Transcutaneous electrical
nerve
(TENS)
stimulation
Two paired of electrodes attached to
women back T10-L1 .
Low- intensity electrical stimulation
is given continuously or applied by
women herself as a contraction
begin .
Block afferent fibers and preventing
pain to travel from uterus to spinal
cord synapses , and facilitate release
of
endorphin
1. Nonpharmacologic strategies
12. Can be effective as epidural
anesthesia
Not available in our hospital.
Carries no risk to the mother and
fetus
Women can refuse to being “tied
down “ to equipment
1. Nonpharmacologic strategies
13. 4.Acupunctur
e
Based on concept that illness result from an imbalance of
energy , to correct the imbalance needles are inserted into
the skin at specific body points , activation of these point lead
to release of endorphins .
Helpful in first stage of labor
1. Nonpharmacologic strategies
14. A randomized controlled trial was conducted with 607 healthy
women in labor at term who received acupuncture, TENS, or
traditional analgesics
To compare the effect of acupuncture with transcutaneous electric
nerve stimulation (TENS) and traditional analgesics for pain relief
and relaxation during delivery.
Primary outcomes: were the need for pharmacological and
invasive methods, birth experience and satisfaction with delivery.
Secondary outcomes : were duration of labor, use of
oxytocin, mode of delivery, postpartum hemorrhage, Apgar
score, and umbilical cord pH value.
(Borup, Wurlitzer, Hedegaard, Kesmodel, & Hvidman, 2009)
15. Result
Use of pharmacological and invasive methods was significantly
lower in the acupuncture group (acupuncture vs traditional, p <
0.001; acupuncture vs TENS, p = 0.031).
Acupuncture did not influence the duration of labor or the use of
oxytocin.
Mean Apgar score at 5 minutes and umbilical cord pH value were
significantly higher among infants in the acupuncture group
compared with infants in the other groups.
CONCLUSIONS
Acupuncture reduced the need for pharmacological and invasive
methods during delivery. Acupuncture is a good supplement to
existing pain relief methods.
(Borup, Wurlitzer, Hedegaard, Kesmodel, & Hvidman, 2009)
18. 1. Nonpharmacologic strategies
6. Therapeutic touch and massage
Based on concept that body contains energy field when
increased lead to health and when decreased lead to illness
touch and massage work to relive pain by increase level of
endorphins
Effleurage is a form of therapeutic touch of gentle abdominal
massage
19. 7.Application of Heat and
Cold
Heat Application :
• Effective in relief back pain and raises the pain threshold.
• To increase blood flow and relieves muscle ischemia.
• increases relaxation
Cold application:
• Applied to the back, chest,
and face to increase comfort
• slowing transmission of pain.
1. Nonpharmacologic strategies
20. 1. Nonpharmacologic strategies
9.Aromatherapy
Their used based on the principle that the sense of smell
plays a significant role in over all health , when essential oil
inhaled it’s molecule transported via olfactory system to
the brain and the brain respond to particular aroma with
emotional responses , when applied externally they
absorbed to the skin and then carried throughout
circulation .
The oils may be massaged into the skin, in a bath or inhaled
using a steam infusion or
burner
22. A randomized controlled trial was conducted to determine
the effect of lavender
aromatherapy on pain intensity perception and
intrapartum outcome in primiparous women
The aroma group received 0.1 ml
of lavender essential oil mixed with 1 ml of distilled water via
tissues attached to their gowns close to their nostrils.
Meanwhile, the control group received 2 ml of distilled
water in a similar way.
Pain intensity perception was measured by Visual Analogue
Scale (VAS) before the intervention and at 30 and 60 minutes
afterwards
(Kaviani, Azima, Alavi, & Tabaei, 2014)
23. Result
The mean of pain intensity perception in the aroma group was
lower than that of the control group at 30 and 60 minutes after
the intervention (p←0.001).
Conclusio
n
This study revealed that aromatherapy decreased the labour pain,
but did not affect the duration of labour phases
Kaviani, Azima, Alavi, & Tabaei, 2014
24. 9.
Hypnosis
Hypnosis is an altered state of conscious and awareness
focus of attention to reduce awareness of the external
environment.
For childbirth, hypnosis is often used to focus attention on
feelings of comfort or numbness as well as to enhance women's
feelings of relaxation and sense of safety.
1. Nonpharmacologic strategies
25. 1. Nonpharmacologic strategies
10. Sterile water injections (SWI)
Sterile water injections (SWI) are an effective method for the relief
of back pain in labour. The procedure involves a small amount of
sterile water (0.1 ml to 0.2 ml) injected under the skin at four
locations on the lower back (sacrum).
27. 1. Nonpharmacologic strategies
The injections cause a brief but intense stinging sensation, lasts
for about 30 seconds and then wears off completely.
To distract from the stinging sensation the injections are done
during a contraction by two midwives.
SWI provides effective pain relief for up to two hours.
http://www.matermothers.org.au/hospitals/mater-
mothers-private-brisbane/labour-and-
birth/switch/about-sterile-water-injections
28. 1. Nonpharmacologic strategies
Benefits of SWI
often immediate effect
no effect on mother’s state of consciousness
no effect on baby
does not limit
mobility
does not adversely affect labour progress
is a simple procedure that can administered by midwife
can be repeated as needed
29. case report
• The woman was given sterile water injections and required no
additional pain relief to cope with labor. The pain relief
effect, measured by the VAS, was very powerful and she
described her experience in highly positive terms.
• The method is a good alternative for women who do not want
pharmacological pain relief during childbirth
(Ma°rtensson,2010
)
Evidence :Intradermal Water Block
30. The evidence
concluded that it was effective but it was based only on 4
studies they found suitable for analysis:
Ader et al compared sterile water to saline. Sterile water worked better
but there was no difference in the requirement for pethedin (Demerol)
Trolle et al compared sterile water to saline and found it twice as effective
(89% vs. 45%).
Martensson et al compared 0.1cc of intradermal water, 0.5 cc of
subcutaneous water, and 0.1 cc of subcutaneous saline. The two water
groups were equally effective and superior to the saline.
Labreque et al. compared sterile water injections to TENS and to standard
care (massage, etc.) Water worked better than the other two, but there
was no difference in epidural requests, and fewer women said they
would choose it again.
31. 11.Biofeedback
use thinking and mental process (focus)to control body
response, to change the response of the stress and pain
Women who are interesting in using this method must attend
several sessions during pregnancy to condition themselves to
regulate their pain response
If women response to pain during contraction with frowning
and breath holding her partner use verbal feedback to help her
to relax
1. Nonpharmacologic strategies
32. 12. Double Hip
Squeeze
The double hip squeeze changes the shape of the pelvis and
releases tension on the sacroiliac joints.
Place hands on each side below iliac crest and over gluteal
muscle with fingers pointing toward midline.
1. Nonpharmacologic strategies
34. Definition:
The ability of subject participate and share in the laboring client’s
feelings (Sauls, 2004).
Emotional LSB assist to occupy the client’s mind with positive
thoughts and diminish or block feelings of fear, and anxiety
2. Emotional
LSB
35. 1. Nursing Presence
Nursing presence is defined as being with the client rather than
performing tasks on the client and as complete
physical, emotional, psychological, and spiritual engagement
between nurse and client.
Nursing presence includes:
high level of nursing skill.
being open
honest.
nonjudgmental with the client.
listening carefully to her needs and concerns.
2. Emotional
LSB
36. 2.partner care
Practice in
Jordan
Companionship or social support during labour has been shown to be
one of the most beneficial practices in maternity care( Hodnett E,2007)
None of the public hospitals in Jordan allowed the presence of a birth
companion including the husband during labour and birth.
Evidence show that :
mothers who had received support during labour were significantly
less likely to have pharmacological pain relief.
and significantly more likely report a good birth experience
Shaban et al., 2011
37. Instruction and information on all aspects of labor and birth
provide clients with an opportunity to be a part of the decision-
making process, which fosters a positive birth experience.
Verbal communication must be culturally sensitive
3. Instructional/Informational
LSB
39. Advocacy includes protecting the client, attending to needs,
and assisting in making choices related to health care; this
requires the establishment of a therapeutic relationship.
Being an advocate for the client, the nurse empowers the
client to give birth with dignity.
4. Advocacy LSB
41. 1. Narcotic analgesic (opioid analgesic)
Act by decrease sensation of pain .
Used for their analgesic effect , all drugs in this category cause
CNS depression , respiratory depression .
Narcotic analgesic includes: pethidine (meperidin) , fentanyl
remifentanil, morphine, tramadol
pethedin is the most commonly used analgesic in labor
because it has additional sedative and antispasmodic actions
, these make it effective not only for reliving pain but also for
relaxing cervix and providing feeling of euphoria and well-being
Narcotic antagonist : naloxon (Narcan)
Pharmacological strategies
42. Advantages and disadvantages of narcotic (opioid )
administration
Advantages
an increased ability for a woman to cope with labor
The medications may be nurse-administered
It has no amnesic effect but create a felling of well-being or
euphoria
Disadvantages
Frequent occurrence of uncomfortable side effects, such as
nausea and vomiting, pruritus, drowsiness, and neonatal
depression
Pain is not eliminated completely
pharmacological strategies
43. Intrathecally (spinal) narcotic
Refer to injection into spinal cord
Opioid used alone:
Ex: fentanyle 1.30-3hr with Multipara
morphine 4-7 hr with Nullipara or women with history of long labor
Excellent pain relief for labor pain they take effect 15-30min and
last 4-7hr
Don’t cause maternal hypotension or affect VS
Women can fell contraction but no pain , her ability to bear down
during second stage of labor is preserved because the bushing
reflex is not lost and her motor power remain intact
pharmacological strategies
45. 2. Anesthesia
The use of medication to partially or totally block all sensation to
an area of the body
• Local anesthesia
Reduce ability of local nerve fiber to conduct pain
Used to numb the perineum just before birth to allow for
episiotomy and repair
• Regional anesthesia
injection of local anesthetic agent such as tetracaine or bupivacine
to block specific nerve pathways that supply a particular organ
or area of the body
spinal analgesia
epidural analgesia
combined spinal epidural
• General anesthesia
Intra Venous Analgesia
Inhalational Analgesia
pharmacological strategies
46. 1.Spinal (subarachnoid)anesthesia
local anesthetic agent such as (bupivacine or ropivacaine) injected
In subarachnoid space through 3dr ,4th
or 5th
lumber interspaces by
using lumber puncture technique .
Anesthesia mixed with CSF, used on elective and emergent CS birth
not suitable of vaginal birth because it useful for shorter and
simpler procedures.
Anesthesia normally raise to level of T10 , up to umbilicus and
including both legs.
pharmacological strategies
48. pharmacological strategies
Complication
hypotension from sympathetic blockage lead to impaired
placental perfusion and ineffective breathing pattern may
occur during spinal anesthesia
Turn the women to her left side
I.V fluid administration to increase blood volume
Vasopressin to increase BP
O2 may be used
Check V/S every 5-10min
49. pharmacological strategies
Complication
spinal
headache
Occur because continuous leakage of CSF from the needle insertion
site or by instillation of air into CSF , shift in pressure of CSF cause
strain in vertebral meanings.
Incidence reduced by using of :
small-gauge needle
Increase fluid intake to replace spinal fluid
50. pharmacological strategies
If headache occurred
:
Ask women to lie flat
Administer analgesic
Blood patch technique : withdraw 10ml of venous blood and
then immediately injected into the epidural space over spinal
injection site , injected blood clot and seals of any further
leakage of CSF .
51. 2.Epidural anesthesia
Anesthetic agent placed inside
epidural space at :
L4-
5
L3-
4
L2-
3
Block not only nerve roots in
the space but also sympathetic
nerve fibers that travel with
them
pharmacological strategies
53. Patient control epidural analgesia
The newest method is the using PCA that will be programmed specially for the
patient by anesthesiologist indwelling catheter and programmed pump that
allow women to control the dose of analgesic , this method provide optimal
analgesia with higher maternal satisfaction and enhance sense of control during
labor. (saito et al,2005)
pharmacological strategies
54. IT is more difficult to insert epidural catheter when the women is
obese , morbidly obese patients are more likely to have failed
epidural placement and accidental Dural puncture.
(valleyo,2007)
pharmacological strategies
55. Advantages of Epidural anesthesia
Women remain alert and more comfortable
Able to participate and achieve good relaxation
Airway reflex remain intact
Gastric empty not delay
Blood loss not excessive
The most effective pain relief.
Fetal complication are rare but may occur
pharmacological strategies
56. Disadvantages of Epidural anesthesia
• Hypotension
• Urinary retention
• Backache
• soreness where the needle is inserted
• nausea and vomiting
• epidural may prolong second stage of labor ,pushing more difficult and
additional interventions such as Pitocin, forceps, vacuum extraction or
cesarean might become necessary
• baby might experience respiratory depression, fetal malpositioning, and an
increase in fetal heart rate variability
pharmacological strategies
57. epidural analgesia appears to be effective in reducing pain during
labour.
women who use this form of pain relief are at increased risk of
having an instrumental delivery
having an epidural was also associated with a longer second stage
of labour, more use of augmentation of labour, more frequent very
low blood pressure readings, problems passing urine, fever, and
being unable to move for a period of time after the birth
What evidence say about epidural analgesia
Cochrane Database of Systematic Reviews
58. The use of epidural anesthesia is associated with a significant
increase in maternal temperature and in the incidence of
intrapartum maternal fever.
(Passini, Amorim, Almeida, & Barros, 2011)
Sever hypotension (systolic BP 100mmHg or less or more than
20% decrease from base line blood pressure ) as a result of
sympathetic block can be an outcome of epidural block .
(anim-somuah,smyth,&howell,2008)
What evidence say about epidural analgesia
Cochrane Database of Systematic Reviews
59. delay the administration of epidural analgesia in nulliparous
women until cervical dilatation reaches 4 cm to 5 cm and that
other forms of analgesia be used until that time to avoid
suppressing the progress of labor
2002, the American College of Obstetricians and Gynecologists
It is recommended that the administration of systematic opioid
analgesia be delayed until labor is well established.
(creehan,2008)
Women in labor most no longer reach a certain level of cervical
dilatation or fetal station before receiving epidural analgesia.
(aab&acog,2007,cunningham et al ,2010)
Time of adminestration of epidural analgesia
60. 3. Combined spinal-epidural analgesia
CSE
• Combination of opioid and local anesthesia injected inside spinal cord and in
subarachnoid space , used to block pain transmission without compromising
motor ability
• It is associated with greater incident with FHR abnormalities than epidural
analgesia alone
pharmacological strategies
61. Inhalational analgesia
during labour involves the self-administered inhalation of
sub-anaesthetic concentrations of agents while the
mother remains awake and her protective laryngeal
reflexes remain intact
pharmacological strategies
62. inhalational analgesia
• N2O does not interfere with
uterine contractions.
• No effect on fetus too.
• Premixed nitrous oxide
&oxygen.
• N2O 50% and
O
2 50%
• ENTONOX-cylinders with a
capacity of 500 L are available.
• Inhalation should begin 45
seconds before the onset of
pain.
pharmacological strategies
63. inhaled analgesia appears to be effective in reducing pain
intensity and in giving pain relief in labour
nitrous oxide appears to result in more side effects compared
with flurane derivatives.
Flurane derivatives result in more drowsiness when
compared with nitrous oxide.
nitrous oxide appears to result in even more side effects such
as nausea, vomiting, dizziness and drowsiness
(Trudy Klomp, Leanne Jones, Di Nisio.2012)
Cochrane Database
What evidence say about inhaled anelgesia
64. Begins with fully cervical dilation (10 cm) and complete effacement
(100%) and ends with the baby’s birth.
Duration of second stage
Multiparous women 1-2hr
Nulliparous women 2-3hr
Second stage of labor
65. Second stage consist of 2phases:
1. latent phase: baby begins its journey through the birth canal, or
vagina, to the outside.
The power for this movement is provided by the contracting
uterus, the diaphragm, and the abdominal and respiratory muscles
of the mother.
With each contraction the baby's head moves down until part of
the baby's head is visible at the entrance of the birth canal .
Second stage of labor
66. 2. Active phase(delivary
mother's pushing produces crowning , fetal station +1
The mother continues to push until the entire head is delivered
The shoulders emerge next, first one and then the other
Finally, the medical attendant slowly eases the rest of the body out
of the birth canal and the baby is born.
Second stage of labor
67. The mechanisms of labor, also known as the cardinal movements
refer to the changes in position of fetal head during its passage
through the birth canal.
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
Cardinal Movements in
Labor
70. Nursing care during second stage
Sign that suggest onset of second stage
• 1. felling of urge to bush or need for bowel
movement
• 2. sudden appearance of sweat on upper lip
• Episodes of vomiting
• Increase bloody show
• Checking of extremities
• Increase restlessness
• Involuntary bearing down
71. Perform every 5-30 min v/s
Assess every 5-15min
FHR
Assess every 10-15min vaginal show and signs of
fetal descent and maternal appearance
Assess every contraction and bearing down effort
Nursing care during second stage
72. Fundal pressure
Use of fundal pressure is not advised because there is no standard
techniques available for this maneuver also no current legal or
regulatory standard exist for it’s use and no evidence related to it
effectives in facilitating a safe vaginal birth is
available.(simbson,2008)
Nursing care during second stage
73. When the fetal head reaches the pelvic floor most women
experience the urge to bear down or push.
Monitor women’s breathing.
Should not hold breath more than 5 to 7 sec.
Remained her to take deep breathing
Bearing Down (pushing)
74. THE “OLD WAY”
pushing immediately at 10 cm regardless of whether the
woman has an urge to push.
closed-glottis pushing (Valsalva's Maneuver).
woman lies in the supine Lithotomy position.
These techniques have the potential to cause harm to the
mother and baby.
(AWHONN,2010)
When and how to push
75. This is when a woman, who in the second stage of labor or the
"pushing stage" has coached to push.
Instructs woman to hold her breath and push for 10
counts/seconds.
Bu
tholding breath for 10 seconds not good during pushing.
Because of:
increase intrathoracic and cardiovascular pressure.
reducing cardiac output.
inhibiting perfusion of the uterus and the placenta.
resulting in fetal hypoxia.
Closed Glottis
pushing/Valsalva's
Maneuver
76. The Best Way
A better approach based on current evidence is to delay pushing
until the woman feels the urge to push.
The latent phase is an ideal time to allow the woman to rest in
preparation for pushing efforts at the appropriate time.
When the time is right for pushing?
the best approach based on current evidence is to encourage the
woman to do whatever comes naturally.
(AWHONN,2010)
When and how to push
78. • The benefits of delayed pushing include less fetal
heart deceleration , fewer forceps and vacuum
assisted birth , less perenial damage
• The longer length of second stage doesn’t associated
with poor neonatal outcomes , as long as fetal status
during this time is normal.
(berghella et al ,2008 ,brancato,church,&ston,2008)
Reaserch evidence
79. Reaserch evidence
• More effective bearing down effort conserve maternal energy
and reduce the risk of operational vaginal birth.
(robert,2002,simbson&james,2005)
Based on this evidence it is essential that prenatal nurse
advocate for the practice of delayed and spontaneous
bearing down
effort.
80. Positioning is an important component of safe and effective pushing.
upright position or lateral position works better than supine
positioning.
Forcing women's legs back against their abdomen during pushing
should be avoided because this results in stretching the perineum
and increases the risk of perineal lacerations.
International Journal of Gynecology and Obstetrics
(2012
)
Position & Pushing
81. small cut in the vaginal opening to prevent tearing
during delivery.
This is often a routine procedure in primigravidas.
episiotomy is a painless procedure done just before the
baby's head is
born.
Episiotomy
83. Episiotomy is routinely practiced in 67% of the
hospitals in Jordan .
Sweidan et al., (2008)
Perineal (episiotomy) Classified as one of the practices that is
frequently used and should be avoided as a routine.
Khresheh et al., (2009)
Practice in Jordan for
Episiotomy
84. There should be a policy of restricted episiotomy (episiotomy only
when necessary).
There is no evidence that a policy of routine
episiotomy resulted in significant:
Reductions in laceration severity.
pain.
pelvic organ prolapse.
better maternal outcomes.
International Journal of Gynecology and Obstetrics (2012)
Episiotomy
85. Episiotomy at first vaginal delivery significantly and independently
increased the risk of repeated episiotomy and spontaneous
perennial tears in subsequent delivery. (Lurie,2012)
Avoiding routine episiotomy in unnecessary condition would
increase the rate of intact perineal and minor perineal trauma and
reduce postpartum delivery pain with no adverse affect nether on
maternal nor neonatal morbidities .(shahraki,2011)
Evidence show that
86. Episiotomy and laceration repair should always be
performed under adequate perineal anesthesia.
such as:
epidural.
local infiltration.
International Journal of Gynecology and Obstetrics (2012)
Episiotomy
87. A comparison of labor and birth outcomes in Jordan
with WHO
guidelines
Pain relief (pethedin) 44% one of the practices that is
frequently used inappropriately.
Low Apgar Score
Admission to NICU
Interrupts mother–baby bonding and disrupts breast
feeding initiation.
Respiratory depression for both mother and infant.
Perineal (episiotomy) 53% Classified as one of the practices
that is frequently used and should be avoided as a routine.
Khresheh et al., (2009)
88. Cultural Differences Among Birthing
Women
The Russian
Culture
Russian women prefer to be alone during labor and
birth
.
They view labor and birth as a private experience.
They prefer not to have their partners present because
they were afraid for their husbands!
90. Cultural Differences Among Birthing
Women
The Russian
Culture
Using female relatives at the birth instead of the
husband is a common practice.
This is popular among many women in Arabic cultures
as well as traditions of Pacific
Islanders, Cambodians, Chinese, Filipinos,
Indonesians,
and Koreans
91. Cultural Differences Among Birthing
Women
The Chinese culture
Chinese women are encouraged to avoid heavy manual
,encourage rest.
Infant boys are considered more valuable than infant girls.
The Chinese avoid “cold” foods such as bean sprouts and
bananas because they believe it increases the risk of
miscarriage.
92. Cultural Differences Among Birthing
Women
In the Chinese culture, eating during labor is the norm.
When asking for water, they prefer warm water. If given ice chips
they are not eaten for fear of upsetting the hot-cold balance.
They may not choose to use ice on episiotomies for this reason
Upsetting the hot-cold balance is thought to cause arthritis in old
age. The “Sitting Month” is the month after delivery where
women are encouraged to rest and recover.
93. Cultural Differences Among Birthing Women
African Culture
It is typical for the woman to deliver while squatting on the
ground surrounded by female relatives. Squatting is
representative of the mother’s connection with the earth.
Midwives only get paid if delivery is successful. Some relatives
act as midwives.
In the Yoruba tribe, in Nigeria, the name given to the child must
reflect circumstances around the birth.
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