Chapter 1 Attitudes and conduct
Childbirth is a physiological function. It is natural that women should want to perform this function in the way that they consider most appropriate. Individual preconceived ideas, the media, and social and cultural background all contribute in varying degrees to the expectations of the woman in labour. Safety of the woman and fetus or newborn must be the prime objective. However, the birth of a baby should also be remembered as a happy and enriching experience. Labour can only be deemed to have been successfully conducted when these ideals are satisfied.
• A congenial atmosphere should be maintained to emphasise the concept that labour and delivery are not illnesses. This should not lead us to believe that a degree of professionalism is not respected by women or their attendant partners. Anxiety is associated with childbirth. Modesty is not automatically relinquished merely because a woman is in labour. Decorum and suitable attire enhance this rapport.
• The shift system for staffing means it is seldom possible for the same medical team to attend for the whole course of labour, although supervision remains the prerogative of the obstetrician in charge. All attendants should have a thorough knowledge of the woman’s history and preferences. This will avoid inadvertent comments which prejudice rapport and undermine confidence.
• Modern technology is used in the labour ward to enhance the safety of the woman and fetus. When the reasons for its use and the value of its application are explained, these instruments and special equipment will be viewed by parents as ancillary aids rather than an intrusion. For example, showing the woman and her partner the pattern of some basic fetal heart rate recordings can invite a sense of additional involvement and commitment.
• For women with their own preferences for the conduct of labour, ascertain the type of antenatal preparation she has had. Within reason, support the concepts and practices she expects. Introduction of alternative practices or procedures at this late stage can confuse, with the resultant loss of confidence. Special preferences which may endanger the woman and fetus should be fully discussed, preferably during the antenatal period, so that risk can be explained and minimised. Flexibility in the attitude of the attendant staff is all important, but it is an indictment against our training and values if we jeopardise the welfare of our charges by subscribing without comment to fashionable idiosyncrasies that we believe may put them at risk of possible medical hazards.
• Husbands or partners are encouraged to stay with the women throughout labour. Demanding or aggressive behaviour on their part may reflect feelings of helplessness in the perceived situation or guilt because they have subjected their partner to the traumas of childbirth. Ensure a woman is comfortable, and if needed there is ready access to analgesia. Ask after the woman’s comfort when her partner is present so that he can be verbally reassured by her. If a woman is obviously overreacting, explain in the presence of the partner that such behaviour is not conducive to an atmosphere of calm for the birth of their baby. This direct approach reinforces communication between the partners to benefit all concerned.
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