20 Review Questions and Answers
(all citations are from: Natural Childbirth: The Bradley Way by Susan McCutcheon)
1. What are some of the long-lasting effects of your choice of a birth attendant? (23, 200)
Choosing a physician who does not interfere with normal labor and birth reduces the baby’s risk of minimal brain damage. Choosing a physician who shies away from routine use of anesthetics and analgesics reduces the risk of a depressed infant. Choosing a physician who is up to date on maternal health and weight gain during pregnancy reduces the risk of toxemia. Choosing a physician whose rate of caesarian sections is between three to five percent will decrease the risk of having an unnecessary C-section.
2. How much protein should a pregnant woman consume, and why is protein important? (30)
A pregnant woman should consume eighty to one hundred grams of protein daily. Protein is important because a diet deficient in protein and other nutrients can be a primary cause of toxemia.
3. Is it “safe” for a pregnant woman to take drugs that are prescribed by her doctor or are obtained over the counter? (36)
No! The Committee on Drugs of the American Academy of Pediatrics states, “There is no drug, whether over-the-counter or prescription, which when taken by the child-bearing woman has been proven safe for the unborn child.”
4. What is the purpose of contractions, and what do they feel like? (50-51, 77)
Contractions are the flexing or shortening of the uterine muscles that help pull the cervix open and back over the baby‘s head. The contraction of the uterine muscles is a powerful sensation because it is the largest group of muscles in the body. A contraction starts at the top of the uterus (the fundus) as the uterine muscles begin to flex. They contract and shorten and continue to contract, gathering strength, and keep on flexing until the mother gets a good stretching and pulling sensation at the cervix. The muscles retract, or stay somewhat shortened, after each flex. Then they relax; after a rest, they will start again at the top to build up to their work, sweeping the mother along to the peak of their strength as they contract all the way down toward the cervix, creating a strong stretching and pulling sensation. Then the sensation gradually diminishes.
5. What specific exercises should a mother do to prepare for birth, and why are they beneficial? (62-69)
A mother should practice tailor-sitting with her knees as close to the floor as she can; frequent tailor-sitting lengthens and stretches the inner thigh muscles to prevent sore legs or leg cramps during pushing. A mother should practice squatting with her heels on the floor and her knees wide apart; frequent squatting prepares the leg muscles for the pushing stage and helps stretch the perineum. A mother should also practice pelvic rocking on her hands and knees; pelvic rocking eases backache, prevents varicose veins, and restore and improve circulation to the legs. A mother and her coach should also practice the legs-apart exercise to strengthen the outer thigh muscles. It is very important for the mother to also practice the Kegel exercises and variations; the Kegel exercises are important for having a strong pubococcygeal muscle to align the baby’s head properly during birth, to support the birth canal’s tissues during the pushing stage, to prevent bladder incontinence, to prevent uterine prolapse, and to increase pleasure during intercourse.
6. What anesthetic does nature provide to numb the perineum during crowning? (55)
The pressure from the baby’s head cuts off the circulation to her perineum and makes it numb.
7. How does nursing immediately benefit the mother? (56)
Nursing stimulates the production of oxytocin, making the uterus contract strongly to shrink the placental site and to prevent maternal hemorrhage.
8. What is the worst position during labor, and how should the mother lie instead? (78-80)
Lying flat on your back is the worst position in labor because it compresses the large blood vessel that takes oxygen and nutrients to the baby and to the mother‘s uterine muscles. It is best for the mother to lie on her side with each part of the body equally supported and no part resting on any other part. She should have pillows under her top leg to make her knee level with her hip and her foot level with her knee. Elbows and knees should be bent slightly, and a pillow should support the mother’s head and arm, with her bottom arm lying behind her shoulder.
9. What is the purpose of relaxation during labor? (77-78)
The purpose of extreme relaxation is just to stay out of the way with a limp body and allow the uterus to do its work unimpeded by other bodily tensions. It takes all of your concentration to keep your whole body really limp and sagging, letting go everywhere as the uterine contraction builds and builds to a peak of strength. When you are tensed or fighting labor, the uterus has to work harder to get the same amount done with each contraction. It is not accomplishing twice as much, just working twice as hard.
10. Why is it important not to coach in a monotone voice? (84-85)
A coach should not use a monotone or a dull, droning voice. The coach is not trying to hypnotize her or put her to sleep. The pregnant woman in labor must think her way through a contraction. She must use her brain, actively observing her body and concentrating on deliberately releasing tension in her muscles no matter how slight the tension seems, so the coach should help keep her mentally alert and thinking. The coach needs to talk with inflection, thinking to himself about what he is saying, helping her continue with her contraction. Just saying “Relax your arms, relax your legs, relax your thighs,” won’t do it. The coach should use different words with an earnest, urgent, actively inflected voice—much like that of a swimming coach! The labor coach can help the woman put it all together, and he is an objective observer able to give direction or encouragement as needed.
11. How should a laboring woman breathe in labor? (91)
A laboring woman should not pant, gasp, or hold her breath. She needs to keep her breathing simple and normal since her primary aim is complete, skillful relaxation. She should use abdominal breathing, which simply means putting calm, stead breaths deep and low into the abdomen. If she is listening within her body to the calm, quiet, steady rhythm of her breathing, then it is impossible to breathe too quickly.
12. What are the six needs of a laboring woman? (104-106)
1: A laboring woman needs darkness and solitude so that she can concentrate completely on her work. 2: A laboring woman needs quiet so that she can limit distractions. 3: A laboring woman needs physical comfort (including pillows to support her, sips of water or ice chips, proper temperature control, reminders to turn over every hour or hour and a half, and reminders to go to the bathroom). 4: A laboring woman needs physical relaxation and help to avoid just holding herself still instead of releasing all those slightly flexed muscles everywhere. 5: A laboring woman needs controlled breathing and reminders to listen to her breathing to assure the continuation of quiet, rhythmic, abdominal breathing. 6: A laboring woman needs the appearance of sleep and closed eyes to guarantee there will be no visual distractions.
13. What are the emotional signposts of labor? (110-115)
The first is excitement; the mother feels elated, excited, and nervous. The second is seriousness; the mother is concentrating and needs to get comfortable, concentrate on relaxing, and listen to her breathing during a contraction. The third is self-doubt; the mother wonders why labor isn’t over yet and if she can make it to the ending, and she also becomes uncertain and indecisive about what she wants or if she can do this. Then, her body is near full dilation and pushing is right around the corner!
14. What is important for the mother and the coach to remember about the first emotional signpost? (110-112)
The mother needs to keep a relaxed tummy throughout each contraction and keep her abdomen hanging loose at all times. During a contraction, she needs to stop what she’s doing, sag her tummy, and breathe with a rhythm way down low in her abdomen. She shouldn’t lie down yet unless she feels that she needs to. The coach should remember that if he sees a smile, then he can know there is a long way to go. The coach should encourage her to relax and enjoy this part of labor, eat or drink if it is mealtime, try to sleep if it is nighttime, and take a couple of pictures of each other.
15. What is important for the mother and the coach to remember about the second emotional signpost? (112-115)
The mother needs to totally concentrate on a limp, sagging, let-go body. The coach needs to help block all distractions. She will be focusing inward and preparing to greet the next contraction with a totally yielding body. She no longer jokes or laughs because she is busy. Be sure to get a good number of these hours of work behind you at home before going to the hospital. The coach and the mother should not make the mistake of dashing off to the hospital the minute they see the serious signpost. The coach should remember to take his cue from the mother and work as earnestly as she does, and the coach should not wait for her to be desperate to start working with her. The primary goal at all times is total relaxation.
16. What is important for the mother and coach to remember about the third emotional signpost? (115-118)
This signpost means that you are almost done, even if you are becoming uncertain and indecisive. Contractions will last seventy, eighty or even ninety seconds, but nature always gives you a rest in between. The mother should listen attentively to her breathing and aim for a quiet and steady rhythm. She should concentrate on a super-limp, relaxed body. The coach should provide plenty of support, confidence, and reassurance. The coach should provide Praise for her efforts, Encouragement to redouble her efforts, and reassurance of Progress that she is almost at the end. She needs emotional support and reassurance, so it is important that the coach not experience self-doubt as well. She needs to be reminded that she has been doing this all along and this is just more of the same thing but closer and longer.
17. How can a mother be positioned and breathe during the pushing stage? (137-143)
The ideal pushing position is a full squat (knees flexed against chest), because that increases the diameter of the pelvic outlet by as much as one and a half centimeters. The mother can be tipped back o her bottom to make it a sitting squat. Her back should be firmly supported upright at a 45 degree angle. Her elbows should be outside of her legs and up at the sides. This keeps her from over extending her perineum. She should be pulling her legs back, not out. She should put her chin to her chest to avoid arching her back. She can push her legs gently back towards herself, not push her torso down to meet her legs. The mother can inhale and exhale completely for two breaths before inhaling and holding her third breath as she pulls her legs back towards her torso. The mother should breathe when she needs to breathe by putting her head back to open her throat and exhaling completely before taking a deep full breath. The coach should remember not to tell her to inhale and exhale since the coach cannot know when one breath is done and another is needed; instead, the coach should encourage her to take the next breath when she is ready. The mothers legs need to be relaxed and apart.
18. What are the risks of electronic fetal monitoring? (201-203, 209)
Electronic monitoring instead of stethoscope monitoring does not improve the outcome for the babies’ health or survival rate; but using EFM does triple the caesarian rate and triple the rate of cerebral palsy in infants.
19. What are the risks of an induction? (215-16)
An induction can make the contractions feel stronger, can cut the uterus off from circulation longer than nature intended, and can cause the mother to feel overwhelmed and full of self-doubt. Having an induction puts the mother and baby at risk of a premature labor and birth, a prolonged latent period, increased possibility of infection, uterine spasms, premature separation of the placenta, tumultuous labor, decreased oxygen supply to the baby, amniotic fluid embolus, lacerations of the cervix and birth canal, postpartum hemorrhage, uterine rupture, fetal distress due to anoxia and intracranial hemorrhage, and failure of induction to work resulting in a caesarean section.
20. What is Baby’s job during nursing? (228-29)
Baby gums up and down on the nipple, which sends a message to Mama’s pituitary gland to send oxytocin into the bloodstream. This oxytocin ejects Mama’s milk from the breast in a spray or squirt, and Baby then gulps and swallows the spray of milk that streams from the breast. Baby’s mouth does make an airtight seal on Mama’s nipple, and there is some suction used to keep the nipple positioned in Baby’s mouth; however, Baby does not receive milk by sucking the breast, and breastfeeding (if done properly) is not supposed to be regularly painful. Some discomfort or soreness in the first few weeks is normal; sharp pain or pinching pain is not normal.