Holding the Space for Human Birth
TED Talk by Saraswati Vedam:
Holding the Space for Human Birth
“WHO Safe Childbirth Checklist” has been developed to support the delivery of essential maternal and perinatal care practices. The Checklist addresses the major causes of maternal death (haemorrhage, infection, obstructed labour and hypertensive disorders), intrapartum-related stillbirths (inadequate intrapartum care), and neonatal deaths (birth asphyxia, infection and complications related to prematurity). It was developed following a rigorous methodology and tested for usability in ten countries across Africa and Asia.
An implementation guide for health facilities has been developed to help birth attendants and health-care leaders successfully launch and sustain use of the WHO Safe Childbirth Checklist. The simple document lists basic interventions. Amongst the six instructions: “Encourage birth companion to be present at birth”.
Birth companions provide support to the mother during birthing and in the postpartum period. They can also recognise danger signs, alert health care workers in case of emergency and care for the baby. Possible birth companions are the spouse, a family member, friend, health worker or doula.
Evidence shows that birth companions can help to improve health outcomes. The emotional and psychological benefit cannot be emphasised enough. The presence of birth companions increases the likelihood that the mother will have a spontaneous vaginal delivery instead of caesarian, vacuum or forceps birth. Mothers with birth companions have also been shown to need fewer pain medication, to have shorter birthing process and be better satisfied with their delivery experience.
This is great news for doulas as they receive validation from the most influential health organisation in the world.
Of the more than 130 million births occurring each year, an estimated 303 000 result in the mother’s death, 2.6 million in stillbirth, and another 2.7 million in a newborn death within the first 28 days of birth. The majority of these deaths occur in low-resource settings and most could be prevented.
Since 2012, WHO has been supporting a multi-centred randomized controlled trial in more than 100 hospitals in Uttar Pradesh, India, to test whether adoption of the Checklist improves health outcomes for mothers and newborns.
The trial is being conducted by the Ariadne Labs, a joint centre of Boston’s Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, with support from the Bill & Melinda Gates Foundation.
Giving birth with ease and grace
1.) Birthing can be calm, gentle, painless and even pleasant for a woman.
2.) A woman and her baby have their own timing which is perfect for them. No “pushing” is needed and no nurse or doctor should interfere, know better and try to shortcut the individual birthing process (“Let me give you an injection and your out of here in no time.”).
3.) If a woman gets her time, space and support, which means she feels safe and can move as she wants, and if she is mentally well prepared (positive affirmations, visualisations, hypnosis, relaxation training and breathing techniques) she can give birth without any synthetic hormones (epidural etc) and without getting her perineum cut.
4.) After the baby arrived “outside” it is best to place the child immediately on the mother’s chest – without slapping its backside, without much wiping, without sucking out liquids from its nose/mouth and without cutting the umbilical chord. The baby will do what is called “breastcrawl”, which means it will find its own way in its own time to the breast of the mother.
5.) Once the newborn latches on mum’s breast another wave of hormones surges within the mother which helps to release the placenta.
6.) When the pulsation of the umbilical chord stops, the baby is able to breath on its own and only then the chord should be cut.
7.) If doctors interfere with the natural process e.g. “forcefully break the water” or introduce artifical hormones, the whole natural cycle is destroyed, especially the mother’s sensitive/delicate yet powerful hormone production which is required for a smooth delivery, and birthing has to be continued and finished with the artificial procedures.
8.) The birthing partner (e.g. husband, friend, mother) plays an important supportive role to the mother during the birth preparation and the actual delivery.