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T h e W a r i a u s P o s i t i ü n s f o r D e l i v e r y D r ä h n e , A . , E . P r a n g , C h . W e r n e r • r
In the B e t h e s d a H o s p i t a l in D u i s b u r g ue h a v e an e x t e n - s i v e p r o g r a m f o r t h e p r e p a r a t i o n o f m a t h e r s * I n t h e
last y e a r s ue h a v e l e a r n e d t h a t t h e warnen c r i t i c i z e t h e n o i ü a d a y s u s u a l m a n a g e m e n t o f b i r t h b e c a u s e t h e y f e e l f o r c e d to be p a s s i v e . In most cas.es, t h e m a t h e r lies i n t h e d e l i v e r y b e d f r o m t h e b e g i n n i n g a n , u h i l e t h e o b s t e t r i t i a n t e a m t a k e s over t h e a c t i v e g u i d a n c e öf t h e b i r t h . - I n our h o s p i t a l ue t r y t o c o m b i n e t h e u o m e n ' s ac'tivity tuith t h e n e c e s s a r y s e c u r i t y c ö n t r o l s o f m q t h e r and c h i l d .
I n t h e p r e p a r a t i o n s c h o o l f o r m a t h e r s t h e v ä r i a u s b i r t h p o s i t i o n s i n t h e f i r s t a n d f i n a l p e r i o d are p r a c t i c e d uiith u o m e n a n d c o u p l e s . I n t h e f i r s t p e r i a d t h e s e are:
• L ü a l k i n g a r o u n d , s i t t i n g , c r o s s - l e g g e d s i t t i n g , c o u e r i n g d o u n , k n e e - e l l b o u - p o s i t i o n , a n d o n a l l f p u r s .
D u r i n g t h e f i r s t p e r i a d a f d e l i v e r y t h e c g u p l e s are a s k e d to t r y t h e s e p o s i t i o n s . E v e r y h o u r t h e r e is a f e t a l m o n i t o r i n g c o n t r o l f o r t u e n t y m i n u t e s . . A t a n o p e n i n g of 3-5 cm the ujoman may t a k e a u ä r m b a t h . üJe h a v e a n a l i z e d t h e r e s u l t s of t h e v e r t i v a l b i r t h P o s i t i o n in 1oo -risk-cases.
R e s u l t s
1. The d u r a t i o n of d e l i v e r y
In our s t u d y the d u r a t i o n of d e l i v e r y a v e r a g e d 8 hrs 3 m t s f o r p r i m a r i e s and 5 h r s 37 mts f o r m u l t i p a r a s . The l e n g t h of b i r t h in the v e r t i c a l p o s i t i o n in com- p a r i s o n to the l y i n g p o s i t i o n is 2 hcmrs s h o r t e r f a r p r i m a r i e s a n d 2 , 5 h o u r s s h o r t e r f o r m u l t i p a r a s ; t h e d u r a t i o n i s , h o u e v e r , l a n g e r t h a n u i t h o c c i t a c i n .
The i n t e n s i t y af the b i r t h p r e p a r a t i a n has a p o s i t i v e i n f l u e n c e a n t h e l e n g t h a f b i r t h uihich i s , b e s i d e s , a n e h a u r l a n g e r f a r e l d e r l y p r i m i - a n d m u l t i p a r a s t h a n f o r y o u n g e r uiomen even i n t h e v e r t i c a l p o s i t i o n . This P o s i t i o n is used f a r the f i r s t and last p e r i a d in
a b a u t 80%, and l a n g e r by m u l t i p a r a s u h a t s u r e l y has got s o m e t h i n g to da u i t h the s h a r t e r t i m e s af b i r t h .
ü J a l k i n g a r o u n d uas t h e m o s t f r e q u e n t l y used v e r t i c a l P o s i t i o n d u r i n g t h e f i r s t p e r i o d . I n a b a u t 12-14% t h e c a n t r a c t i o n s u e r e o v e r c o m e s i t t i n g a n d s t a n d i n g . Four Ljomen p r e f e r e d t h e c r o s s e d - l e g s - ^ p o s i t i a n , tua c a u e r e d d a u n . A p r e m g t u r e r u p t u r e of the m e n i b r a n e did not
l i m i t a t e t h e L ü o m e n!s m o b i l i t y .
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2. E f f e c t of b a t h i n g
T a k i n g a b a t h in the o p e n i n g p e r i o d does not s h o r t e n the l e n g t h of b i r t h . It is, h o u e v e r , g e n e r a l l y f o u n d to be r e l a x i n g and e n j o y a b l e .
3. The use of a n a l g e t i c a
kk% of the ujomen did not need a n a l g e t i c a ; warnen u i t h p r e p a r a t i o n n e e d e d s i g n i f i c a n t l y .less t h a n o t h e r s . T h e use of a n a l g e t i c a increases u i t h m o r e t h a n 8 h o u r s of l a b o u r , Lühile an i n t a c t or r u p t u r e d m e m b r a n e does not seem to h a v e any i n f l u e n c e .
k. I n q u i r y
This is a s u m m a r y of the u o m e n ' s e x p e r i e n c e s :
if.1. The f e e l i n g ofl i n d e p e n d a n c e d u r i n g the d e l i v e r y uias g e n e r a l l y j u d g e d very p o s i t i v e l y . T h e u o m e n ' s f e a r u a s d i m i n i s h e d b y t h e p r e p a r a t i o n p r o g r a m and the r e g u l ä r controls of the u n b o r n c h i l d . k.2. The p a r t n e r1s p r e s e n c e uas f o u n d to be n e c e s s a r y
f o r c a r r y i n g out t h e v e r t i c a l p o s i t i o n .
if.3. A l t h o u g h t h e r e is no ideal b i r t h P o s i t i o n , each ujomen could chose 'the i n d i v i d u a l l y most c o n v e n i e n t one b e c a u s e t h e y had been p r a c t i c e d in the p r o g r a m . 97% of the m u l t i p a r a said t h a t t h e y had b e e n able to e x p e r i e n c e a m o r e e n j o y a b l e b i r t h in c o m p a r i s o n to t h e i r f i r s t b i r t h in a l y i n g p o s i t i o n .
The results o f t h e m o n i t o r i n g shouj t h a t t h e h o u r l y con- t r o l c a r r i e s no risk n e i t h e r f o r the m o t h e r nor the u n b o r n c h i l d .
5. Final p e r i o d
Südes are shoun to i l l u s t r a t e some of the v e r t i c a l p o s i t i o n s .
In the k n e e ^ e l l b o u - p o s i t i o n the p e r i n e u m can be j u d g e d v e r y uell by the m i d u i f e . In the f i n a l p e r i o d a scalpel e l e c t r o d e is a p p l i e d .
The s t a n_d i n g P o s i t i o n n e e d s the aid of an a d d i t i o n a l h e l p e r , i n most cases t h e h u s b a n d . T h e s i t t i n g p o s i t i o n also r e q u i r e s a h e l p e r . The uoman can i.e. sit in the h u s b a n d ' s lap a n d r e l a x c o m p l e t e l y . T h e j u d g i n g o f t h e p e r i n e u m is more d i f f i c u l t , but a r i p p i n g never occured.
It is t h e aim of our b i r t h m e t h o d to lead the uomen out of t h e i r p a s s i v e role and let t h e m p a r t i c i p a t e in t h e i r b i r t h . T h e r e s u l t s shou t h a t our e f f o r t s are g e n e r a l l y a c c e p t e d a n d j u d g e d v e r y p o s i t i v e l y .
L i t e r a t u r e is a v a i l a b l e at the a u t h o u r ' s a d d r e s s :
A. D r ä h n e c/o B e t h e s d a K r k h s . , H e e r s t r . 219, if1 D u i s b g 1
