Blog Date 03/14/2022

Delivery is a natural and physiologic process, but a painful and exhausting phenomenon both for mother and those who care her.This process constitutes a very important physiologic event of woman's life with significant physical, mental, and emotional effects. Delivery is accompanied by pain, mental stress, probable physical injuries, and rarely, death.

Midwives are responsible to provide care and support for delivery of mothers in non-complicated deliveries. Quality and the way of providing midwifery cares are among the factors affecting childbirth outcome. Midwife's functions and actions during this critical stage of woman life may lead to different outcomes ranging from life to death and from heath to physical injuries, with significant effects on the mental and emotional health of mother and child. Delivery care is a process that aims to maintain the health of mothers and children and facilitates their normal growth and development later in life. According to Yanger,[1] care is based on friendly behaviors and attitudes which must have several characteristics. These indications are introduced as five valuable “Cs” including communication, condolence, continue, commitment, and courage. In conventional delivery cares within delivery departments, generally a midwife is responsible for providing care for several delivering women and she mostly needs to do clinical care including monitoring of fetal heart rate and progress of delivery, prescribing drugs, recording delivery data, etc. Precise observational studies in several hospitals have shown that in most of the cases, the women are left alone during delivery and the midwives only spend one-fourth of their time in the bedside of women in delivery room (this time is very short for establishing a continuing and sympathetic relationship with delivering woman),[6] while being alone during delivery causes fear, anxiety, and forlornness in the delivering women.[7] Commission of Health Care in 2007 announced based on a review that 46% of women are left alone during labor, which causes worry in them. In the aforementioned conditions, the woman fears from being alone and also fears from pain, distress, contempt, being naked, and losing control on their behavior, their child's health and death. Facing these fears, anxieties, and tension resulting from predicting negative events is an experimental turning point in delivery, and the delivering woman shall benefit from continuing support and companionship for confronting with them.The policy of providing continuing midwifery care in England's midwifery centers includes providing personal support to women during labor and delivery through one-to-one care (one midwife to one delivering woman) at the first and second stages of delivery. The benefit of this policy is a continuous, persuasive, and responsive support for woman during delivery. On the other hand, fear is the most important factor in causing severe pains and influences normal progression of delivery. Abnormal progression of delivery is the most common reason of primary cesarean. One of the preventive methods in difficult and prolonged deliveries is providing proper support and precise care of woman during delivery. Stress causes muscle contraction and, consequently, increases the severity of pain and the pain increases mother's stress and anxiety. This may lead to slowing fetal heart rate and prolonging the second phase of delivery by causing a defective cycle. Thus, a natural delivery may change to a difficult and troubled delivery. The presence of a caring person (preferably midwife) at the bedside of parturition (delivering) woman can facilitate the contractile activities and uterine bloodstream by decreasing mother's anxiety. The results of Hodnett's study in 2007 showed that the childbirth outcomes of women receiving continuous care during labor were improved significantly compared to the conventional care group. Meanwhile, continuing attendance of midwife, and so, continuing of care in all phases of delivery reinforces woman's body ability in producing endogenous analgesics or endorphins.These endorphins provide comfort, cause drowsiness, and increase euphoria. Unnecessary intervention of midwifery such as induction, premature amniotomy, and perineal laceration are amongst the important factors that decrease satisfaction, and may deteriorate the midwifery care outcomes and cause improper experiences for mothers and midwives. But continuing care may lead to less delivery stimulation and induction, shorter duration of labor, decrease in midwifery surgical operations, lower episiotomy and cesarean, and less need to apply labor's pain-reliving drugs, and thus, to a more physiologic delivery.

Other benefits of continuing care are increasing vaginal delivery, decreasing infection in mother and child, more satisfaction of mother and midwifery, and increasing breast feeding.

Original Post: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061621/

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