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What is the difference between normal and humanized delivery?

What is the difference between normal and humanized delivery?

Conceptually, "normal childbirth" is the traditional vaginal delivery assisted in a hospital setting, in which all procedures and interventions are used as a "routine" procedure.

Among these procedures are the systematic scraping of the pubic hair (tricotomy), use of the bladder catheter to empty the bladder, complete fasting of at least six hours, prepartum intestinal lavage (enema), permanent venous puncture, interventional care throughout (analgesics, anesthetics, sedatives, oxytocics to sometimes stimulate contractions) and in repetitive vaginal touches, early artificial rupture of the pouch (amniotomy), episiotomy (cut in the perineum) or even the application of routine forceps unnecessary.

The woman in general remains lying down belly up on the bed or on the birthing table, legs raised and supported on the leggings, unable to walk or adopt positions that seem more comfortable and facilitating delivery. In addition, the surgical environment under air conditioning and excessive lighting, the absence of a companion and the lack of privacy, "sterilizes" the emotional climate appropriate to that significant moment.

In the later period of labor, even though now absolutely contraindicated, the Kristeller Maneuver is still used when one of the team members makes intense compression of the uterine fund, in an attempt to "help" the uterine contraction. The so-called "normal childbirth" is no longer a physiological event and occurs under a large number of interferences such as those mentioned above, although many of them are already recognized as unnecessary or even harmful by the World Health Organization (WHO).

Humanized delivery

"Humanizing delivery is a set of behaviors and procedures that promote healthy childbirth and birth, as it respects the natural process and avoids unnecessary or risky behavior for the mother and the baby. " (WHO, 2000) It is in the early 1970s that Frederick Leboyer, a French physician at the Obstetrics Clinic of the Faculty of Medicine of the University of Paris, published the principles advocated in his work For a Birth Without Violence. came to question the excess of medical intervention in an existential moment that should be natural, childbirth and birth. Through this new vision and more attentive attitude towards the baby at the birth ceremony, a new look was cast at the woman who was experiencing such intense and complex experience. At this point the concept of humanized childbirth emerges.

According to the

Technical Manual for Prenatal Care of the Brazilian Ministry of Health - 2000

, "the humanization of childbirth care presupposes respect that health professionals establish with women during the parturition process, "and involves concepts such as considering the naturality of labor - which does not require interventionist behavior - to take into account the needs, individual values ​​and feelings of the parturient, recognizing their Still according to the manual, it would be "the right of the woman to choose the place of birth and support for the presence of a companion that she wishes, and also to promote physical well-being and emotional during the whole process, from gestation to birth, as well as accepting your refusal to perform certain behaviors that cause you pain or embarrassment. ""To humanize childbirth is to respect and create conditions so that all dimensions of the human being can be met: spiritual, psychological, biological and social." We must also establish and differentiate what is humanized childbirth from the point of view of the mother, what is the humanization of the birth to the baby (Wid, ML - 1998).

Differences of humanized childbirth for mother and baby

. For him humanization involves delicate or non-aggressive behavior, the moment he arrives in his "outside world," in a comfortable, warm environment, giving his time to cut the umbilical cord so that he learns to breathe with his lungs and to adapt to new conditions in the world.

Systematic aspiration of the nasopharynx in normal and healthy newborns should be avoided. Next, the mother's neck is offered to the child for the first skin-to-skin contact, taking care of previously adapting the temperature of the room, as well as giving the opportunity to suck the mother's breast even in the first hour of life, as recommended the WHO, aiming to strengthen the mother-baby affective bond and to create more efficient immunological defenses for the newborn. Simple attitudes that bring so much benefit to both.

For the mother, in humanized labor, unlike normal labor, each intervention is applied only when it is necessary, with procedures not following predetermined rigid protocols.

In humanized labor, the whole physiology of the process of gestation and parturition must be respected. Care starts from the prenatal period, when we evaluate the health of the pregnant woman and we are preparing her emotionally to understand the experience of generating and giving birth, and to assume her new role as mother. labor, the parturient - main protagonist - should have ample physical and emotional support of the obstetrical team, respecting their privacy and whenever possible, with freedom of position and mobility. In an upright position, like squatting and especially while walking, the pregnant woman counts on the help of gravity and intensifies the efficiency of contractions and her effort, minimizing the so-called "labor pains", accelerating the procedure, significantly shortening the time of work

Due time should be given for the pregnant woman to enter labor naturally, avoiding precipitating the arrival of the baby, that is, before the 39th full week, as well as to respect the rhythm of each birth, which varies for each delivery.

From the course of the 41st week, even in the face of a healthy pregnancy, monitoring of fetal conditions should be done more often, as a way to prevent complications consequent to placental aging (post-datitis).

The bag should break spontaneously during labor. Artificial rupture, if necessary, may be performed only when labor is well advanced, in order to better coordinate the uterine dynamics or even to observe the appearance of the amniotic fluid - presence of meconium - in cases in which there is alteration

The episiotomy should only be performed when there is a precise medical indication at the moment of the expulsion, either to prevent it from being prolonged or to facilitate the performance of some necessary obstetric maneuver.

It is up to the good obstetrician to accompany, be beside, complicit, attentive and not extrapolate his role, intending to "perfect" what nature does, using inappropriate practices or lacking evidence to support his recommendation. pain relief, anesthesia can be used in a humanized delivery in a hospital environment, but its practice can not be liberal, re including the desire of the woman, if this resource is not strictly necessary. It is preferable to use non-invasive, more "natural" methods, such as heated baths (bath or shower), local massages and physiotherapeutic relaxation techniques.If they do not work, introduce drugs that relieve pain, but do not interfere with the freedom to move or the effectiveness of contractions. The anesthesia - rachis or preferably the epidural one - has its place when there is a medical indication or when the other resources are not able to give the woman enough comfort, preventing her from experiencing the birth experience pleasantly.

What I I believe

Based on the above, I conclude:

In humanized labor, the parturient is the protagonist and not the doctor or his team

The obstetrician is obliged to let her participate in the experience of childbirth with freedom and lucidity (wherever possible), having your partner on the side for the first welcome of your child when you reach our world

Understand that it is a time of crisis and vulnerability for the woman as well as for the couple

We do not have the right to unnecessarily transform the simplest event of life, the birth of a new being, into a complex medical intervention.

It is our task as physicians to understand that childbirth is an irreversible process, the physiology of which must r respected, accompanied with attention and responsibility, understanding the anxieties and expectations of each pregnant woman, intervening only when there are proven indications, based on scientific evidence for its application. Only in this way will we create the conditions to reestablish the naturalness of childbirth, without the unnecessary distortions that are still committed by institutionalized medicine and which can lead to profound unfavorable repercussions for mother and fetus.

  • I understand that the concept of humanized childbirth, 40, necessarily involves the process that begins when the woman knows that she is pregnant, extends throughout her pregnancy, with a great respect for the physiology of labor, eliminating all the clearly harmful or ineffective routine practices that were adopted in the normal birth, until reaching the sovereign moment of the baby's acceptance, obeying the principles of non-violent birth advocated by Leboyer.


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