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Childbirth education in Iran

The final day of the workshop was a bit crazy. The hunt was on for a woman that we could use to demonstrate a physiological birth and while we waited for someone to appear, we got on with discussing perineums and third stage.

In Iran, women (and obstetricians) believe that an episiotomy is important for preventing later prolapse and also for better sexual functioning after birth. Kirsten did a great job of explaining how cutting the perineum would have no impact on the pelvic floor muscles or the ligaments that support the uterus, as these structures are higher up and not in any way connected to the perineal tissues. She explained that it was the prolonged, over enthusiastic “push, push, push!” style of management that could cause the supporting ligaments to detach from the pelvic bones, leading to the vaginal tissues collapsing into a prolapse. We also talked about the impact of vaginal scarring on later sexual functioning, and the other potential problems associated with routine episiotomy (excessive blood loss, infection, increased pain and discomfort for the woman in the early post natal period etc).

Third stage is routinely actively managed and we spoke at length about how to achieve a physiologic third stage including the first contact between mother and baby.

There was still no sign of an appropriate woman in labour so after a break and another round of tea, we watched the film “Inner Strength”. Some of the scenes in this film were a revelation, causing some giggling, especially the close relationship between the mother and father during labour and the couple that do a lot of kissing and cuddling (a great way to raise oxytocin levels and increase the effectiveness of contractions!). The sounds the women make were also a surprise to many of our audience. As I pointed out at the end, the outcomes we listed for birth on our first day (healthy mother, healthy baby, increased self-esteem in the woman, low morbidity, good memories of birth etc) were clearly demonstrated in this film – this kind of immediate feedback that occurs in a natural birth requires no further exploration – the outcomes are obvious.

Just after morning tea it was discovered that a woman having her second child was in labour following a spontaneous onset. She was about 4 cm dilated with intact membranes. It was decided to offer her the chance to give birth in the new birth centre and she was moved to this area. A relative who works in the hospital was located as a companion (she got bored and didn’t stay in the end). Kirsten went to meet her and with the aid of an obstetrician and a midwife began the process of getting to know her.

The labour was not very well established and of course had slowed due to the transfer to hospital, so the group, who had been watching through a video link in an adjacent room decided to go and look at the area where the prenatal classes take place. Here are some pictures of the class rooms:

The exercise room.

Sign on the door of the video room for watching DVDs etc.

Each session concludes with a relaxation session on this carpeted area.

After lunch, the mother was still just labouring gently. She had been in the pool for a while, which she reported to be very soothing and was walking about. It was decided to carry on with our program, and although some people had left to catch flights back to the provinces, we looked at ways of achieving change in hospital settings and what would need to be done to implement physiological birth in hospitals. I also set out a selection of the wonderful Fotoset images for them to talk through.

Just as we were having our afternoon tea, the word came through the woman was now labouring well and would be getting back in the bath soon. She was 6 cms and powering along. Unfortunately, Kirsten and I had to leave to catch a flight to Isfahan for the weekend, so very reluctantly we left her in the capable hands of a midwife and supportive obstetrician. We will be very keen to hear how she gave birth when we return to the hospital next week for the next workshop.

Meanwhile, we have a couple of days off to explore Isfahan, a jewel in the crown of the Persian Empire and a city considered one of the most beautiful in the Muslim world.

Posted by andrea at November 05, 2007 04:01 AM