MEDICAL
PATHWAY |
PHYSIOLOGIC
PATHWAY |
Labor |
Labor |
| Induction
of labor. |
Spontaneous
labor. |
| methods
: stripping membranes, amniotomy, gel, Pitocin, Sytotec. |
alternatives
: making love, breast stimulation… |
| Limit
to one support people during labor and birth. |
Presence
of other friends, relatives, siblings, doulas… |
| Enema,
shaving. |
No
enema, no shaving. |
| Confinement
to bed and/or one position. |
Freedom
to walk and change positions as desired. |
| (Hep
lock or permanent) IV fluids for hydration and energy. |
No
Hep lock nor IV line. Drinking fluid or eating as desired… |
| Augmentation
of labor by Pitocin IV. |
Natural
labor. |
| Frequent
vaginal exams. |
Vaginal
exams when requested by mother or for medical reasons. |
| Electronic
Fetal Heart Monitor. |
Listening
to fetal heart with fetal stethoscope. |
| Continuous
Electronic Fetal Monitoring. |
Intermittent
Fetal Monitoring. |
| Pain
relief through medication: analgesics or anesthtics. |
Relaxation,
emotional support, massage, breathing… |
Birth |
Birth |
| Lithotomy
position or semi-sitting in labor bed for pushing. |
Choice
of position and freedom to move. |
| Prolonged
breath-holding and bearing down for expulsion. |
Mother
follows her urge to push. |
| Routine
Pitocin as baby's shoulders come out. |
No
routinely administration of drugs as baby comes out. |
| Limit
of 30 to 45 mn on 2nd stage, then forceps or cesarean birth. |
Allow
for longer 2nd stage and position variations to help progress. |
| Delivery
table for birth. |
Birth
in labor bed, birth chair, other places in the room, bath tub. |
| Lithotomy
position with stirrups for birth; |
Sidelying,
all fours, squattinf, standing with leg up, semi-reclining with back support,
no stirrups. |
| Mother
not allowed to touch sterile field. |
Mother
allowed to touch baby's head as it crowns. |
| Catheterization
in 2nd stage. |
No
catheterization and frequent voiding in first stage. |
| Episiotomy. |
No
episiotomy: massage, warm compresses, slower delivery, coaching to pant
out baby, support to perineum. Late episiotomy with no anesthetic. |
| Forceps
or vacuum extraction. |
Spontaneous
delivery. Mother first to take her baby. |
After
Birth |
After
Birth |
| Cut
of the cord quickly after birth by practitionner |
Allow
time for cord to stop puls. to be cut, poss by father,clamp bb only |
| Intubation/suctionning. |
Waiting
to see if baby can handle own mucus. |
| Immediate
care of baby done out of sight of mother: id bracelet, Apgar, heat lamp,
bath with soap. |
Care
done on mother's abdomen. Baby skin-to-skin with mother and blanket over
them. Mother-baby eye contact. No bath. |
| Limit
of 15-20 minutes on 3rd stage followed by manual extraction of the placenta. |
Allow
for longer time (1 hour) for placenta. Allow mother to move around, nurse
baby, squat. |
| Pitocin
drip or injection for contraction of uterus after placenta is born. |
Evaluation
of uterus before using uterine stimulant routinely. Breastfeeding. |
| Baby
to isolette or nursery for 4-24 hours. Mother to recovery for observation. |
Baby
held by mother or father on delivery table and/or in recovery. |
| Eye
drops applied shortly after birth. |
Omit
eye drops or delay administration up to 2 hours. |
| Baby's
first feeding - glucose water by nurse. |
Colostrum
by mother who plans to breastfeed given by mother. |
| Baby
in nursery except for scheduled feedings. |
Demand
feeding, baby to mother when crying, 24 hour rooming in. |
| Circumcision. |
No
circumcision (orafter months/years). |
| Home
in 12 or more hours after delivery. |
Early
discharge from hospital. |
The
Unexpected |
The
Unexpected |
| Common
Medical Procedures |
Possible
Options |
| Scheduled
surgery. |
Surgery
after labor begins. |
| Mother
without her support person in surgery. |
Father
present to support mother. |
| General
anesthesia. |
Spinal
or epidural. |
| Screen
to prevent viewing surgery. |
Screen
lowered at time of birth or baby held up for mother and father to see and
touch. |
| Mother
not allowed to wear contacts or glasses; |
Mother
to wear contacts or glasses. |
| Baby
sent to intensive care nursery. |
Father
to hold baby and mother to see baby if baby is not in distress. Mother allowed
to breastfeed in recovery if her and her baby's condition permit. Mother-baby
Unit. |
| Adapted
to the French context from the penny press, 1980, (2005) by V. Lemaigre
Dubreuil |
|
|
TOP 