Page 123 - 86 human physiology part-2

Chapter 17

Homebirth midwives provide complete prenatal care including monthly visits, laboratory tests,
screening for infections. They provide nutritional counseling and support for psycho-social
issues. There is a chance that a rare, but critical emergency might occur during the birth where
hospital services may not be able to be obtained quick enough. Again, the WHO states that "it is
just before, during, and in the very first hours and days after birth that life is most at risk," (The
World Health Report 2005) and that "many of the complications that result in maternal deaths
and many that contribute to perinatal deaths are unpredictable, and their onset can be both sudden
and severe." (WHO Birth and Emergency Preparedness in Antenatal Care, 2006) Home birth
midwives are trained to know when an emergency requires medical interface and can provide
stabilizing measures until critical care can be obtained. While homebirth midwives generally
have the training, equipment, and medicine to handle many complications, there is great variation
in training and skill level among midwives. In choosing a homebirth midwife one should careful
examine credentials and training

Postpartum care

After the baby is born the umbilical cord is clamped and cut and the baby is looked over by a
doctor or nurse. The baby is given an APGAR score at one and five minutes after birth. This is an
analysis of how well the baby is performing its vital functions.

The five criteria of the Apgar score:

Score of 0 Score of 1 Score of 2 Acronym
Skin color blue all over blue at extremities normal Appearance
Heart rate absent <100 >100 Pulse

grimace/feeble sneeze/cough/pulls
no response
Reflex irritability cry away Grimace
to stimulation
when stimulated when stimulated
Muscle tone none some flexion active movement Activity
Respiration absent weak or irregular strong Respiration
If tearing, or an episiotomy occurs the wound is closed with absorbable suture. The mother is
closely watched for blood loss, infection, or any other possible complications. Breastfeeding should be
initiated as soon as possible after delivery as the stimulation of oxytocin in the mother aids in
hemostasis.

Risks in Pregnancy

Pregnancies that warrant close attention usually come from an existing medical condition such as
asthma, diabetes, epilepsy, or a condition developed because of pregnancy. Conditions that arise during
pregnancy will require special treatment. The purpose of prenatal care is to detect these conditions, and
to monitor and deal with them before they become serious.

• Preeclampsia is the medical term for high blood pressure during pregnancy. It is also
characterized by edema, blurry vision, liver pain, and can progress into Eclampsia in which the
mother can experience seizures, coma or even death.

338 | Human Physiology