Preparation Before Labor
摘要
Sweeping of membranes performed from 38 weeks reduces the duration of pregnancy and the rate of pregnancies beyond 41/42 weeks, at the expense of higher discomfort for the mother. Antenatal perineal massage is significantly associated with an overall reduction of trauma requiring suturing and episiotomy in nulliparous women, and of pain at 3 months postpartum in multiparous women. Pelvic floor muscle training performed during pregnancy by continent women reduces the risk of urinary incontinence in the late pregnancy and in the mid-postnatal period. Education regarding self-diagnosis of active labor has been shown to help women to cope better with the birth process by arriving at the labor and delivery unit more often in active labor. Women trained in relaxation techniques and self-hypnosis during pregnancy usually require less pharmacological analgesia, including epidural analgesia, and are more satisfied with the pain control during labor. Antenatal breastfeeding education for improving breastfeeding initiation and continuation has not been shown to be effective, at least in high-income countries. Transvaginal ultrasound cervical length assessment is accurate in predicting the onset of spontaneous labor in women at term. The chance of delivery within 7 days is more than 85% for a woman with a TVU CL of 10 mm. Home birth is a reasonable choice only for low-risk women in those high-income countries where midwives are well-integrated into health services after an accurate counselling of potential perinatal adverse outcomes. For low-risk women, alongside birth center birth is associated with maternal benefits and higher satisfaction, compared to hospital birth. Women with risk factors should deliver at a hospital and should be managed in different levels of care according to the condition. In low-risk women, midwife-led pregnancy care and continuous support during labor (generally performed by a doula) are significantly associated with better maternal and perinatal outcomes. Evidence from RCT and non-RCT studies shows that delayed admission for low-risk women during the first stage of labor is associated with better outcomes and fewer medical interventions during labor.