The excruciating pain comes in waves, reaching a peak and ebbing. Amidst the haze of pain of the contractions, until the joy of holding the newborn, how many women yearn for a tender touch on the brow, a whispered word of consolation in the ear and a hand to grip while pushing down hard during birthing.
From time immemorial, when a woman was delivering a baby in homes then unlike in hospitals these days, female relatives would hover around not only assisting her but also giving her moral support.
Now with almost 100% of the deliveries taking place in hospitals, the De Soysa Hospital for Women (Teaching) while providing excellent care and management, has tried out a “back to basics approach” to ease the expectant mothers’ agony and make them as comfortable as possible.
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Erin, Surangi and Nishantha: It was a great help.
Pix by Susantha Liyanawatte
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Both first-time mother Surangi Edinadura and her own mother, Erin Fernando, are all smiles when MediScene meets them at Ward 15 of the Professorial Unit of this oldest women’s hospital in Sri Lanka.
“My mother stroked my head and rubbed my back when I was in the throes of labour,” says Surangi, while Erin adds that it was wonderful to be by her daughter’s side when she delivered her baby girl on January 6.
Loku athdekeemak, says Erin, explaining that it was a huge experience. “Surangi murmured ‘Amme, Amme’ and gripped my hand tightly. She didn’t scream in pain, like some other expectant mothers who didn’t have someone,” she says. “My fears were also allayed because I was there.”
The other person whose anxiousness was taken away by this turn of events is Surangi’s husband, Nishantha. A Major in the army he was at his station far away when he got the news that she had been admitted to hospital on January 5. He was relieved to hear that his mother-in-law was given the opportunity to be with her in the labour room since she was taken in the next morning to the time his daughter was born at 4.40 p.m.
‘Female companions in the labour room’ was mooted by Prof. Hemantha Senanayake, Head of the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo under whom comes Ward 15 of the De Soysa Hospital. He is also the President of the Perinatal Society of Sri Lanka.
Citing the example of an expectant mother who is usually kept in the labour room, a strict no-visitor area, since 7 a.m., he creates the image of her being there at noon when her relatives come but would not be able to see her. She may have her baby around 5 p.m., be kept under observation until 7 p.m. and be sent to the ward then.
She has had a good labour but no human contact with her kith and kin the whole day, although the staff -- doctors, nurses and midwives -- have been efficient and caring.“I felt it was unfair for our mothers to face birthing all alone,” says Prof. Senanayake who was determined to study the Sri Lankan experience (see box), following research elsewhere in the world that ‘doulas’, non-medical persons even with minimal training, who provided emotional and physical support to mothers during and after labour had a positive impact.
Fully supported by De Soysa Hospital’s Director Dr. Mahinda Rajapakse and health education team headed by Dr. D.R.W. Dissanayake, Prof. Senanayake took the matter up with the Director-General of Health Services, Dr. Ajith Mendis, who in turn readily gave the green light to the female labour companion project.
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| Director Dr. Rajapakse fully supports the
project |
Referring to a review of all possible interventions in labour carried out by the American Journal of Obstetrics and Gynaecology, he says two were scored ‘Grade A’. One was ‘active management’ of labour which is a cornerstone and the other was companions in the labour room.
In the west, MediScene understands, labour rooms allow husbands or male partners, but Prof. Senanayake says that in Sri Lanka it is difficult to provide privacy in most obstetric units for a male to be there, but with minor adjustments a female can easily be accommodated.
“We gave them the option of bringing a female and most brought their mothers and continue to do,” he said, pointing out that the companions were given a set of clear guidelines one of which was that they would be asked to leave if there were complications.
With the female companion in the labour room, the mother in labour is indirectly empowered. This is turn improves the staff interactions with the expectant mother. Monitoring would be better and provision of pain relief quicker, says Prof. Senanayake commending his staff for promptly adjusting to this concept and unstintingly supporting it. Even though staffing levels may not be at optimal level the way the midwives and nurses of Ward 15 enthusiastically handled the addition to the labour room is a reflection of the confidence in the services provided by them.
Convinced that “this is the way to go”, he adapts the words of the first man on the moon, Neil Armstrong, “a few steps into the labour room for a woman, but a huge leap for Sri Lankan women”.
As the poet said, although in a different context, female labour companions are……..when pain and anguish wring the brow, ministering angel thou.
Study shows positive effects
Here are the meticulously recorded findings of the study, ‘Effect of a female labour companion and of educating her regarding support during labour on perinatal and labour outcomes’ still unpublished, of Prof. Senanayake and Research Associates U.A.B.P. Somawardana and M. Samarasinghe.
- With a female labour companion by her side, the mother’s level of satisfaction with labour was very high.
- In the 12 hours after birth such mothers breastfed their babies “significantly more” than those without such female companions. (In state hospitals, usually relatives can visit the mother only during visiting hours.)
Studies elsewhere in the world have shown that:
- The mothers had shorter labour.
- The need for Caesarean sections as opposed to normal deliveries was less.
- The requirement for pain relief was also less.
Give the option
to doctors
While hoping that the female labour companion trend will catch on in Sri Lanka, Prof. Senanayake stresses, however, that the Consultant Obstetrician and Gynaecologist should be given the option to decide whether to take it up or not after assessing staffing levels.
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