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This paper describes and discusses the birth of a device. The invention
pertains to birthing device, specifically to obstetric. The invention was born
out of personal reflection and continual aspiration. The chair is intended to
be used in labor and birth to promote the comfort and facilitate natural
birthing process whilst reducing or bringing unnecessary interference to
minimum. ‘F. Birthing Chair’ is designed with the aim allowing birthing women
to be in an upright position. The position makes maximum use of force of
gravity.
Keywords: Invention,
Birthing, Upright
INTRODUCTION
Over many years, the supine position has been commonly
used as standard medical practice by birth attendants. This position seems to
have been adopted without consideration of the physiological consequences for
either the woman or her baby. The literature indicates that there are different
and more efficient positions women can use for labor and birth. Horizontal and
vertical positions are mostly used. The horizontal position is where there is
an angle of less than 45° between the horizontal and the birth canal and the
vertical at the same angle is greater than 45°. Vertical birthing positions are
classified as upright positions such as squatting, sitting, standing, kneeling
and kneeling on all fours [1,2]. In contrast, horizontal positions are
recumbent and semi-recumbent or the full supine lithotomy position [2,3].
Before the 19th century, the upright birthing position was common in
many Western as well as in developing countries. Supine position used for birth
followed the introduction of obstetric interventions such as forceps deliveries
and continuous fetal monitoring in modern obstetric care.
Nonetheless, positioning of
women at the time of birth is potentially an important clinical factor. Being
upright and mobile during labor provides a right angle for the fetus with the
aid of gravity to propel rotation and descent of the fetal head onto the
pelvis. The weight of the fetal head on the cervix assists in the final
cervical dilatation that successfully completes the first stage of labor.
Upright position have a number of physiological advantages, such as shortening
of second stage, no compression on the major vessels, no maternal hypotension,
no reduction in the placenta blood flow and fetal pH [4-6]. Upright positions
enable gravity to assist mothers’ efforts during labor and birth and assist a
baby to descend through the birth canal [2]. A squatting position produces an
increase in the anterior-posterior and transverse pelvic outlet, thus helping
the descent of the presenting part [7]. Kneeling on all fours helps a woman to
feel more comfortable, cope better with labor pains and in control of her
birth; it also helps to reduce the risk of perineal injury [2,8]. Furthermore,
some studies highlight that women who give birth in the upright position
experience less pain and are less vulnerable to incurring episiotomy and
perineal trauma [9,10]. Other benefits reported by a number of studies include
fetal oxygenation, shorter second stage, and decreased risk of needing an
assisted birth, improved strength and frequency of uterine contractions
[5,11,12]. Upright and lateral position for birth is also reported to be
associated with greater maternal comfort and less perineal injury [2,13,14].
There is also significantly
emerging evidence that birthing position has a potential influence on perineal
outcomes [2,15,16]. The use of upright positions for birth could bring about a
reduction in the risk of perineal trauma from either spontaneous
tears or the use of episiotomy. A study compared maternal semi-sitting position
with lateral, squatting, standing and hands and knee positions during the
expulsive phase of second stage of labor
and found that semi -sitting represented a greater risk for 2nd degree tears and
the performance of an episiotomy [16]. Researchers conducted a study to
identify maternal, new born and obstetric factors associated with birth related
injuries, the study reported that position at the time of birth had the
greatest influence on perineal outcome. The study also reported that the use of
episiotomy was high in recumbent position. This suggests that the effect of
position on perineal outcome is significant.
Most women in human societies progress through labor lying in bed for the
entire period of labor and birth. However, evidence suggests the bed is no
place for labor, but often that is all there is in the hospital setting [17].
All women, in both developed and developing countries, when encouraged will
choose upright positions and change to different positions at will to find a
comfortable one [5,18] Current evidence on the benefits of assuming alternative
positions in labor is widely available and accessible [5,7]. Yet, women
continue to give birth in the horizontal position. Upright positions enable
gravity to assist mothers’ efforts during labor and birth and assist a baby to
descend through the birth canal [2]. A squatting position produces an increase
in the anterior-posterior and transverse pelvic outlet, thus helping the
descent of the presenting part [7]. Kneeling on all fours helps a woman to feel
more comfortable, cope better with labor pains and in control of her birth; it
also helps to reduce the risk of perineal injury [7].
In contrast, lithotomy position or lying on the back with hips and
knees flexed thighs apart and sometimes legs up in stirrups. This position
promotes loss of control, and actually pushes the baby uphill while narrowing
the pelvis. The lithotomy position consequently increases vulnerability in women
to spontaneous tears and raises the risk of episiotomies [19]. It can also
result in the damage of lower extremity nerves [20]. In the lying down position
the angle of the sacrum tilts forward and the pelvic outlet is reduced.
The supine position is also associated with compression of the large
vessels by the pregnant uterus. This reduces fetal nutrition and oxygenation
during labor and contributes to hypotension and hemorrhage in the mother
Vessels compressed in the lying down position includes the abdominal vessels,
descending aorta and inferior vena-cava which affect the well-being of mother
and fetus. The weight of the fetus compresses the vena-cava lowering maternal
blood pressure and reducing placental blood flow, resulting in a lowered fetal
pH. A study conducted a randomized experimental study between an upright
position (sitting) and the supine-lithotomy position involving 200 low risk
primigravidae [21]. The results showed reduced pain, shorter second and third
stages of labor, average Apgar scores of 8.7 and 9.9 in 1 and 5 min,
respectively, and maintained baseline blood pressure, in favor of the upright
position (sitting). These study findings are similar to other studies [22],
despite the risks associated with the lithotomy position; it is evidently
accepted as standard practice for vaginal birth in many African countries.
However, while women may not necessarily prefer the lithotomy position
for birth they are offered limited choices. Studies reporting evidence from
randomized controlled trials on the benefits of one birthing position over
another indicated that most women preferred upright birthing positions.
Despite the robust evidence in support of the use of upright position
in childbirth, Most developing countries, continues to use birthing position
and perineal care that are not based on current best evidence and little is
known as to why it is the case. Therefore, my focus of interest is in raising
the profile of midwifery care, maternal health and wellbeing and maintaining
evidence based care that would offer women a better childbirth experience. This
is the factor that led to the invention of a birthing chair to facilitate birth
in upright position, which when in circulation will support women to birth in
varying upright positions. The chair has been recognized and licensed by the
Nigerian Copyright Commission and is currently undergoing patent registration.
DESCRIPTION OF THE INVENTION
(F. BIRTHING CHAIR)
The invention relates to birthing chairs made of rigid non-porous thick
plastic and steel coated materials. The purpose of the plastic and steel
material is to protect the chair from blood and excrement during the delivery.
This is required for adequate cleansing and disinfection after each use to
prevent nosocomial infection.
The chair has series of broad reinforcement structures particularly at
the back and under the seat portion. The structural bars and centrally
positioned steel iron support Pillar with four legs are connected in a way that
allows the chair to sit on the ground surface with great stability. Each of the
support contributes to the structural strength, integrity and stability of the
device. This is essential in order to allow for certain positions in which the
laboring woman is exerting pressure at a varying angles on the chair for
support.
Due to differences in height as well as individual preferences for the
angle of the legs, pelvis and back in a seated or squatted position during
labor and birth, no single height can be ideal for all. The invention has an
adjustable mechanism which facilitates a seated or squatted position at varying
height to accommodate the differences in ergonomic needs of individual woman.
This mechanism ensures that the chair can be moved up and down for the desired
height.
Handles and belts with twisted cord at both sides’ forms areas of
gripping providing the woman extra leverage during labor. The grips are
constructed as separate piece and are integrated into a single part design.
Properly manufactured, the chair is constructed with no mechanical joining of
the handles and grips in order to avoid the creation of gaps and crevices in
which the bodily fluids arising from giving birth might become trapped, thereby
creating a risk of cross infection between users.
Generally, the invention is stable enough to allow certain amount of
flexibility, have several points for gripping, making the chair more suitable
in supporting birthing process as nature intended.
The invention is not limited to the description of the device, other
changes and modifications may be made within the scope of the claims.
CONCLUSION
The invention of F. Birthing Chair represents the first step towards
evidenced based practice in the area of birthing position and perineal care
during childbirth in some of the developing countries.
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