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Midwifery Care of the Perineum

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Providing prenatal care is rare, although postpartum care of mother and child is a duty of many midwives. The term that is used for midwife is often indicative of her primary function. In many languages, it can be translated roughly as "one who receives the child." For example, the southern Chinese midwives are tan-min, "women who catch birth." Among the Tiv of Nigeria, the midwife is "she who seizes the child." The Navajo term for midwife is awe-Xai-is-si, "the woman who pulls the baby out." The Tikopia midwife is te fafine o tesiki, "the woman of the catching."
Care given by the midwife during antepartum and in the labor process has been usually constricted by lack of equipment and facilities. A warm bath is a preferred way to promote relaxation and therefore stimulating labor but many hospitals have no bathtubs which seriously constraint the continued practice of midwifery. Moreover, there are also problems encountered by a lot of midwives in items and traditional techniques for supporting and relaxing the perineum during labor.
All women having an epidural (anesthetic injection) must give birth in a delivery room under sterile conditions. Sterile condition entails the impossibility of the use of poultices and oils to minimize perineal pain and prevent lacerations. In response to this, midwives find their way in improvisation. Instead, they can use available sterile pads, doing a ‘clean catch’ of a lubricant into a sterile cup in order to allow it to be used in the sterile environment and for hot water in labor rooms.
Midwives also have the critical responsibility of informing the mother in a cesarean operation wherein the care and protection of the perineum are compelling. In addition, they also have the responsibility of informing the mother that hormonal activity during pregnancy has an effect on the tone of the perineum.
At one point in labor, as contractions become stronger and closer together, most women exhibit changes in behavior that include shaking, vomiting, difficulty in talking, anxiousness, and a state that can only be described as "spaciness." This marks the transition and indicates that the first stage is drawing to a close, although it may last another 1-2 hours for primiparas. At times, women seem to lose control of themselves during the intense contractions of transition. Crying and whimpering increase.
Finally, the woman begins to make straining motions as she attempts to push the fetus out, marking the beginning of the second stage of labor. At this point, she may assume a variety of postures including squatting, standing, lying down, crouching on hands and knees, or, most commonly, reclining in a semi-sitting position.