As can occur during pregnancy, labor, delivery and

As with any birthing option, there are opportunities for things not to
go as planned. However, being trained in the nursing practice, particularly
midwives that have enhanced knowledge will allow for recognition of any sign
and symptoms of distress or abnormalities. Midwifery care in any setting
includes ongoing clinical assessments that inform risk evaluation and clinical
decision making throughout pregnancy, labor, birth and the initial newborn and
postpartum period (ACNM, 2015). The implications for lotus birth are similar to
that of a normal birthing or cesarean.  Hence,
the nurse caring for a patient choosing lotus birth should establish a
guideline which involves the assessment phase, actual and potential nursing
diagnoses, a planning phase, implementation of planned events and evaluating
the client to ensure success. 

The first priority of
the nurse is physical assessment of the client. Before the labor and delivery
process begins, the nurse should thoroughly assess the mother. During
assessment the nurse will receive necessary information to properly meet the
patient’s needs. While gathering the data, the nurse will be alerted to any
reason that can hinder the lotus birth process. In the case of a client with
history of placental disorders or weaken uterine muscles, the nurse must seek
alternative approach. During the initial assessment, patient educating is
crucial. The teaching is not limited to the patient but extends to the family.
The discussion of risks and complications that can occur during pregnancy,
labor, delivery and post-natal must be clearly outlined. Teaching sessions will
also ensure that all equipments needed for the lotus birth are present because
they will not be provided the hospital or birthing centre. 

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As the nurse begins her
nursing care for the patient and family during labor, she must have already
properly identify any actual and
potential nursing problems as the basis for selecting nursing interventions for lotus birth.
These diagnoses will help allows the nurse to establish an effective plan of
care.  Nursing diagnoses associated with lotus birth are as followed:

• Anxiety – as
expected in any birth option

 • Knowledge deficit –
as it pertains to the care of the cord and placenta following birth

• Risk for
Infection – improper care of the placenta, cord or newborn

• Risk
Social isolation- as the practice of lotus birth is still new and persons
may not understand, the mother may decide not to answer questions regarding her
decision.

• Acute pain- as
expected in labor and delivery

Once the nurse has
appropriately selected the diagnoses, she will formulate a goal for the patient
and prep for delivery while applying her interventions. Firstly, the nurse will
assess the patient to ensure that all items necessary the lotus birth are in fact
present. In her memoir, Samantha Pearson has listed the following as essential
equipments needed for a lotus birth.

1.  A large bowl to serve as
storage for the placenta.
2.  A large sieve to strain the placenta
for the first 24 hours.
3.  An absorbent cloth to place the placenta
on or wrap the placenta in while allowing the placenta to breathe
4.  Sea salt, dried flowers, dried herbs
and essential oils to promote drying of the placenta, mask the scent of the
placenta and prevent bacterial growth.
5.  A placenta bag if desired to place
the placenta in.

The nurse will then assess the client’s vitals signs and pain characteristics,
as any deviation from the norm can indicate that something is wrong. Monitoring
for heavy bleeding is also adamant as it is most likely the patient is
haemorrhaging due to placenta abruption. A detached placenta defeats the
purpose of lotus birth. The neonate should be thoroughly assess
for any sign and symptoms of birth related conditions, such as neonatal
jaundice, apnea, bradycardia, and hydrocephalus. Since, the newborn cannot be
taken immediate for blood investigations, the nurse must ensure that it is not
forgotten.Once the mother
has successfully given birth, await the natural birth of
the placenta, without any use of oxytocic drugs (oxytocic drugs
forcibly expels the placenta which can cause damage); unless having a cesarean
birth. In that event the surgeon will gently remove the placenta from the
uterus. Ensure that the cord is not clamped or being pulled or tugged at. After the
birth of the placenta, place it in a sieve over the
bowl near the mother or baby and keep it level with the baby until
Wharton’s Jelly has solidified. After 24 hour has past get a pitcher of
warm water to gently rinse the placenta, remove all blood clots and wrap
with absorbent cloth to prevent premature rotting and foul odor.  Salt the placenta on both with sea
salt and/or herbs and oils in order to promote a natural drying process. 

With the
lotus birth, the cord and the placenta may interfere
with breastfeeding. The client may need assistance handling the
placenta and the cord. Thus, the nurse must provide aid in the bonding process.
A lactation specialist should be recommended to the client is having
complications and still wishes to breastfeed. Continuous evaluations along with
appropriate nursing interventions are essential in promoting favorable outcomes
for the neonate.  Since patient education
is crucial in providing care of the newborn and placenta, it must be
comprehensive and easily understood to ensure the minimization or prevention of
complications. The risk of infection is predominately high, as the vulnerable
newborn is attached to a decaying piece of meat. Dr Patrick O’Brien,
spokesperson at the Royal College of Obstetricians and Gynecologists stated,
“If left for a period of time after the birth, there is a risk of infection in
the placenta which can consequently spread to the baby. The placenta is
particularly prone to infection as it contains blood. Within a short time after
birth, once the umbilical cord has stopped pulsating, the placenta has no
circulation and is essentially dead tissue.” To prevent infections,
the nurse should emphasize the importance of caring for
the cord and placenta. The family should be educated on the
importance of cleanliness and proper hand washing practices. The patient
will should also be encouraged to place the placenta in clothing that will
allow air circulation. The placenta must be salted daily to promote dehydration.

The mother should also
be educated on caring for the baby’s skin. Even though the cord and placenta
is still attached, the mother must cleanse the skin, careful not to cause any
trauma to the child. The mother should not pull at the placenta or cord
and exhibit patience. The newborn should be dressed in loose fitting clothing
and diapers. The nurse should also educate the mother to socialize and not
remain in isolation because of her decision. The mother can utilize a
cotton bag to carry around the placenta without drawing any attention. The
nurse must follow protocol if any unusual events happen
during the lotus birth. Primary health care provider should be contacted in the
event of accidental detaching of the cord, any sign and symptoms of infection
or if the family opts to clamp the cord. The knowledgeable nurse must also
document all care and teaching provided to the mother and newborn. 

At end of the
postpartum period, the mother and/or family should be able to
demonstrate understanding of all the teachings related to the care of the
placenta, cord, and the newborn’s skin. An understanding of  the importance of good hygiene, the signs and
symptoms of infection, and the baby’s safety must also be demonstrated by the
mother or family. The nurse should ensure that the patient is able to explain
in her own words all teachings about lotus birth.