The Effect of Medical Clowning on Primipara Women During Labor

Introduction Midwives have been known for many years to give support, care and advice to pregnant women during pregnancy, birth and after birth. The word midwife literally means 'with woman'. It is known that throughout the age's women during childbirth depended upon a skilled person (usually a woman in the olden days). Her skill is based partly on art and partly on science. Art: the ability to understand the woman's need, encourage and build her confidence. Science: knowledge and decision-making. The midwife refrains from taking control away from the mother, but is at hand to step in where assistance is needed (Myles 1999).

Literature review Labor is a normal physiological process, but is usually associated with pain and discomfort. (Othman, Jones, & Neilson, 2012). Over the years, various measures to relieve stress, discomfort, pain, fear and anxiety during labor have been explored. (Ganji, shirvani, rezaei-Abhari, & Danesh, 2013). Therefore, these issues that impact the wellbeing of the pregnant and laboring woman are of primary interest and value to caregivers. (Bergstrom, Kieler, & Waldenstrom, 2009). However, many women would like to have a choice in pain relief during labor and also would like to avoid invasive methods of pain management in labor. (Klomp, van Poppel, Jones, Lazet, Di Nisio, & Lagro-Janssen, 2012). Adams, Eberhard-Gran, and Eskild, (2012) concluded that duration of labor was longer in women with fear of childbirth than in women without it. The search for supporting measures such as the use of birthing in water, yoga, and other non invasive approaches in addition to drug administration during labor is crucial.

Midwives support natural birth as much as possible. Thus, preparation classes have been introduced to teach and enlighten pregnant woman, in order for them to understand the changes and process of pregnancy, labor and after birth concerning their bodies. Stress, depression, and anxiety affect 15 to 25% of pregnant women. However, fewer than 20% of prenatal care providers assess and treat mental health problems and fewer than 20% of pregnant women seek mental healthcare (Kingston. D. et al., 2014).

In The Baruch Pade Medical Center there are approximately 60 live births of primiparous women monthly.

Medical clowning has been used as a supportive factor, mostly in pediatric settings (Gorfinkle et al., 1998; Koller & Gryski, 2008; Scheyer et al., 2008). Medical clowns are trained professionals (Bornstein, 2008; Hart, 2012) who master at least one of the various stage arts such as theatre, acting, circus or puppetry. Their aim is to improve the mental and physical well-being of patients by easing pain and anxiety due to hospitalization. The clowns strive to be an integral part of the medical team and are even present during physically intrusive procedures (Hart, 2012; Smerling et al., 1999; Tener, Lnag-Franco, Ofir & Lev-Wiesel, 2012). The medical clown plays a therapeutic and a diagnostic role and is perceived as any other paramedical therapist (Hart, 2012).