Prof. Greg Francis 6/16/081Labor and deliveryIIE 366: DevelopmentalPsychologyGreg FrancisLecture 08Labor and DeliveryI. HistoricalPerspectivesII. Prelabor EventsIII. Three Stages ofLaborIV. Controlling Pain10-week-old fetusTwins at 10 weeksFetal face, 14weeksThird semester, measuringdiameter of fetal headProf. Greg Francis 6/16/082Third trimester, spineI. Historical PerspectivesA. Who delivers? How?Where?B. Maternal and InfantMortality Who? For most of recorded history,midwives. Obstetricians first became common inthe 18th century. Who? For most of recorded history,midwives. How? Seated upright. Who? For most of recordedhistory, midwives. How? Seated upright. Where? At home.Maternal Mortality  In the early part of the 20th century, about 1in 100 women died from complications ofpregnancy or childbirth; 2nd most commoncause of death in 15- to 45-year-oldwomen. Much, much safer today: 1 in 100,000women die from complications of pregnancyor childbirth.Prof. Greg Francis 6/16/083Infant Mortality Dropped from 1 in 100births in 1900 to 1 in1000 in 2000.Infant Mortality There are large group differences ininfant mortality.Infant Mortality Dropped from 1 in 100 births in 1900 to 1in 1000 in 2000. There are large group differences ininfancy mortality. Rate is three times as high with noprenatal care. US has one of thehighest infant mortalityrates of allindustrialized countries. South Korea is not muchbetterII. Prelabor Events “Lightening” orengagement Rupture ofmembranes (waterbreaks)II. Prelabor Events “Lightening” or engagement Rupture of membranes Loss of mucous plugProf. Greg Francis 6/16/084II. Prelabor Events “Lightening” or engagement Rupture of membranes Loss of mucous plug Weight loss Diarrhea Burst of energyIII. Stages of Labor 1: Dilation and effacement of cervix. 2: Expulsion of baby 3: Expulsion of placentaStage 1 of Labor Latent phase: Can last up to 20 hours; cervixdilates to 5 cm. Accelerated or active phase: Usually lasts 2-4hours, during which the cervix dilates from 5 to 8cm. Transitional phase: Usually lasts 30-60 minutes;cervix finally dilates to 10 cm. Times vary enormously across women, butalmost always faster after first birth.Warning!!Prof. Greg Francis 6/16/085IV. Controlling Pain Analgesics: medications that reduce pain, e.g.,Demerol. Often used, but rapidly cross theplacenta and affect the newborn, at leasttemporarily.IV. Controlling Pain Analgesics Anesthetics: General is rarely used today butregional are common. Epidural: anestheticinjected in epidural space in backbone.IV. Controlling Pain Analgesics Anesthetics Childbirth preparationclasses (e.g., Lamaze,Bradley) focus onreducing anxiety andignoring pain, usingbreathing, imaging.Prof. Greg Francis 6/16/086A new issue: saving cordblood Why? source of stem cellsA new issue: saving cordblood Why? source of stem cells Stem cells can be used for blood andbone marrow transplants used to treatleukemia and other blood orimmunological diseases. No problem of donor match. Cost: $1k start up, $100 annuallyNext time Growth and