November 28 2012 Childbirth Morning sickness and tiredness during first trimester During third trimester may have Braxton hicks contractions fake labor and be uncomfortable Baby glow feel better tell others you re pregnant during second trimester Who is around during childbirth Labor Delivery nurse usually with OB in hospital Obstetrician Midwife trained medical professional Licensed to administer medicine Nurse midwife Doula not licensed for medical intervention In the US most hospitals use a semi reclined position with feet in stirrups Why It s easier for the doctor not necessarily the most convenient for the mother Birthing Positions Stages of Childbirth Stage One Cervical Effacement Stage Two Expulsion of the Fetus Stage Three Expulsion of the Placenta Stage One Can last 20 minutes to 24 hours This stage is longer in first births Cervix dilates and thins out Early labor o Amniotic sac ruptures o Cervix dilates to 4 5 cm o Contractions last 30 60 seconds with 5 20 minute intervals Active Labor Transition o Contractions last 1 minutes are more intense and occur every 1 3 minutes o Cervix dilates to 8 cm o Very intense long frequent contractions o Cervix dilates to 10 cm o Fetus moves to pelvic base creating an urge to push Pain Medications may be given though they may cause drowsiness or nausea and may affect the fetus Relaxation techniques breathing and acupuncture have been used to provide relief What is the purpose of fetal monitoring Checking the heart rate indicates if the baby is in distress Stage Two Contraction become less intense last 60 seconds every 1 3 minutes Episiotomy cut may be performed While pushing during contractions the baby s head appears crowning When the face appears mucus and fluid are removed from the mouth and nostrils Umbilical cord is cut after the first breath Newborn is placed on the mother s chest to begin bonding Eye drops are put in the baby s eyes to prevent bacterial infection Apgar test may be performed to check the well being of the infant Contractions continue after the birth The placenta is expelled about 30 minutes after the birth All of the placenta must be expelled If there was an episiotomy or tearing the woman is sewn up Cesarean Section C Section Delivery Stage Three The baby is delivered through an incision in the abdominal wall The rate of babies delivered by C section in the US is 30 Why o Low priority of enhancing women s own abilities to give birth o Side effects of common labor interventions o Casual attitudes about surgery o Limited awareness of potential harms of c section There is not always much talk about the c section o Incentives to practices in a manner that is efficient for providers Scheduled efficient more money for doctor more control saves time When is c section necessary o Dystocia Prolonged non progressive labor baby may be too big wrong position woman s canal may be too small o Placenta Previa Placenta blocking birth canal o Fetal distress Immediate stress on the baby high heart rate cord wrapped around o Other Multiple births twins or more Women s pre existing health condition blood neck pressure STIs etc Procedure occurs in an operating room under general anesthesia or an epidural o Requires longer hospital stay 3 5 days o Can become pregnant and deliver vaginally in the future VBAC vaginal birth after cesarean