Chapter 4 Stages of the birth process Signs indicating labor is near 1 False labor or prelabor upper part contractions that remain brief and unpredictable for several 2 weeks Lightening 2 weeks before birth the head of the baby drops low into the uterus and cervix begins to soften in preparation for delivery It is much more difficult to support the weight 3 Bloody show labor is days or hours away the cervix begins to open the plug of the mucus that sealed it is released producing a reddish discharge Then contractions become more frequent and the first stage of birth begins Stage 1 Dilation and Effacement of the Cervix the longest stage typically lasts for 12 hours in first child 4 6 for later children regular and frequent uterine contractions cause the cervix to dilate open Transition stage climax most intense contractions and the cervix opens completely Ends when cervix is effaced thinning and dilated forming a clear channel from the uterus into the birth canal or vagina Mother must be relaxed otherwise she will bruise the cervix Stage 2 Delivery of the baby lasts about 1 hour for first baby Begins when the baby s head begins to move into vaginal canal Crowning the vaginal opening had stretched around the entire head Ends when the baby emerges from mom With each contraction mother bears down and pushes Stage 3 is expelled from the few final contractions and pushes Birth of the placenta called the afterbirth shortest stage 5 to 30 minutes the placenta Apgar Scale used at 1 minute and then again at 5 minutes after birth to assess the baby s health Evaluates heart rate respiratory effort reflex irritability sneezing coughing grimacing muscle tone and body color score from 0 2 for each category A combined Apgar scale of 7 or better indicates the infant is in good physical condition If the score is between 4 and 6 the baby requires assistance in breathing and other vital signs If 3 and below the infant is in serious danger and requires emergency medical attention Two Apgar scales are given because sometimes babies have difficulties adjusting at first but do quite well after a few minutes Color Appearance heart rate Pulse reflex irritability Grimace muscle tone Activity respiratory effort Respiration Home Delivery Doulas provide emotional support for mother before during and after labor Also linked to improving outcomes such as shorter labors and a higher rate of breastfeeding Methods of Childbirth Natural and prepared childbirth Natural childbirth method aims to reduce the pain and medical intervention and making childbirth as rewarding an experience as possible Mother s fear reduces by education techniques by Grantly Dick Read and Fernand Lamaze Prepared childbirth Participate in 3 activities 1 Classes learn about the anatomy and physiology of labor and delivery and birth process 2 Relaxation and breathing teach relaxation and breathing exercises aimed at counteracting the 3 pain of uterine contractions Labor coach partner learns how to help mother by relaxing her and supporting with encouragement and affection Feel less pain and have a more positive attitude about childbirth and more control than other mothers Medical Interventions Fetal Monitoring Electronic instruments that track the baby s heart rate during labor Can indicate an abnormal heart rate pattern and if so the baby must receive immediate medical attention or delivered because the baby could be distress from lacking oxygen 80 of American births require continuous fetal monitoring While Canada reserves it for babies at risk for birth complications Most popular type of monitor is strapped across the mother s abdomen throughout labor Second more accurate method involves threading a recording device through the cervix and placing it directly under the baby s scalp Safe medical procedure that has saved many babies lives in high risk situations However monitoring is linked to an increase in the number of instrument and cesarean deliveries Some mothers complain about the uncomfortable feeling of the device and how it interferes with the normal course of labor Labor and Delivery Medication Analgesics drugs used to relieve pain may be given in mild doses during labor to help a mother relax Anesthetics stronger type of painkiller that blocks sensation The most common approach to controlling pain during labor is epidural analgesia Regional pain relieving drug is delivered continuously through a catheter into a small space in the lower spine which numbs the entire lower half of the body limiting the pain reduction to the pelvic region Can be used in 1st stage However problems can occur Induced Labor epidural weakens uterine contractions as a result labor is prolonged drugs rapidly cross the placenta exposed newborns tend to have lower Apgar scores One that is started artificially usually by breaking the amnion or bag of waters and giving the mother synthetic oxytocin a hormone that stimulates contractions Justified when continuing the pregnancy threatens the well being of mother or baby Naturally occurring contractions are longer harder and closer together increasing the possibility of inadequate oxygen supply to the baby As a result labor and delivery medications are used in larger amounts and the chances of instruments is slightly greater Occasionally performed before the mother is physically ready to give birth and the procedure fails When this happens a cesarean is necessary A placental hormone called corticotrophin releasing hormone CRH helps predict the success of induction procedures Cesarean surgical Delivery baby is removed from mother through an incision made in the abdomen Various reasons for C sections breech the buttocks are feet of baby would be delivered first too large baby if baby develops complications during labor More dangerous than a vaginal delivery higher infection rate longer hospital stays more expense and stress Some people have schedule C sections Not recommended before 39 weeks of pregnancy can lead to problems for the baby born too early Natural labor after a C section is associated with slightly increased rates of rupture of the uterus and infant death If labor is reduced these risks multiply C section trends 40 years ago it was rare Since then rates have climbed internationally 15 in Finland 19 in Canada and New Zealand 21 in Australia and 30 in U S Latin America 27 of births in Brazil and 40 in Chile When baby is born covered with vernix caseousa a protective skin grease maybe helps baby not lose
View Full Document
Unlocking...