Chapter 4 Preparing for Childbirth Developing a Birthplan affect the event o The planning should involve all of the people who will be affected or o Anticipate when and where the baby will be born and who will assist the birth process When Will the Birth Take Place o Gestational Age the physician can refine the prediction of the due date by estimating this age using bone length measurements from ultrasounds Who Will Facilitate the Birth of the Baby o Obstetrician delivery of babies within a hospital Physician who specializes in the safe and efficient o Although obstetricians are great professionals since they are in high demand they can not provide time and emotional support with the mother therefore another alternative is a midwife Two different types a non physician who is expert in the birthing of babies o Midwife 1 Lay Midwives who expertise derives from informal experience normally the last resort 2 Certified Nurse Midwives who are registered trained nurses Where Will the Baby Be Born o Home Births Some people believe that only the home can provide an appropriate setting for births Physicians believe home births involve too much of a risk o Alternative Birthing Centers ABC Privately operated ABC provides a simulated home environment with equipment in case of emergencies Located within a short drive to a major hospital Managed by a certified nurse midwife and may or may not have a physician there There is no way to know if it is considered safe due to not being able to predict how the birth will go o Hospital Birthing Rooms Room stimulates a home environment but immediate access to Dealing With the Pain and Stress of Labor emergency care o Fear of labor engenders physical tension which increases muscle pain which in turn increases fear big cycle o Two major approaches to prepared childbirth 1 Lamaze Method 2 Bradley Method a Requires the active involvement of both parents with father as the coach b Training starts two three months prior to due date c Learns complex breathing and relaxation techniques which distracts the mother from her pain and a constant emotional support d Goal is to reduce to degree of medication a Total relaxation and normal rhythmic abdominal breathing during contractions b Father has a more central role directing the experience rather than supporting c Mother s focus is on her body and process of childbirth Immediate breast feeding and newborn remains with d mother at all times e Much more emphasis on an unmedicated delivery o Research has shown Lamaze mothers had less C sections fetal distress and postpartum infection Also increase sense of control and self esteem o Dr Frederick Leboyer emphasizes the experience of the infant in gentle birth a Delivery in a dimly lit and quiet room b Immediate skin to skin contact with the mother accompanied by massage c Severing the umbilical cord only after it has stopped pulsating d Bathing the infant in warm water to simulate the experience within the womb Labor and Childbirth is the process when a woman give birth to her baby Labor Labor begins with the first true contraction of the muscles of the uterus Labor ends with the complete delivery of the afterbirth Three stages of labor a First Stage Dilation and Effacement Dilation begins with the increasing pressure of the baby s head on the cervix Effacement is a process where the walls of the cervix stretches over the head of the baby Birth Canal is where the baby moves down into the vagina Transition is normally the most stressful and painful part of the whole process where the vagina cervix is progressively becoming 8 10cm about 4 in in diameter b Second Stage Descent and Delivery c Third Stage Delivery of the Afterbirth The baby gradually moves down the birth canal and ends The vagina gets stretched to its limit when the top of the till baby is born baby s head appears Episiotomy is a surgical incision that widens the opening allowing the head to pass The doctor may do this when they do not think the opening is wide enough and is only used to speed up the delivery reduce risk to the baby and prevent tearing and pain The placenta will detach itself from the wall of the uterus A second series of contractions will force out of the placenta and what remains of the umbilical cord and amniotic sac These contractions are typically painless and beings a few minutes after the baby is born Oxytocin may be given to strengthen the contractions to speed up the process and prevent bleeding If an episiotomy was performed the incision is sewn Medicated Labor mother and baby Local Anesthetics baby s head Regional Analgesia All medications carry the risk of potentially serious side effects for the o Provides pain relief in a very small area of the body relives pain for o Common form is pudendal block which is the injection of anesthetic to deaden a particular nerve through vagina wall o Provides pain relief in a much larger potion of the body but stops short of effecting the entire body of the mother o Most commonly form used is the epidural block which provides pain relief from the waist down without loss of consciousness 60 of births o The procedure starts with a catheter inserted in mother s lower back and analgesia is infused into the hollow space around spinal cord which results as a loss of sensation from waist down o This can slow labor and increase the use of chemical or mechanical means to assist delivery o Maybe used in combination with spinal analgesia which is injected into the spine for immediate pain relief This combined approach is called the walking epidural allowing the mother to walk around Systemic Medications o Effects the entire system of the mother o Can be taken intravenously orally or inhalation with the expectation of emergency situations o Have opiods narcotics that must be given in a highly controlled way because of their potential to put the fetus at risk of breathing problems Babies of mothers who receive large doses of medication tend to be sluggish inattentive and irritable when awake Fetal Monitoring As we have learned before the umbilical cord supplies oxygen and nutrients from the mother to the fetus and throughout labor the fetus remains attatched The fetus can withstand temporary interruptions in its oxygen supply from the pressure on the umbilical cord during labor but if too long fetus will be in fetal distress which can cause varying degree of damage to the central nervous system and sometimes even death Causes of Fetal Distress o One in
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