Labor and Delivery

People there during pregnancy: Midwife- an individual trained to delivery babies at home (not a doctor) may have Rn degree Gynecologist (OBGYN)- medical doctor trained in women’s reproductive health, labor & delivery. Doula- an individual trained to assist the woman in having a positive experience during pregnancy, labor & delivery. Anesthesiologist- a medical doctor trained to administer pain medication, epidurals, etc.

Epidural Pain Relief During Pregnancy Epidural – needle goes between the vertebrae of the lumbar spine used as an anesthetic Numbs from the waist down Takes 15-20 mins. to work Given about 5cm dilated May diminish ability to push Cannot cause permanent damage to the spine

Pre-labor: Lightening – “dropping of the fetus in the pelvis” Passage of Mucus Plug “Bloody Show” – pink or bloody discharge from the vagina caused by passage of mucus blood and dilation of cervix Membranes rupture – “water breaks” (contractions may start before this or after

Mucus Plus -> Bloody Show -> Water breaks

Stages of Labor and Delivery Stage 1 – Dilation and Effacement of the cervix (basically the worst part ) Early labor (cervix 0-3cm) Active labor (cervix 4-7cm) Transition (cervix 8-10cm) Stage 2 – “Pushing Phase” - Birth of the Baby Stage 3 – Expulsion of the Placenta (after birth)

Stage 1 – Dilation and Effacement of Cervix Longest stage Averaging 12 hours Cervix effaces or thins out Cervix dilates or opens up to 10 cm Effacement & dilation may occur at the same time or separately

Stage 1 – Early Labor Cervix dilates 1-3cm Contractions (intense menstrual cramps) last less than a minute every 5-20 mins. Woman can still continue with light eating and activities

Stage 1 – Active Labor Cervix dilates 4-7cms Stronger contractions last at least 1 minute and are about 3 minutes apart Stage last about 2-4 hours Go to hospital!!!

Stage 1 - Transition Cervix dilated 8-10cms (fully dilated finally!!) Intense contractions last 60-90 seconds and occur 2-3 minutes apart Phase lasts about 15 minutes to an hour Usually the shortest phase of stage 1

Stage 2 – Birth of the Baby Often referred to as the Pushing Phase Averages 1-2 hours in length Contractions are approximately 1 minute apart Crowning Occurs: When baby’s head is visible from the vaginal opening

Stage 3 – Expulsion of Placenta Placenta is often called the Afterbirth Usually takes 5 minutes to ½ hour Mild contractions lasting 1 minute or less Placenta weights on average 2 pounds Breastfeeding or a shot of oxytocin will stimulate the uterus to contract strongly to stop blood flow.

Labor and Delivery Terminology Episiotomy - An incision made to perineum to allow baby’s head to pass through Perineum - skin located between the vaginal opening and the rectal opening

Cesarean Section A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. 1 out of 4 birth are C-sections A woman can be awake during birth Incision is made across belly on “bikini” line. Causes a scar. Epidural or spinal anesthesia will be given to numb belly and legs Can be risky Recovery Time Necessary

C-Section

Reasons for an unplanned C-Section Labor is slow and hard or stops completely. The baby shows signs of distress, such as a very fast or slow heart rate. A problem with the placenta or umbilical cord puts the baby at risk. The baby is too big to be delivered vaginally.

Reasons for a Planned C-Section The baby is not in a head-down position close to your due date. You have a problem such as heart disease that could be made worse by the stress of labor. You have an infection that you could pass to the baby during a vaginal birth. You are carrying more than one baby (multiple pregnancy). You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).