Labor & Delivery

Types of Deliveries Cesarean section: a small incision made in the lower abdomen and uterus where the baby is delivered Natural childbirth: no medications, relax the body by using breathing techniques Crouching method: squatting down and letting gravity help deliver the baby- less chance of tearing used in more primitive societies Birth in water: becoming more popular water helps mom relax and softens the shock of deliver for mom Home delivery: still common use of midwife to help deliver the baby mom can be relaxed because she is at home with her family only to be used for low risk pregnancies

New trends in Delivery: Doula: refers to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

Midwives: Are trained professionals with expertise and skills in supporting women to maintain healthy pregnancies and have optimal births and recoveries during the postpartum period.  Birthing Centers: New trend for women who do not want to delivery at a hospital but want more care then at home alone. http://www.fwbirthcenter.com/home.html

Signs of labor One of the main beginning signs of labor is when you pass your mucus plug or notice "bloody show." You may pass your mucus plug — the small amount of thickened mucus that has sealed your cervical canal during the last nine months — if your cervix begins to efface significantly or dilate as you get close to labor.

Signs of labor Cont. Your baby "drops." If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. You might sense a heaviness in your pelvis as this happens and notice less pressure just below your ribcage, making it easier to catch your breath.

Signs of labor Cont. Braxton Hicks contractions: More frequent and intense Braxton Hicks contractions can signal pre-labor, during which your cervix ripens (see below) and the stage is set for true labor. Some women experience a crampy, menstrual-like feeling during this time. Sometimes, as true labor draws near, Braxton Hicks contractions become relatively painful and strike as often as every ten to 20 minutes, making you wonder whether true labor has started. But if the contractions don't get longer, stronger, and closer together and cause your cervix to dilate progressively, then what you're feeling is probably so-called false labor.

Signs of labor Cont. Your cervix starts to change. In the days and weeks before delivery, changes in the connective tissue of your cervix cause it to soften. What's more, Braxton Hicks contractions may do some of the preliminary work of thinning and perhaps opening your cervix a bit. (If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts, but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor is imminent.) When you're at or near your due date, your practitioner may do a physical exam during your prenatal visit to see whether your cervix has started to change.

Signs of labor Cont. Your water breaks. When the fluid-filled amniotic sac surrounding your baby ruptures, fluid leaks. And whether it comes out in a large gush or a small trickle, you should call your doctor or midwife. Most women start having regular contractions before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon. If you don't start having contractions on your own within a certain amount of time, you'll need to be induced, since your baby's more likely to get an infection without the amniotic sac's protection against germs.

Stages of Labor First Stage Second Stage Third Stage Contractions open up the cervix to dilate and expand to 4 inches or 10 cm At the beginning of this stage, contractions are about 15-30 minutes apart Near the end of this stage, contractions are 2-4 minutes apart and are strong and frequent. Baby moves down into the lower pelvis and into position for birth. Second Stage Contractions move baby through birth canal Most Paingful Pushing stage/ Baby’s Head starts to crown Third Stage Uterus continues to contract causing placenta to separate from uterus Expulsion of Placenta is birthed (afterbirth) Shortest and least painful stage

Labor A local anesthetic delivered to the mother to block the pain from the waist to the feet is an Epidural. Epidural anesthesia is the most popular means for pain relief during labor. In fact, more women ask for an epidural by name than any other method of pain relief. Over 50% of women giving birth at hospitals use epidural anesthesia.

Labor Cont. Breech: A type of birth when the baby’s buttocks/feet are being delivered first

Labor Cont. The type of birth where the fetus is sometimes in distress is a Caesarean. Cesarean delivery is defined as the delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the uterine wall (hysterotomy). Because the words "cesarean" and "section" are both derived from verbs that mean to cut, the terms "cesarean delivery" and "cesarean birth" are preferable.

Delivery Interventions:

Newborns

What does a newborn look like? Head is large and wobbly (1/4th the baby’s entire length) It is also pointed from the passage through the birth canal. Eyes are usually dark grayish-blue at birth. Baby’s permanent eye color becomes apparent within several months. Some are born with fine, downy hair all over their forehead, back and shoulders. Milia: Baby Acne (plugged oil ducts) usually disappear in 1-2 weeks.

Fontanels: open spaces where the bones of the baby’s skull have not yet permanently joined.

Apgar Scale A method of evaluating a newborn’s physical condition. (rating 0-2 per category) Five areas: Pulse, breathing, muscle tone, reflex to stimulation, and skin color. A total scale of 6-10 is considered normal. Apgar evaluation is given at 1 minute after birth then again at 5 minutes after birth.

Bonding Newborn is placed on mom’s chest to facilitate lifelong emotional ties. Colostrum: the mother’s first breast milk is given within an hour after birth to newborn. It is rich in antibodies and sometimes thick in consistency.

What do BABIES do? Eat Sleep Have dirty diapers Cry Most babies cry 2-3 hours a day for the 1st 2 -3 months of life 5 p.m. to Midnight is often a fussy time

Newborn Reflexes Moro Reflex: When you fail to support or hold the neck and head, the arms of your baby will thrust outward and then seem to embrace them selves as their fingers curl. This reflex disappears at about 2 months of age. It is also known as the startle reflex. Palmar Grasp: When you touch the palm of your baby's hand, the fingers will curl around and cling to your finger or an object. Plantar Grasp: This reflex occurs when you stroke the sole of your baby's foot, his toes will spread open and the foot will turn slightly inward. It is also known as the Babinski reflex. By the end of the first year this reflex is usually gone. Sucking: While you may not believe this to be reflexive, it is. This ensures that the baby will nurse on a breast or bottle to be fed and occurs when something is placed in the baby's mouth. It is slowly replaced by voluntary sucking around 2 months of age. Rooting Reflex: When you stroke your baby's cheek she will turn towards you, usually looking for food. This is very useful when learning to breastfeed your baby. This reflex is gone by about 4 months.

Reflexes Cont… Stepping Reflex: If you take your baby and place his feet on a flat surface he will "walk" by placing one foot in front of the other. This isn't really walking and will disappear by about 4 months of age. Tonic Neck Reflex: This is also called the fencing reflex, because of the position the baby assumes. When you lay your baby on her back and her head turns to one side she will extend her arm and leg on that side while the opposite arm and leg bend, assuming a "fencing" position. This reflex is present only until about the 4th month. Swimming: If you were to put a baby under six months of age in water, they would move their arms and legs while holding their breath.