Stages of Childbirth

How many centimeters should a pregnant woman dilate for delivery?

1. Draw what you think is 10 centimeters. 2 1. Draw what you think is 10 centimeters. 2. Actually draw 10 centimeters.

Common Signs Labor is Near Lightening = the baby "drops" or engages into the pelvis May occur two to four weeks prior to labor for first-time mothers and often not until labor begins if you have previously had children Your abdomen usually appears lower and more protruding. You may experience a greater ease in breathing, relief from heartburn and an ability to eat larger portions.

Contractions open the cervix First Stage = Labor Contractions open the cervix

Contractions = tightening and relaxing of the muscles of the uterus. LABOR Contractions = tightening and relaxing of the muscles of the uterus. Contractions help dilate (widen) the cervix and push the baby from the uterus through the vagina.

Admission Procedures Admission Changes into hospital gown ID band on wrist Pelvic exam Fetal monitor = register mother’s contractions and baby’s heartbeat Given bed in labor room or birthing room

Contractions grow more intense Active Labor Contractions grow more intense 3-4 minutes apart and last 40-60 seconds This hard work gets results, dilating the cervix up to about 7 cm. Walk around, relax in rocking chair, etc. Coach should encourage, etc.

Transition Moves childbirth from labor to the stage of pushing and delivery Total time = 90 minutes, compared to 14 hours of early and active labor Contractions are regular, extremely powerful = 60 to 90 seconds, every 2-3 minutes Cervix dilates fully to 10 cm.

Most difficult part of labor Transition Most difficult part of labor Medications are generally given at this time Nauseous, drowsy, feverish, then chilled Feels as if baby is pressing down Emotions are increasing Coach should be comforting

Second Stage = Pushing and Delivery The baby is born

Second Stage = Pushing and Delivery If no medication yet, probably needs it now Fully dilated 2 hours = first birth and 1 hour = 2nd and 3rd births

Preparing for Delivery Moved from labor room to delivery room or preparing birthing room Woman’s pelvic and vaginal area is scrubbed and then painted with an antiseptic solution Body is covered with sterile cloth Coach is prepped

Contractions = strong, every minute or two, lasting just as long Delivery Contractions = strong, every minute or two, lasting just as long Burning or stinging in birth canal Forceful pushing pushes baby down birth Canal, facing backwards with the head down Crowning = head begins to emerge

Episiotomy As the baby emerges, there's a chance that skin between the vagina and anus will be stretched to the breaking point. To prevent uncontrolled tearing, many physicians routinely make the minor incision

Delivery Nurse suctions mucous from baby’s mouth and nose Head expands birth canal so the rest of the body can pass Body’s baby rotates to one side, guided by doctor enabling shoulders to come out one at a time Fathers can receive child Umbilical cord is clamped

Bonding Routine tests and procedures Baby is laid in mom’s arms with dad close by Parents talk to and caress baby Infant sees their faces, hears their voices which creates a physical closeness and bonding takes place.

Complications Not all births proceed normally If woman cannot push the baby out herself, forceps or vacuum extractor are used Breech delivery = baby is born feet or buttocks first, which may lead to a cesarean section

Cesarean Section

Why Cesarean Section? Long, difficult labor threatens to injure mom or baby Baby too big Placenta abruption Baby’s heart rate is dropping Fetal distress Woman experiences placenta previa where the placenta covers the opening of the uterus and prevents vaginal delivery STDs Previous C-section Toxemia Woman’s pelvis is too small or she has multiple birth Prolapsed cord Poor presentation

Third Stage = Delivery of Placenta The Placenta is expelled

Delivery of Placenta Occupied with baby, mom may barely notice this stage, which is the delivery of the placenta Nurse may massage abdomen to assist the process = 10-30 min If an episiotomy was performed, it is now repaired Uterus shrinks, bloody discharge may still occur up to 6 weeks.

Caring for the Newborn Neonate = a newborn baby in the first month of life Doctors/Nurses put drops into neonate’s eyes to prevent possible infection and given a vitamin K injection Checked for proper development, weighed, measured and washed ID band is placed on baby Infant’s footprints

Umbilical Cord Care After birth the OBGYN will clamp and cut the umbilical cord, separating the neonate from the placenta. A medication is sometimes applied to the cord as part of a baby's first care. This may be a purple dye or another type of antiseptic. By the time the baby goes home from the hospital, the cord is beginning to dry and wither. The clamp can be removed when the cord is completely dry. The cord falls off by itself in about two to three weeks. Because the umbilical cord may be a place for infection to enter the baby's body, it is important to care for it properly.

The Apgar Scale: 7+ pts = good condition Neonatal Checkup The Apgar Scale: 7+ pts = good condition 0 Points 1 Points 2 Points Heart Rate Absent Under 100 Over 100 Breathing Slow; irregular Good; crying Muscle Tone Limp; no or weak activity Some movements of limbs Active motion Responsiveness No response to stimulation Grimace Cough or sneeze Skin Color: Dark Grayish or pale Strong body color; but grayisg limbs Strong body color; pink lips, palms, soles Skin Color: White Blue or pale Body limbs pink, not blue Completely pink

Neonatal Behavioral Assessment Scale Neonatal Checkup Neonatal Behavioral Assessment Scale Takes 25 minutes to administer Tests baby’s ability to maintain a deep sleep when disturbed by a light, rattle and bell

10% of babies are premature Premature Infants 10% of babies are premature 3 weeks or more before their due date Low birth weight Undeveloped lungs, infection May be placed in an isolette

Reasons Circumcisions are performed: Surgical procedure where part of the foreskin is cut away from the tip of the penis 2nd day after birth Reasons Circumcisions are performed: Religions rights/traditions Medical experts debate health advantages Easier to clean, prevents infection Parents’ decision