Labor and Delivery

Early Signs of Labor Braxton-Hicks contractions May be painful and regular, but usually are not Do not lead to cervical change Lightening – baby drops Burst of energy – nesting instinct Braxton Hicks…don’t do anything. Just cervix practicing

Signs of Labor Water Breaks – amniotic sac/fluid Show or Mucous Plug Contractions Show—like a clear period

What’s happening to your life saver?

Cervix Dilation: How far has the cervix opened (in cm) Effacement: How thin is the cervix (in cm or %) getting thinner, hole is getting bigger..”effacement"—cervix starts a couple inches thick and thins out to a sheet of paper, “dilation” hole getting bigger…needs to get to 10, each contraction helps these 2 things happen)

Progress of Labor Lasts about 12-14 hours (first baby) Lasts about 6-8 hours (subsequent babies) Considerable variation. Effacement (thinning) Dilation (opening) Descent (progress through the birth canal)

1st Stage of Labor “Early Labor” Longest stage of labor Cervix dilates from 0-10 cm Effacement Contractions contribute to dilation and effacement Longer, stronger, closer together

Effacement and Dilation

Management of Early Labor If in bed, lie on one side or the other…not flat on her back Check vital signs every 4 hours Nothing by mouth except ice chips or small sips of water You can’t breathe if you lay on your back Nothing by mouth….in case they have to do C-section (could throw up and get into lungs)

Monitor the Fetal Heart Normal Fetal Heart Rate is 120-160 BPM

Electronic Fetal Monitors Continuously records the fetal heart rate and uterine contractions

Epidural A type of local anesthesia used to relieve pain during delivery Epidural Space around the spinal column. If they hit the spinal column it will drain fluid out (headache)…may need to plug it up with a blood patch. Numbs you for several hours. harder to push but can’t feel the baby or contractions as much

Amni Hook Used to break the amniotic sac If water didn’t break or if Dr. wants to hurry things along. Need to be dialated 4-5 cm first. Helps labor go faster

Orientation of Fetus Palpate vaginally Posterior transverse lie Station: refers to the position of the baby in the birth canal Breech—feet or buttocks first Posterior—Facing toward mother’s front instead of back Transverse—fetus is laying sidewise

Transition Regular, powerful, contractions every two to three minutes that last up to 60 to 90 seconds Last about 90 minutes Baby’s head enters birth canal Cervix dilates to 10

End of Stage 1 Cervix dilates to 10 cm—try it!!!

2nd Stage of Labor Delivery of Baby Crowning is when the top of baby’s head can be seen at vaginal opening Cervix has dilated to 10 cm

Episiotomy A cut made in the perineum so that the woman does not tear Straight cut is much easier to repair. Stitches are dissolvable

Assisted Deliveries Usually happens with huge babies. Can be very dangerous to the babie’s head. Might also happen if mom’s pelvis is too small (should do C-section instead of this) Vacuum extraction….baby comes out with a huge nob on his head.

Clamp and Cut the Cord Clamp about an inch from the baby’s abdomen No nerves in the cord Check the cord for 3-vessels, 2 small arteries and one larger vein Put two plastic clamps or tie it….gradually scabs up (about 1-2 weeks) if it doesn’t dry up it can get infected…don’t let diaper cover it. Placenta Previa…tell them more. D&C…scrape out placenta

3rd Stage of Labor Afterbirth Usually happens 5-20 mins after birth Placental separation & delivery Mild contractions “Afterbirth”

APGAR SCORE Test done immediately after birth to evaluate baby’s condition Appearance (skin color) Pulse (heart rate) Grimace response (reflexes) Activity (muscle tone) Respiration (breathing & effort) Score of how well the baby is doing ….coined by anesthesiologist Virgina Apgar in 1952 Each score is based on a scale of 0-2 (w 2 being highest) The Apgar test is usually given to a baby twice: once at 1 minute after birth, and again at 5 minutes after birth. Sometimes, if there are concerns about the baby's condition or the score at 5 minutes is low, the test may be scored for a third time at 10 minutes after birth.  

Apgar Score Flick heel

Types of Delivery Vaginal Cesarean Delivery (C-section) In water? Squatting Reasons for c-section: heart rate, wrong position, umbilical cord around neck, STDs, etc

Colostrum Colostrum is a yellow fluid rich in nutrients and antibodies produced by the breast in the first few days after childbirth. Colostrum protects the newborn from infections. Mothers are encouraged to give the new baby the colostrum.

Newborn Jaundice Jaundice: too much bilirubin in the blood, causing a yellow skin color and eyes Bilirubin: yellow substance the body creates when it creates new blood cells

Post-partum The time after delivery where rest is the mother’s primary physical need Postpartum Depression http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/symptoms/con-20029130