Chapter 4 BIRTH © 2013 The McGraw-Hill Companies, Inc. All rights reserved.

WHAT EVENTS OCCUR JUST PRIOR TO THE BEGINNING OF CHILDBIRTH? Dropping or Lightening Head of fetus settles in pelvis Braxton-Hicks contractions First uterine contractions may be experienced as early as 6 th month Blood spotting in vaginal secretions Day or so before labor Rush of amniotic fluid from vagina Occurs in 1 in 10 women

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. WHAT EVENTS OCCUR JUST PRIOR TO THE BEGINNING OF CHILDBIRTH? Placenta and uterus secretes prostaglandins Excite uterus muscles causing contractions and softens cervix As labor progresses, oxytocin is released Stimulates contractions powerful enough to expel the fetus

THE STAGES OF CHILDBIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. First stage - Cervix is dilating Late first stage (transition stage) - Cervix is fully dilated and the amniotic sac has ruptured, releasing amniotic fluid Second stage - Birth of the infant Third stage - Delivery of the placenta (afterbirth) Afterbirth: When the placenta, umbilical cord, and other membranes are detached and expelled STAGES OF BIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. FIGURE THE STAGES OF BIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. First stage - Labor Uterine contractions efface and dilate cervix First stage lasts from a few hours to more than a day Contractions increase in strength, frequency, and regularity Fetal monitoring Measure fetal heart rate and mother’s contractions Transition (about 30 minutes) Cervix is nearly fully dilated Head of fetus moves into vagina Frequent and strong contractions STAGES OF BIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Second stage - Birth of the infant Begins when baby appears at opening of birth canal Ends with birth of baby Crowning Episiotomy may be performed once crowning takes place Once a baby’s head emerges from its mother, mucus is suctioned from the baby’s mouth Umbilical cord is clamped and severed STAGES OF BIRTH

CLAMPED AND SEVERED UMBILICAL CORD

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Third stage – Afterbirth Afterbirth: When the placenta, umbilical cord, and other membranes are detached and expelled Lasts minutes to an hour or more Placenta separates from the wall of uterus and is expelled If performed, episiotomy is sewed STAGES OF BIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. 99% of U.S. births occur in hospitals Other options Freestanding birth center, home delivery Who helps during birth process varies across cultures 91% of U.S. births attended by physicians Some exclude fathers from process Some attended by family members or open to community CHILDBIRTH SETTING AND ATTENDANTS

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Midwives Norm in most of world U.S. Certified Nurse Midwives More time with patient in prenatal visits More emphasis on counseling, education Provide more emotional support to mother Are present during entire birth process CHILDBIRTH SETTING AND ATTENDANTS

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Doulas Provide continuous physical, emotional, and educational support before, during, and after childbirth Most in U.S. work independently, typically function as part of ‘birthing team’ CHILDBIRTH SETTING AND ATTENDANTS

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Use of medication during delivery Analgesia is used to relieve pain Anesthesia is used in late first-stage labor and during expulsion to block sensation Epidural block - Numbs from waist down Oxytocin (Pitocin) Synthetic hormones stimulate contractions METHODS OF CHILDBIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Natural childbirth Tries to reduce mother’s pain by reducing fear Prepared childbirth (Lamaze method) Similar to natural childbirth Special breathing technique in final stages of labor METHODS OF CHILDBIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Other methods to reduce pain and stress during labor and childbirth Waterbirth Massage Acupuncture Hypnosis Music therapy METHODS OF CHILDBIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Cesarean delivery Baby removed from uterus through incision in abdomen when baby is in breech or crosswise position Breech position: Position of the baby within the uterus that causes the buttocks to be the first part to emerge from the vagina METHODS OF CHILDBIRTH

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Anoxia occurs during contractions Insufficient oxygen to fetus/newborn Stress hormone secretion protects from oxygen deficiency, prepares infant for birth Vernix caseosa (skin grease) protects against heat loss THE FETUS/NEWBORN TRANSITION

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Apgar Scale: A widely used method to assess the health of newborns at one and five minutes after birth It evaluates infants’ heart rate, respiratory eff ort, muscle tone, body color, and reflex irritability MEASURES OF NEONATAL HEALTH AND RESPONSIVENESS?

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. FIGURE THE APGAR SCALE

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Low birth weight infants: Babies that weigh less than 5½ pounds at birth Preterm infants: Babies born three weeks or more before the pregnancy has reached its full term Small for date (small for gestational age) infants: Babies whose birth weight is below normal when the length of pregnancy is considered PRETERM AND SMALL FOR DATE INFANTS

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. As a group - more developmental and health problems Risk increases as gestation age decreases Norwegian study Preterm-birth adolescents at higher risk for language delays, learning problems, and behavior problems/delinquency involvement CONSEQUENCES OF PRETERM AND LOW BIRTH WEIGHT

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Intensive enrichment programs can improve short-term outcomes Two most popular intervention programs Kangaroo care Massage therapy NURTURING PRETERM INFANTS

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Period after childbirth Mother adjusts physically and psychologically to process of childbearing Lasts about six weeks Involution: Process by which uterus returns to pre-pregnant size POSTPARTUM PERIOD

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Postpartum depression: Involves a major depressive episode characterized by strong feelings of sadness, anxiety, or despair in new mothers, making it difficult for them to carry out daily tasks EMOTIONAL AND PSYCHOLOGICAL ADJUSTMENTS

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Postpartum depression treatments Antidepressants Psychotherapy; cognitive therapy is best Postpartum depression affects Mother-infant interaction Risk of additional psychological disorders EMOTIONAL AND PSYCHOLOGICAL ADJUSTMENTS

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. FIGURE POSTPARTUM BLUES AND POSTPARTUM DEPRESSION AMONG U.S. WOMEN

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Father’s adjustment Experiences considerable adjustment and stress Attention for infant decreases couple’s time Father’s postpartum reactions Prenatal involvement can lessen feelings of depression EMOTIONAL AND PSYCHOLOGICAL ADJUSTMENTS