LABOR & DELIVERY

Pregnant Pumpkin

What is Labor? Energy and effort used to move the baby out of the mothers body The average length of labor for a first baby is about 12-14 hours.

The Beginning of Labor Lightening- baby drops lower into pelvis making it easier to breathe. Lightening may occur days or weeks before labor depending on the pregnancy. Lightening typically occurs closer to delivery with every pregnancy each mother has.

Early Signs of Labor Contractions: Starts as cramps and aches, get more intense and regular. When the uterus contracts, it gets shorter and harder- like any other muscle. With each contraction the uterine muscle , shortens and harden- holds the hardness for a short time, and then relaxes and rest for a few minutes. This is the clearest sign that labor has begun.

Braxton Hicks Braxton Hicks contractions are false labor pains. They begin to feel strong contractions and believe that labor has begun. Doctors look for these 3 signs to determine if labor is false: Contractions are not regular or rhythmic. They do not become increasingly stronger. They end if the woman walks around.

Early Signs of Labor Losing the mucous plug is known as “Show” or “Bloody Show” Throughout the pregnancy the mucous plug seals the cervix. This “show” may come as early as a few days before labor begins.

Early Signs of Labor In some women, the onset of labor is signaled by a trickle- or a gush- of warm fluid from the vagina. We commonly refer to this as the “water breaking.” Occurs when the membrane holding the amniotic fluid surrounding the baby has broken. For most, this membrane does not rupture until she is at the hospital in active labor.

External Monitoring: Records mom and baby’s vital signs, and contractions

Internal Monitoring: Needle attached to the baby’s head inside. Only used when external isn’t working.

Pitocin: Female hormone starts the labor process and decreases bleeding after delivery

Epidural & Spinal Anesthesia: Deadens the base of the spine and lower area. Expensive Continuous

Forceps Special tongs that are designed to fit the shape of the baby’s head. Guides the infant’s head out of birth canal. Can bruise or misshape the head.

Vacuum Extractor: Suction top of baby’s head to pull out Can cause bruising Looks like a toilet plunger

Effacement Thinning out and shortening of the cervix

Dilation Cervix opening 0-10 cm in diameter

Before labor begins- the cervix is normal size and shape.

The 1st Stage: Dilation Stage Early Labor: 0-4 cm. 5-10 min. apart Show: plug of cervix is released Active Labor: 3-7 cm. 2-3 min. apart Transition: 8-10 cm. 1-3 min. apart Hardest part. Baby’s head moves into birth canal. Want to push.

The 2nd Stage Expulsion of baby’s head until completely born. Crowning: See the head from the outside

Baby’s head emerges first Next the shoulders follows. Then the rest of the baby slips out easily.

The 3rd Stage Afterbirth: expulsion of placenta, cord and sac Episiotomy: Cut from vagina toward rectum so won’t tear Easier to sew a straight line than a jagged tear

After Birth the Doctor: Cleans out baby’s airway Cuts the cord Places baby on mom’s stomach

Baby Center Website Labor and Delivery: Inside Pregnancy: Labor & Birth (animated – good) http://www.babycenter.com/2_inside-pregnancy-labor-and-birth_3658872.bc Live Birth: Assisted – Epidural (first) http://www.babycenter.com/2_live-birth-epidural_10314055.bc Induced Labor (first – start on 4:23) http://www.babycenter.com/2_live-birth-induction_10300051.bc

Baby Center Website/YouTube Assisted Baby Delivery – Forceps/Vacuum - model http://www.youtube.com/watch?v=YGYfia8ol34&feature=relmfu C-section (c-section – epidural – placenta) http://www.babycenter.com/2_live-birth-epidural_10314055.bc

Apgar Scale The Apgar Scale is used to rate to health of a newborn.

Heart Rate 1 2 Absent Under 100 Over 100

Breathing 1 2 Absent Slow, Irregular Good, crying

Muscle Tone 1 2 Limp Some movement Active motion

Responsiveness: baby’s reaction when nose is irritated 1 2 No Response Grimace Cough or Sneeze

Color 1 2 Light skinned child: blue or pale 1 2 Light skinned child: blue or pale --------------------------- Dark skinned child: grayish or pale Light skinned child: body pink, limbs blue Dark skinned child: strong body color, grayish limbs Light skinned child: completely pink. ------------------------------ Dark skinned child: strong color with pink lips, palms, and soles

Umbilical Cord Complications Can be constricted – wrapped around neck. Stops flow of blood and oxygen to baby.

Mother’s Pelvis Complications Widened through puberty Needs to be large enough to pass a baby through If not, plan a Cesarean Section.

Cesarean Birth If complications arise during pregnancy or during labor it may be necessary to perform a Cesarean Birth- the delivery of a baby by making a surgical incision in the mother’s abdomen. With the use of certain medications, mother is able to stay awake to see the delivery of her baby.

Cesarean Birth vs. Vaginal Birth C-Section requires 6 week recovery Can be planned or emergency No labor pains if planned Vaginal Go through labor No surgical recovery

Posterior Position of Baby: Baby is face up rather than face down Head has to get up and around the pelvic bone Can make the 2nd stage of labor more difficult

Breech Position: Anything but head first Usually feet or bum first

Fontanels: Open spaces where the bones have not joined yet. One above the forehead One toward back of skull

Lanugo Some babies have fine downy hair called “lanugo” over their forehead, back, and shoulders. This will disappear.

Vernix To protect baby’s skin it is covered with a rich creamy substance called “vernix caseosa.” After birth some vernix may be found in the creases of the skin- it can be removed with warm water and a washcloth.

Milia Some babies also have tiny white bumps scattered over their nose and cheeks. These bumps are called “milia.” They are simply plugged oil ducts. The milia will disappear in a week or two.

Post Natal Care For The Baby

BREATHING 1. Throughout fetal development lungs are collapsed. 2. At delivery they expand and fill with amniotic fluid that may have been in the trachea.

BREATHING The pressure of being squeezed through the birth canal expels most of the fluid. After birth the baby takes its first breath of air.

CIRCULATION 1. Once lungs begin to take in oxygen, circulatory system changes. 2. A valve in the heart closes.

CIRCULATION 3. Blood now circulates through the lungs rather than bypassing them as it did during fetal development. 4. Umbilical cord clamped, blood must reroute through the baby’s body.

DIGESTION 1. Baby’s system must learn to digest food. 2. Meconium Baby’s first bowel movement Black & tarry substance

TEMPERATURE 1. Because circulation is not perfect, wrapping the baby helps keep it warm. 2. Fingers and toes tend to be cooler than the rest of the body.

1. Newborns need to establish a sleep pattern. SLEEPING 1. Newborns need to establish a sleep pattern.

Identification A footprint is taken. Baby is banded, mother and father have matching bands

Testing PKU – Blood drawn and tested Silver Nitrate is put in the eyes to prevent infection.

Bonding & Attachment 1. Should begin as soon as possible in the delivery room. 2. Infants are put right into their mother’s arms.

Bonding & Attachment 3. Breast fed babies may nurse in the delivery room. Newborn instinctively focuses on mothers face. 5. Fathers should participate in bathing, cutting the cord.

Paperwork Parents are responsible to order the birth certificate. Parents are responsible to apply for a social security number.

Post Natal Care For The Mother

Hospital Stay Mom needs time to rest and recover. In some cases healthy moms and babies may go home in 12 hours. Average stay is 2 days after birth.

Emotional Needs Birth is joyous but stressful. Many new mothers go through a few days of “baby blues” Talking about feelings helps. Adequate rest, taking care of self helps. Some women experience Post Partum a depression that occurs after the baby is born. After pregnancy, hormonal changes in a woman's body may trigger symptoms of depression. These can be very subtle but also can be extreme. Each woman is different.

The End