1. Stages of Childbirth

2. How many centimeters should a pregnant woman dilate for delivery?

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

4. 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.

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

6. 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.

7. 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

8. Contractions grow more intense
Active Labor
Contractions grow more intense
3-4 minutes apart and last 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.

9. 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.

10. 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

11. Second Stage = Pushing and Delivery
The baby is born

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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

20. Cesarean Section

21. 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

22. Third Stage = Delivery of Placenta
The Placenta is expelled

23. 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 = min
If an episiotomy was performed, it is now repaired
Uterus shrinks, bloody discharge may still occur up to 6 weeks.

25. 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

26. 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.

28. 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

29. 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

30. 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

31. 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