1. Labor and Delivery

2. 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

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

4. What’s happening to your life saver?

5. 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)

6. 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)

7. 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

8. Effacement and Dilation

9. 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)

10. Monitor the Fetal Heart
Normal Fetal Heart Rate is BPM

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

12. 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

13. 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

14. 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

15. 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

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

17. 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

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

19. 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.

20. 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

21. 3rd Stage of Labor Afterbirth
Usually happens 5-20 mins after birth
Placental separation & delivery
Mild contractions
“Afterbirth”

22. 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.

23. Apgar Score
Flick heel

24. 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

25. 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.

26. 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

27. Post-partum
The time after delivery where rest is the mother’s primary physical need
Postpartum Depression