1. Stages of Childbirth

2. Labor Labor – the process of giving birth
Not everyone woman will experience all signs, but when they occur, they are a clue labor is near

3. Signs of Labor
Experience lightening (baby drops lower into the pelvis)
Can occur a few weeks before labor or it may not happen until just before labor
Few weeks before birth, the cervix (lower part of the uterus) becomes thinner – effacement
Opening of cervix begins to widen – dilate

4. Signs of Labor May notice a pinkish discharge from vagina – show
Results from a loosening of the mucus plug that sealed the cervix during pregnancy
Amniotic sac ruptures when labor begins – breaking of the waters
Labor begins – contractions – a tightening of the uterus muscles, followed by relaxation of the muscles

5. False Labor Real Labor
Contractions may be irregular at first, but then occur at regular intervals
As real labor progresses, contractions intensify & come closer together
Contractions are irregular
Contractions do not become stronger or more frequent

6. False Labor Real Labor
Contractions usually not affected by change in position
Contractions most often start in the lower back & spread to the lower abdomen
The contractions generally stop if the woman walks around or shifts position
Woman feels pain in the lower abdomen

7. The Stages of Labor First Stage Second Stage Third Stage
Contractions cause the cervix to dilate
Second Stage
The baby is born
Third Stage
The placenta is expelled from the mother’s body

8. First Stage Begins with early labor contractions are usually mild
may last second
occur every minutes
Irregular at the beginning
Gradually, grow stronger, last longer & occur more often
Last about 8-12 hours
No need to rush to hospital
Rest or engage in light activity

9. First Stage Active labor Starts when the cervix has dilated to 3 cm
Last about 3-5 hours
Contractions become stronger & more frequent
Mommy-to-be advised to go to hospital when contractions are five minutes apart or less
Sooner if she lives further away

10. First Stage Active Labor Admitted to hospital or birthing center
Hospital gown
Id band attached to wrist
Mother – brief medical history, signs forms & gives urine sample
Pelvic exam (one of many) check degree of dilation & position of baby
Mommy-to-be pulse & blood pressure checked
Fetal monitor – keep track of baby’s heart rate & watch for signs of stress

11. First Stage Transition 30 minutes to 2 hours
Often the most demanding part of labor
Contractions – intensify
Last seconds, occur every 30 seconds
Begging cervix is dilated about 7 cm, during it dilates to 10 cm]

12. At your table…….
List how mommies to be can reduce the discomforts of labor.

13. Bell Work What is the difference between real and false labor?
How many labor stages are there?
Describe each.

14. Reducing Discomforts
Support of loved ones helps make the experience less stressful
Being well-rested – tolerance & endurance during labor
Having eaten (light snacks and ice chips)
Knowing what to expect reduces anxiety & fear = can reduce pain
Using techniques taught in child-birth class

15. Reducing Discomforts Medications
Systemic drug – helps relieve pain, tension or nausea, injected into muscle or vein
Local anesthetic – anesthetic is a medication that causes loss of sensation. Local is given by injection & numbs a small area
Regional anesthetic – numbs large area (epidural) most common type
General anesthetic – produces unconsciousness

16. Second Stage Cervix – fully dilated Delivery of baby begins!!
Mommy – bear down with her abdominal muscles & push baby out of the uterus & through the vagina
20 minutes – 2 hours
Contractions – seconds, 3-5 minutes
Typical birth – baby travels down the birth canal head first and facing the mother’s back

17. Second Stage Baby’s skull – flexibly joined plates of bone
As the head begins to emerge, the baby turns face upward
Episiotomy – surgical cut at the vaginal opening, helping the baby’s head pass through vaginal opening
Head fully emerged – baby’s mouth & nose are suctioned (mucus)
Baby is still attached to umbilical cord – therefore someone must cut it

18. Second Stage Baby is born!!!! Parents are elated to welcome baby
Some will laugh, cry tears of joy & relief

19. Third Stage Final stage Placenta is delivered
Mommy experiences mild contractions
Which separate the placenta from the uterine wall and move it into the vagina – the pushes it out
10-30 minutes
Menstrual-like flow begins
Continues for at several days to six weeks

20. At your table….
What is a cesarean delivery?
When is one necessary?

21. Cesarean Delivery Sometimes called a C-section
Procedure in which a doctor delivers the baby through a surgical opening in the mother’s abdomen

22. Cesarean Delivery May be necessary:
Mother’s pelvis is too small to deliver baby
Fetus is in the breech position (feet or buttocks closest to the cervix)
Mother is carrying multiples
Mother has preexisting medical condition that makes birth unsafe
Placenta covers the opening of the uterus
Long labor threatens mommy and/or baby
Fetal monitor shows baby’s heart rate dropping dangerously low

23. Cesarean Delivery Most conditions are known in advance
Many are scheduled to take place prior to labor
Most cases – mothers are given an epidural. She is alert and awake, but does not feel any discomfort
Birth coach can be present

24. Newborns
Newborn’s skin is covered with vernix – a greasy white material.
Keeps the skin from getting waterlogged by amniotic fluid

25. Newborns
Head may look pointed or lopsided because of being squeezed on its way through the birth canal.
It will take on a rounded shape within a few days

26. Newborns Skin of most newborns looks blotchy at first
Face may be covered with pimple-like bumps called milia
Most skin conditions clear up within the first few weeks

27. Newborns
Jaundice – occurs when a baby’s liver is not yet able to break down a substance called bilirubin.
Skin has yellowish tint
Treated with ultraviolet light (hospital or special equipment at home
Fairly common

28. Newborns
At first baby’s eye may appear crossed – newborns cannot focus
Drops are given at birth to prevent infection sometimes cause the eyes to swell
Light skin babies – almost always have blue eyes at birth
Darker skin babies – often have more brown eyes
Individual eye color develops over several weeks

29. Bonding
Holding baby immediately after delivery
Attachment begins!!!

30. Postnatal Care Both mommy & baby need it Apgar Scale
System used to rate an infant’s physical condition minutes after delivery to detect any problems that require immediate emergency treatment
Scores are recorded at 1 & 5 minute(s) of life
Newborns who score a total of seven or more point are in good to excellent condition

31. Routine Newborn Care
Baby is given a vitamin K injection and a hepatitis B vaccine
Baby is weighed, measured and washed
Before baby leave the delivery room, an ID band that matches the mothers is placed on baby’s ankle or wrist
Footprints are recorded

32. Low birth weight – less than 5.5 lbs
About 10% of all pregnancies is the US result in premature birth (before 37 weeks)
Before prenatal development is complete
Ex. Breathing problems due to lungs are immature
Low birth weight – less than 5.5 lbs
Both require special attention – Neonatal Intensive Care Unit
Constant monitoring & attention
Most are placed in incubator – an enclosed crib in which temperature, humidity & oxygen levels are carefully controlled

33. Rooming In
Practice of allowing the baby to be cared for in the mother’s room rather than in the hospital nursery.
Allows mommy and baby to spend more time together

34. Breast Feeding Takes a few days for milk to come in
However, she will produce Colostrum – a yellow fluid rich in nutrients and antibodies that protect newborns from infection

35. Birth Certificate
Order one. (Hospitals will fill out paper work or send for you to fill it out)
Keep in a safe place
A child cannot get a SSN without one

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

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

38. Review
Identify the six nutrients that should be included in a pregnant woman’s diet?
How much weight should a pregnant woman gain?
Identify three hazards that pregnant women should avoid.
Describe the three stages of labor.
Know the difference between false and true labor
What are two signs that labor is beginning?
What does it mean by the baby being breeched?
When would a c-section be necessary?

39. Common Signs that 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.

40. First Stage = 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.

41. 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

42. 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.

43. 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.

44. 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, etc.

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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

51. 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

52. Cesarean Section

53. Cesarean Section Long, difficult labor threatens to injure mom or baby
Baby’s heart rate is dropping
Woman experiences placenta previa where the placenta covers the opening of the uterus and prevents vaginal delivery
Woman’s pelvis is too small or she has multiple birth

54. Third Stage = 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.

57. 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

58. Neonatal Checkup The Apgar Scale: 7+ pts = good condition 0 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

59. 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

60. 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

61. Circumcision
Surgical procedure where part of the foreskin is cut away from the tip of the penis
2nd day after birth
Religions rights/traditions
Medical experts debate health advantages
Easier to clean, prevents infection
Parents’ decision

62. Birth Certificate Indicates birth is recorded
Hospital does paperwork of registering the birth with the county or community’s office of vital statistics, office issues certificate
Kept in safe place for child’s proof of identity
Cannot get social security number without a birth certificate

63. Birth Certificates Proves:
Legal Age = Vote, serve in military, get a driver’s license, get married or sign a contract
Citizenship = Vote or obtain passport
Relationships = identify parents, guardians and heirs

64. Name Activity
Choose three boy and three girl first and middle names that you think are good, solid names that you would consider naming a child in the future. 