1. Chapter 6.1

2. The Beginning of Labor Early Signs of Labor “Show” or “Bloody Show” – few drops of blood or pinkish vaginal stain that occurs when the mucus that plugs the uterus during pregnancy dissolves May occur as early as a few days prior to birth “Water has Broken” – trickle or gush of warm fluid from the vagina. Amniotic Sac around the baby has broken

3. Contraction – the tightening and releasing of the muscles around the uterus When the uterus contracts, it shortens and closes, pushing the fetus against the cervix. Then the uterus relaxes before the next contraction. In early labor, they are further apart. In later labor, they become more rapid. Fetal Monitoring – Watching of an unborn baby’s heart rate for stress Done during labor and birth Usually done with ultrasound

4. Premature Labor When the fetus has been developing in the womb from 37 weeks or less. Warning signs: Contractions every 10 minutes or less Feeling a constant, dull, backache Leaking fluid or blood Sometimes doctors can give medicine to stop premature labor

5. False Labor Three signs: Contractions are not regular or rhythmic Contractions do not get stronger over time Contractions end with light exercising such as walking or stretching Can occur hours or days before real labor occurs

6. Inducing Labor Doctors can induce labor by artificial means Can be done by using medication or puncturing the amniotic sac Often induced for medical reasons or in emergencies If the baby was slow developing or still in the womb after 42 weeks, the doctor may choose to induce. Also done if the amniotic sac has broken but labor has not begun Inducing labor does not change the labor process

7. The Stages of Labor Stage 1 – Contractions open the cervix Stage 2 – The baby is born Stage 3 – The placenta is expelled

8. The First Stage Begins when the contractions are coming at regular intervals Contractions increase in strength, length, and frequency In the beginning of this stage, contractions are approximately 30 seconds long, and up to 20 minutes apart. Active labor – when contractions are 60 seconds long and only two to five minutes apart Most hospitals do not admit women until they are in active labor

9. Woman becomes focused, and needs support from her partner Using coping techniques – walking, breathing exercises, etc. This stage is when the mother would receive pain medication (epidural) if wanted As the cervix dilates, the baby moves lower into the pelvis Most babies enter the world head-first If feet first, it is called breech presentation. These babies may have a hard time moving through the pelvis, so the doctor will determine if a normal delivery is possible

10. The end of this stage is called “transition” The cervix becomes fully dilated to a diameter of about 10 centimeters (4 inches) Strong contractions that last up to 90 seconds and are two to three minutes apart occur at this point Difficult part of labor A woman needs encouragement and reassurance from her support partner at this time End of Stage 1 – “Transition”

11. The Second Stage Contractions during the second stage are more productive, pushing the baby through the pelvis and out of the vagina, or birth canal. It is safe for women to push at this point When she pushes, she uses her muscles to expel the baby During labor, the hormone called relaxin, allows the ligaments in the mother’s pelvis to stretch like a rubber band. This stretching moves apart the pelvic bones It also makes it possible for the walls of the vagina to stretch so that that baby can pass safely through

12. The baby’s body is designed for this journey A soft skull lets the baby’s head become longer and narrower than usual If the opening of the mother’s body is too small to accommodate the baby’s passage the doctor may widen it with a surgical cut Episiotomy – Surgical cut from the vagina to the anus As the baby’s head emerges, the doctor or midwife provide gentle support to help guide the baby out The head is followed by one shoulder and then the other The rest of the body follows quickly

13. Sometimes the doctor uses surgical tongs called forceps, to grasp the baby’s body and guide it’s movement. A vacuum extractor that applies suction to the baby’s head once it appears may be used if the baby needs to be moved through the birth canal quickly.

15. The Third Stage After birth, the mother may rest briefly, and then may feel a few contractions and a desire to push Usually not painful contractions For the purpose of pushing the placenta out Once the placenta is out, the birth process is over The new mother may now begin to bond with her child If needed, the doctor or midwife will stitch up the episiotomy or tears that may have occurred during birth

16. The final stage is brief but important Scientists have discovered that cord blood contains stem cells. The stem cells can be used to treat many serious blood related illnesses in the baby or other family members Parents can arrange to have the cord blood stored in case there is a future medical need. It also can be donated for use by others

17. Coping with Labor Medication Anesthesia Some injected into veins or muscles Make women and baby sleepy Epidural – lower back Numbs the lower half of the body Childbirth Classes Teaches breathing and relaxation techniques Often called Lamaze classes, but that is only one approach to childbirth education

18. Cesarean Birth If complications arise during pregnancy or birth a C- section may become necessary. Performed for several reasons: Lack of normal progress during labor Discovering the baby is in distress Discovering the baby is turned in the wrong direction Multiple births (twins or more) Special parenting classes if C-section is planned

19. Pain medication Epidural – women remain awake during the surgery General anesthesia – puts women to sleep Father or support person may be present with permission SURGERY Has risks, but can relieve stress on the baby and speed up the delivery Doctor has more control of the birth process Mother may or may not be able to hold baby immediately afterwards Mother taken to recovery room for a few hours after Encouraged to stand up or walk with assistance to speed up recovery Up to six weeks to recover fully

20. Premature Birth 5-6% of all babies are born prematurely Born before reaching 37 weeks of development Weighing less than 5 pounds, 8 ounces The earlier the baby is born, the less developed the organs are and the lower their birth weight

21. Why does premature birth happen? No one knows for sure Mothers more likely to give birth to premature baby: Women who have given birth to a premature baby before Women who have medical problems Teen mothers Malnourished mothers You can help prevent premature births by eating well and getting proper prenatal care

22. Special Care for Preemies They need: Controlled body temperature Controlled breathing Controlled feeding Baby usually put in an incubator Some may be able to breast feed or feed from a bottle Some will have lifelong health-related problems Many premature infants will reach development milestones in the first year a little later than the average child. By the time they are toddlers it is often impossible to know if a child was born prematurely.