BirthBirth

LaborLabor

Labor SignalsLabor SignalsWHAT IS THE FIRST EVENT THAT WHAT IS THE FIRST EVENT THAT

SIGNALS LABOR IS COMING???SIGNALS LABOR IS COMING???– OnsetOnset

First event: engagement/lighteningFirst event: engagement/lightening– Baby “drops” (head down, feet up position)Baby “drops” (head down, feet up position)– ~ 3 weeks prior to delivery~ 3 weeks prior to delivery

Braxton-Hicks contractionsBraxton-Hicks contractions– Preliminary contractions, “practice”Preliminary contractions, “practice”– Usually not consistent, not very strong Usually not consistent, not very strong

LaborLaborWHAT TRIGGERS THE ONSET OF LABOR??WHAT TRIGGERS THE ONSET OF LABOR?? Maturation of the infant’s lungs sends a Maturation of the infant’s lungs sends a

signal to infant endocrine systemsignal to infant endocrine system– hormone cascadehormone cascade– Endocrine change signals an estrogen surge Endocrine change signals an estrogen surge

in the mother in the mother Contractions and dilation of the cervixContractions and dilation of the cervix

cramps, back pain, gascramps, back pain, gas Irregular (about 15 minutes apart)Irregular (about 15 minutes apart) Eventually regularly spaced, close together, & Eventually regularly spaced, close together, &

strongerstronger

– Mucus plug is dislodgedMucus plug is dislodged– Water breaks (caused by the infant’s head)Water breaks (caused by the infant’s head)– Forced delivery within 24 hoursForced delivery within 24 hours

LaborLabor

1st Stage (most of labor) 1st Stage (most of labor) – purpose: to dilate the cervixpurpose: to dilate the cervix– ContractionsContractions

Increased intensity and frequencyIncreased intensity and frequency ~5 min apart~5 min apart

– Transition (usually lasts 1-2 hours) Transition (usually lasts 1-2 hours) (pushing babies head)(pushing babies head)

intense contractions (2 min apart, 90s intense contractions (2 min apart, 90s long)long)

vaginal opening is fully dilated (10 cm)vaginal opening is fully dilated (10 cm)

Medicated delivery?Medicated delivery?

LaborLabor

2nd Stage (30-90 minutes, purpose is to 2nd Stage (30-90 minutes, purpose is to expel the baby)expel the baby)

– Urge to push (hard not to push)Urge to push (hard not to push)– Baby started labor in head down sideways positionBaby started labor in head down sideways position– During this phase, baby rotates, looking at During this phase, baby rotates, looking at

mothers spinal chordmothers spinal chord– Head crowns, pushed out, one shoulder, then the Head crowns, pushed out, one shoulder, then the

other- BIRTH!!!other- BIRTH!!!

3rd Stage (very short duration -5-10 3rd Stage (very short duration -5-10 minutes)minutes)

– Delivery of placenta (afterbirth)Delivery of placenta (afterbirth)

Stress?Stress?

Stress of delivery (good or Stress of delivery (good or bad???)bad???)

– During delivery, high levels of During delivery, high levels of adrenaline and noradrenalineadrenaline and noradrenaline

clears lungs of fluidclears lungs of fluid sends blood to heart and brainsends blood to heart and brain sends stored fuel to cellssends stored fuel to cells increases alertness in infantincreases alertness in infant

Prepared Child BirthPrepared Child Birth

Birth Plan- Discuss with doctor, Birth Plan- Discuss with doctor, sig other, birth coachsig other, birth coach

– Who do you want to deliver the Who do you want to deliver the baby? (Dr? Midwife?)baby? (Dr? Midwife?)

– Where do you want to have the Where do you want to have the baby? (home, hospital, birth center)baby? (home, hospital, birth center)

– Who do you want to be present? Who do you want to be present? (Sig oth? Doctor? Other children?)(Sig oth? Doctor? Other children?)

– What medications (if any) and when What medications (if any) and when do you want them?do you want them?

Prepared ChildbirthPrepared Childbirth

– LamazeLamaze InformationInformation

– knowledge reduces fearknowledge reduces fear Breathing techniqueBreathing technique

– Different types of breathing depending on stage Different types of breathing depending on stage of laborof labor

Visual distractionVisual distraction– Establish something to focus on (like meditation)Establish something to focus on (like meditation)

Conditioned relaxationConditioned relaxation– Use breathing and visual distraction to learn to Use breathing and visual distraction to learn to

relax during contractionsrelax during contractions Support (coaching)Support (coaching)

– Usually the fatherUsually the father– Often significant female friendOften significant female friend

Prepared ChildbirthPrepared Childbirth

Fathers in the delivery roomFathers in the delivery room– Now the norm in western cultureNow the norm in western culture– Began in mid 70sBegan in mid 70s– Pregnancy is mom’s job- having dad there Pregnancy is mom’s job- having dad there

helps keep him in the loophelps keep him in the loop– Different experience of child’s birthDifferent experience of child’s birth

DoulaDoula– Usually experienced motherUsually experienced mother– Often trained in massage techniques- Often trained in massage techniques-

relaxationrelaxation– BenefitsBenefits

less anesthesialess anesthesia fewer instruments/ surgical deliveriesfewer instruments/ surgical deliveries

Prepared ChildbirthPrepared Childbirth

Outcomes with prepared Outcomes with prepared childbirthchildbirth

– Experience less painExperience less pain– Take less pain medicationTake less pain medication– Lower rates of assisted delivery Lower rates of assisted delivery

(instruments, surgery)(instruments, surgery)– More positive attitude about birthMore positive attitude about birth– Father feels more part of the Father feels more part of the

processprocess

Prepared ChildbirthPrepared Childbirth

Medicated deliveryMedicated delivery– Primary Benefit: less pain, but only at the end of Primary Benefit: less pain, but only at the end of

labor. labor. – Drugs cross placenta to infantDrugs cross placenta to infant– Weakens contractions- Why is this not good?Weakens contractions- Why is this not good?– Infant responsesInfant responses

less active alertnessless active alertness slowed social responseslowed social response poor motor controlpoor motor control

– Mother-infant bondingMother-infant bonding infant slow responseinfant slow response mothers felt differentmothers felt different

QUESTION: IS that due to medicated delivery or QUESTION: IS that due to medicated delivery or mom’s who chose non-medicated delivery mom’s who chose non-medicated delivery were different with respect to their attitudes were different with respect to their attitudes regarding infants, mothering, etcregarding infants, mothering, etc

Prepared ChildbirthPrepared Childbirth

C-sectionC-section– Many of the same issues as medicated Many of the same issues as medicated

deliverydelivery– Bypass stress response hormonesBypass stress response hormones– So tend to see:So tend to see:

more fluid in lungsmore fluid in lungs lower heart rate, slower circulatory flow lower heart rate, slower circulatory flow

throughout bodythroughout body decreased alertness than infants born vaginallydecreased alertness than infants born vaginally

– Solution: wait for labor to get process Solution: wait for labor to get process going, then C-Secgoing, then C-Sec

AssessmentAssessment

APGAR (@1 and 5 minutes) 5 items, APGAR (@1 and 5 minutes) 5 items, 0-2 pt scale0-2 pt scale

– Heart rate (over 100)Heart rate (over 100)– Respiration (regular, infant crying)Respiration (regular, infant crying)– Muscle tone (strong, active motionMuscle tone (strong, active motion– Color (pink overall, not blue or grey)Color (pink overall, not blue or grey)– Reflexive activity (cries, coughs, Reflexive activity (cries, coughs,

sneezes, blinks)sneezes, blinks)– If 5 or less at 5 minutes we are If 5 or less at 5 minutes we are

concernedconcerned