Labor and BirthCHAPTER 7.1

About Time

For 9 months, the unborn child has been developing in the womb. Now the baby is ready to make an exit. Prelabor is a period of irregular uterine contractions in which the cervix thins, softens, and may begin to dilate. Labor is commonly divided into three stages wherein the baby is expelled from the uterus through the birth canal and into the world. It begins with irregular contractions of the uterus that occur every 20 to 30 minutes. As labor progresses, the contractions increase in frequency and severity. For women giving birth for the first time, labor will usually last between 12 to 24 hours. However, for women who have given birth before, labor usually averages only 6 hours.

The Beginning of Labor

Lightening occurs when the baby settles deep into the mother’s pelvis, preparing for the baby’s journey into the world.

Early Signs of Labor

“Show”; it may also be referred to as losing the mucus plug. The plug is what seals the cervix. It helps prevent bacteria from entering into the uterus.

Sometimes your water will break. This is the fluid surrounding the baby. The doctor may want the baby to be delivered within 24-48 hours to protect the baby from infection.

The clear sign that labor has begun is contractions.

False Labor

Doctors look for three signs to see if contractions are false labor:

They are not regular or rhythmic.

They do not become increasingly stronger.

They end if the woman walks around.

Stages of Labor

Moves through 3 stages: In the first stage, contractions open the cervix

In the second stage the baby is born.

In the third stage, the placenta is expelled.

Duration varies greatly, depending on the mother and baby. Usually decreases with later babies.

The First Stage The muscles of the uterus pulls up on the

cervix, slowly thinning and opening it.

Contractions get stronger, longer (lasting about 60 seconds) and closer together (5-6mins. apart).

Babies usually are head down. Sometimes they are feet or buttock first, which is called breech.

During the first stage, uterine contractions begin and are usually spaced from 10 to 20 minutes apart. Initially the contractions are gentle, but they tend to become more powerful and sometimes uncomfortable. The cervix dilates with each contraction and the baby’s head rotates to fit through the mother’s pelvis.

Ends with a period called transition, when the cervix becomes fully dilated.

Contractions become very strong lasts longer (up to 90 sec.) and comes more frequently (2-3 mins.)

Usually the most difficult part of labor to cope with.

The Second Stage-Birth The contractions move the baby down through

the pelvis and out the birth canal.

Ends with the birth of the baby.

The second stage of labor usually lasts about 90 minutes. During this stage, the cervix opens sufficiently and the baby begins to move down the birth canal. The mother pushes, or bears down, in response to pressure against her pelvic muscles. The crown of the baby’s head becomes visible in the widened birth canal.

As the head emerges entirely (left) the physician turns the baby’s shoulders (right), which emerge one at a time with the next contractions. The rest of the body then slides out relatively easily, and the umbilical cord is sealed and cut.

The Third Stage

The last contractions usually causes very little discomfort, it helps the placenta separate from the wall of the uterus.

When the mother pushes and delivers the placenta, the birth process is complete.

The stage is brief, but important.

If any parts of the placenta remains, bleeding, infection, and serious illness may result.

Following the exit of the infant, the third stage of labor occurs. The uterus continues to contract, expelling the severed umbilical cord and *placenta, called the *afterbirth. The third stage occurs within ten minutes of the baby’s birth.

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2. Cesarean Section

Cesarean Birth

If complications arise, it may be necessary to perform this:

Mother or child cannot tolerate labor

STDs

Previous C-section

Toxemia

Cesarean Birth It is surgery.

Usually stay in the hospital for about 3 days.

Anesthesia

Most women prefer some kind of anesthesia.

Natural (unmedicated) childbirth is becoming more popular because the anesthesia can make the newborn baby less alert after birth.

An epidural is given in the spinal sheath and deadens the patient from the waist down.

A saddle block deadens the area where you ride a saddle.

A paracervical block, also known as a cervical block deadens the cervix.

A pudendal block is given in the pudendal nerve and will numb the whole bottom and legs.

The cervix must dilate to some degree before any anesthesia is given. For this reason, a mother needs to learn some breathing and relaxation techniques.

The Newborn at Birth

Baby takes first breath.

Lungs begin to take in oxygen, the baby’s circulatory system changes.

A valve in the heart closes and becomes permanently sealed.

Blood now circulates to and from the lungs.

The umbilical cord, is no longer needed.

How Does the Newborn Look?

Newborn’s head is wobbly and large, about ¼ the baby’s length (sometimes lopsides or pointed because of the passage)

Soft spots (above the baby’s forehead and toward the back of the skull)

Newborn’s face may be swollen or puffy.

Baby’s eyes are nearly adult sized. Usually dark grayish blue, permanent eye color becomes apparent within several months.

Circulatory system takes time to adjust (fingers and toes may be cooler for up to 24 hours)

Some babies have fine downy hair called “lanugo” over forehead, back, and shoulders. (hair disappears as baby grows)

Covered with a rich, creamy substance called vernix. (after birth wiped off and cleaned up)

Baby acne or milia on nose and cheeks. Is caused by stimulation from the mother’s hormones. Disappears in a week or two.

baby acne or milia

Lanugo

vernix