Stages of Childbirth

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

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

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

False Labor Real Labor

• Contractions are irregular

• Contractions do not become stronger or more frequent

• Contractions may be irregular at first, but then occur at regular intervals

• As real labor progresses, contractions intensify & come closer together

False Labor Real Labor

• The contractions generally stop if the woman walks around or shifts position

• Woman feels pain in the lower abdomen

• Contractions usually not affected by change in position

• Contractions most often start in the lower back & spread to the lower abdomen

The Stages of Labor

• First Stage– Contractions cause the cervix to dilate

• Second Stage– The baby is born

• Third Stage– The placenta is expelled from the mother’s body

First Stage

• Begins with early labor – contractions are usually mild– may last 30-40 second – occur every 20-30 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

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

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

First Stage

• Transition – 30 minutes to 2 hours– Often the most demanding part of labor– Contractions – intensify– Last 60-90 seconds, occur every 30 seconds– Begging cervix is dilated about 7 cm, during it

dilates to 10 cm]

At your table…….

• List how mommies to be can reduce the discomforts of labor.

Bell Work

• What is the difference between real and false labor?

• How many labor stages are there?– Describe each.

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

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

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 – 45-90 seconds, 3-5 minutes

• Typical birth – baby travels down the birth canal head first and facing the mother’s back

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

Second Stage

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

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

At your table….

• What is a cesarean delivery?• When is one necessary?

Cesarean Delivery

• Sometimes called a C-section• Procedure in which a doctor delivers the baby

through a surgical opening in the mother’s abdomen

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

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

Newborns

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

amniotic fluid

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

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

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

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

Bonding

• Holding baby immediately after delivery• Attachment begins!!!

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

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

• 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

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

•

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

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

How many centimeters should a pregnant woman dilate for

delivery?

1. Draw what you think is 10 centimeters.

2. Actually draw 10 centimeters.

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?

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.

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.

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

Active Labor

• Contractions grow more intense– 3-4 minutes apart and last 40-60 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.

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.

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.

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

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

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

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

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

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

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

Cesarean Section

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

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 = 10-30 min

• If an episiotomy was performed, it is now repaired

• Uterus shrinks, bloody discharge may still occur up to 6 weeks.

• http://www.webmd.com/content/tools/1/slide_fetal_pos

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

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

0 Points 1 Points 2 Points

Heart Rate Absent Under 100 Over 100

Breathing Absent 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

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

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

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

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

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

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.