Labor and Delivery

Delivery There are 2 types of delivery Cesarean section (C section) Vaginal birth

Cesarean Section A surgical procedure to remove the baby from the mother’s uterus through a cut in her abdomen in case of complications prohibiting a vaginal delivery Pain medication is used during a C section. The mother either has an epidural, where she will remain awake, or anesthesia, where she will be put to sleep, for the delivery Up to 6 weeks of recovery

Reasons for Cesarean delivery When the labor is not progressing fast enough and a problem develops Baby in distress or turned in the wrong direction (breech birth) Multiple births (twins or more)

Stages of Labor There is pre-labor and then 3 stages of labor after that. Each stage has distinct factors

Pre-labor Watch for signs of labor Lightening when the baby drops lower into the pelvis During effacement the cervix becomes thinner The cervix dilates or widens A pinkish discharge called “show” comes from the vagina Amniotic sac ruptures Contractions begin by tightening and relaxing of the uterus muscles

First stage of labor Cervix dilates Contractions with pain come every 15 or 20 minutes Full dilation will measure 10 centimeters (4 inches) in width

Second stage of labor: Crowning Lasts from 20 minutes to two hours Typical birth, baby travels down the birth canal head first and facing toward the mother’s back Doctor may make a surgical cut called an episiotomy to widen the opening Cuts the umbilical cord when the baby is delivered Can use forceps to guide baby out if it becomes lodged in birth canal The baby is born

Third stage of labor Placenta is delivered Mild contractions separate the placenta from the uterine wall and it moves into the vagina Nurse massages the abdomen of the mother, usually takes 10 to 30 minutes Mother pushes to expel the placenta

Examining the Newborn Apgar Scale – scale from 0 to 2, checked at one minute, and again at five minutes Normal total score is 6-10 range. 10 is a perfect score. Appearance Pulse Grimace (Reflex irritability) Activity Respiration

Nurse’s check Weight Measurement Dry off Apply antibacterial drops or ointment Injection of vitamin K to prevent bleeding disorder

Cord blood The blood left behind in the umbilical cord contains stem cells The stem cells are capable of producing all types of blood cells and can be used to treat serious blood-related illnesses in the baby or other family members It will be stored at the hospital or another medical area

Advantages and disadvantages of natural childbirth Less sedation, can run into unexpected complications The Lamaze method---can control pain, have to take time to go to classes The Leboyer method---makes the birth less shocking and more comfortable for the baby, fit classes into schedule

Controlling Pain Lamaze- A woman is physically and psychologically prepared through prenatal training in the use of controlled breathing and coached by a partner to facilitate the process of natural childbirth Leboyer- A method of childbirth where delivery occurs in a quiet, dimly lit room and the infant's head is not pulled, minimizing the trauma for the newborn and allowing for immediate bonding between mother and child

Delivery location options Home delivery---only for uncomplicated births, might run into complications Birthing room delivery---more home-like atmosphere, have to go home within 24 hours Standard hospital delivery---insurance companies cover at least 2 days, high cost

Advantages and disadvantages of personnel to assist with deliveries Obstetricians specialize in the care of mothers and babies both before, during and right after birth; expensive Family doctors provide prenatal care and deliver babies; complications can be above the doctor’s skills Licensed midwives assist women in childbirth; complications can be above midwife skills

History of Delivery

Early 1647 Forceps were developed Many babies died in the early years of their use Before 19th century was uneventful – delivery and life went on as normal with no pain relief Mid-19th century Women feared childbirth - painful or even fatal Higher social status, less children you had 1800 Chloroform was used to relieve women of any pain Harmful, even fatal, to mother and baby

Mid 1882 1900 First successful Cesarean delivery Death rate remained high until 20th century 1900 Middle class women were confined to bed rest until well after the baby was born Introduction of maternity clothes (Lane Bryant)

1920 “Twilight labor” 1920-Morphine and scopolamine General anesthesia Proved harmful to baby and mother Use of stirrups to prevent any tearing or ripping

1950 and Beyond 1950-Use of drugs in “assisted” childbirth became popular 1970-“Natural” childbirth and midwives became popular 1980-Back toward hospital births 1990 and beyond-Both mother and father take a more active role in childbirth