The Score

Numbers = control If your life is a mess start assigning a score to things

birth Problems of being an upright mammal Fixed small pelvis, big brain to squeeze through

Stuff that happens during preg. Pelvic bones loosen up, adds ~ 1 in space Uterus changes from sealed pouch to pulsating funnel Cervix is the ringmaster: birth happens when its 4 in (10 cm) wide Mother’s breasts immediately fill with first milk

Things go wrong Without modern meds birth is the most common cause of death for young women and infants Hemorraging if the uterus/placenta don’t rip right Infection can set in once the water breaks and bact come in.

Obstruction of labor Common problem Pregnancy longer than 40 weeks = big baby, maybe too big Rickets can give a mom a pelvis that’s too small Breech: coming out butt first with legs wedged into chest Head gets out, shoulders stuck Stuck baby = squished umbilical cord

History 1817 King George IV’s daughter spends four days trying to get a kid out sideways. It’s born dead and she dies from bleeding Throne passes to Georges brother and his daughter Victoria that’s how she became queen

Fixing problems Cranioclast (forcepts)  –Family of obgyns kept this their secret for ~ a century Head out/ shoulder stuck –You have 5-7 min –Push down from mom’s pubic bone –Slide other shoulder down –Even break it’s collar bone

Cesarean Criminal for much of history –Usually killed the mother whose life usually took precedence. –Historians think it’s a myth that Caesar was born this way since his mother survived

Modern Medicine ~1930’s people switch from home birth with midwife to physician delivery at hospital –People started running stats –No more women were survivng, and more infants were actually dying –Drs had tools, but midwifes were doing better without them –Childbirth needed to be standarized Today ~30% of births are Cesarean

130,000,000 births in the world a year 4,000,000 in the US From 30’s to 50’s death rate had fallen from 1 in 150 to 1 in 2000 pregs. Newborns still had the same death rate 1 in 30

Dr. Virginia Apgar Hadn’t had a baby yet, wasn’t a mother yet, but came up with apgar score Rate babies on –Color (pink = good) –Crying = good –Deep breathing –Moving limbs, –High heart rate ( over 100 = good)

Score has changed management of childbirth Today full term babies die in 1 out of 500, mothers die in less than 1 in 10K