Birth

Labor Labor Signals WHAT IS THE FIRST EVENT THAT SIGNALS LABOR IS COMING??? Onset First event: engagement/lightening Baby “drops” (head down, feet up position) ~ 3 weeks prior to delivery Braxton-Hicks contractions Preliminary contractions, “practice” Usually not consistent, not very strong

Labor WHAT TRIGGERS THE ONSET OF LABOR?? Maturation of the infant’s lungs sends a signal to infant endocrine system hormone cascade Endocrine change signals an estrogen surge in the mother Contractions and dilation of the cervix cramps, back pain, gas Irregular (about 15 minutes apart) Eventually regularly spaced, close together, & stronger Mucus plug is dislodged Water breaks (caused by the infant’s head) Forced delivery within 24 hours

Labor 1st Stage (most of labor) Medicated delivery? purpose: to dilate the cervix Contractions Increased intensity and frequency ~5 min apart Transition (usually lasts 1-2 hours) (pushing babies head) intense contractions (2 min apart, 90s long) vaginal opening is fully dilated (10 cm) Medicated delivery?

Labor 2nd Stage (30-90 minutes, purpose is to expel the baby) Urge to push (hard not to push) Baby started labor in head down sideways position During this phase, baby rotates, looking at mothers spinal chord Head crowns, pushed out, one shoulder, then the other- BIRTH!!! 3rd Stage (very short duration -5-10 minutes) Delivery of placenta (afterbirth)

Stress? Stress of delivery (good or bad???) During delivery, high levels of adrenaline and noradrenaline clears lungs of fluid sends blood to heart and brain sends stored fuel to cells increases alertness in infant

Prepared Child Birth Birth Plan- Discuss with doctor, sig other, birth coach Who do you want to deliver the baby? (Dr? Midwife?) Where do you want to have the baby? (home, hospital, birth center) Who do you want to be present? (Sig oth? Doctor? Other children?) What medications (if any) and when do you want them?

Prepared Childbirth Lamaze Information Breathing technique knowledge reduces fear Breathing technique Different types of breathing depending on stage of labor Visual distraction Establish something to focus on (like meditation) Conditioned relaxation Use breathing and visual distraction to learn to relax during contractions Support (coaching) Usually the father Often significant female friend

Prepared Childbirth Fathers in the delivery room Doula Now the norm in western culture Began in mid 70s Pregnancy is mom’s job- having dad there helps keep him in the loop Different experience of child’s birth Doula Usually experienced mother Often trained in massage techniques- relaxation Benefits less anesthesia fewer instruments/ surgical deliveries

Prepared Childbirth Outcomes with prepared childbirth Experience less pain Take less pain medication Lower rates of assisted delivery (instruments, surgery) More positive attitude about birth Father feels more part of the process

Prepared Childbirth Medicated delivery Primary Benefit: less pain, but only at the end of labor. Drugs cross placenta to infant Weakens contractions- Why is this not good? Infant responses less active alertness slowed social response poor motor control Mother-infant bonding infant slow response mothers felt different QUESTION: IS that due to medicated delivery or mom’s who chose non-medicated delivery were different with respect to their attitudes regarding infants, mothering, etc

Prepared Childbirth C-section Many of the same issues as medicated delivery Bypass stress response hormones So tend to see: more fluid in lungs lower heart rate, slower circulatory flow throughout body decreased alertness than infants born vaginally Solution: wait for labor to get process going, then C-Sec

Assessment APGAR (@1 and 5 minutes) 5 items, 0-2 pt scale Heart rate (over 100) Respiration (regular, infant crying) Muscle tone (strong, active motion Color (pink overall, not blue or grey) Reflexive activity (cries, coughs, sneezes, blinks) If 5 or less at 5 minutes we are concerned