1. Chapter 11 The Birth Process Objectives 1.Summarize what happens during the three stages of childbirth.

2. The End of the Beginning As the due date approaches, a mother-to-be eagerly anticipates the big event. Three stage of childbirth: labor pushing delivery

3. History of Delivery

4. Early 1647 Forceps developed—many babies died in the early years of their use Before 19th century was uneventful - life went on as normal 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 – it was harmful and even fatal to mother and baby

5. Mid 1882 First successful Cesarean delivery, death rate remained high until 20th century 1900 Middle class women would be confined until well after the baby was born –Introduction of Maternity clothes (Lane Bryant)

6. 1920 “Twilight labor” morphine and scopolamine (general anesthetic) –(These drugs proved to be harmful to baby and mother) Use of stirrups to prevent any tearing or ripping

7. 1950 and Beyond 1950 Use of drugs in “assisted” childbirth becomes popular 1970 “Natural” childbirth is newly popular –Midwife becomes popular 1980 Back toward hospital births 1990 and beyond Mother and Father take a more active role in child birth.

8. Stages of Childbirth What about a woman weeks past her due date with no sign of labor? the child may be in distress the child may be growing too big to deliver easily delay could signal a complication labor may be induced, or caused to begin the doctor injects a drug to begin contractions or causes the amniotic sac to rupture when continuing a pregnancy poses health risks to mother or child

9. First Stage: Labor A woman in labor experiences contractions (tightening and relaxing of the muscles of the uterus. help dilate (widen) the cervix push the baby from the uterus through the vagina may begin at the upper part of the uterus and move around to the back or begin in the lower back and move to the front resemble menstrual cramps those felt in the lower back are called back labor grow longer, stronger and more frequent as labor progresses

11. First Stage: Labor Early Labor may experience nausea, leg cramps, shakiness or hiccups emotionally, feel relieved but excited early labor contractions come every 20- 30 minutes and last 30-40 seconds After several hours of labor, the woman heads to the birth site.

12. First Stage: Labor Admission Procedures pelvic exam to check the degree of dilation and the position of the fetus mother’s pulse and blood pressure are checked regularly through this stage her contractions and the baby’s heartbeat are registered by a fetal monitor (wide belt that wraps around the mother’s abdomen and connects with wires to a machine) she may only have ice chips or an IV

13. First Stage: Labor Active Labor contractions grow more intense contractions come 3-4 minutes apart and last 40-60 seconds the cervix will dilate to about 8cm (3 inches)

14. First Stage: Labor Transition rapidly moves childbirth from labor to the stage of pushing and delivery commonly takes just 2 hours (compared to 14 hours of early and active labor) contractions (regular and extremely powerful) last from 60-90 seconds and come every 2-3 minutes the cervix dilates fully to 10cm (4 inches) medications are more likely to be given during this time panting exercises help the woman avoid putting pressure on the cervix (pushing) before the cervix is fully opened

15. Medication During Childbirth anesthetic: medication that reduces or eliminates pain Four types of anesthetics: 1.systemic—this injection into a muscle or vein can relieve tension or nausea 2.local—used when an incision must be made, this injection numbs a small area 3.regional—this injection numbs a larger area, in this case the lower half of the body spinal block (injected into spinal canal) epidural (injected outside the spinal canal) 4.general—this leaves the woman unconscious and is used mainly for surgical deliveries

16. Stages of Childbirth Signs that labor is near: a pink spotting of blood, call the show the woman’s “water breaks”—the amniotic sac surrounding the fetus ruptures, causing fluid to trickle or gush from the vagina When the water breaks, head to the hospital.

17. Objectives 1.Summarize what happens during the three stages of childbirth.

18. Pop Quiz 1.What is the piece of equipment that monitors a woman’s contractions and the baby’s heartbeat? 2.Labor may be __________, or caused to begin, through the use of drugs or breaking of the amniotic sac. 3.Dilate means to _____ the cervix. 4.The cervix is fully dilated at _____ cm. 5.A pink spotting of blood is called the _____. Bonus: What is it called when the amniotic sac surrounding the fetus rupture, causing fluid to trickle or gush from the vagina.

19. This is when a woman “turns the corner”. lasts about two hours for the first delivery and one hour or less for subsequent births the cervix is fully dilated she is now allowed to push down with her abdominal muscles Second Stage: Pushing and Delivery

20. the woman is moved from the labor room to delivery room the woman’s pelvic area and vaginal area is scrubbed, then painted with an antiseptic solution her body is covered with a sterile cloth on the delivery table, she may lie on her back or lean forward (alternative positions include kneeling, squatting or lying on one side with the upper leg supported) Preparing for Delivery

21. Second Stage: Pushing and Delivery Birthing Positions Squatting opens the pelvis, especially when you hold onto something stable and stretch away from it. This position can be used for pushing during contractions and for delivering the baby. Squatting Kneeling over a chair, ball, or cushions is good for active labor and for when you need to rest, concentrate, or calm yourself. This position is easy to move into and out of when you feel the need to change position. You may find it eases back labor. Kneeling

22. Second Stage: Pushing and Delivery Delivery contractions come every minute or two and last almost as long during a contraction, the woman takes a deep breath, pushes to the count of ten, then repeats she may feel burning or stinging in the birth canal the baby travels down the birth canal facing backwards with the head down the skull is made of flexibly joined plates of bone as the head begins to emerge, called crowning, the baby turns upward

24. Second Stage: Pushing and Delivery Delivery episiotomy: a small cut made at the vaginal opening to ease the passage of the baby’s head cut is made under local anesthetic lessens the risk of tearing, which is harder to stitch up

25. Second Stage: Pushing and Delivery Delivery as the baby’s head emerges, an attendant gently suctions mucous from the baby’s mouth and nose the head expands the birth canal so the rest of the body can pass through easily the baby’s body rotates to one side, gently guided by the doctor, enabling the shoulders to emerge one at a time a few more contractions complete the baby’s exit the doctor will hold the infant by the legs to let mucous run from the mouth the umbilical cord is clamped or tied, then cut

26. Second Stage: Pushing and Delivery Bonding routine procedures and tests on the baby are often delayed so the parents can hold their child immediately lying on the mother’s stomach or in her arms, the newborn feels her skin and heartbeat physical closeness begins the process of bonding bonding: the creation of a loving link between a parent and child

27. Second Stage: Pushing and Delivery Complications If a woman cannot push the baby out by herself, the doctor may use forceps, a pincer-like instrument, to reach into the birth canal and pull the baby out. A vacuum extractor, a metal or plastic cup that uses suction to pull the baby out of the birth canal, is another possibility.

28. Second Stage: Pushing and Delivery Complications breech delivery: a baby is born with feet or buttocks first

29. Second Stage: Pushing and Delivery Complications cesarean section: the child is delivered through an opening cut in the abdominal wall and uterus Other complications requiring Cesarean delivery: a long or difficult labor threatens to injure the mother or child the fetal monitor shows the baby’s heart rate dropping dangerously placenta previa, where the placenta covers the opening of the uterus and prevents the baby from vaginal delivery a woman’s pelvis is too small or she has a multiple birth

30. Second Stage: Pushing and Delivery Water Birth process of giving birth in a tub of warm water can labor in water and get out, or delivery in water theory behind water birth is that the baby has been in the amniotic sac for 9 months and birthing into a similar environment is gentler for the baby and less stressful for the mother

31. Third Stage: Delivery of the Placenta mild contractions expel the placenta and other membranes through the birth canal a nurse massages the abdomen to assist the process, which takes 10-30 minutes if an episiotomy was performed, it is now repaired after delivery, the uterus shrinks, accompanies by contractions and strong cramps bloody discharge may continue for several days to as much as six weeks

32. Objectives 1.Suggest strategies a woman and her coach can use to ease labor and delivery. 2.Describe complications that can affect the mother or newborn during labor and delivery. 3.Describe the care given to a mother and newborn after delivery.

33. Review What’s a Cesarean section? Why might a woman need one? What’s it called when a woman’s placenta covers the opening of the cervix? What’s it called when a baby comes out feet and butt first? What happens when a woman goes into the delivery room? Hint: scrubbed What’s it called when the baby’s head emerges? What’s the small cut made at the vaginal opening called?

34. The Newborn’s Appearance The newborn’s skin is covered with ?—flecks of blood and a greasy, white material that keeps it from getting waterlogged by amniotic fluid. The skin may appear grayish-blue, but that changes with the first cries and deep breath. The skin may look transparent or slightly wrinkled, or be covered with fine hair, called lanugo. Newborn acne, if present, disappears within days.

35. The Newborn’s Appearance The Head slightly pointed takes a round shape within a few days may have a lump, called a caput a scalp monitor may leave a swollen red mark any hair present at birth may fall out The Eyes light-skinned babies almost always have slate blue eyes eyes may appear crossed the drops given at birth may cause swelling

36. Caring for the Mother after Delivery she is kept under observation for at least an hour her pulse, breathing rate and blood pressure are checked every 15 minutes she is usually allowed a snack if an episiotomy was performed, a nurse will show her how to keep the incision clean to avoid infection

37. Caring for the Mother after Delivery If breastfeeding: the baby should nurse briefly and frequently to stimulate milk production for a few days after delivery, the breasts product colostrum colostrum: a yellow fluid rich in nutrients and antibodies, which help protect the newborn from infections

38. Caring for the Mother after Delivery a mother and child leave a birth center in nine hours after a delivery the average hospital stay is one to two days following a vaginal delivery, four days after a cesarean section a father can visit any time the baby may room-in with the mother

39. Caring for the Newborn neonate: a newborn baby in the first month of life receives drops in eyes to prevent possible infection from STDs given a vitamin K injection baby is checked for proper development, weighed, measured and washed

40. Caring for the Newborn before leaving the delivery room, an identification band that matches the mother’s is placed on the wrist or ankle the infant’s footprints are recorded for hospital records

41. Neonatal Checkup most babies are born healthy—fewer than four percent of all infants are born with birth defects newborns are given a quick medical checkup to detect any problems that require emergency treatment the checkup includes simple tests for rating their physical condition

42. Neonatal Checkup: The Apgar Scale Names for Dr. Virginia Apgar who invented the test n the 1950s. Newborns who score seven points or more are in good to excellent condition. Infants scoring between four and six points may need resuscitation. Those scoring less than four points are in poor condition and require dramatic life-saving measures.

43. Neonatal Checkup: The Apgar Scale Activity (muscle tone) 0 — Limp; no movement 1 — Some flexion of arms and legs 2 — Active motion Pulse (heart rate) 0 — No heart rate 1 — Fewer than 100 beats per minute 2 — At least 100 beats per minute Grimace (reflex response) 0 — No response to airways being suctioned 1 — Grimace during suctioning 2 — Grimace and pull away, cough, or sneeze during suctioning Appearance (color) 0 — The baby's whole body is completely bluish-gray or pale 1 — Good color in body with bluish hands or feet 2 — Good color all over

44. Neonatal Checkup: The NBAs the Neonatal Behavioral Assessment Scale (NBAs), developed by T. Berry Brazelton used in many hospitals worldwide and takes about 25 minutes to administer tests the baby’s ability to maintain a deep sleep when disturbed by light, rattle and bell other parts of the exam test motor skills and ways the baby reacts to people and stress

45. Premature Infants about ten percent of all pregnancies in the U.S. means the infants are born three or more weeks before their due date face numerous health problems such as undeveloped lungs and infection a baby of 5 ½ pounds or less are considered at risk may be hospitalized for days or months

46. Premature Infants isolette: a transparent, boxlike device that controls temperature, humidity and oxygen

47. Circumcision circumcision: a procedure in which the foreskin is cut away from the head of the penis usually done the second day after birth part of a religious rite in some faiths medical experts debate is health advantages—some think it makes the foreskin easier to clean, thus helping to prevent infections of the penis http://www.pennhealth.com/health_info/ surgery/graphics/circumcision_1.jpg

48. Birth Certificate Parents should receive a birth certificate, which indicates the birth has been recorded. A birth certificate is essential for: proof of identify getting a social security card proving legal age citizenship relationships

49. Reminders tomorrow will be review time (with several worksheets) we will have a test on Thursday Friday, if you BEHAVE, you may cook