Transcript Chapter 11 The Birth Process

Chapter 11
The Birth Process
Objectives
1.
Summarize what happens during the three
stages of childbirth.
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
History of
Delivery
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
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)
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
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.
Stages of Childbirth
What about a woman weeks past her due date with no sign of labor?
delay could signal a
complication
•the child may be in distress
•the child may be growing too big to deliver easily
when continuing a pregnancy poses
health risks to mother or child
•labor may be induced, or caused to begin
•the doctor injects a drug to begin contractions or causes the
amniotic sac to rupture
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
First Stage: Labor
Early Labor
•may experience nausea, leg cramps,
shakiness or hiccups
•emotionally, feel relieved but excited
•early labor contractions come every 2030 minutes and last 30-40 seconds
After several hours of labor, the woman heads to the
birth site.
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
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)
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
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
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.
Objectives
1. Summarize what happens during the three stages of
childbirth.
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.
Second Stage: Pushing and Delivery
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
Preparing for Delivery
•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)
Second Stage: Pushing and Delivery
Birthing Positions
Squatting
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.
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
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
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
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
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
Second Stage:
Pushing and Delivery
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.
Complications
A vacuum extractor, a
metal or plastic cup that
uses suction to pull the
baby out of the birth canal,
is another possibility.
Second Stage:
Pushing and Delivery
Complications
breech delivery: a baby is
born with feet or buttocks first
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
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
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
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.
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 the
baby’s head emerges?
What’s the small cut
made at the vaginal
opening called?
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
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.
The Newborn’s Appearance
The Head
•slightly pointed
•takes a round shape within a
few days
•may have a lump, called a
caput
The Eyes
•a scalp monitor may leave a
swollen red mark
•any hair present at birth may
•light-skinned babies almost always have slate
fall out
blue eyes
•eyes may appear crossed
•the drops given at birth may cause swelling
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
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
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
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
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
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
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.
Neonatal Checkup:
The Apgar Scale
Activity (muscle tone)
0 — Limp; no movement
1 — Some flexion of arms
and legs
2 — Active motion
Grimace (reflex response)
0 — No response to airways
being suctioned
1 — Grimace during suctioning
2 — Grimace and pull away,
cough, or sneeze during
suctioning
Pulse (heart rate)
0 — No heart rate
1 — Fewer than 100 beats per
minute
2 — At least 100 beats per
minute
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
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
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
Premature Infants
isolette: a transparent,
boxlike device that
controls temperature,
humidity and oxygen
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
http://www.pennhealth.com/health_info/
surgery/graphics/circumcision_1.jpg
•medical experts debate is health
advantages—some think it makes
the foreskin easier to clean, thus
helping to prevent infections of
the penis
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