Labor and Delivery

1. Labor and Delivery

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

3. 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

4. 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)

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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. History of Delivery

19. 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

20. Mid • 1882 • 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)

21. 1920 “Twilight labor” • 1920-Morphine and scopolamine • General anesthesia • Proved harmful to baby and mother • Use of stirrups to prevent any tearing or ripping

22. 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