First-Time Labor: Understanding the Stages and Indicators - What to Expect

1. I’m Going Into Labor!!! (What do I do now?)

2. Labor • Labor is the energy and effort used to push the baby out of the womb. • Dilation is when the cervix dilates from 0 – 10 cm. • Effacement is the thinning of the cervix. • Average length of labor for a first baby is 12 – 20 hours.

3. Reliable Indicators that labor has begun • The Show: Spotting of blood because of the mucus plug coming out when the cervix begins to dilate. • Water Breaks: Rupture of amniotic sac causing fluid leaks through cervix. • Contractions: Muscle contractions at regular intervals than cannot be “walked off.”

4. Contractions • Contractions are the rhythmic tightening and relaxing motions of the muscles of the uterus. • Braxton-Hicks Contractions are called “false labor.” They can occur throughout the pregnancy and typically involve the back, not the uterus. They are not regular and can go away with exercise.

5. Induced Labor • A doctor causes labor to begin by injecting pitocin that begins contractions • A doctor ruptures the amniotic sac to begin contractions.

6. First Stage of Labor • Contractions begin • Cervix dilates to 7 • Average length is two to ten hours • Longest Stage • Contractions grow stronger, longer, and more frequent • Fetal monitor attached

7. Transition • Regular, powerful, contractions every two to three minutes that last up to 60 to 90 seconds • Last about 90 minutes • Baby’s head enters birth canal • Cervix dilates to 10

8. Epidural • Injection in back next to spinal canal. • Numbs the lower half of the body • Given when mother is partially dilated • Usually to about 4 cm • Depends on the anestheseologist External/Internal Monitoring

9. Positions for Giving Birth • Lie on back • Squatting • Lie on side • Sitting • Kneeling • In water • Purpose of contractions during the 1st stage of Labor – to dilate the cervix

10. Second Stage of Labor • The second stage of labor is the birth of the baby • Crowning is when the head of the baby can be seen. • Sometimes forceps or a vacuum is used if progress is not being made and the baby is in the birth canal too long. • Fontanelles are the soft spot on the baby’s head. The purpose of contractions during the 2nd stage of labor – to push the baby out of mom’s body.

11. Episiotomy • An episiotomy is a surgical cut in the perineum to enlarge the vaginal opening to make birth easier and prevent tearing. • The cut is stitched back together after delivery.

12. Third Stage of Labor • The third stage of labor is the delivery of the placenta. • The placenta detaches from the uterine wall as the uterus shrinks. • The placenta is expelled typically within 20 minutes.

13. Who does what? • Obstetrician – concerned with pregnancy and childbirth • OBGYN – Obstetrician/gynecologist – specializes in pregnancy, childbirth and other female concerns • Mid-Wife - A midwife is a health care professional who provides an array of health care services for women that can include medical histories and gynecological examinations, contraceptive counseling, prescriptions, and labor and delivery care. Providing expert care during labor, delivery, and after birth is a specialty of midwives that makes them unique. • Labor and Delivery Nurse - They care for women during labor and childbirth, monitoring the baby and the mother, coaching mothers and assisting doctors. As a Labor and Delivery Nurse, you’ll prepare women, and their families, for the stages of giving birth and help patients with breastfeeding after the baby is born.

14. Delivery Options • Vaginal Delivery – Baby is delivered vaginally through the birth canal. Preferred because it helps the baby expel the amniotic fluid and gain strength • Cesarean Section Delivery - a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus. • Birthing Room – used for regular, vaginal deliveries • Operating room – used for cesarean deliveries

15. Anesthesia & Complications

16. Breech Delivery • A breech delivery is when a baby is born feet or butt first. • A feet first delivery is especially worrisome due to broken bones or displaced joints. • Breech delivery is a concern because the cord and head must come at the same time pinching off the oxygen supply as the baby descends through the birth canal. • Many breech babies use cesarean delivery.

17. Other Deliveries • Normal – head down • Posterior – face up • Transverse – shoulder first • Fetus doesn’t drop – C-section

18. Cesarean Delivery Used When: • The labor is long and difficult and the life or the baby or mother is threatened. • The fetal monitor shows a drop in heart rate. • Placenta Previa—placenta is covering the opening to the cervix. • The woman’s bone structure is too small to allow vaginal delivery.

19. The Apgar Rating • The Apgar rating is used to determine if emergency steps need to be taken with a newborn. • The rating goes from 0 to 10 with a score of 7 or higher indicating a healthy newborn.

20. Colostrum • Colostrum is a yellow fluid rich in nutrients and antibodies produced by the breast in the first few days after childbirth. • Colostrum protects the newborn from infections. • Mothers are encouraged to give the new baby the colostrum.

21. Sitz Bath • Soaking the perineum for short periods of time after childbirth. • Keeps area clean to prevent infection of episiotomy.

22. Problems of Premature Infants • Low birth weight • Underdeveloped lungs • Infections • Slow development later in life • Little or no sucking reflex